DNR...is there a grey area?

After reading several post in the Biggest Mistake thread. I have a question. IF someone is DNR that does that mean in all sceniarios? OR say they are DNR due to a terminal illness then it would go without saying according to the pts advance directives. So lets say a patient is choking, you do they hemilich (spelling) and the object does not come dislodged, they go unconscience, they have a DNR. Are we to do nothing at this point? Im wondering if there is a grey area with this subject. Or maybe I am confused. I have worked with only a handful of DNR's so any information or clarifications would be great.

that's a good question and I would sure like the answer. Seems to me if they were dying because they had aspirated as opposed to their disease process, then you would be obligated to do everything possible to prevent death...but how could you without chest compressions, etc.????

i spend a lot of time explaining the dnr to families.

dnr does not stand for do not treat. i get a lot of calls from some er nurse who calls the nursing home with "why did you send him here? he's a dnr what do you expect us to do with him?" there always seems to be one who is riding the high horse.

answer: treat the patient in accordance with the familie's wishes.

if your patient is choking on his lunch, you do the heimlich on him. in the case of a dnr, i'd say you stop treating when the heart stops.

there is still this mindset in the community that signing the dnr is like signing a death certificate. there are even a few nurses out there that think if a patient is dnr that they don't get antibiotics and that we're allowed to neglect them to death.

in most nursing homes, cpr is very basic: no defibrillator, no crash cart with all the meds, etc......but you really need to know ahead of time if a patient is dnr or not because its not all that unusual to walk in and find that someone has passed away. calling the poa and asking them to make that kind of decision suddenly isn't realistic, and probably wouldn't hold up legally.

unfortunately, most of this is a gray area.......there are always a lot of possiblities and most folks don't get the luxury of a cut & dried scenario.

Yes it is a grey area. However, if the DNR was made whilst the patient was an inpatient then it needs to be reviewed weekly by their consultant. Changes could happen and the patients condition might have improved.

If for example there is a directive that the he/she dont want to be resusitated because of other co-morbid conditions then it must be upheld. If there are no other co-morbid conditions surely when he/she is discharged, DNR is no longer viable. I would have thought that DNR ruling is reviewed at all times unless indicated otherwise.

ch10