Doctor Asked For A "Kind" Nurse

[LasVegasRN]

Let me preface this thread by stating a few things:

1. I'm not posting this thread to bash certain religions, I'm posting to vent, gain understanding, and get a variety of views.

2. Whatever your belief, please respect the beliefs of others.

That said, I admit to not understanding how parents can stand by and watch their child bleed to death.

Teenager, throwing up blood for 2 days, H & H 6.1 and 17.0. Platelets 14. WBC 1.0. Pancytopenia. A religion that does not allow blood products or transfusions. Essentially we will be watching this patient die. As the majority of us know, some fresh frozen plasma, units of packed cells, the ability to SAFELY do an EGD and the patient would be discharged home in about 2 days.

Instead, in 4 hours when the next CBC was done, the Hgb was down to 5.8.

I overheard the attending doc asking the charge nurse to assign a "kind" nurse as this was a "difficult" case. I felt that was unnecessary, because as hard as it is for all of us to watch this, we still treat the patient and family with compassion.

My main point: I'm hoping someone could explain to me, how in the world can you stand by and allow your child to die?

Harsh question, and I'm sure an age-old question, but I do not and can not understand it.

[Spidey's mom, ADN, BSN, RN]

oh, you are way too fast for me . . .

thanks for the link.

[Tweety, BSN, RN]

Originally posted by stevielynn

I found the verse that JW's use for their refusal to take blood.

Acts 15: 28 and 29

"For it seemed good to the Holy Spirit and to us to lay no greater burden on you than these requirements: You must abstain from eating food offered to idols, from consuming blood or eating the meat of strangled animals, and from sexual immorality. If you do this, you will do well. Farewell."

I just plugged in Jehovah's Witnesses and found lots of info.

Is this accurate Fab4Fan? Help us out here. Thanks.

Plus if they took blood and saved themselves they would be put out of the church, his own parents would disown him, shun him. A fate worse than death in some of their eyes. You may as well tell him to eat his dog, he isn't going to take the blood, they are that adamant.

[fab4fan]

This is the ONLY official website for our faith: http://www.watchtower.org

Any other sites are not official, and could actually be giving incorrect info intentionally.

[Disablednurse]

Fab4, thanks for the link. I have a clearer understanding now. just never knew where their belief came from.l

[P_RN, ADN, RN]

Several of our orthopods have done many total joints on people of this faith without use of blood. Some would agree to cell-saver and autologous retransfusion, but some did not. The lowest hgb I recall was 5 something.

On another note we lost a friend last year whose family member was of this faith but he was not. The family member refused any blood products.

[kids]

Originally posted by Flynurse

I was just thinking....this would really really bite if this teenager was 17...and just months of making his own decisions!

My question is:

At what point, if parents are witholding treatment can a child/teen say "I don't want to die?"

What happens if the a child/teen makes this statement?

[cna on her way]

I have to say that I don't understand this either. I could not stand by and watch my child die when there was something that I could have done about it. If a child is under the age of 18 and you bring them to a hospital for treatment, then we should be allowed to do just that. Just as a christian can believe "spare the rod, spoil the child" would it not be child abuse to hit a child with a rod? Children are not our property and we should not be able to decide if they live or die. This is just my opinion and I am not trying to put down anyones faith. I just don't see how allowing a minor child to die if blood would've saved their life can be justified.

[ShandyLynnRN, BSN, RN]

I cannot understand it either, but then again, I have friends of different faiths than me, and they don't agree with many of my beliefs either. We have actually gotten into some heated debates before we agreed to disagree.

I think the point is, is that the JW faith, those that refuse blood and blood products, obviously feel very strongly about their faith. Otherwise they wouldn't put their lives in jeopardy.

I was also under the impression that if the patient is a minor, that the hospital is able to take the case before a judge to get the proper treatment for the child.

Even as much as I agree with supporting all faiths, etc, I could never in good conscience not atleast attempt to have family services or a judge or whatever to intervene to get a child proper treatment.

Then again, as a Christian who believes in the gifts of the spirit and divine intervention, I suppose people could argue that I should just be able to lay my hands on the child and heal him.

I don't understand it. Most ppl not of the JW faith don't understand it. But I do commend them for being so strong in their faith. I am not sure that I would be so strong when it came to the life of my child.

[caroladybelle, BSN, RN]

Originally posted by 3rdShiftGuy

Couldn't the patient at least have an EGD and maybe find the source of the bleed?

5.8 is not too horribly low for an 18 year old to recover from, unless he continues to bleed profusely. There's a few other options for him. But stopping the source is paramount.

As far as an EGD is concerned, many Gastroenterologists refuse to scope anyone with platelets less than 60 to 75 - a platelet count of 14 would definitely fall well below acceptable parameters, especially when you know that transfusions (in case of a perforation) are not an option. The 5.8 hemoglobin would also be worrisome for the sedation involved.

I frequently have onc patients that need scoping for major bleeds and the GI's refuse until acceptable blood counts are achieved - it seems not to matter that you can't get a good count until the bleeding stops.

If the 5.8 hemoglobin occurs slowly, there is generally a better recovery. However, if it occurs rapidly, recovery is much more difficult. I've had elderly ladies that drove themselves to the MDs office, feeling "a little tired" with hemes of 3.7, and had youngsters fainting w/heme of 8.5.

Fab4fan - is Neumega (increases platelet production) or Procrit (increases red cell production) considered acceptable. Other options - vitamin K and amicar(?) to increase clotting in absence of adequate blood clotting components - iron supplements (IV/IM/PO) - Tagamet/Pepcid/Zantac to decrease upper GI bleed - some places use iced gastric lavage, do not know the success rates of that.

Studies have shown that hospitals draw way too much blood from critical low patients and that pedi tubes could easily be used on adults with little loss of accuracy. We frequently use them for checking JW patients to minimize blood loss.

Vegas, inform that gluteus maximus of an MD that 95% of the people that work in nursing these days are "Kind" nurses. Nobody else but a "kind" person could do this job.

[Spidey's mom, ADN, BSN, RN]

Hey Fab 4 - misconceptions run amok . . . :) I see what you mean.

" spare the rod and spoil the child" by cna

I've always heard that was comparing raising our children to sheparding sheep . . . . the shepard guides the sheep with the rod. They don't hit them with the rod.

And now, off to work.

[Tweety, BSN, RN]

Originally posted by caroladybelle

As far as an EGD is concerned, many Gastroenterologists refuse to scope anyone with platelets less than 60 to 75 - a platelet count of 14 would definitely fall well below acceptable parameters, especially when you know that transfusions (in case of a perforation) are not an option. The 5.8 hemoglobin would also be worrisome for the sedation involved.

I frequently have onc patients that need scoping for major bleeds and the GI's refuse until acceptable blood counts are achieved - it seems not to matter that you can't get a good count until the bleeding stops.

If the 5.8 hemoglobin occurs slowly, there is generally a better recovery. However, if it occurs rapidly, recovery is much more difficult. I've had elderly ladies that drove themselves to the MDs office, feeling "a little tired" with hemes of 3.7, and had youngsters fainting w/heme of 8.5.

Fab4fan - is Neumega (increases platelet production) or Procrit (increases red cell production) considered acceptable. Other options - vitamin K and amicar(?) to increase clotting in absence of adequate blood clotting components - iron supplements (IV/IM/PO) - Tagamet/Pepcid/Zantac to decrease upper GI bleed - some places use iced gastric lavage, do not know the success rates of that.

Studies have shown that hospitals draw way too much blood from critical low patients and that pedi tubes could easily be used on adults with little loss of accuracy. We frequently use them for checking JW patients to minimize blood loss.

Vegas, inform that gluteus maximus of an MD that 95% of the people that work in nursing these days are "Kind" nurses. Nobody else but a "kind" person could do this job.

Excellent points, I didn't consider the low platelet count. Thanks for pointing that out.

Not to answer for Fab4, but the neuro case I mention the family allowed procrit.

[ayemmeff]

Thanks for the insight Terri.