DNR res.

If the resident has "lost signs of life", they are already "gone". Do not begin CPR if they have a DNR in place. Of course call the family and tell them what has happened. If an illness or injury is "life-threatening" and you cannot take care of them at your facility, call the doctor and the ambulance and the family.

When in doubt --- ship 'em out. DNR does NOT mean do not treat. If the patient is awake and alert, we always ask them before we send them. I, however, do not always wait for the MD to call back before I call rescue.

Absolutely correct, if your patient is pulseless and apnec (not breathing) then you do nothing because the resident is no longer alive and if you perform CPR then you are resuscitating.

The trick is, you MUST have the paperwork in your hand or in your sight before doing nothing. Without the paperwork you can not be 100% sure they are a DNR...so I always make sure that paperwork is in their charts or in their rooms in a known location. You CAN NOT take the word of a family member or POA either at this point because the laws state that a POA or Spouse can only okay the resusitation efforts not say no (in case the POA or family has their own best interests in mind..it is a protection from abuse). So be very leary of this...you can not take the verbal word, you must SEE the DNR orders just like paramedics or MD's do!

Now it depends on facility or your state on what to do once a person has expired. Normally a coroner is called, but as I just found out be aware of what numbers to call! My newest Nurse accidentally called the dispatch number and the police had to investigate the passing of a 103 year old man who was expected to die...oh nelly did that cause upset with the family who had to answer some very hard questions as they mourned their loved one! OOPS! Make sure you know your numbers to call when it comes to the coroner, many times they have a separate line for known or natural expected deaths.

Family is also called as soon as possible, and I use my instinct on time and what not between calling the coroner first or the family. Normally I get that call to the coroner in first for documentation purposes of time of death (for the record), and notify the family that I have called, and ask if they would like me to have their funeral arrangers come in now or after they have a chance to see their loved one.

The last person I call is the PCP, because frankly they are busy with the living at this point, and I usually just leave a message their office is not open.

Dependant on the situation, on an expected death only, I will clean and dress the body so they look presentable for family if they are to come in...just seems proper and nice. If the death is not expected, or is not from a known natural cause you leave the body be till the coroner has done their investigation (and I alert the family as to this as well if they are to come in). If in doubt ask the coroner if you may move/clean the body before doing such.

Now the nicest thing is when hospice is involved! All I do at that point is one call to hospice and they do the rest! Most of my patients are on hospice at the point of near death, comes in very handy! Love my hospice nurses!!!!!!