DNR/DNI Status

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We have a dilemma at work... A pt has a DNR status... What do we do to him, should he stopped breathing? 'cause he didn't wish NOT to be intubated - hence, just DNR. Any inputs about this? Thanks!

Specializes in FNP, ONP.
Wow , I thought I was a hard a**.

However.. things change when you have to pull the plug on your own father.

Life goes on.

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Specializes in being a Credible Source.
Given the chance, I'd put a pillow over my father's face. He has dementia and the sooner he goes, the better.
I watched my father descend through dementia; his terminal cancer was a godsend and his final transition was a blessing.

Quite sad do I find our society's prevailing attitude towards end-of-life... and how often are our patients' express wishes disregarded for various reasons.

{Gotta get me one of those snazzy caps a'la Klinger... always looking to wrench some chuckles out of my patients and that would do nicely, m'thinks.}

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Specializes in FNP, ONP.
I watched my father descend through dementia; his terminal cancer was a godsend and his final transition was a blessing.

Quite sad do I find our society's prevailing attitude towards end-of-life... and how often are our patients' express wishes disregarded for various reasons.

{Gotta get me one of those snazzy caps a'la Klinger... always looking to wrench some chuckles out of my patients and that would do nicely, m'thinks.}

Ha, you quoted me while I was editing. I thought someone would freak out, so decided to delete that. Yes, if I could legally euthanize my father I'd do it in a heartbeat. He is not a DNR because my sisters won't allow it and they have the POA. If there is such as thing as hell, I think they are likely going to go for what they are doing to him, but I have been relieved of this culpability for this torture. I have watched hundreds of people die. There are worse things.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Ha, you quoted me while I was editing. I thought someone would freak out, so decided to delete that. Yes, if I could legally euthanize my father I'd do it in a heartbeat. He is not a DNR because my sisters won't allow it and they have the POA. If there is such as thing as hell, I think they are likely going to go for what they are doing to him, but I have been relieved of this culpability for this torture. I have watched hundreds of people die. There are worse things.

I have to say from personal experience.......I believe that we are kinder to our animals. we don't allow them to suffer and allow them to be placed out of their misery....we love them enough to let them go. I firmly believe that there are worse things than death.

However......removing my father from life support was the easiest decision to make .

It was the hardest gut wreching, most heart wrenching emotionally raw, singular thing I have EVER done.

I miss you Dad ((BIG HUGS))

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

OP....please refer to your facilities policies and procedure to see what your facility considers a DNR.

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Specializes in being a Credible Source.
...if I could legally euthanize...
I understood you perfectly... *legal* being the implied part of your "Given the chance..." statement.

If I could edit out your quote, I would. Unfortunately, I'm not up for paying for the privilege so unless a mod wants to honor your request, I'm afeared it's here to stay.

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Specializes in Trauma Surgical ICU.

I couldn't agree more. Yes, there are worse things than death and I find myself saying the same things. If it was binding, I would have DNR ,DNI and no peg tattooed across my chest..

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They won't breathe long without their heart beating.

Their heart won't beat long without breathing. :)

And the knee bone is connected to the thigh bone...

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Specializes in GICU, PICU, CSICU, SICU.
Intubate. No compressions though should it come to that.

In Belgium we use three grades of DNR appropriately named DNR 1 - 2 - 3. They are increasing restrictions to resuscitative efforts and related subjects. And a DNR 2 cannot be active without a DNR 1 active as well (same for a DNR 3 it needs DNR 1 and 2). So in practical/legal terms one can't opt to not get intubated but still expect to receive chest compressions in case of circulatory arrest.

Our hospital has an electronic version of these for easy referral.

DNR 1 states no chest compressions, no intubation, no defibrillation only in case of circulatory arrest.

DNR 2 has a checklist of things the patient/family member or MD no longer wishes or is medically no longer indicated: e.g. intubation/invasive ventilation, non invasive ventilation, starting pressors, upping the dose of pressors, but also admit to ICU, blood products, etc.

DNR 3 is a free text part of the form that is reserved for stepping down in treatment, like stopping ABX, stopping pressors, adding morphine etc.

And apart from all that there is a commentary check box that allows the MD to specify things e.g. CPR duration limited to a maximum of 5 minutes, including x rounds of epinephrine 1 mg (to prevent our on call junior MD coding a severely septic patient for over an hour). Or pressor Y maxed to x mcg/kg/min. And another frequently used: only defibrillate x3 in case of pulseless VT/VF no chest compressions. Hospital policy states only senior MDs can institute DNR measures.

And there is a box to indicate if it has been discussed with family/patient or not. Usually DNR 1s in our ICU aren't specifically discussed with family members but just told to them as medical decisions (the same for a DNR 1 + DNR 2: no dialysis) "if your family member goes into circulatory arrest on top of all the other problems he/she is currently facing we won't perform CPR on him because he/she will have nothing to gain from resuscitative efforts". And we've hardly ever had family members protest to this. Other limitations to the DNR are discussed with family members/patient e.g. intubation.

I'm not sure what the law dictates where you work Jenni811 but in Belgium if we decide to intubate someone but he/she would code during the procedure it is considered an iatrogenic cause and the DNR is to be ignored by law and we have to resuscitate them. This usually causes a lot of grief to family members that have agreed on a DNR but if we don't code these patients we are held accountable for wrongful death, manslaughter or even murder.

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Thanks to all of you who posted their comments about this issue. My workmates and I really appreciated them all... Happy Nurses' Week! :)

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