Against Patient Wishes

Topic: NSG 430: Critical Care Nursing

Against Patient Wishes

At the beginning of this scene, a code blue was initiated. The code blue is seen on the monitor at the nurse’s station. When the doctor answers the code blue, he walks into the room and checks the patient’s carotid pulse. The nurse that activated the code blue was not performing BLS or ACLS. This is not realistic. One of the critical things the nurse could do is began chest compressions, but the patient has DNR sign above the bed. The show is titled “Against Patient Wishes.” The patient is terminally ill and has a do-not-resuscitate order in place. Despite the patient’s wishes, Will asks for a crash cart and begins CPR.

There were many things in this scenario that were unethical, but real. One of the other doctors is pleading with Will to not continue CPR and to not use the defibrillator. What was clearly not realistic was the chest compressions. They were too fast. What was realistic was the order of 4 mg of epinephrine. Will continues CPR while a nurse prepares to administer epinephrine according to the code blue algorithm. Epinephrine is the go-to drug for a patient in VF or VT. A code blue team or rapid response team was not called. One doctor is going against the patient’s wishes, one doctor is pleading with him to stop and let him know it is illegal. The nurses are doing what they were asked to do by the doctor.

I do not know how to read the monitor, and we are learning how to read EKG strips, but what I saw on the monitor in the background did appear to be accurate. Chest compression roles are switched, and the doctor asks for a laryngoscope to intubate. The monitor showed the patient in VF. After intubating, the doctor recognizes that the patient is still in VF and decides to use the defibrillator. I’m not sure how realistic it is for two doctors to debate whether to honor the patient’s wishes in the middle of a code or to do what they think is best for the patient.

My mother had A DNR, but lifesaving treatments were initiated. I was not there to witness how or why the decision was made to keep her alive. The second time she showed no signs of life, the hospital honored her DNR wish. Not realistic in this scene is just after the shock, it appeared like the monitor showed the patient in asystole. CPR continues, the monitor quickly shows a pulse but just before the second shock, the monitor shows asystole. Will defibrillates the patient. Also, not realist is Will shocking the patient over her gown. There needs to be more accurate in what the monitors show in the background. Many healthcare personal watch these shows and observer everything.

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