what to do with DNR

  1. Most of the pt's where I work are not their own guardians. When someone is made DNR that cannot make that decision for themselves What part of the decision is for the medical personel involved to make and what part is for the guardian to decide concerning the medical care of the pt? I always thought when we were providing comfort care that we were to do everything possible to keep pt comfortable. For example would it be right to withhold insulin from a severe IDDM pt just because they are DNR? And if you dont agree with what is being done or not being done should you should you do something about it. Please let me know what you think I am really struggling with this?
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  2. 30 Comments

  3. by   cactus wren
    DNR...Do Not Resicitate(sp?)


    not Do Not treat........


    Look at what is on chart...what does it say?? No IV`s? no meds?. No tubes?? Many are actually getting more inclusive, and are actually helpful....
  4. by   RNonsense
    whoa...is there a story that goes with this?? I don't know what state you are from...but it's my understanding DNR simply means no CPR. We have different levels here in Canada called "Degree of Interventions" outside acute care, none that I know of would include witholding insulin...
  5. by   Sally_ICURN
    DNR mean Do Not Resuscitate. If the patient codes, don't do cpr, don't shock, don't give epi, atrophine, etc., don't intubate (no BLS, ACLS).

    In no way does it mean don't give insulin. Docs need to write orders for exactly what treaments they want.
    Last edit by Sally_ICURN on Feb 22, '03
  6. by   angelbear
    Pt is still getting most meds but had what I consider a very important prn med DC'd at guardians request. I am concerned because i feel this prn was needed to provide comfort and without it I feel I am being forced to watch pt suffer unnecessarily. We can still call MD for an order for it but this wastes precious time. And we are not given specific perameters to follow concerning when to call MD. This happened to me I was told to holdoff on calling by one supervisor but when it happened and I hesitated I was reprimanded for waiting. I am so confused
  7. by   Sally_ICURN
    Originally posted by angelbear
    Pt is still getting most meds but had what I consider a very important prn med DC'd at guardians request. I am concerned because i feel this prn was needed to provide comfort and without it I feel I am being forced to watch pt suffer unnecessarily.
    If it was an opiod or a sedative, I would try to find out the motive for wanting it d/c'd. I find that a lot of times family members feel that if a certain drug is stopped then their loved one's breathing will get better or they will wake up to spend the last moments alert. Unfortunately, I have found that some believe that the opiod perscribed for comfort actually hastens death. It's so sad and so important to prepare them for exactly what to expect to see when one is dying and then help them realize that the comfort of the patient is obtained through these drugs. Unless of course, the patients directive says otherwise, which in this case doesnt seem to be the case.
  8. by   nurseBe
    As far as I am aware, DNR does not mean not to treat. On our unit we have some specifics, but I have never heard of withholing insulin.There is a specific form for ACLS meds, compressions, intubation, assisted ventilations and defribillation, The doc fills out this form. Mostly we do all other interventions unless otherwise specificed. If a pt. is already comatose of course we don't give the PO meds ordered but the doc would be aware. What always amazes me is some of the choices like yes for intubation and no for ACLS meds!
  9. by   nurseBe
    Also DNR does not mean comfort care! Comfort care is usually specified.
  10. by   angelbear
    Can I tell the med without violating cofidentiality.
  11. by   RNonsense
    of course
  12. by   angelbear
    diastat for seizures
  13. by   RNonsense
    ok...valium essentially...it was prn, right? Do you know why the family/whomever wanted it d/c'd? Was your pt. still having seizures? You have every right to act as an advocate for pt's in your care...
  14. by   Sally_ICURN
    Originally posted by RNonsense
    You have every right to act as an advocate for pt's in your care...
    Not only a right, an obligation.

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