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Discussion

Did I do something illegal?

Good afternoon everybody, I have a question. I work for a home care agency & I'm currently working with a 3 month old baby girl who is on hospice. She is a DNR. She is on alternating cpap & high flow 02. I'm not sure if I violated her DNR yesterday or not. She started vomiting & aspirated. She became extremely cyanotic and her HR dropped dramatically. I switched her from cpap to high flow O2 via nasal cannula. I also used the suction machine to suction her orally. She regained her color & her O2 saturation came back up. Did I technically "resuscitate her" by giving her the oxygen? It all happened so quickly that I didn't even think about it until after the fact. This is my first hospice/DNR case so I'm not totally sure what I can do & what I can't do. I also documented that I administered the O2 & suctioned. Thank you for your help.

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    • Experts

    I would consult with your clinical supervisor and/or your Director of Patient Care Services.

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    Sounds to me as if you were just managing her symptoms to provide comfort. I've suctioned hospice patients and given oxygen.

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    • Author

    Ok good thank you!

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    Working with adult DNR pts, I've suctioned and initiated oxygen therapy.

    Like Nascar nurse, I provided comfort care while managing pt S&S.

    Just what you did.

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    The baby was choking and you relieved an airway obstruction. A comparison would be an adult DNR patient who chokes on a sandwich at lunch. In that case, would you stand by and withhold the Heimlich maneuver? I don't believe you would.

    Intervening to alleviate a witnessed choking episode prevented this baby from experiencing an untimely and excruciating death. I believe that is far different than resuscitating a patient whose natural death is imminent due to a known and non-recoverable condition.

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    NurseWC2 you did absolutely the right thing! Just as you would not let her drown in a bathtub or die in a house fire, not saving her from dying of aspiration when she is in distress is not the intention of a DNR. The intention of a DNR is to not perform life extending care when the patient is dying of their natural disease process. Yes, she may ulitmatly die from an infection due to aspiration, or die from respiratory complications, she should not choke to death on her vomit. Poor baby, but she is blessed to have you as her nurse. You have a hospice heart and an especially rare hospice heart as you care for peds hospice patients. Thank you for your care!

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    Everything you stated was in the realm of "comfort care." You're good í ½í¸‰

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