Would you call a code/MET on a pt. who is a complete DNR?

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Sorry if this is a stupid question, but I'm a new nurse, freshly graduated.

If I walk into the room of a complete DNR pt and he/she is unresponsive, diaphoretic, breathing is labored, should I call a MET/Code?

Thanks...

Specializes in Hospice.

While it's true that many DNR patients are end-stage something ... many are not. It's totally appropriate to explore hospice and end-of-life care but it's also important to recognize when it's not appropriate. It's not a clear-cut either/or situation.

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So regarding comfort measures...if you give pain medicine to make them comfortable and the patient expires....then what? :eek: I've always wondered this...

Then, hopefully, they would have died pain-free.

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Specializes in Hospice.
Then, hopefully, they would have died pain-free.

What she said. And furthermore, it will have been the underlying disease that killed the patient, not the drug that relieved the patient's distress.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.
So regarding comfort measures...if you give pain medicine to make them comfortable and the patient expires....then what? :eek: I've always wondered this...

...you do post mortem care?

Are you wondering if the pain medicine caused the death?

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So regarding comfort measures...if you give pain medicine to make them comfortable and the patient expires....then what? :eek: I've always wondered this...

This is known as the "doctrine of double effect". A very interesting concept in law and ethics; doing something good that may in turn cause something bad, is ok to do if the bad outcome/side effect was not intended (the most common example in medico-legal circles is releiving pain in a terminally ill patient, whereby the side effects of the drug may "speed up" or bring about a patient's death).

There are of course criterion to meet, for the doctrine to be applicable. And there are debates as to wether it really is an ethical concept. That's why it's so fascinating! Gets you thinking and challenging your thoughts and beliefs.

This is a good article from the BBC regarding ethics, specifically the doctrine of double effect.

Hope that helps :-)

parko

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In regards to the original question of would I call a MET/RR on a patient who is NFR/NFI?

Yes. Just because a patient has been documented as not for resus/intuabtion/icu/inotropes/whatever esle, doesn't mean thay are not for continued medical management on the ward.

I am an ICU nurse and am part of the MET team at my hospital. We often get calls from the wards for patients who have deteriorated, but are not for resus. Most common example for us is the COPDer who has come in with a nasty pneumonia (which is potentially a reversible cause), who has had previous ICU admissions and has had treatment limitations put in place (most common is not for invasive mechanical ventilation, BiPap only). They are, however, still for ALL available medical management, including AB's, fluids, bronchodilators, pain relief, medical imaging, invasive procedures etc etc...

Unless they have been documented as "NFR/NFI, for comfort cares only" would i not call one. But a phone call to the RMO mightn't go astray to give them the heads-up, and also in the case of needing a review for pain relief/sedation.

It's certainly a grey area, but at the end of the day it is your registration, and yours alone. You worked hard for it, so do what you have to do to protect it!

parko

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Specializes in LTC, Psych, Hospice.
So regarding comfort measures...if you give pain medicine to make them comfortable and the patient expires....then what? :eek: I've always wondered this...

You do post mortem care. The disease process killed the pt, not the pain meds. The meds only made them comfortable.

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Specializes in cardiology, alternative medicine.

This does occur. The term "comfort measures only" in and of itself implies impending death. The key is to keep in close communication with the family (and physician); you'll find most family members prefer that their loved one dies a peaceful death with as little discomfort as possible. Let them have an active role, teach them about the meds available and the actions of the medications. I have come across very little resistance. In fact, the family often will come to me asking for more pain medication/sedation knowing not only the benefits but also the possibility of depressed respirations/respiratory arrest.

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Specializes in cardiology, alternative medicine.

I am an ICU nurse and just cared for a patient last night who had comfort measures only. We did not have any lines in him. We stopped taking vital signs,. dc'd all lab draws, etc. because death was imminent and it was the family's wishes. The family wanted him to stay in ICU until he passed. We basically performed oral care, administered pain meds/sedatives prn and repositioned him. Much of our time was spent giving family support.

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Specializes in Geriatrics.

Thank you 2mochas- I am a long term care nurse. nothing sucks worse than doing cpr on a 98 year old frail resident, praying that the ambulance gets there quick- all because no one can let "gramma " go. (Even if no one has visited her in 9 months). I do truly apprecitate you!

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Specializes in cardiology, alternative medicine.

Calling a code is quite different than calling the MET or Rapid Response Team. You would not call a code on a DNR patient but you would call the RRT. As others have written, you are not calling for CPR or intubation when you call for Rapid Response. It may well be that the distress this patient is experiencing can be reversed with meds, O2, etc. You are calling in a team will help you analyze the situation and go from there. Remember to communicate using SBAR--situation, background, (assessment) and recommendations. If you are caring for a lot of patients, it's hard to remember specifics, so it's a good idea to have the chart handy. And, remember, you only have to have a gut feeling that something is wrong to call the RRT. At our hospital, even family members are informed they can call the RRT (hasn't happened yet, though).

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I have a hard time differentiating between something that could be treatable...like just a low blood sugar, and something that would require intubation, etc. Now of course if they are pulseless, or agonal breathing (actively dying), i wouldn't call anyone but the gray area is what concerns me. Would it hurt to call a MET/RR and just let them know they are DNR? Or is it pointless?

If they have a low blood sugar, I would check orders for D50 or glucagon and give those if within the parameters for their blood sugar. A DNR is not for low blood sugar- unless they're already dead from it. It might not do anything for the long-term situation- but blood sugars are easily reversed without a 'team' to do it.... jmo :)

In a LTC situation, blood sugars that aren't treated can get a facility shut down- regardless of DNR status. If the person is also having an MI that is going to kill them, fixing the blood sugar won't matter :)

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