We see them every once in awhile - at least on our floor. The older pts who have multiple things going against them, yet either them (if they are A&O) or their family still wants to be a full code. Their choice, no problem.
But since I haven't been in any code experience yet, I was wondering how it is handled when these pts finally code, or get to the point where us health professionals know the end is coming.
I'm asking, as there's a pt who has been on our floor about a month now - He's in his 70s, has a Hx of cancer, which was treated/organ was removed, now has cancer mets in at least 2 other part of the body - also is in CHF (last BNP I remember was nearly 3500), respiratory issues (doesn't help him he is about 350lb), bed ridden, incontinent, kidneys are failing, has had multiple paracentesis, swallowing issues so he's also on tube feedings.. Poor man is a mess. He's very nice and friendly, A&O, but as his choice he's still a full code. Someone brought hospice in, but I don't think he's ready for that yet. I think his family is finally starting to come to terms with exactly what's going on.
But with a patient like that, if he did start having issues not sustainable to life and we called a blue or rapid response, how exaclty would it be handled?
I wish more people who were knocking at Death's door would realize they are doing just that, and sign the danged DNR. And that family members who are in charge of Mummy's health decisions would realize she's been banging away at that door for days or weeks and she wants to be let in. Let her go.
As nurses, it's not our decision to do the code or not: we do it if there's no advance directive not to. It's not our decision how long that code is in effect; the MD running the thing calls it in the end.
Be very, very careful of that term "slow code". Heard by the wrong person at the wrong time, it could get you pulled into a tasty lawsuit. They do happen, but nobody in their right minds should ever admit to having been part of one.
Pt education, family education, involved caseworkers and social workers, a doctor with a clue and more than three minutes to spend on the pt and family all go a long way to helping them make the right choices, the BEST choices for them and their families. And in the end, it's always their choices.
We've got a guy on our unit right now, 10 % ejection fraction, uses cocaine like I use soap, bouncing between afib and a flutter, and will bring cocaine into the hospital and use it. Full code. We'll probably end up coding him on this admission, and none of us feel good about it -- you only have a thumbnail of working heart tissue, so we're going to slam it with electricity and epi. The family -- and this is one of those kind of families where they all have substance abuse problems and usually one of the family is on the unit at any given time -- are already saying if we can't "save" him via CPR, etc., they're going to sue everyone involved. If they even heard a breath of "slow code" they'd not only sue us, they'd probably shoot us (we've taken weapons off them at each admission).
RNsRWe, ASN, RN
3 Articles; 10,428 Posts
I wish more people who were knocking at Death's door would realize they are doing just that, and sign the danged DNR. And that family members who are in charge of Mummy's health decisions would realize she's been banging away at that door for days or weeks and she wants to be let in. Let her go.
As nurses, it's not our decision to do the code or not: we do it if there's no advance directive not to. It's not our decision how long that code is in effect; the MD running the thing calls it in the end.
Be very, very careful of that term "slow code". Heard by the wrong person at the wrong time, it could get you pulled into a tasty lawsuit. They do happen, but nobody in their right minds should ever admit to having been part of one.
Pt education, family education, involved caseworkers and social workers, a doctor with a clue and more than three minutes to spend on the pt and family all go a long way to helping them make the right choices, the BEST choices for them and their families. And in the end, it's always their choices.