DNR orders

lovingtheunloved, ASN, RN · Nov 15, 2005

I find it much more effective, at least on my wing, to know who the full codes are. There's only about seven of them. The other 25 are DNR.

pkeyrn · Nov 18, 2005

in my faciility a DNR order is good for 60 days and if the dr hasnt renewed it by the time the 60 days is up, the whole process has to be put into place from step one and the resident becomes a "do resuscitate" until it is finalized again

Balder_LPN, LPN · Nov 18, 2005

We had EMS bring a pt. in the other day c/o diff. breathing, who had a DNR. Sats were decreased, pt. was barely holding on - had she not had the DNR, EMS would have intubated her pre-hospital. But b/c of her DNR, they had her on a non rebreather. She died at triage. And no one touched her, because of the DNR. EMTs do not resuscitate as long as they see a signed DNR.

Do you actually mean "no one touched her", what about comfort care short of resusitation?

nialloh, RN · Nov 19, 2005

Do you actually mean "no one touched her", what about comfort care short of resusitation?

If all her vital signs are going down, the only comfort care tx you can give is O2. Any thing else is to revive her. Morphine, ect will only depress her resp even more. Sometimes, all you can do is hold their hand and say goodbye.

joyflnoyz, LPN · Nov 19, 2005

If all her vital signs are going down, the only comfort care tx you can give is O2. Any thing else is to revive her. Morphine, ect will only depress her resp even more. Sometimes, all you can do is hold their hand and say goodbye.

WHAT!!???

Do Not Recusitate doe **NOT** mean do not TREAT symptoms.

In the two states I've worked, it means if a patient is found

dead, you don't start CPR. Perhaps the state you work in has different view.

Respiratory distress does not mean she's dead.

As for morphine...heck hospice pts get it all the time. Frequently.

The point is to relieve discomfort. By NOT treating the discomfort, all involved were guilty of not caring properly for the patient. As for "hastening death", legally, it's all about *intent*

Reading back thru the posts, the DNR papers when on a lady who went on to respiratory distress and passed out IN A PRIVATE HOME. I probably woulda called 911 too. Who else wold you call for for a police/EMS emergency? If the woman had died in the home, the police would have to be called anyway. Documentation and legalities and all that..

nialloh, RN · Nov 19, 2005

WHAT!!???
Do Not Recusitate doe **NOT** mean do not TREAT symptoms.
In the two states I've worked, it means if a patient is found
dead, you don't start CPR. Perhaps the state you work in has different view.
Respiratory distress does not mean she's dead.

I agree, but I don't have a pt in front of me, so I'm doing a lot of guessing. I am assuming (maybe wrongly) that the pt was not conscious considering how fast she passed on reaching the hospital. You can give O2, resp tx, ect., but you can't put her on a vent, which is what she needed. She died in triage, so the nurse might not have had much time to do anything.

As to the morphine, you are correct. I didn't express my thought correctly. I was still thinking of her living, and that morphine would kill her. For comfort care while passing, you are exactly correct.