DNR situation

[hbncns35]

I am a PCT set to graduate BSN in May so generally I do not know everything nor do I claim to know everything, instead I ask questions in order to learn the things I do not know.

Won't completely describe entire situation but a woman with a DNR was choking on a pill the nurse gave her and was being assisted to expel it.

Later on I asked the nurse how the DNR fell into that and she said "I wasn't just going to let her choke!" She really did not give me any further info about it so I tried to get more clarification from her which I really didn't. About five hours later, my manager approached me and said she heard I had some confusion about the situation. I said that Nurse A really did not offer any reasons or rationales behind her statement so I did not fully understand. My manager then explained in detail that just because you have a DNR doesn't mean we are supposed to let them suffer and choking would be a means of suffering. It is only when you approach the pt and they are not breathing or heartbeat do you DNR. She said there were alot of gray areas with this and that this was one of them. Just like if you are in anethesia you are a code I instead of DNR automatically. So it was a good talk but I am still wondering if Nurse A felt she did not explain it well or did not know how to explain it and that is why she got the manager involved. I am thinking that if you are a nurse you should be able to explain that to someone who isn't sure instead of getting higher management involved. Not sure what the motive was there but now I do have a better understanding of the process regardless of where the info came from.

Any thoughts?

[traumaRUs, MSN, APRN]

The nurse knew why she did what she did but perhaps didn't have time to explain it? Maybe? Anyway, the nurse did the proper thing. A DNR order doesn't mean we don't treat, just that we don't resuscitate. There are many levels of DNR also. You should research your state's public health dept or board of nursing site to gather more info. Good luck. This is a very good question.

[hbncns35]

Hi Trauma,

Did some research on the web and due to the lack of time I found limited info in my state or too much info that I need to look through at a later time. A question that arose while I was searching was this: If you are doing the Heimlich maneuver and it is unsuccessful and the patient passes out not breathing and pulse is waning, Then what? With a DNR you are just allowed comfort care in form of Heimlich because my thinking is that at that point you wouldn't continue if measures were unsuccessful. Because isn't part of DNR not wanting chest compressions? From what I read you help up to that point but you do not go to the next level. Is that your experience?

HB

[leslie :-D]

Hi Trauma,

Did some research on the web and due to the lack of time I found limited info in my state or too much info that I need to look through at a later time. A question that arose while I was searching was this: If you are doing the Heimlich maneuver and it is unsuccessful and the patient passes out not breathing and pulse is waning, Then what? With a DNR you are just allowed comfort care in form of Heimlich because my thinking is that at that point you wouldn't continue if measures were unsuccessful. Because isn't part of DNR not wanting chest compressions? From what I read you help up to that point but you do not go to the next level. Is that your experience?

HB

you would call 911 where an emergency tracheotomy would be performed (if they're certified to do so). chest compressions would not help in this case- the obstacle needs to be removed from the airway.

a dnr typically does not pertain to 'accidents'. and as in accidents, you always treat til everything possible has been done.

leslie

[SharonH, RN]

She did the right thing. It's good to ask questions. Good luck.

[angelladyclaire]

The patient in question was choking. The question of resuscitation does not enter into the situation. To let them choke would be negligent. You would not be resuscitating when doing the Heimlich. Upon removal of the obstruction, the patient should resume functioning as they were before with respirations and a heartbeat. As a previous poster said, DNR does not mean do not treat. I have run into a situation before where one of my NA's did not realize the difference between comfort care status and DNR status. DNR status does not mean that we are being passive and letting the patient die... it just means that if they crash we won't intervene (assuming it's a standard DNR order... some pt's have really long lists of procedures they do and don't want withheld). Lots of patients with DNR orders still undergo surgery and other invasive life saving treatments.

I realize this doesn't account for the freak accident situation you described above where Heimlich is unsuccessful... That is a good question indeed.

[pn2rn08]

Thank you so much for your posts about this! This recently just happened to me luckily I responded by performing all treatments possible. Suction, 02, heimlick, hob elevated & I was able to stabalize the guy. I did ask a nurse I work w/regarding the DNR status & situation but she wasn't sure either. The next day I was recapping the situation as much of us do & thought about the DNR again like what is considered appropriate so I came to this site :)