I went back to work. First day wasn't too bad. A LOT of new orders.
I have a patient with Ogilvie syndrome - it's like uber megacolon - the colon is SUPER dilated but there's no mechanical obstruction. My pt got a NG and rectal tube - he's full of air on both ends. When the surgeon was putting the rectal tube in the pt started belching majorly and passing excessive amounts of gas. And the NG was hooked up to suction - then the Dr came in today and decided to run PegLyte (bowel prep medication) but didn't write an order to stop the suction. So of course I had to call him for that. Which of course I got the order. But this guy also has an IV running and a foley so we have to watch the IN&OUT... which when I added it up during shift change he was sitting at a fluid EXCESS of +400mL. I notified the Dr of this and he wasn't concerned about this AT ALL - except that in my opinion it was only going to get worse because this guy's clearance was <30cc/hr and we're running his IV at 100 which means his fluid excess would just get higher and higher. Dr said that until his scrotum became the sizes of watermelon not to notify him of the fluid excess. He asked me what I wanted him to do - I said some Lasix would be nice. Shot me down on that one - said that his kidney function was already going kaput so that wouldn't really help. I asked HIM what we were doing for this guy then - why have the IV if you aren't going to do anything about the excess. I was told that he wants him to be a DNR but that family won't approve - that they are living in a fantasy world of denial and think that he can improve...
Let me paint this picture for you about this guy -
* Bilateral stroke (rare and very detrimental)
* Obese
* Diabetic
* 2 previous MI
* Blind (due to the diabetes)
* and this bowel issue
Now, if I ever had a family member with this sort of picture - hello DNR! But they just don't get it - no matter how many Dr's talk to them - even our best palliative doctor. I hope this guy codes on someone else's shift and not mine!
Showing posts with label DNR. Show all posts
Showing posts with label DNR. Show all posts
Sunday, February 23, 2014
Monday, February 3, 2014
Advance Directives - AKA Living Wills - power of attorney - my thoughts on these
For ethics I have to read two positions on this. Funny thing is is that I have personal experience with this - outside of my role as a nurse.
About 3-4 years ago my mom's good friend Jane (not her real name) - her husband Joe (again not a real name) was walking about 15 minutes from home to go to the local coffee shop (Tim Horton's for us Canadians) where he would meet up with his chums for a morning pick-me-up. He reached the traffic light, pressed the button and when told to cross he did so. Unfortunately at the same time was a young girl who went through the (green for her) light and struck Joe. He was thrown about 15-20 feet and landed in a snow bank. EMS showed up and rushed him to the local hospital. He was stabilized and was discovered to have a massive head injury that required immediate surgery. We live in a (smallish - approx. 75, 000 pop) community that does not have a brain surgeon so he was air lifted to the closest center that could perform this - happened to be in the US. So there he went. Well his wife was notified and off she went to the US to be with her husband. She permitted them to do brain surgery and he was intubated (naturally) and was ventilated for his surgery. The surgery went according to plan and he was brought back to the ICU. He was touch and go for several days and when they tried to take him out of the medically induced coma he would not regain consciousness. He was in an actual coma. He remained this way for several weeks. When he finally DID come out of the coma he was found to have major brain trauma which stripped him of his ability to function - approx. 25% of what he was previously. It took him almost 2 years to be able to even slightly talk (remembered how to curse though which is hilarious) but he had a feeding tube and ended up also needing a catheter. He was wheelchair bound and required support 24 hours a day. He was put into a nursing home for this care but his family also provided for him additional care during the day hours so that his therapists could work with him more personally and often and TRY to regain some function. Then he started to get complications upon complications. This inevitably caused his death. During some part of this his wife was notified that she was NOT allowed to make decisions in regards to his health OR expenses because they had had NOT created a power of attorney, living will or advance directives and so someone else had to make these decisions PLUS she had to go to court in order to get these right given to her (as it should have been).
Because I've seen this and what Jane and Joe had to go through - from this side - and seeing what patients and their families have to go through when these things aren't put into place..... as well as when they are (it's wonderful when they have been). I would like to make it known what I would want or not want.... husband and I tend to disagree on some of it. He would like me to be kept alive (on a ventilator and everything else) so that he could be with me. I on the other hand would NOT want to be kept alive if I were to be incompacitated or diagnosed brain dead.
I had a conversation with my BFF about some of these things and we talked about scenarios because I told her in no uncertain terms that I would NOT want a tracheostomy. Well she made me realize that I would ONLY want it if it could come out - and I would only allow it for 30 days (ever seen the episode of Grey's anatomy - 30 days and that's all I get - if you can't figure it out by then I'm being taking off support) then take it out and if I live then i live - if not I die and I'm ok with that. Clearly I wasn't meant to live.
Now the ONLY time I want to be on a ventilator and kept alive is if I were pregnant and the fetus could be viable and NORMAL (no cerebral palsy due to hypoxemia) then keep me alive until I could "give birth" then take me off life support.
Now if I were expected to live but have some deficits - if I could be expected to be at least 75% of who I was previously (mental faculty wise) then do extradinary measures. If I need antibiotics - please give - I completely agree with them. Don't give him a G/J or any other kind of tube to extend my life. I see enough of this at work and do NOT agree with it. I WANT to be able to drink and eat the "normal" way and if I would die if I didn't have a tube going into my body then that's not the way I would want to live. Again if it's longer then 30 days - let me die! When it comes to tests - do them, do as many as you can to try to figure out what's wrong with me and try to fix it - I'm ok with that - I like tests, it makes treatment easier and WAAAY more effective. When it comes to CPR it's a bit trickier - inately I agree with CPR. However, the longer that CPR is done, the less likely it is that mental faculties will be back to 100% so really, would I want extended CPR?! I suppose I will have to ask a doctor about this to truely know what my answer is to this one. I agree 100% with dialysis and pain medication - I think these things are totally important. I can't think of other things that should be included but I will totally update these kinds of things as I learn and see more.
I think MORE people should put it in writing what they want. And try to think of ANY and ALL kinds of situations.
About 3-4 years ago my mom's good friend Jane (not her real name) - her husband Joe (again not a real name) was walking about 15 minutes from home to go to the local coffee shop (Tim Horton's for us Canadians) where he would meet up with his chums for a morning pick-me-up. He reached the traffic light, pressed the button and when told to cross he did so. Unfortunately at the same time was a young girl who went through the (green for her) light and struck Joe. He was thrown about 15-20 feet and landed in a snow bank. EMS showed up and rushed him to the local hospital. He was stabilized and was discovered to have a massive head injury that required immediate surgery. We live in a (smallish - approx. 75, 000 pop) community that does not have a brain surgeon so he was air lifted to the closest center that could perform this - happened to be in the US. So there he went. Well his wife was notified and off she went to the US to be with her husband. She permitted them to do brain surgery and he was intubated (naturally) and was ventilated for his surgery. The surgery went according to plan and he was brought back to the ICU. He was touch and go for several days and when they tried to take him out of the medically induced coma he would not regain consciousness. He was in an actual coma. He remained this way for several weeks. When he finally DID come out of the coma he was found to have major brain trauma which stripped him of his ability to function - approx. 25% of what he was previously. It took him almost 2 years to be able to even slightly talk (remembered how to curse though which is hilarious) but he had a feeding tube and ended up also needing a catheter. He was wheelchair bound and required support 24 hours a day. He was put into a nursing home for this care but his family also provided for him additional care during the day hours so that his therapists could work with him more personally and often and TRY to regain some function. Then he started to get complications upon complications. This inevitably caused his death. During some part of this his wife was notified that she was NOT allowed to make decisions in regards to his health OR expenses because they had had NOT created a power of attorney, living will or advance directives and so someone else had to make these decisions PLUS she had to go to court in order to get these right given to her (as it should have been).
Because I've seen this and what Jane and Joe had to go through - from this side - and seeing what patients and their families have to go through when these things aren't put into place..... as well as when they are (it's wonderful when they have been). I would like to make it known what I would want or not want.... husband and I tend to disagree on some of it. He would like me to be kept alive (on a ventilator and everything else) so that he could be with me. I on the other hand would NOT want to be kept alive if I were to be incompacitated or diagnosed brain dead.
I had a conversation with my BFF about some of these things and we talked about scenarios because I told her in no uncertain terms that I would NOT want a tracheostomy. Well she made me realize that I would ONLY want it if it could come out - and I would only allow it for 30 days (ever seen the episode of Grey's anatomy - 30 days and that's all I get - if you can't figure it out by then I'm being taking off support) then take it out and if I live then i live - if not I die and I'm ok with that. Clearly I wasn't meant to live.
Now the ONLY time I want to be on a ventilator and kept alive is if I were pregnant and the fetus could be viable and NORMAL (no cerebral palsy due to hypoxemia) then keep me alive until I could "give birth" then take me off life support.
Now if I were expected to live but have some deficits - if I could be expected to be at least 75% of who I was previously (mental faculty wise) then do extradinary measures. If I need antibiotics - please give - I completely agree with them. Don't give him a G/J or any other kind of tube to extend my life. I see enough of this at work and do NOT agree with it. I WANT to be able to drink and eat the "normal" way and if I would die if I didn't have a tube going into my body then that's not the way I would want to live. Again if it's longer then 30 days - let me die! When it comes to tests - do them, do as many as you can to try to figure out what's wrong with me and try to fix it - I'm ok with that - I like tests, it makes treatment easier and WAAAY more effective. When it comes to CPR it's a bit trickier - inately I agree with CPR. However, the longer that CPR is done, the less likely it is that mental faculties will be back to 100% so really, would I want extended CPR?! I suppose I will have to ask a doctor about this to truely know what my answer is to this one. I agree 100% with dialysis and pain medication - I think these things are totally important. I can't think of other things that should be included but I will totally update these kinds of things as I learn and see more.
I think MORE people should put it in writing what they want. And try to think of ANY and ALL kinds of situations.
Tuesday, November 20, 2012
The one lie nurses will tell
We've had a string of deaths on the unit, majority of them are our DNR's and palliative pt's and surprisingly I'm still a virgin (meaning none of these ppl have died while they're in my care) and tonight when I went to work I found out that one of my pt's I had Saturday night had passed.
I was surprised and when the nurse who had the pt came onto shift I asked about the details. While talking with him we talked about how he informed the family. Another nurse was in the room when I brought this up and gave this piece of advice...
If a family member wants to know if anyone was there when they died, tell them YES - EVEN IF THAT MEANS YOU HAVE TO LIE!!! NEVER EVER tell them that they died alone. Hell, make up a story if you want to, but never tell them they died alone... it's like the #1 fear that family members have when their family member's in the hospital.
Well sure enough, we had a sudden death on our unit tonight.... and what ONE question did that family member have?! Yep, "did he die alone". Thankfully we could answer this one truthfully because she had like 4-5 nurses around her when she took her last breath.
Moral of the story - ALWAYS tell a family member that someone was there when they took their last breath, never leave them with guilt that they couldn't be there when they died. At least the family will take comfort in knowing that at least SOMEONE was around, even if that isn't the truth.
I was surprised and when the nurse who had the pt came onto shift I asked about the details. While talking with him we talked about how he informed the family. Another nurse was in the room when I brought this up and gave this piece of advice...
If a family member wants to know if anyone was there when they died, tell them YES - EVEN IF THAT MEANS YOU HAVE TO LIE!!! NEVER EVER tell them that they died alone. Hell, make up a story if you want to, but never tell them they died alone... it's like the #1 fear that family members have when their family member's in the hospital.
Well sure enough, we had a sudden death on our unit tonight.... and what ONE question did that family member have?! Yep, "did he die alone". Thankfully we could answer this one truthfully because she had like 4-5 nurses around her when she took her last breath.
Moral of the story - ALWAYS tell a family member that someone was there when they took their last breath, never leave them with guilt that they couldn't be there when they died. At least the family will take comfort in knowing that at least SOMEONE was around, even if that isn't the truth.
Tuesday, November 13, 2012
Withdrawing care & comfort care measures
I've spoken about this before, but we see it ALOT on our unit. Because we have many stroke patients come through our unit, it really gets to me that ppl don't know how to bring up this subject.
Why is it so hard to talk to ppl about death and dying and being realistic. Why hold out hope that your family member/patient will pull through to just be a burden on the system and the family?! IMO, if God wills this person to live, they will but don't put in a NG/G/Peg tube to prolong the life of ppl. I think it's a pointless to prolong these lives.
There's one family I dealt with who their father had a stroke several years back, he lived for 3 yrs with complications before finally dying. Because of this, their mother indicated verbally (of course not in writing!) that should anything like that befall her, to make her a DNR and let her die! Well go figure, same happens to her and this family makes her a full code!!! Then when she stabilizes, the family is FINALLY persuaded to make her a DNR BUT they want to put in a G-tube.... STUPID!!!! UGH But of course I have to keep my opinions to myself and respect the decisions of this family. After a month or so, the only thng she had done was open her eyes. Not much of a life right?! Another pt we've dealt with is semi-comotose and they put a g-tube in her. It's soooo frustrating.
On the other side of this coin, we've had several where the family decided to withdraw care other than comfort care measures and these people have passed peacefully without having to suffer from bed sores, infections,etc. I relish those times.
I have also dealt with a family who had their loved one come in with pneumonia, possible TB and the person is elderly and cognitively intact and doesn't want to eat or drink. What's going to be their decision???? I think that if ppl can make decisions before they lose their minds, let them do what they want! Provide comfort care measures and end of life support and allow them to pass they way they want to!
Why is it so hard to talk to ppl about death and dying and being realistic. Why hold out hope that your family member/patient will pull through to just be a burden on the system and the family?! IMO, if God wills this person to live, they will but don't put in a NG/G/Peg tube to prolong the life of ppl. I think it's a pointless to prolong these lives.
There's one family I dealt with who their father had a stroke several years back, he lived for 3 yrs with complications before finally dying. Because of this, their mother indicated verbally (of course not in writing!) that should anything like that befall her, to make her a DNR and let her die! Well go figure, same happens to her and this family makes her a full code!!! Then when she stabilizes, the family is FINALLY persuaded to make her a DNR BUT they want to put in a G-tube.... STUPID!!!! UGH But of course I have to keep my opinions to myself and respect the decisions of this family. After a month or so, the only thng she had done was open her eyes. Not much of a life right?! Another pt we've dealt with is semi-comotose and they put a g-tube in her. It's soooo frustrating.
On the other side of this coin, we've had several where the family decided to withdraw care other than comfort care measures and these people have passed peacefully without having to suffer from bed sores, infections,etc. I relish those times.
I have also dealt with a family who had their loved one come in with pneumonia, possible TB and the person is elderly and cognitively intact and doesn't want to eat or drink. What's going to be their decision???? I think that if ppl can make decisions before they lose their minds, let them do what they want! Provide comfort care measures and end of life support and allow them to pass they way they want to!
Thursday, August 23, 2012
Am I losing my touch with humanity?
Lately on our unit we've had an increase in the amount of deaths. Now I understand that eveyone has to die, heck we don't live in the age of the bible/torah/quran and live to be 800 yrs+
That being said, we've also had people on our unit who are DNR (do not resuscitate) who I can't help myself in thinking that many of these people I would rather see die... but only because IMO they are suffering.
The last shift I worked was one such case - I had a patient who's not very old - I'd say youngish, on TPN (since like 2001/02), was severely emaciated, had several comorbidities and had been in and out of units (whenever he gets readmitted he gets put back on our unit for some reason - totally unrelated to the fact that our unit is for neuro pts) for like a year+.
During this last admittance, he suddenly started vomitting blood EVERYWHERE and had to have an emergency scope to have varices in his stomach banded/cauterized. When he returned back to us, he required like 6-10 units of blood, plasma, IV fluids, etc...
To see him, he was CLEARLY suffering - and I'm thankful that he passed because you could see that not only was he suffering, but so was his family.
Another pt we've had on our unit is an older patient who is also a DNR, tho has late stage dementia. She's been on our unit for several months I think and recently became a DNR, the family was in denial about her condition for so long. This woman moans CONSTANTLY, is completely delirious and is VERY difficult to take care of, emotionally and psychologically because there's nothing that we can do to settle her. Even super strong anti psychotics don't touch her. She's REALLY difficult to feed or get her to drink and therefore she's starving herself. At least with the DNR in place, we don't have to give her a feeding tube. I'm hoping that she's passed, her family is having such a hard time seeing her waste away, physically and psychologically. They cry almost every time they come to visit but know that a DNR is the best thing to do. Thank goodness!!!
We have another lady on our unit who's on restraints because she has a neuro disorder that causes these involuntary movements. Now, in our province, no LTC (long term care) facility will take a pt with restraints, and therefore must stay with us in the hospital. This family, tho will not make her a DNR. I don't understand why, or maybe the Dr hasn't talked/pushed the family into making her a DNR. It's not like this lady's condition is going to improve, it'll only get worse! It's a terminal disorder. And I certainly don't want to be pushing down on this lady's chest when the time comes that her brain is going to deteriorate to the point where she stops breathing and I have to call a code on her, because she isn't a DNR. SOOO frustrating. I am surprised tho that this family comes to the hospital DAILY - for lunch or for dinner and personally feed her. It astonishes me because you think that that would eventually fade.
My question to you folk out there.... have you ever thought about delaying calling a code on someone who should VERY obviously SHOULD be a code????
That being said, we've also had people on our unit who are DNR (do not resuscitate) who I can't help myself in thinking that many of these people I would rather see die... but only because IMO they are suffering.
The last shift I worked was one such case - I had a patient who's not very old - I'd say youngish, on TPN (since like 2001/02), was severely emaciated, had several comorbidities and had been in and out of units (whenever he gets readmitted he gets put back on our unit for some reason - totally unrelated to the fact that our unit is for neuro pts) for like a year+.
During this last admittance, he suddenly started vomitting blood EVERYWHERE and had to have an emergency scope to have varices in his stomach banded/cauterized. When he returned back to us, he required like 6-10 units of blood, plasma, IV fluids, etc...
To see him, he was CLEARLY suffering - and I'm thankful that he passed because you could see that not only was he suffering, but so was his family.
Another pt we've had on our unit is an older patient who is also a DNR, tho has late stage dementia. She's been on our unit for several months I think and recently became a DNR, the family was in denial about her condition for so long. This woman moans CONSTANTLY, is completely delirious and is VERY difficult to take care of, emotionally and psychologically because there's nothing that we can do to settle her. Even super strong anti psychotics don't touch her. She's REALLY difficult to feed or get her to drink and therefore she's starving herself. At least with the DNR in place, we don't have to give her a feeding tube. I'm hoping that she's passed, her family is having such a hard time seeing her waste away, physically and psychologically. They cry almost every time they come to visit but know that a DNR is the best thing to do. Thank goodness!!!
We have another lady on our unit who's on restraints because she has a neuro disorder that causes these involuntary movements. Now, in our province, no LTC (long term care) facility will take a pt with restraints, and therefore must stay with us in the hospital. This family, tho will not make her a DNR. I don't understand why, or maybe the Dr hasn't talked/pushed the family into making her a DNR. It's not like this lady's condition is going to improve, it'll only get worse! It's a terminal disorder. And I certainly don't want to be pushing down on this lady's chest when the time comes that her brain is going to deteriorate to the point where she stops breathing and I have to call a code on her, because she isn't a DNR. SOOO frustrating. I am surprised tho that this family comes to the hospital DAILY - for lunch or for dinner and personally feed her. It astonishes me because you think that that would eventually fade.
My question to you folk out there.... have you ever thought about delaying calling a code on someone who should VERY obviously SHOULD be a code????
Thursday, August 9, 2012
Death & Dying - what I learned
I was working the other week, and one of my co workers had a patient who had been going downhill. It was such a sad story - the husband and wife came to Canada from out east to visit their children and the husband had a stroke and the wife forced her husband to come to my hospital. He of course was admitted. Now of course when ppl go on holiday they don't (always) think to get health insurance so now that they're at my hospital, there's no way to pay for the care and so the hospital goes after the children's ability to pay.
During grand rounds I learn that this person has been going through cycles since coming to the hospital - that his doctor had been trying to make him healthy enough so that he could get on a plane to go back to his parent country. Unfortunately, he would get well for about a week and then would start to spike a temperature and would have to be held up and begin a round of antibiotics, and that would be the cycle. It was like EVERY time he was well enough to get a clean enough bill of health as is required by airlines to allow sick ppl onto their airplanes, he would spike another temp and wouldn't be able to go back.
The shift I worked, I was told by the nurse taking care of him that he wasn't doing well, his BP was REALLY poor but his O2 was alright, but that he didn't look good. Thankfully the family had made him DNR so at least if things went awry we wouldn't have to pound on this poor patient's chest to revive him and keep him alive for longer than he needs to be.
The nurse came out and explained that she thought he would die during that particular shift and felt that there wasn't anything that could be done to alleviate any suffering. She called the on-call doc, who just happened to be one of my favorite docs and he ordered some dilaudid for him and some scopolamine as this med dries up secretions and the "death rattle" is less so the family isn't as upset by it.
The doc agreed that he was in the final throes of dying and that it wouldn't be long before he died. I was talking to the doctor and a couple of the other nurses when the wife comes out to the nursing station speaking Hindi - a language that not enough of us speak but we did have a couple of ppl on at that time and we pulled one of them (the male of the two) to translate as the wife was trying to speak to the doctor and pull him back into the patient room. Now when we pulled the male nurse to translate the face he was making was hilarious and it was almost as though he had NO idea why we were grabbing him and it was hilarious so I laughed.
I found out when the doc came back to the station was that her husband had just breathed his last breath and was coming out to indicate this.
I felt soooooooooooo bad that one of the last things that this woman may remember will be laughing when her pain was excrutiating. I am not someone who enjoys seeing another person in pain. I wish I coudl have spoken the language with enough fluency to apologize for any pain that I may have inadvertently causing her.
Morale of the story - get health insurance whenever you travel, you never know what's going to happen and you really do need to be covered. And never laugh at ANY point in time if someone is dying on your unit, because it may be perceived in another manner in which you meant it. ESPECIALLY if someone speaks another language. They have NO idea why you're laughing, and nothing is funny when your loved one is dying.
During grand rounds I learn that this person has been going through cycles since coming to the hospital - that his doctor had been trying to make him healthy enough so that he could get on a plane to go back to his parent country. Unfortunately, he would get well for about a week and then would start to spike a temperature and would have to be held up and begin a round of antibiotics, and that would be the cycle. It was like EVERY time he was well enough to get a clean enough bill of health as is required by airlines to allow sick ppl onto their airplanes, he would spike another temp and wouldn't be able to go back.
The shift I worked, I was told by the nurse taking care of him that he wasn't doing well, his BP was REALLY poor but his O2 was alright, but that he didn't look good. Thankfully the family had made him DNR so at least if things went awry we wouldn't have to pound on this poor patient's chest to revive him and keep him alive for longer than he needs to be.
The nurse came out and explained that she thought he would die during that particular shift and felt that there wasn't anything that could be done to alleviate any suffering. She called the on-call doc, who just happened to be one of my favorite docs and he ordered some dilaudid for him and some scopolamine as this med dries up secretions and the "death rattle" is less so the family isn't as upset by it.
The doc agreed that he was in the final throes of dying and that it wouldn't be long before he died. I was talking to the doctor and a couple of the other nurses when the wife comes out to the nursing station speaking Hindi - a language that not enough of us speak but we did have a couple of ppl on at that time and we pulled one of them (the male of the two) to translate as the wife was trying to speak to the doctor and pull him back into the patient room. Now when we pulled the male nurse to translate the face he was making was hilarious and it was almost as though he had NO idea why we were grabbing him and it was hilarious so I laughed.
I found out when the doc came back to the station was that her husband had just breathed his last breath and was coming out to indicate this.
I felt soooooooooooo bad that one of the last things that this woman may remember will be laughing when her pain was excrutiating. I am not someone who enjoys seeing another person in pain. I wish I coudl have spoken the language with enough fluency to apologize for any pain that I may have inadvertently causing her.
Morale of the story - get health insurance whenever you travel, you never know what's going to happen and you really do need to be covered. And never laugh at ANY point in time if someone is dying on your unit, because it may be perceived in another manner in which you meant it. ESPECIALLY if someone speaks another language. They have NO idea why you're laughing, and nothing is funny when your loved one is dying.
Thursday, December 8, 2011
What nurses talk about....
At the end of my shift last night, a bunch of us nurses gathered to talk about a couple of things.... we talked about one of the new hire nurses (got hired at the same time as I) experiences and how it differs from the veteran nurses experiences - more like what one would do vs. what another would do.
The situation was this.... if you did a bladder scan on a patient because they were complaining about fullness and pain - found that there was a substantial amount that was being retained, would you do a straight in and out THEN call the Dr for the order OR would you call the Dr, report the finding and request an in & out, also, what would you do if a Dr refused it....
Veteran nurse said that she would NOT have waited for a Dr's order, would have done the in & out and called the Dr for the order - neglecting that policy indicates otherwise... and even said that she didn't care if she got fired for it because it was in pt's best interest.
Newbie nurses (I included) - have called Dr's for such FIRST - but this is seen as us not having a back bone.
So what would YOU do?
When I have called Dr's for in & out's, I have already done a bladder scan and feel that information is a girl's best friend. I think it's like arming yourself for when questions get asked. Now, if I had a pt who required an in & out but a physician was refusing to give one (did happen to that newbie btw), I think I would go to the unit leader/charge nurse to speak about it, since having the leader on your side is like arming yourself - it's peer review and support. I know that the nurses on my unit support one another, and their patients - and ultimately would do what's best for the patient. Even if that means going against a Dr.
The newbie kept paging that Dr. for several HOURS, probably not realizing that the other option available to him was to do the in & out without the order and that one could be obtained later from the MRP (most responsible physician).
We also talked about our past patients and where they are... one of the nurses generally checks out various units within the hospital, as some of our patients end up on rehab units, we like to know if they're still there or not...
Last night this nurse revealed that one of our patients.... the one I told this blogging world about - the woman with the MASSIVE CVA (AKA stroke). Turns out that she aspirated at home - from the family trying to feed her! And she was back in ICU, intubated and STILL not a DNR (Do not resuscitate)... it amazes me, truely astonishes me that a family would WANT to watch someone suffer. If that was MY family member, I would NOT want my family member to be a full code if they are going to have crappy quality of life. If they can barely move, can barely communicate, and are entirely dependent on others for EVERYTHING, and that the family isn't all that interested in learning to take care of this family member.
It's crappy when people keep a loved one around for THEIR need, not caring about how it is for their family member. I guess this is something that I will learn to live with, because there is NOTHING I can do about it.
The situation was this.... if you did a bladder scan on a patient because they were complaining about fullness and pain - found that there was a substantial amount that was being retained, would you do a straight in and out THEN call the Dr for the order OR would you call the Dr, report the finding and request an in & out, also, what would you do if a Dr refused it....
Veteran nurse said that she would NOT have waited for a Dr's order, would have done the in & out and called the Dr for the order - neglecting that policy indicates otherwise... and even said that she didn't care if she got fired for it because it was in pt's best interest.
Newbie nurses (I included) - have called Dr's for such FIRST - but this is seen as us not having a back bone.
So what would YOU do?
When I have called Dr's for in & out's, I have already done a bladder scan and feel that information is a girl's best friend. I think it's like arming yourself for when questions get asked. Now, if I had a pt who required an in & out but a physician was refusing to give one (did happen to that newbie btw), I think I would go to the unit leader/charge nurse to speak about it, since having the leader on your side is like arming yourself - it's peer review and support. I know that the nurses on my unit support one another, and their patients - and ultimately would do what's best for the patient. Even if that means going against a Dr.
The newbie kept paging that Dr. for several HOURS, probably not realizing that the other option available to him was to do the in & out without the order and that one could be obtained later from the MRP (most responsible physician).
We also talked about our past patients and where they are... one of the nurses generally checks out various units within the hospital, as some of our patients end up on rehab units, we like to know if they're still there or not...
Last night this nurse revealed that one of our patients.... the one I told this blogging world about - the woman with the MASSIVE CVA (AKA stroke). Turns out that she aspirated at home - from the family trying to feed her! And she was back in ICU, intubated and STILL not a DNR (Do not resuscitate)... it amazes me, truely astonishes me that a family would WANT to watch someone suffer. If that was MY family member, I would NOT want my family member to be a full code if they are going to have crappy quality of life. If they can barely move, can barely communicate, and are entirely dependent on others for EVERYTHING, and that the family isn't all that interested in learning to take care of this family member.
It's crappy when people keep a loved one around for THEIR need, not caring about how it is for their family member. I guess this is something that I will learn to live with, because there is NOTHING I can do about it.
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