CPR and DNR Orders

Nurses General Nursing

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What is your opinion on this:

A terminally ill patient is given two more weeks to live. There is a DNR order in place. On your shift, the patient goes into cardiac arrest and says "I've changed my mind, I don't want to die!" What do you do, perform CPR or let die, as was stated in her DNR?

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A patient always has the right to change their mind about DNR status. You do what they say they want at the time. So, you'd go ahead and run the code.

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Specializes in ER, ICU, Nursing Education, LTC, and HHC.

Totally agree.. you are legally obligated to do as the patient requests, unles they are deemed incompetent or have a power of attorney on file to make the health care decisions..

What did you do in this case??

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Specializes in ER, ICU, Nursing Education, LTC, and HHC.
What is your opinion on this:

A terminally ill patient is given two more weeks to live. There is a DNR order in place. On your shift, the patient goes into cardiac arrest and says "I've changed my mind, I don't want to die!" What do you do, perform CPR or let die, as was stated in her DNR?

I have an after thought here....

Ok.. wait a minute.. If he is in cardiac arrest, he is not breathing and has no pulse therefore he could not tell you he changed his mind... Now if he were having chest pain and changed his mind, then you would have to honor his request.....

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Specializes in LTC, assisted living, med-surg, psych.

I was thinking that too......I've never seen a pt. in cardiac arrest who was able to speak. :stone However, I agree that you have to do what the patient wants at a given time, DNR or no DNR.

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This is a scenario for Ethics class (BScN degree) in which I am looking for the experiential views of real world nurses. Who better to ask than the experts?

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This is a scenario for Ethics class (BScN degree) in which I am looking for the experiential views of real world nurses. Who better to ask than the experts?

First semester ADN student here, and we have brought this up in our legal/ethics class. Our instrutor has her MSN, and also has a law degree. It seems perfectly OK for the patient to rescend a DNR at any given moment. But when requesting that nothing be done, which would be a bedside DNR request, you had better be able to find the Doc and get it written on the patients chart. It has to be on the chart and done by attending Doc. Which to me is so very backwards, You should still honor the patients request. But the legal implications for this side of it can be tremendous. Family sue because you didn't do what you had to to save their loved one. One of those instances when ethical(right) not really legal, and that really sucks.

Jerry

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Specializes in Education, Acute, Med/Surg, Tele, etc.

I have been in various situations where a DNR was verbally changed during acute CHF...and this is what I have been told.

A Patient can verbally change the DRN if they wish, and you perform CPR. A legal medical representitive POA or spouse can too if the patient is non-verbal. However, a POA or Spouse doesn't have the right to say DNR if the patient doesn't have a legal written DNR...I find this is actually more tricky!

I have had spouses/POA's say "nooooooo don't do anything!", and trying to explain this to them while you are trying to save someone is not fun! But in the three cases of this I have been in, the patient was breathing and had a pulse...just unresponsive (whew!), and I had to explain I was not resusitating them. I was simply putting them into position for interventions if necessary, calling 9-11, and for them to find the order or the paramedics and I would have to consider the patient a full code! I have been thanked each time :).

It really helps sometimes to have the spouse or POA find the orders...gets them out of the room for a moment so you can assess the situation better than with them yelling or freaking out over your head! I tell my patients to tape them inside a kitchen cubboard door for easy access just in case...

The fun one for us normally is the 'no long term IV's" order...okay notice it says long term...so this gives us room to get one in short term (under 3 days) for comfort meds. This is the most misunderstood order in my state, and docs don't really tell folks the paramedics have the right to do this if they feel it would be better for the patient to receive comfort meds this way. That one will get patient families in a tizzy, and I am the one to have to explain it to them...well that and the fact that the patient isn't being resusitated (again, all mine were breathing!).

We just had a family have a huge tizzy over this, and the patient died in the hospital ER. They were furious at the paramedics for putting in a IV...but the patient had a pulse and was breathing at the time they arrived, and was still in that state when they left the ER. They wanted to take the paramedics to court...till the definition of DNR and the fact he was not dead hit them...then they dropped it. My best advise...always have a witness with you if you can ;).

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Someone posted that if patient tells you at the bedside that they want to be a DNR then you better find a physician and get it written on the chart. In IL, if a patient ( who is of sound mind) tells his/her nurse that they want to be a DNR, the nurse can chart that under nursing notes and it works as advance directives. Most hospitals have policy/procedure for a physician to write the order, but sometimes you don't have time for the physician to write the order before the patient codes, but as long as it is in the nursing notes you are covered. Also a patient can terminate a DNR at anytime. That is one of their rights.

On a side note, IL is changing Do Not Resucitate to Do Not Attempt Resucitation. Due to laws that govern nurses, physicians, and paramedics it was decided the language needed to be clarified. IL is doing this because anurse's definition of resucitation might be different than a paramedic's definition.

Schroeder

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Specializes in Home care, assisted living.

I've been put in a sticky situation with DNR at work before. One night I came to work and was told that if Mrs. So-and-So were to stop breathing that night, that she had a verbal DNR. In other words, fake CPR and then tell the paramedics that it didn't work. Since she didn't have a written DNR yet, I decided that if she stopped breathing, we WOULD perform CPR until that DNR was on paper--I wanted something to show the medics. (Turns out that the DNR order arrived on paper just hours before she died. Whew.)

Now, if someone changed their mind about the DNR order, I'd be calling my boss (the nurse) PRONTO to inform her, since she would know what to do.

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Specializes in A myriad of specialties.
What is your opinion on this:

A terminally ill patient is given two more weeks to live. There is a DNR order in place. On your shift, the patient goes into cardiac arrest and says "I've changed my mind, I don't want to die!" What do you do, perform CPR or let die, as was stated in her DNR?

You'd have to do CPR because she has the right to change her mind.

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Specializes in Med-surg; OB/Well baby; pulmonology; RTS.

If the patient is a DNR, and they are A & O x3 and recant their status, you have to run a full code. Make sure you ALWAYS document this conversation or statement in the nurses notes.

Also, if you have a patient that is a DNR and the family starts screaming for you to "Help them", you have to run the code as well then too.

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