DNR Question

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Obviously I know the basic of what DNR is, but I was wondering when a person that is a DNR should they be placed on telemetry?? Alot of people at my hospital seem to think that because they are DNR we should not have them on telemetry. Also if the patient is in uncontrolled a-fib 160's should the treatment plan include a Cardizem drip etc. Just wondering what people think, I am a new nurse and this wasn't an issue we discussed alot in nursing school. I personally think we need to treat, please let me know what you think. THANKS for your opinions.

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Specializes in Oncology/Haemetology/HIV.

DNR does not mean Do Not Treat.

DNR, with comfort measure only ocasionally limits treatment but DNR in and of itself only means that if the heart suddenly stops, you do not resuscitate.

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yeah- I agree. If the issue were no curative treatment, then the patient should be under hospice care. DNR just means that the pt does not want to go through rib cracking chest compressions and tooth chipping intubation if they are already going that far downhill. That's where good assessment comes in- if we can watch and pick up on little indicators, we can prevent many codes from happening.

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Specializes in Med-Surg.
DNR does not mean Do Not Treat.

DNR, with comfort measure only ocasionally limits treatment but DNR in and of itself only means that if the heart suddenly stops, you do not resuscitate.

I agree.

There is a big difference between a patient who is dying and on comfort measures only and a patient who is a DNR. I can't see placing a cmo patient on telemetry and being all aggressive.

In this case a patient would be treated for his A-fib, but if it didn't work and his heart went aystole, end of treatment, DNR. But the DNR order doesn't mean not to treat.

I think if nurses are confused as to the issue, it's no wonder patients are too. I think more people would make themselves DNR if they understood this aspect of their care. They're afriad they won't be treated if they make themselves a DNR.

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I think if nurses are confused as to the issue, it's no wonder patients are too. I think more people would make themselves DNR if they understood this aspect of their care. They're afriad they won't be treated if they make themselves a DNR.

And sad to say, they are probably right! The majority of the nurses at my facility seem to think that DNR means do not treat. Someone gets sick, the first thing asked is, "Are they a DNR?" If they are a DNR, their odds of getting sent to the hospital are slim to none. :stone

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Thank you so much for your responses. I believe the same thing. Just because they are DNR does not mean do not treat. I couldn't believe I had three different nurses tell me, after my pt was transfered to the unit for Cardizem drip that we shouldn't be doing that because she is a DNR. I'm glad that other nurses belive DNR does not mean do not treat heart problems. Thanks

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Specializes in PACU, ED.

DNR is just a way for the patient to refuse certain treatment. Here in Arizona I have seen advanced directives that spell out what procedures the patient does and does not want such as meds but no compressions. Good discussion.

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Specializes in Too many to list.
And sad to say, they are probably right! The majority of the nurses at my facility seem to think that DNR means do not treat. Someone gets sick, the first thing asked is, "Are they a DNR?" If they are a DNR, their odds of getting sent to the hospital are slim to none. :stone

Most LTC's I've worked in, have understood this. The problem comes when you have to send them to the ER. I've had EMT's be very rude about transporting CMO's. Not all EMT's just some. Having to educate them is trying. And, I'm not knocking EMT'S here.

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Specializes in Geriatrics.

We were told a DNR doesn't even or shouldn't even come into play unless the pt is diagnosed with a terminal illness. We were given this example: A 34 year old woman has DNR noted in her chart. She is treated for breast cancer ( cancer was deemed curable so pt decided to undergo treatment) after the chemo she develops sepsis. Should she be treated?? Yes, because her cancer wasn't terminal and she opted for the treatment with the hopes for a cure. She wasn't diagnosed with a terminal illness and although sepsis can be fatal in this case it should be treated. That was how it was explained to us at the hospital.

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Specializes in PACU, ED.

Certainly you would treat the sepsis. However, if her heart were to fail and you decided to perform CPR you could be charged with assault in Arizona. If she refused antibiotics then you wouldn't be able to treat the sepsis. Some people refuse blood transfusions but that doesn't mean you must withhold high iron foods. It's just about respecting the patient's right to make their own healthcare decisions.

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Specializes in Geriatrics.
Certainly you would treat the sepsis. However, if her heart were to fail and you decided to perform CPR you could be charged with assault in Arizona. If she refused antibiotics then you wouldn't be able to treat the sepsis. Some people refuse blood transfusions but that doesn't mean you must withhold high iron foods. It's just about respecting the patient's right to make their own healthcare decisions.

I guess it depends on which you state you live in, someone in the orientation class brought up that exact same question and we were told that you should perform CPR since she was originally admitted with the intent to get better and be discharged. It is a rather sticky situation.

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Specializes in Med-Surg.
We were told a DNR doesn't even or shouldn't even come into play unless the pt is diagnosed with a terminal illness. We were given this example: A 34 year old woman has DNR noted in her chart. She is treated for breast cancer ( cancer was deemed curable so pt decided to undergo treatment) after the chemo she develops sepsis. Should she be treated?? Yes, because her cancer wasn't terminal and she opted for the treatment with the hopes for a cure. She wasn't diagnosed with a terminal illness and although sepsis can be fatal in this case it should be treated. That was how it was explained to us at the hospital.

Non-terminal patients can have a DNR order. You can bet when I reach a certain age, even if I go into the hospital for a toenail clipping, I'm going to be a DNR, even though my intention was to be admitted, recover and come back home.

Here, a DNR comes into to play when the patient quits breathing and their heart stops.

It doesn't make sense to me that you resuscitate a patient with a Do Not Resuscitate order.

In the above scenerio, the patient would be treated for sepsis, however should the treatment fail and her heart stop, IF SHE HAS A DNR ORDER, we do not resuscitate.

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