what to do with DNR - page 2
Most of the pt's where I work are not their own guardians. When someone is made DNR that cannot make that decision for themselves What part of the decision is for the medical personel involved to... Read More
Feb 22, '03yes active seizures. As to why guardian does not want it see post #6. I just feel horrible. I dont know what to do. I have talked on several occassions to the powers that be. They say they agree with me and are trying to talk to the guardian. Meanwhile we floor nurses are left with no parameters no clear cut direction and watching our pt seize. I have had to deal with this on 4 of my shifts so far. I feel that without parameters to follow my license is on the line. Rumer has it that we will be subjected to an inservice by said(non medical) guardian on how to handle the seizures. I do not agree with this and am highly offended. I am a licensed professional with training in this feild and I feel this is demeaning and just wrong for management to allow this. What ever happened to backing your staff. Am I right or just overstressed and to sensitive.
Feb 22, '03Originally posted by angelbear
Am I right or just overstressed and to sensitive.
You are stressed and justifibly so.
You are NOT too sensitive.
What do the doctor's have to say about this. How do they seemingly get off scott free here? I know how hard this can be, but bringing up your concerns to the doctor(s) will maybe help alleviate some of the world that is on your shoulders? Surf the web or break out an old textbook and do a little reading up about palliative care and go get em!
Sorry you're going through this...take care of yourself!
Feb 22, '03Thank you so much for the responses. It is so good to have somewhere to go to talk things out. I sure hope I didnt break any rules or confidentiality issues. That is a big big thing where I work. If I did someone please delete me. Thanks again
Feb 22, '03Is the patient actively in the process of dying? That makes a difference.
If all treatments have been stopped. Then the patient should be given adequate pain medicine to leave this world quietly.
If she is very ill however, and still being treated for various things, then that's a whole other issue.
I struggle with this too. There seems to be grave difference of opinion sometimes between the nurse, the doctor, and the family as to what is comfort measures. I would think valium for seizures would be a comfort drug and a treatment drug. Perhaps the family needs a little educating. Perhaps they are confused.
Feb 22, '03That's what I'm thinking, 3rd shift. Maybe they don't understand what the drug is b/c that just seems cruel to withhold that. Do her guardians see her seizing now? Do they ask why?
I would speak up. Your patient can't. Good luck.
Feb 22, '03Regarding insulin at the end of life, it has been my experience that blood sugars often stabalize somewhat at the end of life, and often we do discontinue long-acting insulins, as well as decrease the frequency of blood-sugar checks, but I wouldn't ever without sliding scale insulin, especially for a brittle diabetic. One thing to consider regarding both insulin and antihypertensives, is that the "normal" ranges are considered to be the ranges in which no long term damage is likely to occur secondary to the disorder. At the end of life, it's futile to worry about how the kidneys are going to be 5 years from now. As far as Diastat for seizures, there is absolutely no reason for this medication to be withheld, in my opinion. The order needs to be questioned to the attending, taken to the facility medical director if the attending won't reconsider.
Feb 22, '03DO YOU HAVE A HOSPICE AGENCY AVAILABLE TO YOU? I AM A HOSPICE NURSE THAT WORKS MOSTLY WITH PT IN LTC THAT THE FAMILY OR GUARDIAN HAS ELECTED HOSPICE TO OVER SEE THE CASE, WE BASICALLY DIRECT CARE. IF THE PT IS SYPTOMATIC WE WOULD NEVER D/C INSULIN OR SEIZURE MEDS. THAT IS ABUSE. CALL THE OMBUDSMAN(ANONYMOUSLY) OR THE STATE AGENCY THAT REGULATES YOUR FACILITY. IF ALL FAILS AND YOU ARE UNABLE TO ETHICALLY CARE FOR THIS PT ASK TO WORK ANOTHER AREA AND PUT YOUR CONCERNS IN WRITING AND KEEP A COPY FOR YOURSELF. THIS IS NOT COMFORT CARE!!!
Feb 22, '03angelbear:
- As one who is just entering the nursing field (I am taking my CPR class next Sunday - so am a true newbie), I wanted to ask:
- What does your hospital administration say about DNR?
- Can you take this question to your charge nurse?
- Do you hold "roundtables" with nurse staff/management to discuss these issues?
- What if you are an agency nurse? Could it be possible that different hospitals have different procedures/policies for the issue you mentioned? If not, then who do you see/call?
- Would seem like grounds for a lawsuit if you made the decision by yourself (idependent of higher authority).
- Again, I am comming at you from the position of a total outsider to the nursing profession. Hope the above questions are not considered juvenile in nature.
Feb 22, '03what does your state board of nursing say about this?
When theres a question about pt care, your responsibility, and practice, you should find out from them first because thats who you & your license will have to answer to.
Feb 23, '03Not a hospital LTC. No no round table discussions. My pt comfort as well as my license were what I was concerned about. UPDATE coworker and I refused to work until we had a specific written protocal to follow. PRN diastat order reodered by MD including protocal. Thanks for all the support and advise. John I dont know about anyone else but there are no stupid questions except those not asked. Welcome to our world.
Feb 23, '03Originally posted by angelbear
Not a hospital LTC. No no round table discussions. My pt comfort as well as my license were what I was concerned about. UPDATE coworker and I refused to work until we had a specific written protocal to follow. PRN diastat order reodered by MD including protocal. Thanks for all the support and advise. John I dont know about anyone else but there are no stupid questions except those not asked. Welcome to our world.
You may be covered by the MD's order, but now you are against the wishes of the family. Can they sue you? Is your license still on the line? Just questions?
Sigh....whate a world it is.