Does DNI mean no CPR?

Nurses General Nursing

Published

Here is the defiinition on our md order for DNI:

(Do Not Resuscitate) comfort interventions only. You will not receive cardiopulmonary resuscitation (CPR) treatment with electromechanical devices. A tube will not be placed in your nose or mouth. You will not receive air artificially by either bag or breathing machine.

Is this correct? We all were arguing that DNI ONLY means no intubation (do no intubate) and the patient WOULD recieve CPR. I thought no CPR was DNR. Are we wrong? This is very important because this is what we have to go by (im in homehealth).

Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.
There are so many choices of resuscitative measures that it gets confusing. Do not intubate, CPR only, but no vasoactive drugs, no CPR and only vasoactive drugs (shakes head), etc.

There should be two choices: DNR or full code - no variations. Is there something wrong with that?

There are, but it really is for the benefit of the patient and for you.

Imagine the patient with a bad heart (whatever the reason) who has been told by his cardiologist that if his heart stops or arrests it aint coming back. With that in mind he asks for no cpr to be performed. However, his bad heart also leads to CHF with occassional fluid overload. It sets on quickly, but a quick intubation, some lasix, and he is back to baseline within 24 hrs. If this is what he wants - who are we to say no? (So he would be no cpr, but ok for intubation)

Now take the person with chronic copd who realizes that once intubated he will remain so forever. He doesn't want to live like that. However, his heart has been "experimenting" with different rhythms lately and the docs are trying to stabilize his medication regime so his heart remains beating in sinus. One day, one of those experimental rhythms occurs at just the wrong time and he goes into V-fib. A quick shock and 2 minutes of cpr put him back into sinus. Should we deny this?

I find confusion really only comes into play when the treatment options and alternatives are not explained well. People don't like talking about death so they gloss over it and lifesaving treatments become "do you want us to pound on your chest or stick a tube down your throat?" -- Well no, not if you put it that way.

Start with what the patient really wants, and then make the treatment surround that. Hope this helps

Pat

Specializes in Cardiac.
Im just uncomfortable with it. If a patient wishes ONLY to not be intubated, but wishes to receive CPR...that isnt an option for the standing orders. I dont like the setup at all. I will discuss this with my manager tomorrow. I just dont feel comfortable with it.

My facility has a DNR form with a checklist of what they want or dont' want. Vasopressors, ACLS meds, CPR, feeding, hydration, Abx, intubation, etc.

It's all on the list, and the Drs check off what they want, or don't want. It's easy.

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

Last time I had a DNI order I discussed it directly with the patient to find out exactly what her wishes were. She expressly did not want to be intubated. She was a severe COPDer who did not want to ever be placed on a ventilator. I explained to her that the most likely cause of her heart stopping would be respiratory failure and she understood that.

In that case, she would likely not have a shockable rhythm, I suppose meds could be tried as her heart slowed and stopped, although differential diagnosis might well rule that out, since resp failure would be the cause. If bagging and bipap failed, that's as far as she wanted to go.

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