...DNR VS AND Do not resuscitate (DNR) or no code, is a legal order written either in the hospital or on a legal form to withhold cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS), in respect of the wishes of a patient in case their heart were to stop or they were to stop breathing. “No code” is a reference to the use of “code” as jargon for “calling in a Code Blue” to alert a hospital’s resuscitation team. The DNR request is usually made by the patient or health care power of attorney and allows the medical teams taking care of them to respect their wishes. In the health care community, Allow natural death (AND), is a term that is quickly gaining favor as it focuses on what is being done, not what is being avoided....
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...Introduction Cardiopulmonary Resuscitation (CPR) was introduced in the 1960s and was intended to reverse cardiac arrests occurring during surgeries. Activating (CPR) codes needs special and careful considerations (Blinderman, Krakaue, Solomon, 2012). Under certain circumstances, CPR may not offer the patient direct clinical benefits, either because the resuscitation will not be successful; usually when the whole picture of the patient medical status and reports judging this patient as a hopeless case or because surviving the resuscitation will lead to co-morbidities that will merely prolong suffering without reversing the underlying disease and even worsen life quality (Braddock...
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...Burns: Understanding Nursing Research, 4th Edition Critiquing Exercise Knott, A. & Kee, C. C. (2005). Nurses’ beliefs about family presence during resuscitation. Applied Nursing Research, 18(4), 192-198. |STANDARDS/EVALUATION CRITERIA 50|KEY CONCEPTS IN CRITIQUE | |points | | |Descriptive Vividness 5 pts | | |Was the significance of the study adequately described? |1. The significance of the study was adequately described. | | |Family presence (FP) during resuscitation is a matter that | |Was the purpose of the study clearly described? |warrants more investigation as to whether or not it should, or | | |should not be allowed. Furthermore, the study proposes the | |Were the interpretations presented in a descriptive way that |necessity of protocols in place in institutions to guide | |illuminated more than the quotes did? |decisions on this matter. | | | ...
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...morbidity (Becker et al., 1993). A large body of evidence from animal models indicate that hyperthermia (a temperature higher than the threshold value of 37C) due to brain injury or ischemia can exacerbate the degree of permanent neurological damage following cardiac arrest. Each degree Celsius higher than 37C can cause cerebral destruction through increased metabolic expenditure, excitatory neurotransmitters resulting in calcium cellular reflux and accumulation of oxygen free radicals (Busto et al., 1987). To improve the outcome of patients who survive cardiac arrest requires not only reducing the ischemic process as quickly as possible, caused by cardiac arrest, but also preventing post resuscitation syndrome caused from reperfusion (Safar, 1993). Cerebral reperfusion after successful resuscitation can trigger harmful chemical cascades such as oxygen free radical production which can result in multifocal brain damage. Therapeutic hypothermia (TH) is considered as an effective method for reducing the deleterious neurological outcomes in patients who have out-of-hospital cardiac arrest. Clinical and animal studies have shown that TH following cardiac arrest reduces both the cerebral metabolic rate and oxygen demand and it is thought to attenuate reperfusion injury, global inflammation and endothelial dysfunction, all consequences of cerebral...
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...Information 14 Informed Choice 17 Forcing Information Upon Patients 20 The Nurses Role 22 Conclusion 25 References 26 Appendix 27 Glossary of terms CPR: Cardiopulmonary Resuscitation. DNACPR: Do Not Attempt Cardiopulmonary Resuscitation. NMC: Nursing & Midwifery Council. GMC: General Medical Council. BMA: British Medical Association. GP: General Practitioner Introduction The Aim of this module is to encourage me to enhance my personal and professional skills, to increase the efficacy of patient care and interaction. Also to make me more aware of the legal, professional and ethical implications of practice. The module allowed me to further develop my knowledge of these topics: Ethics & Accountability, Legal Aspects of Practice, finally Accountability & Professional Practice. I was then asked to submit an essay of 4500 words based on the following: “Critically analyse an aspect of care from your practice setting that encompasses the ethical, professional & legal role of the nurse. Issues of accountability should be incorporated into this essay”. Aspect of care The aspect of care I have chosen to include in my essay is the “Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)” Adult Policy 2010 (please see Appendix 1). I decided to choose this topic as there was a situation on my ward recently where a patient discovered a DNACPR form in the front of her nursing notes. The patient was...
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... reject, or discontinue. The effect of the Patient Self-Determination Act has given each patient the right to choose what is best for them upon their beliefs. And the advance directives protect their rights when making these decisions. The act also protects the health care institutions when the agency has to decide what is best for the patient as well. Durable Power of Attorney for Health Care, a draft for a durable power of attorney will be written in case the patient becomes mentally incapacitated; this is a document appointing an agent to act for a patient in the event of incompetence and will take effect immediately. The agency can not make the decision for the patient unless they are unable to make the decision themselves. Do Not Resuscitate (DNR) Order, is request not to be given CPR (cardiopulmonary resuscitation) if the patient heart stops or stops breathing given by the patient. Living Will, a legal document that explains the medical treatments or life support treatments the patient wants in case the patient becomes terminally ill. And these are the advance directives. Organ or Tissue Donor, the patient has authorized the hospital to remove organs and tissues. Medical suitability for donation is determined at the time of...
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...Advance Directives Advance directives are medical documents that are created by the patient that assist health care providers, and loved ones provide care and make decisions for the patient. Four types of advance directives exist including a Living Will, Durable Power of Attorney (DPOA), Uniform Anatomical Gift Act, and Do Not Resuscitate (DNR) orders (Fremgen, 2009). This paper will discuss one type of advance directives, the DNR order. The DNR order alerts medical professionals not to perform cardiopulmonary resuscitation (CPR), per the patient’s request. This means that health care professionals will not attempt emergency CPR if the patient’s breathing or heartbeat stops (Smith.). Advance directives and DNR orders are important to have drawn up by the patient because in the event they are unable to speak for themselves, an order is put in place stating their wishes. This helps in assisting family members and health care professionals in making decisions when the end of life is inevitable. Advantages and Disadvantages of a DNR Order When it comes to making this difficult decision, there are many advantages and disadvantages of a DNR order. The advantages as stated in the report called, “Recording “Do Not Resuscitate” and other Life-Sustaining Orders in the Out-of-Hospital Setting” are: * Available to all patients * No personal discomfort * Deals with a range of treatment * Easy to maintain * No loss of privacy (Pace, 2002). For example, when a person...
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...condition for mechanical activity. In pulseless electrical activity, the heart either does not contract or there are other reasons why this results in an insufficient cardiac output to generate a pulse and supply blood to vital organs. This condition is usually noticed because a person loses consciousness and stops breathing spontaneously. This is confirmed by examining the airway for obstructions, observing the chest for airway movement (rise and fall, and feeling a pulse (which is usually the carotid pulse) for a ten second period. The possible causes of pulseless electrical activity is remembered as the six Hs and the six Ts. The six Hs are as followed: hypovolemia, hypoxia, hydrogen ions (acidosis), hyperkalemia/hypokalemia, hypoglycemia, and hypothermia. The six Ts are also as followed: toxins (drug overdose), cardiac tamponade, tension pneumothorax, thrombosis (myocardial infarction, pulmonary embolism), tachycardia, and trauma (hypovolemia due to blood loss). The diagnosis of pulseless electrical activity comes when you see electrical activity on the device capable of electrocardiography but the person does not produce a pulse. Cardiopulmonary resuscitation is initiated immediately,...
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...discussion, we will look at how there can be instances where a coverage gap in care can occur when the patient is no longer capable of making decisions for themselves. We will also talk about advance directives, how they can assist healthcare professionals and patients, in such cases. What are advance directives? An advance directive states the patients detailed intentions for care if they become incompetent or lose communicable capabilities. They may also indicate a representative to make decisions for them. There are several types of directives: • Living Will • Durable Power of Attorney • Do Not Resuscitate Order (DNR) • Uniform Anatomical Gift Act...
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...well below the lower tip of the breastbone. Pull fist upward into the stomach with a quick upward thrust. Repeat up to four times. If choking continues, seek medical help. If the victim becomes unconscious, lay him or her down, roll to side, pull the tongue and jaw forward and with your index finger, dislodge any visible matter. Perform mouthto-mouth resuscitation and/or CPR. object, pull the upper lid down and over the lower lid and let it slide back up. This may dislodge the particle. If pain and tearing persist, seek medical help. FAINTING Lay patient on his or her back and raise both legs above the heart. Check airway to be certain it is clear. Loosen tight clothing and apply cold cloths to the face. If fainting lasts more than a minute or two, keep patient covered and seek medical help. BLACK EYE As soon as possible following the injury, dip a cloth in ice water and hold next to the area for at least 10 minutes. A “black eye” is essentially a bruise around the eye that will cause pain and swelling and gradually fade in time. If the bruise does not fade or if there is a change in vision, consult a physician. FALLS Stop any bleeding and cover...
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...doing chest compression that I learned years ago when I was in high school. As I resumed chest compressions I see a lady running out of a building with an Ambu bag. Ironically, the accident had occurred in front of a veterinarian clinic so the clinic provided us with means of oxygenating the individual without having to perform mouth-to-mouth resuscitation on his pale, dusky lips full of blood, glass, and dirt. Hard and fast I continued to preformed chest compressions allowing for full chest recoil during compressions to let the heart to completely refill with blood. After 30 compressions I stopped to check for a carotid pulse. Complete silence filled the air as everyone stood hoping for a single sign of life, but no pulse was felt. The lady from the veterinarian clinic saw me nod my head giving the clearance to resume cardiopulmonary resuscitation, CPR, and she gave the man two breaths using the Ambu bag. I resumed my high-quality chest compression at a rate of at least 100 chest compressions a minute. Sweat dripped down my nose onto the man’s lifeless body. My body was exhausted but I was fueled with so much adrenaline that I could not stop. The thoughts of this man being someone’s son, father, grandfather, and maybe someone’s husband...
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...The key issue within this case is that Dr. Bronson has, through his knowledge of the situation and the family’s experiences with Ms. Rose, decided to write do not resuscitate on her chart should she experience cardiac failure. Dr. Bronson did not actively engage with the family members in order to gain verbal reasons to put a do not resuscitate on Ms. Rose’s chart or not, instead he relied too much on the physical language of the family; Dr. Bronson also did not allow the family any time or privacy to discuss the decision. The case analysis will supply evidence that Dr. Branson is not in the wrong within ethical and moral boundaries and that Ms. Rose should not be resuscitated after cardiac failure, but that he should have taken a less deciding...
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...CARDIOPULMONARY RESUSCITATION * Collapses * Becomes unresponsive 1. Check Responsiveness * Tap the person's shoulder and shout, "Are you OK?" * Look for normal breathing. Call 911 if there is no response. * Start Hands-Only CPR. * Hands-Only CPR should not be used for adults whose cardiac arrest is due to drug overdose, near-drowning, or an unwitnessed cardiac arrest. In these cases, do a conventional CPR combination of chest compressions and rescue breathing. 2. Do Chest Compressions * Place the heel of your hand on the center of the person's chest. * Place the heel of your other hand on top of your first hand, lacing fingers together. * Keep arms straight and your shoulders directly over your hands. * Push hard and fast, compressing chest at least 2 inches. * Let chest rise completely before pushing down again. * Compress at least 100 times per minute. 3. Stop Only if: * The person starts breathing normally * A trained responder or emergency help takes over * You are too exhausted to continue * There is an automated external defibrillator (AED) to use 4. Use an AED as Soon as One Is Available * Turn on the AED. It will give you step-by-step instructions. * Wipe chest dry. * Attach the pads. * Plug in connector, if needed. * Make sure no one is touching the person. Say "Clear" so that people know to stay back and not touch the person. * Push the "Analyze" button if necessary. * If...
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...Heart disease is defined by the decreasing of blood flow to coronary arteries that supply blood to the cardiac muscles. The lumen of blood vessels become increasingly narrower, due to a build of plaque through a process called atherosclerosis. The resulting tissue necrosis eventually leads to heart attacks, cardiac arrests, and heart failure. Moments after the patient will stop breathing and become unresponsive. Emergency maneuvers to maintain perfusion in these cardiac emergencies are key to favorable post-emergency outcomes. Out-of-hospital cardiac emergencies historically have been associated with poor post emergency health outcomes (Nichol & Kim, 2015). Initiation of the chain of survival, activation of the EMS system, use of an automated cardiac defibrillator (AED), and CPR all have been shown to improve patient outcomes (Drager, 2012; Vadeboncoeur, Richman, Darkoh, Chikani, Clark, & Bobrow, 2008). Many cardiac emergency victims look to be in...
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...Necrotizing Fasciitis Necrotizing fasciitis is a rare disease which is characterized by the bodies inflammatory response initiated by the immune system. Necrotizing fasciitis quickly spreads throughout the body (WebMD 2014). The inflammatory response is followed by necrosis of fascial planes and surrounding tissue. Trauma usually ensues after the infection. The infection is usually triggered when an injury occurs. Minor abrasions or lesions are enough to allow susceptibility of this bacterial infection (Bellapianta et al., 2009). What is the causative agent? There are two factors that are crucial in developing necrotizing fasciitis. These include exposure to bacteria of the group A Streptococcus and the susceptibility of an individual to the bacteria. The genus Streptococcus belongs to a group of Gram-positive bacteria. Group a streptococci are mostly facultative anaerobes and some are strictly anaerobes. This genus has also been associated with the following medical conditions; scarlet fever, rheumatic heart disease, glomerulonephritis, and pneumococcal pneumonia. The microbe, Streptococcus pyogenes, is the causative agent of necrotizing fasciitis, it is also referred to as the flesh eating bacteria. The S. pyogenes capsule is composed of hyaluronic acid. Hyaluronic acid is also found in the connective tissue of human. Thus, the bacterium is regarded as antigenic. The cytoplasmic membrane of S. pyogenes has a semblance to the antigen of the human...
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