acquiesce1908

I really am bothered by a situation that I encountered at work the other day. I seek an honest opinion from whomever wishes to comment. Here was my situation that occurred... I work on a Surgical Heart unit. There was a pt that had been on our unit for over a week that had Open Heart surgery. The pt indeed was realy sick and thus death was eminent. On this particular day I worked, the patient's family had made the patient a DNR. The patient was on about seven different gtts which about 3-4 were inotropes and pressors. When I received report from the previous nurse, the nurse informed me of the DNR order that was recieved today. At the time of report the pt.'s BP was 80/40 (58), so naturally I wanted to increase one of the patient's gtts. I was told that when a patient is a DNR, that gtts are no longer titrated. Now the DNR order reads as follows: DO Not call a code blue, No CPR, No ventilation, and No initiation of new medications or change in current medications for RESUSCIATIVE efforts. Now, if I were to increase the pt's gtts, would that have conflicted that DNR order? Was increasing a gtt classified as a "resusciative effort"? O.K. so that was one issue. The next was that the nurse that gave me report told me that the cardiac surgeon had told the nurse that when the patient's gtts ran out, to hang "pretty bags" (plain IV fluids). Now this was a major problem for me, I could not believe that someone would say something like that. Now remember that I told you all that this patient's death was eminent, but I do not wish to rush anyone's process of death. Oh, but this is not the end of my day..... The patient's BP dropped to 50/30 (45) so natuarlly I called the family and the chaplain to come in to be with the patient. I spoke to the same cardiac surgeon shortly after and just give a quick update. After telling the surgeon the BP, the surgeon says to me " Well you can just shut off the Levophed. 50/30 is not really a blood pressure. I mean it depends on how you feel morally".:angryfire Once again I could not believe that someone would put me in a situation like this. Needless to say, I made sure that the patient remained comfortable. I gave the family time to sit with the patient and so forth. After the family had been there for most of my 12 hour shift bascially waiting for the patient to die, the spouse told me that they were going home and asked me if I thought that the patient would go soon. So I explained to the spouse that part of the reason that the pateint was still here was because of all of the medications and temporary pacemaker and so forth. I went on to expalin that the patient is a DNR (that only if the patient were to arrest we would not do anything) that treatment (medications, etc.) was never withdrawn. The spouse immediately told me "Oh, no I do not want any of those things anymore, {the patient} has gone through too much already". It was then that I obtained a witnessed consent for the withdrawal of treatment and when the cardiac surgeon made rounds shortly after, orders were written to stop the medications and to disconnect the temp. pacemaker. The patient died shortly after the pacemaker was disconnected. I apologize for this being so long, but this entire situation has been bothering me since its occurance.

Sounds pretty good to me too. Just one question....What is there "turn over rate"?

Yes, my hospital has implemented a RRT about 3 or 4 months ago or so. I guess that it has been going o.k. It appears to be a "spin-off" of calling a code (just a easier way of stating it over the intercom). Most of the patients that need the RRT has coded, thus needing to be transferred to an ICU. So I really do not understand its true purpose. Supposedly this is what is called when a nurse (or any staff member) thinks that a pt "looks different" and you need the RRT to come access them. Like I said, on a Med-Surgical floor where patient-nurse ratios are higher, by the time a RRT is called... you probably needed to call a code blue instead.