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DNR? details please

Nurses   (343 Views 7 Comments)
by SDANG SDANG (New Member) New Member

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What is a DNR? Is it simply NO chest compressions? I always thought that it ALSO meant NO ACLS medications to resuscitate, and NO intubation. If the patient would allow or want either meds to resuscitate or intubation, then it would be considered a "PARTIAL CODE." Is this INCORRECT?

Can these details about a definition of DNR vary from facility to facility?? Can it vary state to state? Or country to country?

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Davey Do has 35 years experience and works as a Behavioral Health RN.

14 Followers; 1 Article; 73,873 Visitors; 5,970 Posts

Each DNR specifies the wishes of the the patient or legal representative. The interventions can range from absolutely no interventions in the event of  cardiopulmonary arrest to full treatment.

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Sour Lemon has 9 years experience.

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12 minutes ago, SDANG said:

What is a DNR? Is it simply NO chest compressions? I always thought that it ALSO meant NO ACLS medications to resuscitate, and NO intubation. If the patient would allow or want either meds to resuscitate or intubation, then it would be considered a "PARTIAL CODE." Is this INCORRECT?

Can these details about a definition of DNR vary from facility to facility?? Can it vary state to state? Or country to country?

It does vary from place to place. Where I live now, we have POLST forms and some people are classified as "DNR II" instead of DNR. "Comfort Care" also means something very different from one region to another.

But as Davey says ...whatever type of form you have, it's always customizable.

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From the understanding I've gathered from speaking with the palliative care physician that helped formulate the NY state MOLST form, DNR only refers to cardiopulmonary resuscitation in the event of a cardiac arrest.  There is a separate order for DNI.  You can be DNR only, DNI only (makes no sense, but whatever), or both.  The way "DNR" is interpreted in every healthcare facility that I've worked in is that you're doing every intervention needed to sustain life prior to cardiac arrest, but allowing for natural death in the event that it does occur.  

MOLST forms allow patients and families to decide on other advanced directives (ex.: do not hospitalize, no feeding tube, no IV fluids, no antibiotics, etc.), but these are in addition to the DNR order...or sometimes without, as you can wish for CPR and still have directives for "no feeding tube."

Good question though.  Advanced directives can be confusing and have a ton of grey areas.

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MunoRN has 10 years experience and works as a Critical Care.

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DNR commonly refers to resuscitation in the setting of cardiopulmonary arrest, but the term "resuscitation" broadly refers to reversing medical conditions which threaten imminent death (shock, respiratory failure, etc), generally speaking a large portion of ICU care is technically "resuscitation".  

How a provider interprets the terms doesn't really matter though, there always needs to be more patient specific clarification of which medical interventions the patient would want and which they wouldn't, not to mention which medical interventions would be appropriate to offer for the patient to accept or decline.

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Here.I.Stand has 16 years experience as a BSN, RN and works as a RN.

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Well the ACLS drugs are useless without compressions/defib.... even defib needs to be paired with compressions — the brain needs that blood circulation until the heart can provide it.  Years back I remember hearing about “chemical code”... but that would be pointless.  You can inject until the cows come home, but the drugs can’t even circulate if nothing is pumping the blood

by the same token you can’t really have a DNI order alone.. you can’t resuscitate without an airway....... I mean technically they could use an ambu bag with a facemask or a LMA, but I’ve never really seen adequate respiratory function the second we achieve ROSC.  They still need mechanical ventilation

The DNR order NOT with a DNI makes sense; the pt in this situation would probably want to be intubated if they had pneumonia or something similar that doesn’t require compressions

 

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