Information needed on Advanced CPR

[flamingpie2500]

We have recently placed my father-in-law in a nursing home. Severe dementia, congestive heart failure. During the admissions process the family was asked about do no recusitate orders. The family is split on this decision, and I am looking for specific info and the process, and what it can do to an elderly persons body, etc. Google hasn't turned up much for me yet. I think my mother in law would have second thoughts about the process if she was more informed about what can actually happen to this poor man. The nursing home does not distinguish between basic cpr and advanced. We cannot separate the two.
Thanks in advance

[SarahB]

1. I'm a nursing student.

My ex-husband was an instructor in advanced CPR. From my knowledge, the only difference is that advanced CPR goes into more detail for medical professionals.

One thing that may be an option is for instance to make CPR okay, but to eliminate the possibility of your FIL being put on a ventilator by not allowing him to be intubated. That way, if this is a concern, he won't have the possibility of being stuck in the position of a "machine breathing for him" as the means of keeping him alive. I'm sorry for your family's pain right now. :hug:

[MuseRider]

2. A DNR order

has nothing to do with advanced recusitation. It is a denial of all life saving methods used in the proceedure of CPR. If you are DNR and your vital signs stop nothing at all is done. No meds, no CPR, nothing. I was an ICU nurse but it has been many years but I doubt the meaning of DNR has changed. Advanced was something we learned(different meds, intubation etc.) but CPR was CPR.

You should speak with his doctor or his nurse and find out what all you need to know.

[flamingpie2500]

3. yes we currently do not have the dnr order in place. But we feel that

should be changed. The decision was made under very hard circumstances, and of course the first thought was to recusitate. But now we feel the damage done by such a procedure would be much worse than simply getting him breathing again etc.
It is not that simple.
We are trying to gather as much information on this as possible to help everyone make such a decison.

[Tallison]

7. About 90% of people who receive

code blue intervention either pass despite it or never regain consciousness (i.e., wind up indefinitely on a ventilator or sustain such profound brain damage from lack of intermediate oxygen). As an RN who's performed it many times, I'd never order it for myself or for a loved one.

I'm so sorry for your family's painful circumstance. :hug:

[Tallison]

8. According to my hospital's policy

there's only code-blue resuscitation, of which CPR is a basic part that takes place prior to the code team's arrival. Not sure what OP means by "advanced" CPR, do you?

edit for grammar

[GardeningGal]

4. Personally, when I'm older I will have a DNR

My experience with my father convinced me. He did not have a DNR and was intubated. It was a very frightening process because they could not get the tube through his nose and had to go through the throat. I believe it was traumatic for him and would have been better to have not been done. He passed on 7 days later.

After that, my mother went out and got the state approved DNR and she signed it and had her doctor sign it. She was adamant and made sure the family was aware of her feelings. Her doctor told us that the percentage of people that were revived and able to live their life the same as before was very low.

It's a personal decision and hopefully this experience will encourage your family to talk about it and make a good decision. I know it's hard because you don't want to lose a family member. But sometimes it just prolongs the inevitable.

[greenman3610]

5. Intubation is always done thru the throat

unless there's some kind of trauma that doesn't allow it.

I was a paramedic for 15 years, and currently a hospital
nurse.
If your relative has a reasonable chance of surviving
rescuscitation, and some reasonable quality of life,
then by all means go for it.

Most people, however, have no idea of what it
means once a "code" is called.
It means the cavalry comes, and they do
everything in their power to keep that
heart beating, no matter the consequences to
the individual or the disruption to the
dying process.
They have to. It's the law. They'd be
wide open to horrendous
lawsuits if they didn't.
I've been in rooms with family PLEADING to
let Grandma go, and being completely ingnored
by a team of professionals pounding away at the
loved one. If the paperwork is not there, that's the way
it's done.
I was glad my Dad, at 85, died in his sleep, and I know
he would have wanted it that way.

[Mayberry Machiavelli]

6. Yes, as others have pointed out, it's not the difference between "basic"

and "advanced", but it's more the decision: What should be done if he is found not breathing, or without a pulse? Should efforts be made to resuscitate him at all?

In such a scenario, if no efforts were made, obviously the result would be that he would die.

If full resuscitation efforts were made, it's quite likely (actually, probable) that he would not survive in any case. But if he were to survive, then consider what the possible outcomes would be.

The "best possible" scenario is that he would endure some kind of intensive care unit stay, likely on a ventilator, with the best possible outcome for him to have the same degree of dementia and cardiac problems as now, the same "quality of life".

Another possible outcome is that he would undergo varying lengths of intensive care unit therapy, and emerge with additional neurologic damage (i.e. severe stroke or coma or braindeath) due to the period with poor circulation or lack of oxygen.

Another, likely, outcome is that he would under some period of intensive care unit therapy, and die after some time, which could be days or even weeks.

It goes without saying that if he still has any assets that those would likely be depleted by ICU care.

[undeterred]

9. I know someone who had resuscitation after a heart attack at age 78

and two years later she is still alive and living at home.

However, she told me that the weeks after the heart attack (she was in the hospital for a month) were simply horrible and she did not want to ever go through it again. I took her to some appointments after her hospitalization and she told me, "If I have a heart attack in the car, don't take me to the emergency room!" In the weeks after she recovered she made sure everyone knew of her wish not to be resuscitated.

Of course having the elderly person be of sound mind and know what the experience is like is the best of all situations. She loves life but accepts the reality of death for someone with her heart condition.