adpie

Resuscitation Code Status

• Full Code

  • Definition: Indicates that if a patient goes pulseless, chest compressions and resuscitation efforts will be initiated.
  • Actions:
  • Start chest compressions immediately (irrespective of how long the patient has been pulseless).

• DNR (Do Not Resuscitate)

  • Definition: Indicates that if a patient goes pulseless, resuscitation efforts will not be initiated.
  • Important Clarification:
  • DNR status does not imply that the patient will be left to suffer.
  • Interventions for comfort may still be provided, such as:
    • Administering oxygen if the patient is struggling to breathe.
    • Providing IV fluids if blood pressure is low.
  • Code Status Compliance:
  • Interventions for comfort are not against the DNR status unless explicitly stated otherwise (e.g., “do not give anything”).

• Identification of Code Status

  • Hospitals may use colored bracelets to signify a patient’s code status.
  • Example:
    • Purple bracelet indicates DNR status at the speaker's previous workplace.
  • In nursing homes, some patients may have special bracelets indicating DNR, purchased by family members.

• Legal and Ethical Implications

  • Administering compressions on a patient with DNR status may result in legal consequences (lawsuit).
  • If there is no code status indicated in a patient's chart, treat the patient as a full code.

The Nursing Process: ADPIE

• Overview of ADPIE

  • Definition: A framework utilized in nursing practice that stands for Assessment, Diagnosis, Planning, Implementation, and Evaluation.

• Assessment (A)

  • Continuous process: Observing patients through visual assessment, auscultation, and vital sign monitoring.
  • Example Scenario:
  • Patient throwing chairs and exhibiting altered mental status (potential indicators of UTI).

• Diagnosis (D)

  • Clinical judgment based on assessment data.
  • Example:
  • Diagnosis could be “UTI related to altered mental status.”

• Planning (P)

  • Communication with the doctor:
  • Informing the physician about the patient's altered state and need for further testing (e.g., urinalysis).
  • Documentation of plans for further diagnostics and treatment measures.

• Implementation (I)

  • Execution of planned interventions:
  • Obtaining urine samples for urinalysis and culture.
  • Administration of antibiotics if the urinalysis reveals a UTI.
  • Regularly changing briefs for incontinent patients to prevent complications.

• Evaluation (E)

  • Monitoring patient’s response to treatment:
  • Assessing effectiveness of antibiotics after a prescribed course (7-14 days depending on physician's orders).
  • Reassessing with follow-up for ongoing symptoms potentially indicative of UTI complications.

Alert and Oriented Assessment

• Definition of A&O (Alert and Oriented)

  • A&O times four:
  • Indicates the patient is alert and oriented to:
    1. Person (who they are).
    2. Place (where they are).
    3. Time (date, month, year).
    4. Situation (reason for hospital visit).
  • A&O times three:
  • Typically observed in long-term care settings (nursing homes).
  • Indicates awareness of person, place, and time, but not situation.

• Clarification and Documentation

  • The need for specificity in documentation when reporting A&O levels.
  • Example:
  • A&O times two should indicate specifically which aspects of orientation (e.g., person and place) are recognized.

• Common Questions and Responses

  • Addressing patient A&O levels:
  • Example predictions based on context, such as confusion common among elderly patients.
  • Different patient populations may yield differing A&O assessments.

Additional Considerations

• Importance of continuous patient assessment as a nurse.
• Nurses play a crucial role in medication administration and monitoring patient condition over time, including making recommendations based on patient status.
• Emphasis on the autonomy and responsibility of nursing staff to drive patient care decisions and interventions.