what to do with DNR

cactus wren · Feb 22, 2003

DNR...Do Not Resicitate(sp?)

not Do Not treat........

Look at what is on chart...what does it say?? No IV`s? no meds?. No tubes?? Many are actually getting more inclusive, and are actually helpful....

RNonsense · Feb 22, 2003

whoa...is there a story that goes with this?? I don't know what state you are from...but it's my understanding DNR simply means no CPR. We have different levels here in Canada called "Degree of Interventions" outside acute care, none that I know of would include witholding insulin...

Sally_ICURN · Feb 22, 2003

DNR mean Do Not Resuscitate. If the patient codes, don't do cpr, don't shock, don't give epi, atrophine, etc., don't intubate (no BLS, ACLS).

In no way does it mean don't give insulin. Docs need to write orders for exactly what treaments they want.

angelbear · Feb 22, 2003

Pt is still getting most meds but had what I consider a very important prn med DC'd at guardians request. I am concerned because i feel this prn was needed to provide comfort and without it I feel I am being forced to watch pt suffer unnecessarily. We can still call MD for an order for it but this wastes precious time. And we are not given specific perameters to follow concerning when to call MD. This happened to me I was told to holdoff on calling by one supervisor but when it happened and I hesitated I was reprimanded for waiting. I am so confused

Sally_ICURN · Feb 22, 2003

Originally posted by angelbear
Pt is still getting most meds but had what I consider a very important prn med DC'd at guardians request. I am concerned because i feel this prn was needed to provide comfort and without it I feel I am being forced to watch pt suffer unnecessarily.

If it was an opiod or a sedative, I would try to find out the motive for wanting it d/c'd. I find that a lot of times family members feel that if a certain drug is stopped then their loved one's breathing will get better or they will wake up to spend the last moments alert. Unfortunately, I have found that some believe that the opiod perscribed for comfort actually hastens death. It's so sad and so important to prepare them for exactly what to expect to see when one is dying and then help them realize that the comfort of the patient is obtained through these drugs. Unless of course, the patients directive says otherwise, which in this case doesnt seem to be the case.

nurseBe · Feb 22, 2003

As far as I am aware, DNR does not mean not to treat. On our unit we have some specifics, but I have never heard of withholing insulin.There is a specific form for ACLS meds, compressions, intubation, assisted ventilations and defribillation, The doc fills out this form. Mostly we do all other interventions unless otherwise specificed. If a pt. is already comatose of course we don't give the PO meds ordered but the doc would be aware. What always amazes me is some of the choices like yes for intubation and no for ACLS meds!

nurseBe · Feb 22, 2003

Also DNR does not mean comfort care! Comfort care is usually specified.

angelbear · Feb 22, 2003

Can I tell the med without violating cofidentiality.

RNonsense · Feb 22, 2003

of course

angelbear · Feb 22, 2003

diastat for seizures

RNonsense · Feb 22, 2003

ok...valium essentially...it was prn, right? Do you know why the family/whomever wanted it d/c'd? Was your pt. still having seizures? You have every right to act as an advocate for pt's in your care...