DNR Question

i'm not even convinced that all md's know what constitutes a dnr.

i specifically recall one of my hospice pts, who developed pneumonia (presumed pneumonia in absence of cxr).

she had a temp of 103 w/wet, junky breath sounds.

all i wanted for her, was an order for an abt.

the md kept on insisting that she was dying and cmo.

my contention was she'd be a heck of alot more comfortable if the pneumonia was treated.

after one hell of a fight, i got my order for levaquin and within 48 hrs, my pt was afebrile w/improved o2 sats and clearer bases.

sheesh.

leslie

The laws of DNR vary from state to state. In my state theres full code, DNR-CCA (comfort care arrest) and DNR-CC (comfort care). A CCA is everything up until the heart stops, you can push ACLS drugs, intubate, etc etc. A DNR-CC is basically comfort measures only, usually depending on the patients choice we will use oxygen (can even include bi pap if patient wishes), pain/anxiety medications, and regular medications if they chose.

Also if a patient has undergone surgery as long as they are under the effects of anesthesia they are considered a full code, which every doctor has a different belief how long this should last. I took care of a patient before who was a DNR-CC who underwent a double mastectomy due to the uncomfortable nature of large tumors in her breasts, it was not to cure her cancer, but for a couple of days after the surgery she was a full code.

In my region, we have four levels of advance care planning (resuscitation status). Level 4 is all treatment, including full CPR. Levels 1-3 have no CPR, but vary in the amount of treatment provided. eg. Level 1 provides only comfort care--no ICU, tube feeds transfusions, IV's, no CPR--only measures focused on aggressive relief of pain and discomfort. Level 2 allows for treatment of reversible conditions,eg. pneumonia or blood clot, but no CPR. Level 3 allows treatment of all conditions, both reversible and nonreversible with no restrictions, except for no CPR. Pts. can be admitted to ICU, telemetry etc. on this level, even though if their heart stops, no code would be called. We've found that these levels of care help clarify how aggressive the pt &/or family wish to be.

There is a chemical code only no cpr no intubation. We need to specify the DNR status and have to addressed with every admission.