No rapid response for a DNR? - page 2

This wasn't my patient, but last week on my med/surg floor a LOL who happened to be a DNR suddenly developed an irregular very fast heartrate and became less responsive. It was early in the shift,... Read More

  1. Visit  SaoirseRN profile page
    2
    It is more than reasonable to treat a DNR patient with an acute crisis if it can be medically managed, particularly if the patient's baseline involves a decent quality of life and there is a reasonable chance they could return to that with some medical intervention that does not involve CPR, intubation, etc. I think the doc was unreasonable.

    I don't have a rapid response team where I work, so for above issue I would be calling a GP (unless internal medicine was already involved) and I'm sure they would want to at least attempt to treat the patient.
    sapphire18 and uRNmyway like this.
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  3. Visit  DeLanaHarvickWannabe profile page
    12
    We could take his argument even further...why even admit that patient to the hospital at all? Some people are DNRs even though they are fairly healthy - they just don't want to be coded should the unthinkable happen!

    Goodness. Some people's children.
    on eagles wings, LTCNS, Vespertinas, and 9 others like this.
  4. Visit  Dbohr1012 profile page
    0
    wow thats crazy, you still treat patients even though they are a DNR
  5. Visit  dudette10 profile page
    4
    In my workplace, a DNR means no CPR. Intubation, electrical cardioversion, antiarrhythmics, and vasopressors are considered pre-arrest emergency measures. Unless the patient/family has said no to all pre-arrest emergency measures, calling the rapid response was the right thing to do. Even if the patient had said no to such measures, I would have at least called the doc to inform him/her of the new findings.
  6. Visit  VivaLasViejas profile page
    7
    Quote from DeLanaHarvickWannabe
    We could take his argument even further...why even admit that patient to the hospital at all? Some people are DNRs even though they are fairly healthy - they just don't want to be coded should the unthinkable happen!
    Exactly! I had this same argument with my PCP when I asked him to sign my POLST form a few years ago when I turned 50. He didn't want to because I was "too young to be a DNR". Well, I'm here to tell you that when I no longer have a pulse or respirations, I don't want to be brought back. The form provides for different levels of treatment up to the moment of death, and sure, I want somebody to at least try to save me if I'm ill or injured; it's when my life is clearly over that I want to be left in peace.

    Besides, as I told him, we've both been in code situations and I don't want CPR done on me. He wound up signing my DNR order.
    LTCNS, TheCommuter, Vespertinas, and 4 others like this.
  7. Visit  anotherone profile page
    6
    Doctor sounds like a clown. Part of this is probably the patient's age too, just a guess. I have seen many pts who are DNRs and still somewhat healthy. Meaning not expected to die ANY MINUTE NOW. If a walkie talkie DNR ( have seen them) , pt had been fine all day and now temp 103.5, hr , abdomen firm, bp 80/50, hr 110 ..... should staff just ignore it ? Some doctors treat everything AGGRESIVELY. others see dnr, ( especially in elderly pts) and are lax about treating anything.
    LTCNS, uRNmyway, nrsang97, and 3 others like this.
  8. Visit  Sugarcoma profile page
    5
    The doc was wrong. We just had a similar incident with a doc on our unit and per risk management at my hospital DNR simply refers to what measures to take should the patient arrest. A-fib with RVR is not an arrest and should be treated, DNR or not. The nurse did a good job advocating for her patient.
    dudette10, LTCNS, Ir15hd4nc3r_RN, and 2 others like this.
  9. Visit  Sugarcoma profile page
    1
    Quote from DeLanaHarvickWannabe
    We could take his argument even further...why even admit that patient to the hospital at all? Some people are DNRs even though they are fairly healthy - they just don't want to be coded should the unthinkable happen!

    Goodness. Some people's children.
    Love this response!
    DeLanaHarvickWannabe likes this.
  10. Visit  hodgieRN profile page
    0
    I would have called the family and not called a rapid response. To me, medically treating a DNR means routine stable care (antibiotics, xrays, medications, feedings, etc). If things start becoming unstable, then the end is probably near. The pt and the family came to the conclusion that current treatment is to keep things status quo and any major treatment is basically futile. There's a reason the pt was a DNR. Comfort measures only is actively withholding all treatments and actively moving the process along with comfort. If a DNR had a high blood sugar, I would give insulin. If a DNR had a UTI, I would give antibiotics. If a DNR become unresponsive, I would give dignity and respect for their end of life. If a pt is in the hospital with a telemetry box on, no pt is going to die peacefully in their sleep. And no know dies instantly. So, that means there is going to be an intervention at the first sign of end of life. I don't why a DNR was on telemetry in the first place. Putting a DNR on titrated drips is resuscitation. If the heart rate isn't fixed with digoxin, or the blood pressure isn't fixed with some fluids, then it's time.
  11. Visit  nuberianne_RN profile page
    9
    Quote from hodgieRN
    I would have called the family and not called a rapid response. To me, medically treating a DNR means routine stable care (antibiotics, xrays, medications, feedings, etc). If things start becoming unstable, then the end is probably near. The pt and the family came to the conclusion that current treatment is to keep things status quo and any major treatment is basically futile. There's a reason the pt was a DNR. Comfort measures only is actively withholding all treatments and actively moving the process along with comfort. If a DNR had a high blood sugar, I would give insulin. If a DNR had a UTI, I would give antibiotics. If a DNR become unresponsive, I would give dignity and respect for their end of life. If a pt is in the hospital with a telemetry box on, no pt is going to die peacefully in their sleep. And no know dies instantly. So, that means there is going to be an intervention at the first sign of end of life. I don't why a DNR was on telemetry in the first place. Putting a DNR on titrated drips is resuscitation. If the heart rate isn't fixed with digoxin, or the blood pressure isn't fixed with some fluids, then it's time.
    I'm actually horrified at your post. Perhaps I missed something. The pt referred to in this thread was not on comfort measures. The pt was a DNR which is not the same at all. Previous posters have done a great job at defining what DNR status means so I won't rehash it.

    Pt's go into a-fib w/rvr for a variety of reasons. It doesn't necessarily mean the end is near and the pt should be left to die. What you have described is practicing medicine by picking and choosing what you would and would not treat. The Board of Nursing in any state would find your method of nursing practice noteworthy to say the least. And to say "Putting a DNR on titrated drips is resuscitation." is grossly ignorant.

    I'm going to use some restraint and end my post here. I am going to respectfully suggest that you please read some of the previous posts. I think you have the terms DNR and comfort measures or hospice confused for each other.
    LTCNS, Luckyyou, monkeybug, and 6 others like this.
  12. Visit  Ntheboat2 profile page
    4
    I think the nurse did the right thing. It's not like she called a Code Blue. She probably wasn't sure what exactly to do in the situation and needed some support. Isn't that what a Rapid Response is for? You're damned if you do and damned if you don't. Had she done nothing then she would've been criticized for that as well.
    LTCNS, Ir15hd4nc3r_RN, sapphire18, and 1 other like this.
  13. Visit  DeLanaHarvickWannabe profile page
    8
    Quote from hodgieRN
    I don't why a DNR was on telemetry in the first place. Putting a DNR on titrated drips is resuscitation.
    DNR means that in the event of cardiac or respiratory arrest, no attempts will be made to resuscitate. That also means we are going to do everything in our power to prevent that cardiac or respiratory arrest.

    Titrated drips are not CPR. DNR means no CPR.
    LTCNS, dudette10, Ir15hd4nc3r_RN, and 5 others like this.
  14. Visit  SoldierNurse22 profile page
    1
    Quote from hodgieRN
    If a pt is in the hospital with a telemetry box on, no pt is going to die peacefully in their sleep. And no know dies instantly. So, that means there is going to be an intervention at the first sign of end of life.
    Not sure where you heard this. I've seen many a patient just stop breathing, go completely pulseless and just drop off. And yes, with proper medication for pain and attention to comfort, many patients DO die comfortably in their sleep.
    Esme12 likes this.


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