Choking in LTC

Specialties Geriatric

Published

This may seem like a stupid question. I know exactly what to do for someone who is not DNR when they are choking, but has anyone ever had a resident choke who was DNR and was not able to get them to clear it immediately? How did you respond? Did you use suctioning and was this effective? Ever since I worked in LTC this has been one of my biggest fears because so many of them can choke so easily.

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Specializes in medsurg, everything in LTC.

No question is stupid, never esitate to ask.........Choking and DNR have nothing to do with each other. Choking is usually resolved fairly easily, causes are different...... DNR is for cardiac arrest, respiratory arrestand so forth....... interventions are different....CAN NOT stand by and do nothing with choking, you must intervene, that is way a suctoning machine must be in dining room areas.

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Suzann, you do EVERYTHING for a DNR patient that you would do for one who is full code. DNR just refers to CPR. It does NOT mean "leave to die."

Heimlich. Suction can cause dysrhythmias. Usually residents clear their airways spontaneously.

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Specializes in LTC, home health, critical care, pulmonary nursing.
Suzann, you do EVERYTHING for a DNR patient that you would do for one who is full code. DNR just refers to CPR. It does NOT mean "leave to die."

Heimlich. Suction can cause dysrhythmias. Usually residents clear their airways spontaneously.

Yes!

DNR just means no chest compressions and no manual ventilation. Everything else is done for these patients. DNR status is very misunderstood.

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Specializes in Hospice / Psych / RNAC.

Resolving choking is considered a comfort measure and should absolutely be done. DNR's are very specific as to what measures should not be instituted meaning when they stop breathing you let them go and not institute life saving measures. Other then that codes will be specific.

Remember that actress that married that very rich billionaire and was taken to court by the son when the old man died... Well when in court she screamed to the son that "Rusty you are the one who killed him when you made them not be able to suction" I was astounded that a doctor would approve a code that excluded suctioning as it is a comfort measure and to let some one drown like that is barbaric.

Suctioning and oxygen are considered comfort measures and unless the codes specifies not to institute such measures; do.

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Specializes in LTC, Hospice, Case Management.

It amazes me how many get DNR and "do not treat" mixed up . I do NOT mean the OP or any other new nurse with limited experience.

I have argued with many an experienced nurse and even doctors that have been practicing for years. Had an administer yelling at me a few years ago for calling 911 or a resident in severe distress. He tried to tell me that you were never to call 911 on a DNR patient. I informed him that I will never call 911 ONCE THEY ARE DEAD, but until then I have an obligation to help them. (P.S. Family was present, resident still alert and all wanted him transfered out ASAP).

Good question OP...now you will not be one of the misinformed :)

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Specializes in LTC, home health, critical care, pulmonary nursing.

Even a comfort care only patient I would attempt to dislodge whatever was in the airway. What a dreadful way to die.

And "never call 911 on a DNR?" How many times did THAT administrator get sued?

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Specializes in LTC, Psych, Hospice.
This may seem like a stupid question. I know exactly what to do for someone who is not DNR when they are choking, but has anyone ever had a resident choke who was DNR and was not able to get them to clear it immediately? How did you respond? Did you use suctioning and was this effective? Ever since I worked in LTC this has been one of my biggest fears because so many of them can choke so easily.

Good question! Many people think that just because a pt is DNR we shouldn't do anything for them. A couple of weeks ago I had a nurse in an LTC call to let me know one of my hospice pts had a fall. I asked if the pt was hurt and she stated, "well she seems to be in a lot of pain". I got an order for a mobile xray, which showed a fx of the femur, and the doc ordered her to be sent to the ER. By this time, I was at the facility to assess pt and waiting on orders. This nurse (with 20+ yrs experience) argued with me about sending the pt out because "she's a DNR". I tried to explain DNR status to her and ended up calling for transport myself. I spoke to the DON @ the facility the next morning and SHE wasn't even aware of what DNR meant. She told me that it was her understanding that no hospice pt was ever sent to the hospital.

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Specializes in LTC, home health, critical care, pulmonary nursing.
Good question! Many people think that just because a pt is DNR we shouldn't do anything for them. A couple of weeks ago I had a nurse in an LTC call to let me know one of my hospice pts had a fall. I asked if the pt was hurt and she stated, "well she seems to be in a lot of pain". I got an order for a mobile xray, which showed a fx of the femur, and the doc ordered her to be sent to the ER. By this time, I was at the facility to assess pt and waiting on orders. This nurse (with 20+ yrs experience) argued with me about sending the pt out because "she's a DNR". I tried to explain DNR status to her and ended up calling for transport myself. I spoke to the DON @ the facility the next morning and SHE wasn't even aware of what DNR meant. She told me that it was her understanding that no hospice pt was ever sent to the hospital.

In our facility, we typically do not send out hospice patients since the goal is comfort, however it is very UNCOMFORTABLE to hang out with a femur fx, and for COMFORT the patient should have intervention.

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Specializes in LTC, Hospice, Case Management.
In our facility, we typically do not send out hospice patients since the goal is comfort, however it is very UNCOMFORTABLE to hang out with a femur fx, and for COMFORT the patient should have intervention.

We wouldn't typically send out a hospice patient either. But, in the case of a fall with a fracture, this would generally be considered to not be part of the reason for hospice services therefore we might send them. It's an iffy game when hospice is involved. I would call hospice and family and figure out what they wanted me to do. Then call MD and run it past him/her. Not my decision to make at that point.

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Durn, I don't care if I am dying, please reduce my fracture while I do!

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Specializes in LTC, Psych, Hospice.
We wouldn't typically send out a hospice patient either. But, in the case of a fall with a fracture, this would generally be considered to not be part of the reason for hospice services therefore we might send them. It's an iffy game when hospice is involved. I would call hospice and family and figure out what they wanted me to do. Then call MD and run it past him/her. Not my decision to make at that point.

True and that's why hospice is called. Femur fx has nothing to do with the terminal dx, but hospice should ALWAYS be called.

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