Published Dec 31, 2007
Ms.RN
917 Posts
here is another code scenerio: if patient is no cpr but wants to be sent to the hospital, iv's and if patient is about to code, woluld you still call 911?
fultzymom
645 Posts
If they want sent then you have to send them. Then it is up to the EMS what goes on after that. Them and the hospital.
TheCommuter, BSN, RN
102 Articles; 27,612 Posts
DNR means "Do Not Rescuscitate." It does not equate to "Do not treat."
I have sent very sick DNR patients out to the hospital per their request, because they still must receive healthcare regardless of their code status. We still must treat patients with DNR status, but we are not to revive them if they die.
Nascar nurse, ASN, RN
2,218 Posts
DNR means "Do Not Rescuscitate." It does not equate to "Do not treat."I have sent very sick DNR patients out to the hospital per their request, because they still must receive healthcare regardless of their code status. We still must treat patients with DNR status, but we are not to revive them if they die.
100% agreed. I am always amazed at the misperception with this. DNR only means not to revive.. it does not mean let em die. We even have a couple of Drs. that need reminded of this.
If someone wants to be transfered to the hospital, that is where they are going.
CapeCodMermaid, RN
6,092 Posts
DNR should be changed to DNAR---do not ATTEMPT resuscitation....otherwise it's misleading. We don't often actually resuscitate them....
Daytonite, BSN, RN
1 Article; 14,604 Posts
If the patient is alert and telling me this, I had better follow up and not just ignore what the patient is telling me. If there is a guardian or POA I'd be on the phone with them and definitely with the patient's doctor telling them what the patient's condition is and what the patient is saying. I'd probably press the doctor for an order to send the patient to the hospital. I wouldn't call 911 unless there was an actual emergency and the patient actually codes. A patient has the right to rescind their "No Code" orders at any time. The minute they do that and they are about to code, you must notify the doctor.
This is a bit off topic, but if you think you should send someone out 911, send them and then get the order. If you wait for the doc to call back it might be too late.
I've argued with docs about this issue. I had a patient who was a DNR and was in significant respiratory distress. I called the doc and told him I was going to send her out rescue. He said.."don't bother-she's old, she's demented, she smokes, she's a DNR and the hospital ER is jammed and they are diverting to another town."
I replied-she might be a DNR but she's not dead yet, she's not so demented because she can remember all her kids' names, her grand kids' names and MY kids' names, and how would it look on the front of the newspaper DOC REFUSES TREATMENT BECAUSE PATIENT SMOKES"
Needless to say, I sent her. She was fine after a few weeks and lived another 5 years in relative good health.
But see, my goal is to get them out BEFORE they code (and I don't mean to imply that I would 911 w/ lights/sirens just anyone/anything either). But if I get that feeling that they are going bad and they want to go.. then they are as good as gone (preferably to ER and not to heaven). I will call Dr/family as soon as I can get to it, before if possible, after if not.
Simplepleasures
1,355 Posts
The above reminds me of a situation we had recently. I work in LTC doing MDS. I had the LPN come request that I look at at patient. I went out and before I even got in the patients room, I could hear her breating. RN supervisor was doing nothing!! I had the LPN get a chest x-ray. She had bilateral infiltrates. RN did nothing because patient was a DNR. She could not figure out why we were doing something. UH.........you don't let someone die from pneumonia when they have nothing else wrong with them!!!! DUH!! She never did get it. Only said, "She is a DNR!" By the way, this woman did end up in the hospital and died from it.
UM Review RN, ASN, RN
1 Article; 5,163 Posts
Geez, some of these stories are scaring me!
We always treat our DNRs, even if they're looking really bad -- in acute respiratory distress, we'll give Lasix, maybe put them on a bipap for the night. If they come out of it, they come out of it, but until that last heartbeat, we do everything we can unless they tell us to stop.
Sent a terminal CA DNR Hospice patient to the ICU the other night because of an arrhythmia and crashing BP. A couple of days later, the patient was sent home. You might argue that these were extreme measures, but the patient was a/o X 3 and the doc discussed her options with her and got her OK before we did any ICU interventions.
I have no desire to see anyone go that doesn't absolutely have to, and especially if it is not a "good" death, like the choking scenario described by another poster.
So to answer the OP's question, yes, I would send the patient out.
lil' girl, LPN
512 Posts
We have "comfort care only" orders. The RP (responsible party) and the doctor signs it. It states EXACTLY what we can or cannot do. Like... no IV's, no hospital, etc. And yes these patients have a DNR also.