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Who tells?

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PrincessMuni:
Imagine the following situation:   You are assigned a 91-year-white female, admitted with urosepsis, requiring mechanical ventilation and intubation. Despite IV antibiotics, fevers jump through the roof along with climbing WBC counts and bands with a left shift. Within hours, Levophed is infusing at 60 cc/hr, NS is running wide-open, urine output stops flowing, and acrocyanosis arrives. Dopamine is added. Pitressin comes next. Soon you run out of electrical wall sockets as more inotropic drug support is added to sustain life.

The family hovers outside the door, without any sort of DNR discussion with the medical team. As the night wears on, the patient looks paler and paler, her cardiac rhythm now shows major ST depression leading way to a wide complex slow ventricular rhythm. By morning the patient's systolic blood pressure is near 54/?, and she's unresponsive as you provide oral care. Yet still the family "wants everything done." But there is nothing more to do. Palpable pulses barely exist. Mottling creeps along her limbs. There is no life.

The two residents seek to place a new arterial line instead of sitting down with the family to initiate a discussion about medical futility and comfort care. The nurse mumbles to the team, asking them to talk with the family about death and dying all night long, to no avail. The family continues to wonder in the hallway, hovering outside her room as her HR slowly begins to drop. They want dialysis now.

Still, no one talks to them about DNR options. No healthcare proxy exists. If you were in this situation, what would you have done?
Does a nurse have the right to tell a family about DNR options or should it remain a discussion with the physicians?   ??? ???

Would like to see nurses and doctors opinions about this situation.

Yaxya:
i think DNR is not allowed in Islam since it is part of mercy killing ....
u can see this link:
http://somalidoc.com/smf/index.php/topic,988.0.html

PrincessMuni:
Oh! i never knew that DNR is not allowed ?
ok then, your answer solved the problem :) thanks alot
How about another question...
Does nurses have the right to tell the patient or the patient's family about his condition? seriously ? coz i've seen in here that whenever a patient ask the nurse about his condition or even the family, they say: The doctor will come now??

Ikram:
his is a good question that bares thinking about,

From my professional experience where I have  found myself the middle person in the communication barrier. You always have to remember that you are the families advocate and it is your responsibility that the family/patient are treated with integrity and respect. I always try to be as honest as possible baring in mind that there some issues that you can not disclose, but that does not mean that you have to be misleading the family  about the assessment of your patient. I would encourage the doctors to sit down with the family to prepare them for the various outcomes. If this does not work, then you just have to be  assertive.

Ikram

PrincessMuni:
To Yahya,
u said DNR is not allowed in Islam... Yesterday there was a 1 7/12yr child with SMA .. parents asked for DNR
they were Muslim Indians and by 11pm child passed away.

so.. is DNR allowed?

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