DNR orders - page 3

by Erin

23,608 Views | 53 Comments

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... Read More


  1. 6
    Quote from calledtodo
    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.
    Usually we very politely and respectfully appologize to the patient, explaining that it was an error.

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



    [j/k]
    LPNnowRN, sharpeimom, Roy Fokker, and 3 others like this.
  2. 0
    LOL, reminds of a SLOW CODE or two I've been in.
  3. 0
    Quote from TiredMD
    Usually we very politely and respectfully appologize to the patient, explaining that it was an error.

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



    [j/k]
    :roll:roll:roll
    hehe omg
  4. 0
    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?"
  5. 1
    Quote from Nurse4years
    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?"
    grrrr Don't you just hate that?? Some patients/people just don't realize that those papers are absolutely no good at home.
    mscsrjhm likes this.
  6. 0
    "At home" is at least better than "In the safe deposit box."
  7. 0
    Quote from easttexasnurse31
    grrrr Don't you just hate that?? Some patients/people just don't realize that those papers are absolutely no good at home.
    So you don't know where "the file" is either?
  8. 0
    There was a 67 year old pt on my ward with a history of CHF, multiple MIs, a CVA, a hx of brain ca, lung ca and was currently being treated for mets in his face and still no DNR!

    And the other day I had to go into a room with a doctor while he told a pt with intellectual disabilities and her family that the lesion they had removed from the pts brain was a met from a breast cancer. THe family were quite clearly devastated and had taken this to mean it was terminal - I explained to them later that the doctor hadn't mentioned the word "terminal" and there were plenty of options at this time and they needed to wait on further histology and tests before they should start discussing funerals and what not. Then in the notes I saw the doctor had written "informed pt and family of diganosies, family understood and were happy with my explanation". Well, from spending 30 minutes in an office with the mother of the pt, listening to her sob and go on about how to bridge the subject of what the pt wanted done (funeral wise) it was clear the family did not understand!

    And it was the first time I've ever had that issue given I'm a new grad! The doctor had more years under his belt of practice and I had a few months!
  9. 3
    What about a family in denial who refuses a DNR? I had a 104 year old end stage Alzheimer's pt who was sick with it for 30 years and the family wanted the works on him. He had no quality of life and they forced him to stay alive in that wasted body because they believed he'd snap out of it and get well.

    I felt his sternum and ribs disintegrate when we coded him for the last time.

    He died on Christmas day. This recent Christmas. The family showed up with presents because we called with the news after they'd already left the house. So they were screaming in the halls, devastated.

    It was charted that they'd had DNR explained to them, and they wanted us to go after this guy with all guns blazing if his heart stopped.

    Am I horrible if I say I feel no sympathy for this family, but my heart goes right out to that poor old man who was kept alive and miserable for so long? Who wants to spend the end of their lives like that?
  10. 0
    Quote from nitenite
    What about a family in denial who refuses a DNR? I had a 104 year old end stage Alzheimer's pt who was sick with it for 30 years and the family wanted the works on him. He had no quality of life and they forced him to stay alive in that wasted body because they believed he'd snap out of it and get well.

    I felt his sternum and ribs disintegrate when we coded him for the last time.

    He died on Christmas day. This recent Christmas. The family showed up with presents because we called with the news after they'd already left the house. So they were screaming in the halls, devastated.

    It was charted that they'd had DNR explained to them, and they wanted us to go after this guy with all guns blazing if his heart stopped.

    Am I horrible if I say I feel no sympathy for this family, but my heart goes right out to that poor old man who was kept alive and miserable for so long? Who wants to spend the end of their lives like that?
    It never ceases to amaze me when something like this happens. I work LTAC ICU,, where I see my more than my share of these dramatic outbursts. I've seen grown men and women throw themselves on the floor in an epileptic FIT when their 92 yr old grandparent died after being a nsg home pt for more than 10 years, contracted, drooling and out of it for YEARS... It is something that I can honestly say that the whole family has psychotic issues. Dellusions, falling just short of an active psychosis. I've studied these people for years and can't get my mind wrapped around where these false hopes come from. I certainly have made a point not to come close to giving any.

    I know that typically, a family will accept that their loved one is aging and is ready to die when they're past 75-80 yrs old. BUT, that occassional family who is like what you described here... their loved one past 90, 95 and even 100..... Those poor old grandma's and grandpa's who have lived a wonderful life, it only takes one or two compressions to break their sternum and ribs. I think that (absent a REAL psychotic diagnosis) the family would understand better if they REALLY knew what happened to the patient's body when we started giving Levophed or did compressions.. or if they really knew how it felt to be intubated. The family only sees the patient once they've been cleaned up, looking their best possible. They don't stay in there to see the look on the pt's face when they're intubated, contracted, with bed sores, as you rip off the tape from their butt and wash their stage 4 sacral decubs and insist on repositioning them Q2 hours, while you're telling them you're sorry but you must do this, so they will "get better".. yeah right, okay... The family is full of delusions and false hopes.


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