DNR

'Do not resuscitate' does not mean 'do not treat'. It means withholding of cpr, intubation, and ACLS in a terminally ill patient. Food, hydration and antibiotics do not artificially prolong life.

DNR means basically what it says--Do Not Resuscitate---keep the patient comfortable, medicate them, feed them, wash them, take vitals etc....but, if they stop breathing and there heart stops, do not do CPR, let them go in peace....that's how i explain it to families..

I agree with Terilyn.

So if they stop breathing, or need suctioning to breathe, does that mean that you would not suction them?

CPR - Cardio Pulmonary Resusitation.

As long as you are not "bouncing" on their chest in an effort to re-start their heart, would you consider that "artificial" resusitation?

Devil's Advocate [And I'm not being stupid], if the pt choked on something, and only needed their airway cleared, would that be a violation of a DNR?

Our facility has changed it's policies recently, in keeping with current regs, I guess...We now have "No CPR" policies, and then "Levels of Intervention"... i.e.: NO treatment if a condition is irreversible (Incl. IV fluids, antibiotics, etc...) and so on. DNR meant that if a person arrested, then we did not initiate CPR. It certainly did NOT mean that a person was left to choke to death, whether by food, liquid, or secretions! Suctioning is not really considered a life-saving intervention, but more of a comfort measure.

So if the person is suctioned and their airway is cleared, their heart continues to beat - would applying O2 and bagging them until they begin to breathe on their own be a violation of a DNR order?

application of o2 is supplementing room air but bagging is resuscitating. You are than breathing for the patient. I would not bag the patient unless supplenemtal to suctioning. If there is aspirate it is routine airway management to clear airway. That is different from breathing for them.

Suctioning is (IMHO) a comfort measure, even as uncomfortable as it can be.

I have watched a patient suffocate to near passing out (due to a growth pressing on his airway, even a trach would not have helped him) I was horrified at how absolutlely terrifed he was. The swelling went down, and he told me it was the worst feeling he had ever had in his life, and he had NO bad feelings for me, (I had called for help, but it was not a siruation we could fix, and he did not want to be moved)

Enough rambling on and on

Suctioning is not rescusitation, it is maintanence of an airway.

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*** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

This may have seemed like a frivolous exercise, but in my experience as an agency nurse, I have been told everything from withholding CPR to withholding suctioning, insulin, and enteral feeding when they had already had a PEG tube placed. It is very frustrating to walk into a situation where a swift, rational decision needs to be made, and that decision is misinterpreted as challenging an institution's standard of practice.

In one particular situation, I was working as a RN Shift Supervisor. A resident with a PEG tube, in a semi-vegetative state began to aspirate feeding solution, secondary to not having the head of the bed elevated after being turned by the NA's on care rounds. When I found this resident, she was ashen, gasping, and struggling for breath. I suctioned her aggressively, and supplemented oxygen by bagging her for two to three breaths. She began to breathe on her own, and a nasal cannula was applied with oxygen until her color returned to normal.

Another nurse working on a separate floor began to be very vocal, and very critical of my decision to "resuscitate" a DNR, which divided the staff. The Nursing Director of the institution did not criticize my performance. But as a result of the incident, I have elected not to return to this particular institution, as their policy was unclear, and this had not been the first time that as a nursing supervisor, my interpretation of an ambiguous policy was neither exonerated nor corrected.

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Keeping the Faith

I can see how it would make you question the whole "DNR" thing...That is why we have made the move toward very specific health care directives.

I would have probably done the same thing you did, in fact. What are you supposed to do? Have a team meeting on DNR specifics while the patient chokes?? I personally think that the staff could have been found negligent in their care if you HAD left the patient to die, as much as if you had walked in and found the call bell cord wrapped around their neck and ignored it!!

DNR, I think, should have the reserved meaning of a spontaneous respiratory failure, cardiac failure, etc...not one caused by an outside stimulus. Makes ya think, though, about how specific policies NEED to be in place!!

Suctioning a pt. who is a DNR is not violating his wishes. Suctioning is a comfort measure. I could not sit a watch a patient drown in his own secretions. We provide oxygen, suction, give tylenol to pts. with high temps, but do not intubate and perform chest compressions. People should be able to die in peace and comfortably, not choking on their own saliva....

Ahn- I found a patient in a geri-chair in the hallway with a tube feeding pulled up int her nose and noisy lungs. She had aspirated feeding. I got help to get her back to bed and suctioned her airway. She continued in respiratory distress and I called her doctor. The patient was a no code blue patient. I did not call a code and the doctor was upset when she arrived because the patient was getting worse. We eventually did code her and I asked why. The physician explained that because she had aspirated the tube feeding we should try to correct that. The patient was elderly with multiple problems and a poor prognosis. There is probably some liability for nosocomial problems regardless of code status.