DNR ethics

txspadequeenRN, BSN, RN · Sep 14, 2005

DNR means if you walk in and find her dead you leave her that way. Hospice is all about comfort care and if suctioning causes the patient to rest more comfortably then do it. If it causes more distress and anxiety then dont. Patients that are in the dying process probably are way past hungary and they could not process food anyway. There would be oh so much more distress on that note. A DNR and advanced directive serves as the patients and /or families wishes. This is something that can be changed or retracted by the POA at any time. How much morphine is the patient on, sounds like she needs some different approaches. Maybe some routine morphine (inject,gel or pill) mixed with some roxanol... Something ... Dont let your patient die in pain

Hello, I'm a nursing student for the army and we ran into an ethical conflict today regarding DNR's. The patient we had today is on DNR and has mucous deep down her throat. The students were told that we would not suction because it would "not be comfortable" to the patient. Yes she is terminally ill and may be on palliative care since she was admitted from a hospice. Even with that, should we still ignore this problem?
In addition the patient refuses to eat. Currently she is on a lot of morphine and anything I do with her you can tell she's in pain. She'd respond with moaning and will look you in the eyes. Now even though she doesn't want to eat, does that mean we should let her starve? Does she need some kind of order to allow her to make those decisions?

txspadequeenRN, BSN, RN · Sep 14, 2005

If your patient becomes distressed with suctioning ..show him. Explain exactly what is happening and let him see her response. It might be better at this point to check on getting an order for atropine or a scope patch. Explain those meds and effects ( used together for the first 24 or so hours creates much better results) and I would imagine he will stop asking for her to be suctioned.

wow thanks for the responses, I'm glad that there is documentation that it is advised not to suction because it will most likely cause more harm than good. That was a big issue today where us, the students, got pretty heated up and ended up being put under control by a higher ranking officer, lol. Not forcing the food makes sense too. What happens if the husband requests if the patient to be suctioned. Afterall when you step into the room, you can obviously tell the patient is laboriously breathing.

txspadequeenRN, BSN, RN · Sep 14, 2005

Resp at 26/ min means she is in pain and needs some ativan intensol mixed with a heavy dose of roxanol. When I have a patient in this much pain I give the PRN ativan and Roxanol as often as I can to get the pain in control then back off to see what type if control we have and with how much meds. If she is spiking a temp ,it is a terminal temp and we would be giving PR tylenol for comfort only X1 UNLESS giving the supp causes more pain/distress than a comforting effect of reducing the temp. You are not going to get rid of the temp beacuse of the meds, it will be back and relativley fast. Her O2 Sat is not bad for a person in the dying process. This is all things I would expect to find with any passing person...

well the patient was breathing at 26 resp a min! and was spiking a temp at the time as well. Her pulse ox was at 93% and it felt strange that no one checked twice about my finds. Maybe cuz i'm still relatively new to death and am only 20 years old :stone Wow i never knew states had their own laws on comfort care! and now that I think about it, I'm finding it more and more strange that the patient appeared to be as distressed as I had found her with morphine! I think I'll bring that up tomorrow if I get a chance. I guess the problem with using our own judgements is because us students are still relatively low in rank and we're used to taking orders, not making the judgements. From the information we gathered, the patient being DNR, we felt that didn't imply allowing the patient to rot herself away by refusing all treatment, food, and water. Anyone of you know good sources to read up on this information. I would very much like to give a presentation on it. Again I greatly appreciate the help!