Hands Off! Do Not Resuscitate

By Angela Morrow, RN, About.com Guide

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

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Do you wish to be resuscitated if your heart stops or you stop breathing? This is a common question of the chronically ill and the elderly in the health care setting. It’s usually presented at the time of admission to the hospital, nursing facility, home health or hospice program. When I admit patients in to the hospice program I work for, I am often assured that the patient and their loved ones have decided against it and have already signed a Do Not Resuscitate (DNR) form. Sometimes, however, I’m answered with a look of shock and quick “of course!”
Television has done an excellent job of distorting true medicine, including the resuscitation of dying patients. The medical shows may depict a man who is in cardiac arrest getting CPR and waking up in the middle of chest compressions. Many of the patients shown on TV in the emergency department are revived and back to their old selves in no time. Is it really that simple, though?

Recently, I was talking with a patient of mine about whether he would like to sign a DNR. His first answer was that he would like to sign one. He didn’t want to be resuscitated, because he wouldn’t want to live with any kind of brain or heart damage. His daughter then interjected and assured him that people have heart attacks all the time, and they’re fine -- no brain or heart damage. That was enough to change his mind.

He had completed advanced directives previously that stated his wish not to be kept alive on life support. I reminded him of this, and both he and his daughter replied that the paramedics should get him breathing again and to the hospital, and then the doctors could decide what to do. This man had terminal lung cancer that had spread to his brain.

I hated to be the bearer of bad news, but I had to inform him of what he was facing. Resuscitation isn’t as clean and gentle as they portray on television. The chest must be compressed hard and deep enough to pump the blood out of the heart. This can lead to broken ribs, punctured lungs and possibly an injured heart. Paramedics move beyond the gentle mouth-to-mouth breathing and insert a breathing tube into the patient’s throat. Electrical shocks may have to be delivered to attempt to shock the heart back into a normal rhythm. An intravenous line (IV) would be started, so potent medications could be delivered through it. The patient is transported to the hospital, and if they aren’t already pronounced dead, they may be instantly hooked up to life support machines, without consulting with family.

What are the chances that all of this will work? The statistics, while not highly accurate due to variances in reporting methods, show that survival after resuscitation is 6 to 15% for patients already in a hospital, 1 to 2% for patients in nursing homes and between 4 to 38% for patients who were resuscitated in non-health care settings. The statistics are the worst for patients who have chronic illnesses, cancer or dementia. Since most people who are on palliative care or hospice care have one or more of these conditions, their survival would most closely resemble that of nursing home residents -- 1 to 2%. It’s important to note that the 1 to 2% of patients often have some kind of damage to the brain or heart.

The question now becomes, “Is it worth it to put myself or my loved one through the traumatic process of resuscitation for a 1 to 2% chance of survival?” For some patients, the answer is yes. Others, though, will see that even if resuscitation were successful, they would still have the same illness or condition they have now, like the patient I was meeting with who told his daughter, “I’d still have the cancer. Even if they got me breathing, it would just happen again at some point.”

Instituting a Do Not Resuscitate or a No Code Order
In a hospital, an order to withhold resuscitation is commonly called “no code." Only a doctor can write an order for a patient to be “no code." If you or your loved one are in the hospital and you haven’t been asked your preference for resuscitation, be sure to bring this up with the doctor. If your wish is to not be resuscitated, inform the doctor and nurses about this. Each state has its own procedure for instituting a no code order, and there may be forms you need to sign.

If you or your loved one is in a nursing home, you would need to sign a DNR form to formally let the nursing home’s staff know that you don’t want to be resuscitated. Nursing home staff are legally bound to perform resuscitation on their patients unless they have a signed DNR. Most nursing homes have forms in addition to DNRs, sometimes called "Preferred Intensity of Care" (PIC) forms. These forms allow you to make decisions about whether or not to be hospitalized or receive antibiotics, IVs and artificial nutrition.

Outside of a health care institution, paramedics, if called to the scene of an unresponsive patient, are required by law to attempt resuscitation and transport the patient to the hospital, unless they are shown a valid DNR form. Hospice and home health agencies, as well as doctors offices, have these forms available to their patients.

If it is truly your wish or the wish of your loved one to not be resuscitated, take the necessary steps to ensure that your wishes are honored. Talk to your doctor or health care provider about a “Do Not Resuscitate” order today

indahnya wanita...

Allah berfirman:

"Ketika Aku menciptakan seorang wanita, ia diharuskan untuk menjadi seorang
yang istimewa. Aku membuat bahunya cukup kuat untuk menopang dunia;
namun, harus cukup lembut untuk memberikan kenyamanan."

"Aku memberikannya kekuatan dari dalam untuk mampu melahirkan anak dan
menerima penolakan yang seringkali datang dari anak-anaknya."

"Aku memberinya kekerasan untuk membuatnya tetap tegar ketika orang-orang
lain menyerah, dan mengasuh keluarganya dengan penderitaan dan kelelahan
tanpa mengeluh."
"Aku memberinya kepekaan untuk mencintai anak-anaknya dalam setiap
keadaan, bahkan ketika anaknya bersikap sangat menyakiti hatinya."

"Aku memberinya kekuatan untuk mendukung suaminya dalam kegagalannya
dan melengkapi dengan tulang rusuk suaminya untuk melindungi hatinya."

"Aku memberinya kebijaksanaan untuk mengetahui bahawa seorang suami yang
baik takkan pernah menyakiti isterinya, tetapi kadang menguji kekuatannya
dan ketetapan hatinya untuk berada disisi suaminya tanpa ragu-ragu."

"Dan akhirnya, Aku memberinya air mata untuk dititiskan. Ini adalah khusus
miliknya untuk digunakan ketika ia diperlukan."

"Kecantikan seorang wanita bukanlah dari pakaian yang dikenakannya, susuk
yang ia tampilkan, atau bagaimana ia menyisir rambutnya. Kecantikan seorang
wanita harus dilihat dari matanya, kerana itulah pintu hatinya, tempat
dimana cinta itu ada."
--------------------------------------------------------------------------------------
wanita..
kadang2 dirimu mampu menjadi penawar..
kadang2 dirimu mampu juga menjadi racun..
seorang lelaki mampu naik kerana mu..
seorang lelaki jatuh juga keranamu..

9 sifat wanita yg laki suka..

Keibuan

Banyak lelaki yang terpikat pada wanita yg
bersikap keibuan, lembut,mengambil berat dan
penuh kasih sayang. Wajah yang keibuan mampu
membuat lelaki berasa tenteram ketika sedang
stress, cemas dan gelisah dan senang hati ketika
mahu bermanja. Jangan tunggu sampai
melahirkan baru nak tonjolkan sikap keibuan.
Setiap wanita ada potensi keibuan dalam diri
masing2.

Keanak-anakkan

Dalam batas yg wajar, sifat keanak-anakan
seorang wanita menjadi daya tarikan di mata
lelaki. Mereka berasa terhibur dengan keletah
anda. Tetapi tentulah bukan sifat keanak-anakkan
yg melampau dan menyakitkan hati tetapi sikap
keanak-anakan yang menyenangkan. Misalnya,
kemanjaan wanita yang membangkitkan naluri
kebapaan dan kelakian lelaki. Wanita ceria
membuat lelaki lebih berghairah.

Penuh Pengertian

Sikap pengertian wanita membuat lelaki berasa
dihargai dan diterima seadanya. Sikap ini
tercermin dari perasaan mudah
memaafkan,memilih waktu yang tepat utk
berbincang masalah dan sebagainya. Contohnya
ketika lelaki melakukan kesilapan, wanita yang
berpengertian tidak terus mengeluarkan kata2
yang kasar atau menuduh bukan2 sebaliknya
cuba mengerti duduk persoalannya.

Menghargai

Wanita yang menghargai lelaki adalah wanita
idaman lelaki. Berbeza dgn wanita yg suka
diperlakukan dgn lembut, lelaki suka dihargai,
dipuji dgn tulus ikhlas dan diberi kepercayaan.
Penghargaan dari wanita membuat lelaki berasa
bangga.

Menjaga Penampilan

Lelaki menyukai wanita yang pandai menjaga
penampilannya agar sentiasa kelihatan cantik,
bersih, kemas dan menarik. Penampilan yg baik
menunjukkan wanita tersebut menghargai
dirinya.Dia akan murah senyuman, pandai
merawat tubuhnya, meningkatkan kualiti hidupnya
dan memberi yang terbaik kepada dirinya.Dia
suka dan bersyukur dengan dirinya dan secara
tidak langsung memancarkan pesona yang
menyebabkan lelaki juga menyukainya.Apabila
sudah berumahtangga, wanita tersebut terus
menjaga penampilan dirinya dan kesihatan tubuh
badan walau sudah beranak-pinak.Siapa yang
tidak suka isteri yg masih kelihatan cantik dan
ramping walau dah punya anak 3?

Pandai berbicara

Lelaki tertarik dgn wanita yang pandai
berkomunikasi dan boleh diajak berbual. Walau
topik perbualan yang disukai lelaki berbeza dgn
topik kegemaran wanita,wanita tersebut dapat
mengimbanginya. Dia bukan sekadar teman
berbual yg pasif, tetapi dapat memberi respon
dan pendapat yang baik. Dia juga tahu menjadi
pendengar yang baik, serta mengalihkan topik
yang agak serius kepada perbualan yang lebih
menarik. Lelaki juga suka dengan wanita yg suka
bergurau dan pandai berjenaka serta boleh
menerima jenakalelaki dgn baik dan berfikiran
terbuka

Pandai Bergaul dan Menyesuaikan Diri

Wanita yang pandai bergaul dan menyesuaikan
diri mempunyai nilai lebih di mata lelaki. Wanita
tersebut tahu menghadapi orang yang lebih tua
dan cara berhadapan dgn orang yg lebih muda.
Apabila berhadapan dgn suasana yang baru,
wanita tersebut tidak gentar malah cepat
menyesuaikan diri. Dia mudah diajak ke mana
saja dan tidak kekok samada di bandar atau di
kampung.

Menghormati Diri Sendiri

Lelaki suka dgn wanita yg menghormati dirinya
sendiri sebagai seorang wanita, bersikap sopan
dan mempunyai etika. Wanita yang menghormati
dirinya sendiri mempunyai keyakinan dan tahu
apa yg baik dan buruk diperlakukan oleh seorang
lelaki terhadap dirinya. Jadi dia tahu apa yg dia
inginkan dan mahu elakkan serta menjaga
maruah dirinya. Dia tidak akan merendah-
rendahkan dirinya dan tidak akan membiarkan
lelaki memperlakukan dirinya sesuka hati

Simpati dan prihatin

Lelaki suka wanita yg murah hati, mengambil
berat, simpati pada nasib yang susah, sayangkan
kanak-kanak dan tidak memilih bulu. Kebaikan
yang wajar dan spontan mencerminkan hati yang
mulia. Ada kecantikan dalaman pada dirinya yang
memancar keluar dgn indah dan mempesona