DNR orders

Nurses Education

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After having once again witnessed a doctor ask a patient (this time a 91 YO) "if your heart stopped would you want us to do anything?" and then write orders for a full code without any further explanation to the pt of what this would entail, I have to ask what others do in this situation. Do you confront the doctor? (which I did and got no where with), or do you talk to the pt and actually explain what a code is? (I didn't this time since it wasn't my patient and he wasn't critically ill-but that still wasn't the point).

what if a patient who is dnr is resuscitated and is brought back to life? what is the next step or what usually happens when this occurs? just curious. :eek:

i *think* if someone performs resuscitation on someone who they know has a dnr then they can actually be charged with assault and battery. although i must say, i don't see that actually happening very often.

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I once had a patient who was a DNR and "saved" by a good intentioned passerby. He was a very angy, frustrated man. Bitter towards everyone related to healthcare. He had made his peace and was ready to go and was brought back.

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Specializes in Assisted Living nursing, LTC/SNF nursing.

Yes, I've seen the little old man as a full code and we worked for what seemed like an hour to bring him back, fly him out to a larger facility, then a week later shipped back to us to die in Hospice care. Sad

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Specializes in tele, oncology.

I have actually used the words "It's not like you see on TV in shows like ER when we code a patient" to family members when they ask. The first time, it just popped out, not the most tactfully either to my chagrin. However, the family was receptive to that statement and wanted to know just how it was different...and went on to become angry at "those people who make those shows" for the inaccuracies usually portrayed. I have come to use that situation as a building block for discussion with subsequent families..."I know most people just have a vague idea of what a code involves based on what they've seen on TV and in the movies, and that's usually not accurate. Why don't you tell me what your impression is of what occurs and we can figure out where you've been misinformed, so you can make the decision based on the facts."

We also have to ask about advanced directives with our admit paperwork, which gives a great opportunity to broach the subject with patients/families, and to explain the different levels of care available (medical management vs. comfort care). Thankfully, our hospitalist group (which sees on average 50-75% of our patients) is pretty good about listening to the nurses about this when we have suggestions for who would be open to DNR status.

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Specializes in Hem/Onc, LTC, AL, Homecare, Mgmt, Psych.

I happen to enjoy this video about DNR-- I think in certain circumstances the message really applies.

It is rarely explained to patients well what DNR status is.

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Specializes in Oncology, Triage, Tele, Med-Surg.
I happen to enjoy this video about DNR-- I think in certain circumstances the message really applies.

It is rarely explained to patients well what DNR status is.

Wow! Thanks for sharing this. :bowingpur

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Just having a living will and a DNR is not enough,i have an 86 yr old family member with both of these,and a partner with a POA who supported him,and when he requested palliative care after an obstruction,was denied palliative care,told he had no option but surgery,he also has diabetes/CHF/COPD/Vascular dementia/Peri[heral vascular disease and has been in severe chronic pain for 20 years,when he woke up from the surgery he again requested palliative care,and even though his primary doctor and his psychologist supported him,he was overruled by the surgeon.

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Specializes in Oncology, Triage, Tele, Med-Surg.
Just having a living will and a DNR is not enough,i have an 86 yr old family member with both of these,and a partner with a POA who supported him,and when he requested palliative care after an obstruction,was denied palliative care,told he had no option but surgery,he also has diabetes/CHF/COPD/Vascular dementia/Peri[heral vascular disease and has been in severe chronic pain for 20 years,when he woke up from the surgery he again requested palliative care,and even though his primary doctor and his psychologist supported him,he was overruled by the surgeon.

Who signed the surgical consent form?

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What if a patient who is DNR is resuscitated and is brought back to life? What is the next step or what usually happens when this occurs? Just curious. :eek:

Usually we very politely and respectfully appologize to the patient, explaining that it was an error.

Then we . . . you know . . . kill them.

:D

[j/k]

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Specializes in Med surg, Critical Care, LTC.

LOL, reminds of a SLOW CODE or two I've been in.

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Specializes in ICU.
Usually we very politely and respectfully appologize to the patient, explaining that it was an error.

Then we . . . you know . . . kill them.

:D

[j/k]

:roll:roll:roll

hehe omg

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Kardex indicates DNR or AD, reported by off going shift that pt is a DNR or has AD, but there is a 50/50 chance that this is actually addressed on the chart. I have to address the issue with a patient almost every shift- and the answer is frequently: "I have been here before- they have it on file". Working agency, different hospitals, yet oddly, this is a common response.

Where is this file?

The other answer is always: "it's at home- do you need a copy?"

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