Legal issue involving DNR...please comment

Katnip, RN · Jun 8, 2009

I would get him treated for the respiratory distress. DNR comes into play once the patient has died, not before. Unless the patient went further and said comfort measures only, in which case you'd still give him something to relieve the distress.

barefootlady, ADN, RN · Jun 8, 2009

Agree with Katnip. DNR is when patient has died, until then you as the nurse are required to treat what you see.

allnurses Guide · Jun 8, 2009

Also, a patient can verbally revoke a DNR.

steph

Straydandelion · Jun 8, 2009

Not knowing the legal angle to it, however when a patient asks you to "do something" I am assuming they want all done unless they say different, this would negate the DNR IMO if they stopped breathing.

Reno1978, BSN, RN · Jun 8, 2009

If the patient is able to say "Please help me, I can't breath," they can breath :) Absolutely you would give them appropriate care to relieve their distress, be it position changes, medication, comfort measures, etc. Like others have mentioned, DNR measures is what happens upon respiratory or cardiac arrest.

I think one thing a lot of nurses think (especially where I work in the ICU) is, "OK, the patient's a DNR and/or DNI, great!" and they don't address how the patient wishes to be treated while they're still alive. Some prefer to have full aggressive treatment, others want comfort/palliative care measures, some want chest compressions, some don't, some want to be shocked, some don't, some want pressors, some don't... Don't forget to address how the patient wants to be treated before they die! That is, after all, what a lot of nursing care is about! If you aren't sure, ask the patient or whoever is making decisions for the patient.

If the patient is alert and competent, they can absolutely revoke their own DNR order.

Aneroo, LPN · Jun 8, 2009

If it's those last moments where you're stuck between intubate or start bagging and gettin' ready to code, and someone said that to me, I'd get ready to intubate.

However, if I was a DNR and hadn't said anything and you put a tube in my throat, I'm gonna come back and haunt you. Especially if I can't get weaned!

SuesquatchRN, BSN, RN · Jun 8, 2009

"Do not Resuscitate" does not mean "Do not Treat."

allnurses Guide · Jun 8, 2009

"Do not Resuscitate" does not mean "Do not Treat."

I run into the same in hospice . . . . being a hospice patient doesn't not mean we don't treat a UTI.

steph

logans_mommy · Jun 8, 2009

Thank you everyone!!! I really need to rephrase the question. This is actually a quiz question for nursing school and I didnt ask it in the nursing school section because I thought you seasoned vetrans might have a more acurate answer for me. So here is the actual question.

The client has a documented advance health care directive that indicates that no resuscitative measures should be employed in the even of a respiratory or cardiac arrest. The client begins to exhibit sever dyspnea and air hunger and says, "please do something. I can't breathe." What action should be taken by the nurse?

A) Offer the client comfort measures until death occurs.

B) Initate resuscitative measures.

C) Call the client's physician for direction.

D) Check the medical record to ascertain the terms of the directive.

Sorry for any confusion!!! I choose a simply for the fact like you all said they are not passed yet and he didnt say anything about not wanting to die, just to help him. I think I might be reading into this one too far.

heron, ASN, RN · Jun 8, 2009

I would still answer C. In addition to getting direction from the physician, I would probably start 100% O2, give morphine and/or ativan if pt has an order. There are no assessment findings in the question, so we don't know if pt is in pulmonary edema or some other reversible process is going on ... and as others have pointed out, DNR is not do not treat. Treatment includes preventing the arrest in the first place.

SuesquatchRN, BSN, RN · Jun 8, 2009

Yeah, I'd want O2 on him. Suffocation's scary.