Hello, I'm a nursing student for the army and we ran into an ethical conflict today regarding DNR's. The patient we had today is on DNR and has mucous deep down her throat. The students were told that we would not suction because it would "not be comfortable" to the patient. Yes she is terminally ill and may be on palliative care since she was admitted from a hospice. Even with that, should we still ignore this problem?
In addition the patient refuses to eat. Currently she is on a lot of morphine and anything I do with her you can tell she's in pain. She'd respond with moaning and will look you in the eyes. Now even though she doesn't want to eat, does that mean we should let her starve? Does she need some kind of order to allow her to make those decisions?
The question is:
Is she DNR or is she DNR/palliative or comfort care only.
DNR does not mean "do not treat". DNR means that she is to be treated UNTIL her heart stops beating on its own, and then we withdraw care instead of calling a code.
Palliative/comfort care is different. The symptoms are treated from the standpoint that they have a terminal condition and aggressive treatment for the disease would be ineffective and cause more harm/discomfort to the patient. If the patient is terminal and is palliative care/hospice/comfort care then that should be documented in the chart somewhere by the attending. At my facility there has to be an order stating a pt is comfort care only.
You can do deep suctioning on a hospice patient, but use your nursing judgement. Mostly from your post, if the patient was in that much pain even with her morphine, I would say that pain management is the priority at the time. Then AFTER her pain was under control, discuss with her (if she is alert/oriented) if she would like suctioned. I have done this with comfort care patients that are alert and oriented, and many have told me if they needed/desired it or not.If the pt is comatose and death looks iminent in the next 24, I usually withdraw suctioning unless family requests it...I'd rather use scopalamine to "dry" up the secretions...less invasive and more comfortable.
Also, she might not be eating because she is dying...tube feeding would just prolong her pain...it's normal for terminal patients to not eat towards the end.
Last edit by elthia on Sep 13, '05