Legal issue involving DNR...please comment

Keysnurse2008 · Jun 8, 2009

also, a patient can verbally revoke a dnr.
steph

completly agree...patients revoke dnr sometimes when faced with the reality of impending death. you cant argue with them and say " no i have it right here in black and white....you signed a dnr and a promise is a promise so dont go asking for something like....oxygen. you signed the dnr". :yeah: :lol2: . they can always revoke and often do. it is all about their wishes

oregonchinamom · Jun 8, 2009

Sorry to disagree but NO WAY would I take "I can't breath, please do something" as an implied revocation of a DNR! My next step would always be to ask if they want to feel more comfortable with medication or do they want to go on a breathing machine. Depending on their clinical status (i.e. I thought they were in danger of going into respiratory distress) if they say they just want to be more comfortable, I would make sure they understand that this course of action could lead to death and verify that they do not wish to go on the breathing machine in the event of a respiratory arrest.

Assume nothing.

allnurses Guide · Jun 8, 2009

I personally never said that "I can't breathe, please do something" means automatic revoking of a DNR order.

Just saying that folks can revoke it.

The case here seemed to me to be intervention with O2 and morphine and ativan . . . for comfort measures.

However the patient is in charge of that.

steph

cursedandblessed · Jun 9, 2009

o2 stat-check for order for rt treatments, morphine, etc, call the doc if none and respiratory distress continues. respiratory distress causes extreme anxiety. i had a patient today with it, tripod positioning, o2 sats at 86% on 2 l, respirations at 26 per minute--i don't know if she had a dnr or not, i was just helping out another nursing student who was behind in her vital signs. if she had one that doesn't negate her need for the o2 or the respiratory therapy treatments.

another thing, if the inability to breathe was caused by anaphylaxis to medication i don't believe anyone would fail to treat the anaphylaxis just because of the dnr. though i am i just a student, i could be wrong.

kkluczynski · Jun 15, 2009

Another nurse where I work had a situation where a resident recently took a turn for the worse but her code status was still a full code. She tried earlier in the week to get the daughter to sign a DNR, she refused because she was unsure if thats what they wanted to do at the time. So two days later, the resident is in kidney failure retaining a ridiculous amount of fluid has CHF and pnuemonia. She is on IV ATB which trying to get an IV started and staying in her was like taking a shot in the dark with your eyes closed because she is very swollen all over. Anyway, she was on 2L oxygen and her sat was dropping only between 74-79%. She was gurgling fluid and her lungs sounded like she was under water. We called the doctor and his exact words were "get her out, shes a full code." Ok so we got everything ready called the daughter and 911. The daughter was mad, said that she was a DNR and her mom wouldn't want anything done. We said shes a full code still you didn't sign the paper, remember?? Yesterday we got a fax from the hospital that stated in the H&P that we refused to treat her, shes been a DNR for a long time, and we refused to accept her back from the hospital. WHAT??? Thats ridiculous she would have coded if we wouldn't have done anything then the daughter wouldve jumped all over us for not sending her because she is a FULL CODE. What a mess, I think we did the right thing sending her out, anyone have an opinion??

logans_mommy · Jun 15, 2009

I am still a nursing student but I think you did the right thing. I know its all about the patients but in situations like that you really have to look out for your licence. You are absolutely right, she would have come after you if you didnt send her out. Maybe the entire situation was a set up to try to sue. You just never know these days. When in doubt resusciated right? Or at least thats what I was taught.