DNR does not mean do not treat, people!

Specialties Geriatric

Published

Specializes in Med-Surg, LTC.

I just wanted to vent. I've heard several people say, over the past few days, "Well, they're a DNR so why are we doing XYZ?" Um, because if their heart stops they don't want CPR, but the last time I checked treating Afib with coumadin was not CPR? Most recently I was giving report to the oncoming supervisor, and was telling her about a LTC patient who was being worked up for ca. She asked if the patient was a DNR, which she is, and then asked why we were doing a ca workup on a DNR patient-"they don't do chemo on DNRs" Oh really? :uhoh3: This nurse was new to our facility-she's an ICU nurse who acted like LTC/SubAcute was beneath her and that she knew everything there was to know about geriatrics because "people in the hospital are old". (her words)

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Specializes in Med-Surg/Peds/O.R./Legal/cardiology.
:confused: She is VERY ill informed :banghead:
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Specializes in LTC, Hospice, Case Management.

Thank You OP...Somedays I would like huge posters up to remind others of this. I even have trouble with a particular MD on this. I also need to remind him that HE doesn't get to decide who is/isn't a DNR. So frustrating!

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Specializes in Hospice / Ambulatory Clinic.

Yes there IS a difference between DNR and Hospice/Palliative care. Even in hospice I come across nurses who are like why are we giving medicine for xyz they are on hospice. Um yes there are mostly likely going to die but doesn't mean they are going today

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Specializes in Complex pedi to LTC/SA & now a manager.

My father was hospice. With a DNR/DNI/DNH order. But that didn't stop a certain LPN from calling my mom all hours of the day & night trying to transfer my father back to the hospital or request consent to do an invasive test (like a HIDA scan). My mom got smart & changed the contact # to mine, and also advised the hospice nurse of the situation. Thank goodness we had an awesome hospice nurse & team.

When my grandfather made himself a DNR, fortunately his nurses knew exactly what it meant. He did agree to a feeding tube at one point (as he was fully coherent and the massive dehydration was painful & uncomfortable).

It's amazing, even when DNR orders were extended to pre-hospital care, certain EMT's and paramedics would complain if called to a scene & found out that the patient had a DNR to be included with the paperwork. A broken arm requires treatment people, it has nothing to do with not wanting CPR.

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Specializes in Med/Surg and ANCC RN-BC.

I feel like I've heard this too at my hospital. It just shocks me on how people are that silly when it comes to DNR. We still care for the patient and treat them for what they came in. Not just let them hang out to dry.

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I had a fairly healthy 60 something year old who was a DNR. Her request. She wasn't going anytime soon. The day shift nurse tells me she doesn't know why she's a DNR she's fine. I bite my tounge not to say anything. People have no clue!

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Amen! ....and I'm only currently a CNA (going to school to be an RRT) I have heard many confused nurses in our facility confusing DNR, Hospice, and Pallative care. Geez....didn't they go over all this stuff in nursing school???

It worries me when they are explaining these to the families also. ....off the soap-box.

Thank you for a great post OP. I was feeling the same way lately.

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Specializes in ICU, Telemetry.

I'm all for routine care, maintenance meds for someone who's a DNR -- why wouldn't you give them their coumadin if their coag panel is okay and they're not aspirating everything that goes down the PEG or NGT? If they've broke a hip, fix it if they can tolerate the surgery, sure. But when the ultimate result of care or testing is not going to help the patient (or will actually make them worse), then I think it's time to truly advocate for your patient and look at what's best for them.

I've seen too many DNRs who even the janitor knew couldn't take the physical stress of chemo get useless liver biopsies and bone marrow aspirations and yet, here we went, digging for that marrow, or taking those samples. I've seen DNRs who you'd know with a 30 second look at their labs/cardiac history/kidney function that they'd never survive chemo, yet chemo them we do, and they die horribly. I've seen elderly end stage dementia patients who were a sea of bed sores, no kidney function to speak of, no bowel sounds, but the docs put a PEG tube in them after a massive stroke, and they die drowning in Glucerna instead of slipping away into a hypoglycemic coma and dying in their sleep. That's not fair to those who trust us to do the best we can by them.

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Specializes in CCU,ICU,ER retired.

Nothing but nothing chaps my behind more than nurses not doing pallitive care on a DNR patient. I have known nurses who don't even turn or move a patient. Okay I get that the family don't want anything done, but Jeez could you lay in the same position for 2 days I can't. Words just can't express how mad I get when I have gotten a patient that has not recieved mouth care or peri care. I have written up people that do that.

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Specializes in Family Medicine.

A coworker of mine has a step mother who is dying from cancer (she is receiving home hospice at this time).

A couple of weeks ago, my coworker told me her step mom was not able to eat or drink much of anything by mouth. I followed up this statement by asking if her step mom was receiving any IV fluids or enteral or parenteral nutrition. The coworker scoffed at me and said, "she is a DNR and won't be getting any of that."

I was pretty shocked by what she said, however, since I am totally clear on the feeding and fluid recommendations for DNR hospice patients, I was unable to come up with a good response.

I understand that the metabolic needs for the dying are decreased. I also understand that TPN can be contraindicated if a patient's liver isn't functioning. Nausea and vomiting could also make it difficult to tolerate enteral feedings.

Can someone clarify what the feeding and fluid recommendations are for patients like my coworker's step mother?

I should add, I am a nursing student and my workplace is completely unrelated to health care. So, my coworker is not a a health care worker.

noyesno

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noyesno, the food and fluid recommendations for actively dying patients is this; they get what they want. If they want to eat, they eat; if they don't want to eat, they don't. People stop eating and drinking as a normal part of the dying process. It's usually the beginning of the end.

DNR and hospice are different. DNR is just do not resuscitate, that means no cpr in the event of cardiac arrest. Hospice is palliative treatment only, that means treatment for alleviating pain and suffering only.

Death is a physiological process, much like birth. I hope you get the chance to learn about it in nursing school.

And, in general, the best response to people who are dying and their loved ones is just to listen.

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