Choking in LTC

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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.

Thank you everyone for answering my question, although I felt a little silly asking it, since I have already asked some people at work and have them look at me like I was an idiot for asking such a question :S . I thought it would be appropriate to heimlich them however I have never been able to speak with a nurse who has actually had it happen and get to the point of the heimlich since typically all of them stated the obstruction was cleared with encouragement. I have had co-workers who have had to suction after a meal when their resident was laid down flat and aspirated on some leftovers :(

But again thank you and I am glad there are some professionals here who do not mind humouring a newbie's questions.

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Hey, ask away.

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IMHO DNR means do not do CPR on someone who has no pulse or respiration, usually from natural causes. If anyone is choking even if they are a DNR, they get suctioned to keep them comfortable if they cannot handle their secretions. If a person is choking, the first thing I do is try to figure out on what. I would look in their mouth to see if I can remove the object. If not then I would try the heimlech manuver that I was taught in CPR. Of course 911 needs to be called. I would only use a suction machine if a person was choking on liquid. Elevating the HOB and turning the person on their left side also helps.

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Specializes in LTC, home health, critical care, pulmonary nursing.
True and that's why hospice is called. Femur fx has nothing to do with the terminal dx, but hospice should ALWAYS be called.

We don't actually utilize outside hospice agencies, all our hospice care is provided by us, so that's one less involved party to have to call.

And Suesquatch, you're my BFF. Reduce my fx too. What a way to go...ugh.

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Specializes in LTC.
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.

I agree 100 % with this post. I have sent a couple of my hospice residents to the hospital as well. I have also done the helmich manuever ( excuse spelling) on a DNR resident.

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It still amazes me how many seasoned MD's & nurses argue over what DNR means. I've taken care of numerous residents in LTC with a DNR status...they still continue to get treated for UTI's, CHF, etc. DNR means just that, Do Not Resuscitate, it is not "Do Not Treat". I've cared for Hospice patients who were treated with antibiotics for infections & have given Lasix for CHF as this is considered comfort also. How many of us would like be uncomfortable due to our lungs filling up with fluid or suffering the burning pain of a UTI in our last days? And I have sent Hospice residents to the ER for falls/increased pain but I would always notify Hospice first. Thanks!

jerenemarie

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Specializes in Gerontology, Med surg, Home Health.

Heimlich away but if the food is stuck, no amount of suctioning will get it out. And to the poster who thought suctioning was a 'comfort measure' apparently she has never had anyone stick a yankauer catheter down HER throat. It is NOT comfortable in the least and suctioning usually produces more sputum.

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Foreign Body Airway Obstruction: Start Heimlich Maneuver until airway is opened or the person becomes unresponsive. then start CPR. These are the new guidelines. I renewed my BLS certification yesterday. I did not asked to the instructor if the patient is DNR What should I do if the client becomes unresponsive or if the person is DNR and chock in a public place and becomes unconscious. I have been looking online but I have not found an answer. I did not have this questions yesterday until I found this thread today. Thanks.

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