DNR question - page 2

Hey, I had a patient yesterday and wanted to share a story, then get everyone's opinion. A 53 year old lady with a 40 pack/yr smoking history was admitted with end-stage pulm fibrosis and stage 4 lung ca. She was made a DNR.... Read More

  1. 0
    Quote from RNperdiem
    You did everything I would have done.
    A DNR is not the same thing as withdrawing support.
    How would you define DNR?? It means not to resuscitate, not to interrupt the dying process by providing medical intervention. If someone starts to die, you don't stop them. Withdrawal of support is also a form of a DNR...it means you stop all medical interventions you are currently using to also allow the dying process to take place.

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  2. 2
    For me DNR means not trying to bring back the dead. In a simpler time, dead was defined as no heartbeat and no breathing.
    No CPR and no defibrillation. Otherwise, we treat the DNR's just like any other ICU patient.
    DNR or no DNR, the human mortality rate remains fixed at 100%.
  3. 0
    I live in a small town 45 minutes east of Toronto Ontario Canada. The facilities (Retirement homes, Nursing Homes, Hospitals, Home) the DNR forms that are filled out by the patient or SDM (Substitue Decision Maker) clearly state what kind of DNR they would like. Either it be Comfort Measures Only, No Intubation, No CPR etc. This is a legal document. It clearly states what the patient wants done when death is certain. I do agree with what you did though. I would have done the same thing. Not only did you assess the situation correctly, you consulted with the on-call Physician. There should be no question in your mind about what you did. You showed compassion for the family, for the client. Bravo to you
  4. 1
    Quote from annienhrn
    i think what happened here is that the family did not have a clear plan in place with the doctor when she was made a dnr. this is the time when a doctor should talk about what the family's/pt's wishes are. what can they expect during her last days/weeks? what do they want done? he also needs to discuss hospice and what comfort measures would entail.
    i am sorry you were put in the situation you were in. i understand when a pt is monitored and has vitals signs like you stated you were obligated to call the doctor. my question is why was this terminally ill pt with a dnr on a monitor? i think a quiet hospice room would have been more appropriate.
    my hospital has a renowned hospice unit -- so i'm told. the difficulty is, that even when we make a patient a dnr, we keep them in our icu. with monitors. many places don't have policies that allow for a nice, quiet, appropriate hospice room.
    WalkieTalkie likes this.
  5. 0
    I agree with the OP's actions. At my hospital a DNR is simply a DNR. If a patient/family doesn't want pressors, intubation, shocks, etc, there is a difference. We use a DNAR form that has check boxes for every kind of intervention. There are some patients who want no shocks but cardiac meds, no intubation, but want to be cardioverted, etc.

    I really like using this form because it clears up a lot of confusion.

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