Worried That Doctor's Orders Will Hasten A Patient's Death

Mommavik, ADN · Jun 5, 2016

I've been in that situation; DNR does not mean no care. .. That being said, it depends what the reasons are for the blood draws; if they are to determine med doses or electrolytes, for instance, they may still need to be done. We can't say with certainty " this person will die within the next week so we don't need to monitor her potassium etc. , " even if we're sure of it.

PrincessNur · Jun 5, 2016

A bit off topic, but are you sure your cousin is actually a nurse? She doesn't just work in some sort of facility and call herself a nurse?

She has a legit BSN,however I believe she is bipolar.

allnurses Guide · Jun 5, 2016

I really want to become a nurse, but this has put fear inside of me. As a nurse if I feel it's too much blood to draw from a patient- do i have the right to tell the lab and doctor, "sorry, if we take anymore, the patient's death will be hastened."
plz helps, I'm scared on this.

I left out the first part of your post, but I wanted to add to the others advice and say that we frequently have pre-nursing students post here regarding their fixation on one particular thing that most likely won't come up at all for months (since they teach the basics first) or the nursing school experience itself will answer the question in due time.

It's normal to feel anxious about the future (I freely admit I was a nervous wreck at first, too), but I feel once you get started, the real knowledge will begin to displace that one thing that goes over and over in your mind.

All the best to you!

PrincessNur · Jun 5, 2016

I've been in that situation; DNR does not mean no care. .. That being said, it depends what the reasons are for the blood draws; if they are to determine med doses or electrolytes, for instance, they may still need to be done. We can't say with certainty " this person will die within the next week so we don't need to monitor her potassium etc. , " even if we're sure of it.

Yes my grandma's situation was DNR.All she wanted was an IV with vitamins, and she wanted to die at home- but that didnt happen . Can the dying request a nurse to come to their homes with an iv hooked up etc? I think when the point reached where she was turning blue, if she lay down to far back, I think that's when hospitals put the patient in hospice mode? because they told us she needed to be taken home, because she is refusing the treatment, was DNR , and because she was at the hospital a week before, and she signed a document to get out. But at this point everyone in the family knew she looekd so weak and needed the hospital care, so they didnt listen about taking her out, so when I went to visit her the next day, they took her oxygen from out of her nostrils and told us she doesnt need it anymore.....and she was just laying there, looking blueish, but she talked and then slept. Will hospitals take out a patients oxygen if they know the person is going to die at any moment? The hospitals told us we could enter her in hospice cares, but again the family was too scared to do it. She died that same day....and thats when the family went crazy saying it was when the hospital took out the oxygen...when in reality she was gonna die regardless

PrincessNur · Jun 5, 2016

I left out the first part of your post, but I wanted to add to the others advice and say that we frequently have pre-nursing students post here regarding their fixation on one particular thing that most likely won't come up at all for months (since they teach the basics first) or the nursing school experience itself will answer the question in due time.
It's normal to feel anxious about the future (I freely admit I was a nervous wreck at first, too), but I feel once you get started, the real knowledge will begin to displace that one thing that goes over and over in your mind.
All the best to you!

Thank you for your words.Yes Ive been really anxious these past days- especially since now I believe my father might be in the end of life stages as he is around 74 ( he married later in life). For instance he can no longer control bowels, and it looks as if a couple of toes have gangrene. He is also diabetic.. He also fainted when he tried to climb the stairs and a family member did cpr on him to revive him.... He doesnt want to go to the hospital and he too wants to die at home. It's really stressful to see, especially since my grandma died last year, and the year before that an aunt died. The end of life symptoms seem to come rather quickly. So I find myself being full of anxiety.

wanderlustnurse88, RN · Jun 5, 2016

Oxygen is generally used in palliative patients as comfort only. We aren't treating the numbers (O2 sat) anymore. If they appear to be short of breath and the oxygen seems to help calm them down, then it is used. Sometimes it agitates patients to have the nasal prongs in the nose, so it might be taken off. It's hard to know why they did it in your grandma's case.

There is so much that can be done in the home to allow a patient to die at home. Generally in palliative care, IVs are not used but subcutaneous injections are used. A subcutaneous line is put in either the abdomen, upper arm, or upper thigh so that they are not getting poked with a needle each time. Usually pain medications are pushed through as needed, at regular intervals, or as a continuous infusion. This can be done in the home, as well as having oxygen set up on the home.

PrincessNur · Jun 5, 2016

Oxygen is generally used in palliative patients as comfort only. We aren't treating the numbers (O2 sat) anymore. If they appear to be short of breath and the oxygen seems to help calm them down, then it is used. Sometimes it agitated patients to have the nasal prongs in the nose, so it might be taken off. It's hard to know why they did it in your grandma's case.
The is so much that can be done in the home to allow patient a to die at home. Generally in palliative care, IVs are not used but subcutaneous injections are used. A subcutaneous line is put in either the abdomen, upper arm, or upper thigh so that they are not getting poked with a needle each time. Usually pain medications are pushed through as needed, at regular intervals, or as a continuous infusion. This can be done in the home, as well as having oxygen set up on the home.

You are amazing. Thank you so much for taking the time to respond, you have no idea how much this helps me. God Bless, I'm so happy I found this website. everyone is so great around here.

pixierose, BSN, RN · Jun 5, 2016

She has a legit BSN,however I believe she is bipolar.

Ok. And?

(Advocating for zinc oxide = totally bipolar)

MPKH, BSN, RN · Jun 5, 2016

I think, in due time, your questions will be answered as you progress through nursing school. Focus on getting through school and dealing with personal things first.

NotAllWhoWandeRN, ASN, RN · Jun 5, 2016

Hi PrincessNur, it looks like you have a lot of misconceptions that can be cleared up with education.

It sounds like your family has a lot of fear around modern medicine, and if you do choose to pursue a career in nursing, it's possible you could help educate them and soothe some of their fears, as well (maybe, maybe not! humans are a stubborn species, especially when it comes to long-held beliefs).

Taking some college courses in anatomy & physiology, biology, and microbiology will help. You will start to learn about scientific theory (What happens when we do this? Are the results consistent? Are they objective? Are they verifiable?). Early in nursing education you learn about evidence-based practice (often shortened to EBP). What do we do to treat patients? Why do we do what we do? What are the results? Are these results consistent across large populations?

One of the most important things that you learn is that correlation (two things happening near each other, or one after the other) is not causation (one thing causing the other to happen). Your family believed that herbs caused swelling, but that was likely due to some other problem in her body - for example (and I am not diagnosing here!) heart failure. If the heart does not pump well enough to get blood all the way through your body and back, you are likely to have swelling starting in areas farthest from the heart or toward the ground. Your grandmother might have died shortly after oxygen was removed, but if she was turning blue, her body was already not doing what it needed to do to keep her alive, and the oxygen in her body was already very low. As someone has already said, oxygen can be used for comfort in end of life care, but it does not keep a person alive or kill them.

As you can see, there are different schools of thought on end of life care, even within healthcare. But you can also hopefully see that we try to guide care based on what is best for the patient, and that a good nurse will fight an order if they believe it is not in the patient's best interests. A 4-7 mL blood draw is nothing to the person with an average of 5,000 mLs of blood in their body. Let's say we draw two tests totaling 11 mL, three times a day. The person is losing 0.0066% of their blood daily. That's a lot of blood draws, and not a lot of blood loss.

Even if you decide you are not comfortable providing end of life care, that's fine! Most nurses don't do that on a regular basis anyway. There area lots of ways to let a patient to die with dignity, and there are also lots of ways to be a nurse and not care for the dying. I'm echoing the support for you to shadow a nurse - maybe several nurses in different jobs! So that you can get a stronger idea of what nursing is like.

Nature_walker, ASN, BSN, RN · Jun 5, 2016

I think it is wonderful that you want to educate yourself on these matters. You came in with a several misconceptions, but it sounds like you have honestly listened to the advice you have received here. Keep that open mind that you have shown here and I think you'll be on your way to a very rewarding education. Best of luck as you move forward!

TheCommuter, BSN, RN · Jun 5, 2016

Moved to the Patient Safety forum.