DNR means Do Not Treat

stbernardclub · Jan 6, 2005

DNR mean DO NOT RESUSCITATE....which comes into effect only if the patient codes. There is a LIVING WILL which if the patient cannot speak for themselves, such as coma, decline in condition, they can pick and choose ahead of time what they would want eg: yes to tube feed...no to peg tube... yes to i.v's...ect...them the POA is a person who can legally make the decision for the patient if there is not dnr or living will.However, that can get hairy also if say 5 children are there at the icu, dad just crashed, and 4 want everything done, poa says no, then the ethical decisions come into play.

bobnurse · Jan 6, 2005

I believe a DNR is only enacted when the following happens: 1) Loss of Pulse or 2)Loss of respirations. Otherwise a living will takes effect..........

stbernardclub · Jan 6, 2005

thats right :)

I believe a DNR is only enacted when the following happens: 1) Loss of Pulse or 2)Loss of respirations. Otherwise a living will takes effect..........

Tweety, BSN, RN · Jan 6, 2005

Someone correct me if I am wrong, but I was taught that a DNR would mean NO HEROIC MEASURES to save a patient's life. A pacemaker is NOT a heroic measure.

A DNR simply means as was stated by above means do not resusitate when the patient quits breathing and/or the heartbeat stops. It's up to the families/living wills and MDs to decide what "heorics" mean on a living DNR patient. And it could be different on different patients. For example if I go to the hospital with chest pain and need a pacemaker, I'll take it, even though I'm a DNR. Some people is fair to good condition are DNRs and recieve different medical treatment than those who are in very poor to critical condition.

I guess what I'm saying is a pacemaker could be considered heroic on a patient that it's not really going to change the outcome or improve quality of of life on. Have to look at each patient.

**canoehead, BSN, RN** · Jan 6, 2005

I gotta tell you that when we had an external pacer placed on a 92 year old overnight with no sedation, I wished that they had just let her go. IMO someone that age that needs a pacer is circling the drain and a peaceful death surrounded by family would be more dignified than what she got- or for that matter, better than an internal pacer insertion when confused. But I understand that families can't just give up- I don't know if I could either.

Sometimes I think that giving people ALL the options is cruel, but how could we edit them and still be ethical?

Malt123 · Jan 6, 2005

DNR means we do not revive them, many times a pt. will also have a living will that states what treatments they want done and if they want to be transfered to a hospital. if they don't go to the hospital then that leaves out a lot of treatments that simply can't be done in a LTC setting. I have also run across many doctors when you call with condition changes they ask if they are DNR before any orders are given especially if they are covering for another doc. and don't know the pt. I try to contact the family and find out if they want further treatment and transfer to the hospital if doc orders it.

bobnurse · Jan 6, 2005

But if they are symptomatic and a DNR, it doesnt mean you dont treat them. For example.....a heart rate of 180 and b/p 58/18......You dont treat them because they are a DNR....You fix the HR which should bring up the B/P.....

Also, you give a IV Narc and 30 min find the patient with resps of 2.....You dont just let them die.....You reverse the narc.......But many nurses and Docs will let the patient "pass" because they are a DNR, even though they have a reversible condition

nialloh, RN · Jan 6, 2005

DNR mean DO NOT RESUSCITATE....which comes into effect only if the patient codes. There is a LIVING WILL which if the patient cannot speak for themselves, such as coma, decline in condition, they can pick and choose ahead of time what they would want eg: yes to tube feed...no to peg tube... yes to i.v's...ect...them the POA is a person who can legally make the decision for the patient if there is not dnr or living will.However, that can get hairy also if say 5 children are there at the icu, dad just crashed, and 4 want everything done, poa says no, then the ethical decisions come into play.

No ethical problem here. I had a pt whose POA was not a family member because he knew his family wouldn't honor his DNR. Pt coded, POA said no code and that was that.

bobnurse · Jan 11, 2005

a family member cannot make someone a DNR unless they have POA....So how often do we go in and say, your dad is dieing..Do you want him to be a DNR or not...Legally the son cannot answer that.....What you do say is....Have you and your dad ever talked about this situation and what would he want us to do as far as resuscitation...Then its in the patients words and his wishes, not what the son wants.

mollie · Jan 11, 2005

I think alot of the MD's thing DNR means do not treat, pt has an acute problem any infection, pick an infection, you treat it. You know how many times I've gotten"They are 90 yrs old what do you want me to do? They are a DNR" My response? Thats why so many families are making these 90 yr old people FULL CODES you jack a$$" Then its you will order an antibiotic (or whatever is needed) or I'm calling the medical Director!
UGHHHH
Cheryl

When I turn 90 years old or even 80 years old I do not want anyone treating anything if I am dnr! Which I most certainly will be. Why would you even think that a patient who went to the trouble to have a dnr put in place would want to have infections ,ect treated? Why? Does dnr mean the only death you are allowed to let me die is death by MI? Not for me! There is a time to live and a time to die. I really don't think we embrace death very well as a society. We want to keep people alive at any cost no matter how much they are suffering. That is part of the reason are health costs are so out of control. My mother-in law has been being "kept alive" for 5 months after a heart valve replacement and bypass sx. She has been miserable! But they keep" trying one more thing". It is heartbreaking. She is 84 years old and went from walking a mile a day and going to church and having her hair fixed every week and visiting with friends to being confused unable to pull herself up in bed and unable to eat. But she did not have a dnr in place. and from what I'm understanding you to say it wouldn't have mattered anyway.

We each have a right to our opinion of course. And I don't have all the answers. But I agree with the md "she is 90 years old with a dnr" Can't she be allowed to die?

Elenaster · Jan 11, 2005

I find this thread very interesting, because as an ICU nurse, I've had the opposite experience with DNRs. Most of the time we do far more that the patient ever wanted, even if it's completely futile. Most of the time the docs won't even initiate a DNR until after we've already coded the patient at least once and they are still trying to die despite be vented and maximum support.

We've never used a DNR status as and excuse to not treat. If they have an infection, we identify and administer abx. If they are hypotensive, we may give extra fluid. Working in neuro, I've treated plenty of DNRs that are vented with feeding tubes, and we continue to ventilate and feed them unless the family wants to withdraw support.

bobnurse · Jan 11, 2005

When I turn 90 years old or even 80 years old I do not want anyone treating anything if I am dnr! Which I most certainly will be. Why would you even think that a patient who went to the trouble to have a dnr put in place would want to have infections ,ect treated? Why? Does dnr mean the only death you are allowed to let me die is death by MI? Not for me! There is a time to live and a time to die. I really don't think we embrace death very well as a society. We want to keep people alive at any cost no matter how much they are suffering. That is part of the reason are health costs are so out of control. My mother-in law has been being "kept alive" for 5 months after a heart valve replacement and bypass sx. She has been miserable! But they keep" trying one more thing". It is heartbreaking. She is 84 years old and went from walking a mile a day and going to church and having her hair fixed every week and visiting with friends to being confused unable to pull herself up in bed and unable to eat. But she did not have a dnr in place. and from what I'm understanding you to say it wouldn't have mattered anyway.
We each have a right to our opinion of course. And I don't have all the answers. But I agree with the md "she is 90 years old with a dnr" Can't she be allowed to die?

Thats what an advanced directive is for.....

DNR = Do not resuscitate.........Its only existence is to prevent CPR, Tubes,etc. Treating infections and so forth is up to your living will. Some people feel the same as you, but many feel the opposite. I cant count the times ive talked to a patient in regards to a DNR and their first question is "does that mean no more treatments?" Or patients being scared to become a DNR due to a lack of treatment.