So I am not a nurse yet, but I would like to enroll in a community college to become one. My concern is that when a doctor orders me to draw blood 2-3 times a day to an elderly patient, this will hasten their death. Or if he orders me to give them morphine or something which also accelerates a patients death. I am not being cynical or anything. I know doctors are out there to help people. But I just remember a time, where a nurse would draw blood from my grandma three times a day, and the head nurse shouting "this is BS, THE LABS DONT NEED THIS MUCH" And the doctor refused to listen to the head nurse and said the blood is a must for lab work.
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."
I also wanted to add that alternative medicine is sometimes evidence-based and sometimes not. If it is based on anecdotes, question it. For example, some people believe there are herbs that will help you recover from a cold. Maybe Mary Sue took some and felt better, so she starts recommending it to her friends. Mary Sue might have been at the end of the cold and getting better anyway. Mary Sue might have experienced the placebo effect, meaning she was expecting to feel better so she did (we don't know WHY the human mind and body do this, but they do! The opposite is the nocebo effect where people will have very real physical reactions if they think you have given them something that will harm them). Regardless, if she felt better she will probably recommend it to her friends, and if it happens to work for any of them, the belief that it's helpful will get stronger, whether it's true or not.
Some acupuncture is evidence-based, some is not. Some "natural" nutritional supplements have evidence-based results, some do not. You will learn how to do your own investigating through the research techniques taught in science and nursing, to learn whether particular treatments are helpful or harmful.
Specializes in ward nursing - cardiac, medical, neuro.
Sometimes patients will refuse blood transfusions for any number of reasons (sometimes religious, or other, but they have that right). Sometimes patients have very low hemoglobin levels, or are bleeding, and the amount of blood work drawn will actually affect the patient's ability to recover from whatever it is they are ill with, because their hemoglobin truly drops even further. Sometimes patients are on medications, or are so ill, that frequent monitoring of things like coagulation, hemoglobin, lactate, etc are required. So...this question is not entirely off the mark. What we do for these patients in our department (ICU) is use paediatric blood tubes, which take less volume of blood. Also, the doctors know that these patients are at risk, and they will order blood work to be drawn as infrequently as possible while still measuring the values we need to monitor.
Last but not least, the nurse yelling, especially in front of family members, for whatever reason, was not being professional. Whether her concerns were legitimate or not, emotional outbursts are not going to be helpful. People need to be level headed, think clearly, be supportive, and take their concerns to the people who can do something about them (E.g.the physician), and not instill fear in people who do not understand what is happening.
Sometimes patients will refuse blood transfusions for any number of reasons (sometimes religious, or other, but they have that right). Sometimes patients have very low hemoglobin levels, or are bleeding, and the amount of blood work drawn will actually affect the patient's ability to recover from whatever it is they are ill with, because their hemoglobin truly drops even further. Sometimes patients are on medications, or are so ill, that frequent monitoring of things like coagulation, hemoglobin, lactate, etc are required. So...this question is not entirely off the mark. What we do for these patients in our department (ICU) is use paediatric blood tubes, which take less volume of blood. Also, the doctors know that these patients are at risk, and they will order blood work to be drawn as infrequently as possible while still measuring the values we need to monitor.
Last but not least, the nurse yelling, especially in front of family members, for whatever reason, was not being professional. Whether her concerns were legitimate or not, emotional outbursts are not going to be helpful. People need to be level headed, think clearly, be supportive, and take their concerns to the people who can do something about them (E.g.the physician), and not instill fear in people who do not understand what is happening.
Just my humble opinion.
That's all certainly valid. I was commenting more with the focus of OP's fears that we are draining patients via lab draws so the patient will die and we can put someone else in the room. Lab draws being a true danger to the patient is the exception, not the norm. For a person with no education or background in healthcare, but a lot of fear, I believe it's harder to explain those exceptions without creating more fear.
Youre also right in that the nurse in that case was highly unprofessional. If we are concerned about a doctor's order we're supposed to advocate for the patient by speaking with the doctor, and if the doc won't listen, to bring in leadership of some kind. Emotional outbursts do no one any good.
First of all, ((((hugs OP)))) for the loss of your grandma, and the possible coming loss of Dad.
I agree with geeimjo about her yelling in front of family. There are instances where we have to question the MD and refuse a treatment if truly dangerous -- but 1) it doesn't like this was such an occasion, and 2) I would avoid doing it in front of the family if at all possible. It can undermine that family-physician relationship, especially in cases like yours where the family has put themselves in an adversarial relationship with the system, and 3) the dr may feel a stronger need to save face, and refuse to change the order.
But yes, we do have that right, and responsibility to question what we know to be unsafe. It's always best to remain professional and calmly state why we are concerned about the order. Not yell "this is BS!!" Example: patient had too-high BP and had two meds ordered to be given as needed. Med #1 was ineffective, and med #2 had plummeted her heart rate when we used it. So I called the MD and told him that info, and asked "should I start a drip of a med #3, or do you have other suggestions?" He agreed, wrote for med #3, and cancelled to order for med #2. Easy peasy. In 13 years of nursing I've never had to say "if you want pt to have this, you need to come do it yourself because I'm not."
To address the issues of blood draws and morphine:
We can get away with taking very little blood. I work in a SICU and sometimes we have patients on every ("q") 4 hr draws, even up to q 1 hr if they are very critical. We take maybe 1/2-1ml of blood for each tube, or else the lab tech can do a finger poke and squeeze very tiny amounts into a pediatric blood tube. The exception is 1) the tubes with the blue top need to be full...and I think those are 3 ml, and 2) blood cultures. That could be 40 ml of blood, so a little more than a standard 30 ml medicine cup. If a person is critical enough to need all those draws, they will at least be getting a CBC checked q day. If they are very anemic (regardless of the reason) the dr will order a blood transfusion.
Once I did care for a Jehovah's Witness who'd hemmorhaged postpartum. Her hemoglobin was down to 2.3. She was transferred to my hospital because we have a sophisticated bloodless surgery program, so were able to help her without the blood transfusion she had expressly declined. For this situation, we were clearly worried about any blood loss; we were only checking labs if her body was telling us something was wrong. So for example, if her urine output were to plummet they'd have ordered a BMP which would give us info about her kidneys.
For comfort care only patients, our drs discontinue all orders for lab work, and for all medications that serve purposes other than comfort (e.g. their BP meds, thyroid meds, etc). They then prescribe meds for pain, anxiety, and to help dry the oral secretions they are too weak to swallow or spit. For one who is actively dying, we give meds for comfort without regard to their vital signs. They are already dying. I can assure you as a pro-life Christian, these meds are used as tools to make the death that is happening easier for that patient -- not to cause a death to happen.
For your typical elder who just had a hip replacement and has morphine ordered for postop pain: you will learn how to balance pain relief without overdosing her. That's what nursing school and clinicals (practice shifts in the hospital with an instructor) are for. Same with someone who has a DNR order but is not yet comfort care only.
I'm going to differ here with Muno and agree with NightNerd. I'm a hospice nurse as well and we have patients on high (not "comparatively small") amounts of Morphine and Dilaudid for pain control and that isn't what kills them. In fact in some of the cases it allowed them to get up out of bed and actually start living their lives to the fullest again. And they lasted [i']months[/i] on the meds when at admit, some were curled into a fetal position, emaciated, and unable to move until their pain was controlled. I'd love to tell stories but it would just be anecdotal. Suffice it to say, I've never given Morphine or Dilaudid and had a person die because of it.
Even at end-of-life and respiratory distress, it can take hours and hours for a patient to die even when we give Morphine or Dilaudid or Ativan.
The idea that morphine kills people is what keeps people from signing up for hospice and hospice nurses and docs have been trying to educate the public about that for years.
I'm sorry if this is a derail, but I just wanted to nod my head in agreement with Spidey'sMom. We often have CMO patients on our floor and while the hospice nurses will say we aren't quite as liberal with the morphine/ativan/dilaudid as they normally would be, I have never, in my 2 years, have had a pt die directly after a morphine administration. Even on a morphine drip (not PCA, actual drip) the pts are less restless, agitated, grimacing/moaning, calling out, crying. The load of severe pain is lifted off their shoulders, and after the pt has found some relief you can see family just ease down from their panic. But they have never just up and given the ghost. To say that we are misleading the public worth false studies is horrendous.
Op, shadow a nurse. Read the job labor outlooks in your area. Check what is needed to get into college on your area. Observe on AllNurses. Nurses are not infallible saints (see your cousin (?) and others) nor are they angels of mercy or death. You sound like you're on the right path, but don't be surprised if your family alienates you if you pursue nursing and adhere to the more scientific, rational approach to healthcare - a generationally-entrenched belief system does not tolerate dissent well.
Good luck.
There are certainly situations where morphine can actually be physiologically beneficial and potentially extend life, and many more where morphine does not alter duration of dying either way, but morphine and other opiates have established risks for adverse effects, I'm not sure how it can be argued that these don't exist. Particularly when we use at least one of those adverse effects, respiratory depression, as an intended effect in treating air hunger (we're tricking the brain into thinking it doesn't need to work as hard to breath as they actually do to support survival).
I completely agree that we need to do away with stigma against opiates in end-of-life care. But the argument should be that while opiates may shorten the dying process in some cases, there's nothing wrong with that since easing suffering is the priority, saying that opiates don't have the potential for adverse effects, which could potentially hasten death, is too easily recognized as false by the general public and only fosters distrust of the end-of-life care community.
Jeez you are absolutely correct! I just read that zinc oxide removes the first layer of dead skin.....what the hell was my cousin doing then! Grandma's legs/feet were already raw......thats just crazy, i didnt bother to look it up before, cuz i trusted her..... :S
Regarding your concern about morphine: as a hospice nurse, I just die a little every time someone says that morphine kills people. IT DOES NOT. Used appropriately, comfort care measures such as morphine have been shown to actually extend the life of terminally ill patients in some cases. Their bodies aren't being as worn down by pain, and they have a greater quality of life for their remaining time. I have had several patients who were breathing 40-50 times per minute (normal being 12-20) who received morphine (or Dilaudid, or whatever) specifically to decrease their work of breathing. If a patient's goal is to be comfortable at end of life, morphine is often a very helpful tool to meet that goal.
Amen!! I hate it when I hear "Morphine kills people." Or that hospice does for that matter. Keep getting the word out.
First of all, ((((hugs OP)))) for the loss of your grandma, and the possible coming loss of Dad.
I agree with geeimjo about her yelling in front of family. There are instances where we have to question the MD and refuse a treatment if truly dangerous -- but 1) it doesn't like this was such an occasion, and 2) I would avoid doing it in front of the family if at all possible. It can undermine that family-physician relationship, especially in cases like yours where the family has put themselves in an adversarial relationship with the system, and 3) the dr may feel a stronger need to save face, and refuse to change the order.
But yes, we do have that right, and responsibility to question what we know to be unsafe. It's always best to remain professional and calmly state why we are concerned about the order. Not yell "this is BS!!" Example: patient had too-high BP and had two meds ordered to be given as needed. Med #1 was ineffective, and med #2 had plummeted her heart rate when we used it. So I called the MD and told him that info, and asked "should I start a drip of a med #3, or do you have other suggestions?" He agreed, wrote for med #3, and cancelled to order for med #2. Easy peasy. In 13 years of nursing I've never had to say "if you want pt to have this, you need to come do it yourself because I'm not."
To address the issues of blood draws and morphine:
We can get away with taking very little blood. I work in a SICU and sometimes we have patients on every ("q") 4 hr draws, even up to q 1 hr if they are very critical. We take maybe 1/2-1ml of blood for each tube, or else the lab tech can do a finger poke and squeeze very tiny amounts into a pediatric blood tube. The exception is 1) the tubes with the blue top need to be full...and I think those are 3 ml, and 2) blood cultures. That could be 40 ml of blood, so a little more than a standard 30 ml medicine cup. If a person is critical enough to need all those draws, they will at least be getting a CBC checked q day. If they are very anemic (regardless of the reason) the dr will order a blood transfusion.
Once I did care for a Jehovah's Witness who'd hemmorhaged postpartum. Her hemoglobin was down to 2.3. She was transferred to my hospital because we have a sophisticated bloodless surgery program, so were able to help her without the blood transfusion she had expressly declined. For this situation, we were clearly worried about any blood loss; we were only checking labs if her body was telling us something was wrong. So for example, if her urine output were to plummet they'd have ordered a BMP which would give us info about her kidneys.
For comfort care only patients, our drs discontinue all orders for lab work, and for all medications that serve purposes other than comfort (e.g. their BP meds, thyroid meds, etc). They then prescribe meds for pain, anxiety, and to help dry the oral secretions they are too weak to swallow or spit. For one who is actively dying, we give meds for comfort without regard to their vital signs. They are already dying. I can assure you as a pro-life Christian, these meds are used as tools to make the death that is happening easier for that patient -- not to cause a death to happen.
For your typical elder who just had a hip replacement and has morphine ordered for postop pain: you will learn how to balance pain relief without overdosing her. That's what nursing school and clinicals (practice shifts in the hospital with an instructor) are for. Same with someone who has a DNR order but is not yet comfort care only.
Thank you for taking the time to write all of this. God Bless you-you are amazing :)
if hospital staff know the person is dying, will they start to back off from the 2-3 times blood drawing and just do it once daily...?
It depends less on the physician and more on the family.
If the family has the compassion to make the patient comfort care then no labs at all. If the family persists on insisting that everything be done to prolong the patient's life then sure, frequent lab draws are likely.
That's what hospice does in my experience; they will come out to the person's home and if needed just supportive care which may include iv pain medication; iv fluids would kind of defeat the purpose (prolonging life but not helping otherwise) they set up home oxygen and other needed things to keep the person comfortable.
No offense but this is clearly a comment made in ignorance from someone who clearly has zero medical knowledge. Post on all nurses when you're taking classes, in clincals, have a license...
Same with someone who has a DNR order but is not yet comfort care only.
NotAllWhoWandeRN, ASN, RN
791 Posts
I also wanted to add that alternative medicine is sometimes evidence-based and sometimes not. If it is based on anecdotes, question it. For example, some people believe there are herbs that will help you recover from a cold. Maybe Mary Sue took some and felt better, so she starts recommending it to her friends. Mary Sue might have been at the end of the cold and getting better anyway. Mary Sue might have experienced the placebo effect, meaning she was expecting to feel better so she did (we don't know WHY the human mind and body do this, but they do! The opposite is the nocebo effect where people will have very real physical reactions if they think you have given them something that will harm them). Regardless, if she felt better she will probably recommend it to her friends, and if it happens to work for any of them, the belief that it's helpful will get stronger, whether it's true or not.
Some acupuncture is evidence-based, some is not. Some "natural" nutritional supplements have evidence-based results, some do not. You will learn how to do your own investigating through the research techniques taught in science and nursing, to learn whether particular treatments are helpful or harmful.