[BULLYDAWGRN]

i belive rn1980 is refferring to when a pt is sent to the icu from the er or floor and the pt is basically like the one he was talking about in his post an 80 something stoked out unresponsive type pt, not one that was tubed and then made dnr...and obviously if they'er on pressers keep'em in the unit. i basically feel if they are not on a vent, send them to the step down unit, or lower level of care. the fact is alot of nurses come to the units to get away from taking care of that type of patient, if you like dnrs type goto the floor, or nursing home. and the way medicare is starting to refuse payments it wont be long till they start looking more closely at dnr types in critical care.

[cardiacRN2006]

I like a good septic shock as much as the next guy. But again, DNR doens't mean, let die over preventable stuff.

I've had tons of patients who are DNR who were DNR prior to coming to the floor. But they needed ICU care.

I understand what RN1980 is saying--we don't like DNR pts who are ABLE to be on a step-down unit. Especially if it's just to keep the Dr from being paged all night.

But, if the pt needs ICU care, then they need and deserve ICU care.

[suanna]

Just a little story:
My mother was a DNR for her last 4 or 5 admissions to the hospital. End stage COPD, S/P CVA, Hip Fx, largely bed-fast--up to chair with asst of 2. None the less when she was admitted we wanted everything done short of intubation/cpr because
that is what mom wanted. She was at times a bit confused but generaly oriented and cooperative with care. The point is, with all her medical problems she often required more care than could be provided on a gen med floor. Q2 resp Tx., IV lasix, electrolyte replacement, glucose monitoring, ectopy management (SVT, PACs, blocks.) As a result of aggressive management she got to see her last son married and one more grandchild born. We were thankful for every day we had with her but if her "time came" we were OK letting her go. She didn't want to live on the vent with trach/peg. Statisticaly speeking survival to discharge is very poor even with well managed codes. You may get a pulse back for a while but if the body is willing to "code" odds are the patient isn't going to get out of the hospital alive.
Code status is no indicator of the need for ICU management. Sometimes all we are doing is keeping the person alive with a lot of care to give the family time to accept the inevitable. This is a worthwhile goal.