[luvmy2angels]

Originally Posted by azhiker96

Certainly you would treat the sepsis. However, if her heart were to fail and you decided to perform CPR you could be charged with assault in Arizona. If she refused antibiotics then you wouldn't be able to treat the sepsis. Some people refuse blood transfusions but that doesn't mean you must withhold high iron foods. It's just about respecting the patient's right to make their own healthcare decisions.

I guess it depends on which you state you live in, someone in the orientation class brought up that exact same question and we were told that you should perform CPR since she was originally admitted with the intent to get better and be discharged. It is a rather sticky situation.

[Tweety]

Originally Posted by luvmy2angels

We were told a DNR doesn't even or shouldn't even come into play unless the pt is diagnosed with a terminal illness. We were given this example: A 34 year old woman has DNR noted in her chart. She is treated for breast cancer ( cancer was deemed curable so pt decided to undergo treatment) after the chemo she develops sepsis. Should she be treated?? Yes, because her cancer wasn't terminal and she opted for the treatment with the hopes for a cure. She wasn't diagnosed with a terminal illness and although sepsis can be fatal in this case it should be treated. That was how it was explained to us at the hospital.

Non-terminal patients can have a DNR order. You can bet when I reach a certain age, even if I go into the hospital for a toenail clipping, I'm going to be a DNR, even though my intention was to be admitted, recover and come back home.

Here, a DNR comes into to play when the patient quits breathing and their heart stops.

It doesn't make sense to me that you resuscitate a patient with a Do Not Resuscitate order.
In the above scenerio, the patient would be treated for sepsis, however should the treatment fail and her heart stop, IF SHE HAS A DNR ORDER, we do not resuscitate.

[nursesarah]

Originally Posted by Tweety

Non-terminal patients can have a DNR order. You can bet when I reach a certain age, even if I go into the hospital for a toenail clipping, I'm going to be a DNR, even though my intention was to be admitted, recover and come back home.

Here, a DNR comes into to play when the patient quits breathing and their heart stops.

It doesn't make sense to me that you resuscitate a patient with a Do Not Resuscitate order.
In the above scenerio, the patient would be treated for sepsis, however should the treatment fail and her heart stop, IF SHE HAS A DNR ORDER, we do not resuscitate.

i agree. treat the patient for any and all conditions....but a DNR is means Do Not Resuscitate. so if they crash...don't resuscitate.

[earle58]

i'm not even convinced that all md's know what constitutes a dnr.
i specifically recall one of my hospice pts, who developed pneumonia (presumed pneumonia in absence of cxr).
she had a temp of 103 w/wet, junky breath sounds.
all i wanted for her, was an order for an abt.
the md kept on insisting that she was dying and cmo.
my contention was she'd be a heck of alot more comfortable if the pneumonia was treated.
after one hell of a fight, i got my order for levaquin and within 48 hrs, my pt was afebrile w/improved o2 sats and clearer bases.
sheesh.

leslie

[LoraLou]

The laws of DNR vary from state to state. In my state theres full code, DNR-CCA (comfort care arrest) and DNR-CC (comfort care). A CCA is everything up until the heart stops, you can push ACLS drugs, intubate, etc etc. A DNR-CC is basically comfort measures only, usually depending on the patients choice we will use oxygen (can even include bi pap if patient wishes), pain/anxiety medications, and regular medications if they chose.
Also if a patient has undergone surgery as long as they are under the effects of anesthesia they are considered a full code, which every doctor has a different belief how long this should last. I took care of a patient before who was a DNR-CC who underwent a double mastectomy due to the uncomfortable nature of large tumors in her breasts, it was not to cure her cancer, but for a couple of days after the surgery she was a full code.

[LouleeRN]

In my region, we have four levels of advance care planning (resuscitation status). Level 4 is all treatment, including full CPR. Levels 1-3 have no CPR, but vary in the amount of treatment provided. eg. Level 1 provides only comfort care--no ICU, tube feeds transfusions, IV's, no CPR--only measures focused on aggressive relief of pain and discomfort. Level 2 allows for treatment of reversible conditions,eg. pneumonia or blood clot, but no CPR. Level 3 allows treatment of all conditions, both reversible and nonreversible with no restrictions, except for no CPR. Pts. can be admitted to ICU, telemetry etc. on this level, even though if their heart stops, no code would be called. We've found that these levels of care help clarify how aggressive the pt &/or family wish to be.

[icare4icu]

There is a chemical code only no cpr no intubation. We need to specify the DNR status and have to addressed with every admission.