DNR's

Long Term Care Columnist / Guide · Aug 11, 2003

I have never had to perform CPR in long-term care, although some residents (almost always the most frail ones in the building) were full codes. My mantra was, "When in doubt, ship 'em out"--if a resident started going bad, I called 911 and sent them to the hospital. The crash cart in many LTC facilities consists of a suction canister, bag-valve mask and an oral airway---no drugs, no IV equipment etc. Running a code would have been a joke. So......off to the hospital they went, and if we (and they) were lucky, they passed away there before having to be put on the vent, feeding tubes, etc.

ajaxgirl · Aug 11, 2003

That's good. I would do the same. I just wouldn't want to be doing CPR on some of those elderly residents. Thanks for your reply.

I have never had to do CPR and hope I never have to.

Monica RN,BSN · Aug 11, 2003

Sadly enough, Not nearly enough of them in LTC are actually DNR's. We ship 'em out as well, as opposed to the alternative of having to do CPR. We have had to do it though, but not real frequently. Only about 3-4 times in the past year and half I have been in LTC in the place I work.

Just Angi · Aug 12, 2003

When I reach that point in life- I think I will have DNR tatooed on my forehead. That way no one will misunderstand. So many times by the time people reach LTC the family is making that decision. I suggest that if you don't come to see your relative but once or twice a year, don't make them suffer with making them full code. I wish everyone was required to have a living will at the age of 18. That way, whether it is old age, a wreck, or anything else that will alter the mind the person will have the wishes they have for themselves carried out.

Long Term Care Columnist / Guide · Aug 12, 2003

I had to do compressions once on an 89 YO lady who probably weighed 80# and had such severe osteoporosis that she had fractured her hip just by trying to get up from her wheelchair. ORIF was done on the insistence of the family, who were in the hallway arguing with her PCP about her full code status just as I was calling the code. Her post-op vitals had been heading downhill ever since she'd been brought to the floor, and suddenly she dropped her pressure to nothing. Having never done CPR on a real person, I was unprepared for the sickening sensation that travels all the way up your arms when you fracture ribs, and I almost freaked out. (I still get chills just thinking about that first time.) Thank God the doc FINALLY talked some sense into those people---that, and the fact that they all heard that first "crunch" made them realize hey, maybe we're not doing Granny any favors here---and we were permitted to stop the code when she flatlined.

Again, as I stated on another thread, I feel this is cruel and unusual punishment, and I can't imagine why anyone would put a fragile, sick elderly relative through it. I know a male nurse who has DNR tattooed directly over his heart, and several of my friends at work (along with myself) are DNRs as well, even though we're all still (comparatively) young and healthy. If the only other option is suffering interminably, I'd rather not, thank you!

shygirl · Aug 13, 2003

Hi, Most of ours are DNR. The few that aren't, we call 911!

I'v never had to do CPR on a resident.

Shygirl

NJ LNHA · Aug 29, 2003

I agree not nearly enough are DNR's. As a former social worker in LTC I tried to educate my residents and families as much as possible about making grandma a DNR. I went as far as to implement docimentation for out of hospital DNR's in case they coded in the ambulance on the way to the hospital. My nurses have called codes and started CPR, it's not pretty. I always wanted to find some type of video to show my families what really happens, even though that would have been a little morbid.

PROFETA548 · Aug 30, 2003

HELP!!! DOES ANYONE KNOW, HOW OFTEN IN LTC ONES HAS TO REVIEW THE DNR--- SOME HAVE IT- FROM THE HOSP. THEN THE SW JUST INTERVENE IF THEY STILL WANT TO RENEW IT, FOR OUR FACILITY.. THEN, WE DO HAVE PT'S, THAT DO GET MUCH BETTER.... HELP THANKS

NJ LNHA · Aug 30, 2003

My experience has been reviewing the DNR quarterly with the care plan and family/resident. Which of course does not mean a good social worker or nurse should review with the resident if the resident rallys. Then again we all know what happens sometimes when a resident rallys. . . .

snoogans · Sep 12, 2003

the vast majority of nurses at my LTC facility are all for DNR so we are reviewing them on a fairly regular basis, esp quartly with care planning. The floor nurses that actully know the resident do the carplans so we know what is going on. some of my folks are wards of the state and even my 89 mr man with a feeding tube and in chronic pain who aspirates real bad at least three times a year goes up to the hospital for treatment and what do you mean he is a full code the er nurses will ask when I tell them in my report of the code status.

I know this is my major ethical issue I deal with being a nurse.

I give a very simple yet effective speech when families are himming and hawing about iv fluilds/feeding tube/dnr

Even though your loved on goes to the hospital thier condition is very poor. The hospital might not even be able to start an iv. Research shows iv fluids do not extend the life of a dying person. Their body is not drinking, eating for a reason. It is thier time. They may get hydrated and perk up for a few days but just go back to not eating or drinking. They are not swallowing to take an anitbiotic prescribed (usually for aspiration or sepsis)I say a few other things and always get a thank you for being honest.

I firmly beleive there is too much medical intervention on somethings. A 90y.o end stage alzhiemers patient doesn't need to have some other food/formula suppliment crammed down their throat becuase they have lost five pounds. They just need nature to takes its course.

We've done basic cpr about 5 times this year at our place. Most end with the medics calling the er doc after three rounds of acls meds to ask if they can stop cpr.

caffine addict · Sep 14, 2003

I have been working in LTC for about 10 years and have worked at a few different facilities. My observation has been that DNRs are different in different facilities based upon the culture of the facility as well as the different age groups and cultures within the facilities. For instance I worked in a non profit religious affiliated facility who's population was mainly female and over 70, most of them were DNR and Hospice. I now work in a facility that has a large male population ages 35 - 90 and they are all full code. And I agree with the above our crash carts are a joke as well. My thory is as above ship them out, and as fast as you can. However here is another thing to ponder. The few families who choose DNRs dont realise that if they want their loved one to go out to the hosp. for treatment for lets say Pneu. will be coded in the ambulance if anything goes wrong. EMS has their own rules. I've had to deal with many upset families in my career.