Pt choking and DNR....

kids · Dec 25, 2010

Full Code.
The choking is unrelated to the illness that the DNR was issued for.
This very question was not only a test question in an ethics chapter but it was also in Saunders when I studied for my NCLEX.
DNR's generally do not apply in the operating room either.

I don't understand what you mean by the DNR being related to an issue.

Our POLST (DNR) forms don't even have space for an issue/illness/diagnosis. A DNR is a DNR, you don't resusitate regardless of what caused the arrest, yes you work to prevent an arrest but once it occurs you're finished.

And a DNR most certainly applies in the OR.

Maybe it's a regional thing.

MunoRN, RN · Dec 25, 2010

I've worked at two facilities and neither would allow you to go to surgery as a DNR, or to a heart cath or even colonoscopy, or to be admitted to the ICU as a DNR.

kids · Dec 25, 2010

...and that is when I would answer:
"Mr. Smith signed a DNR because he had terminal liver cancer but was alert and oriented x 3 until he swallowed a piece of bread that was lodged in his trachea and he turned blue. Mr. Smith signed the DNR WITH THE UNDERSTANDING that it would be cancer-related complications leading to his death...he never signed the DNR believing he was going to slowly aphyxiatiate to death from eating which can take as long as 3 to 4 minutes which causes an insurrmountable amount of suffering which is INCONSISTENT with how liver-cancer patients usually die. Therefore, I full stand behind my decision to fully code this man who was NOT ready to die from the illness FOR WHICH THE DNR WAS SIGNED."

No, Mr. Smith signed a DNR because he did not want to be revived if his heart stopped. Period.

That he has terminal cancer is only the event that lead to the discussion.

Unless that DNR states "DNR only if it's the cancer that kills him, other wise resusitate", I sure as heck wouldn't be the one who busts his ribs.

I'll go one step farther and question who in their right mind would resusitate someone with terminal cancer, it's unethical and verges on criminal. What a horribal thing to do to someone.

Healthy individuals, with no reason to believe they are going to die anytime soon, sign DNRs.

My healthy 45 year old husband was asked about his code status when he had rotator cuff surgery.

My very healthy 26 year old son was asked about his code status when he had arm surgery with a nerve block.

indigonurse · Dec 25, 2010

I would follow the advance directive, living will, MD order, etc. DNR means DNR.

netglow, ASN, RN · Dec 25, 2010

Babylady, in response to your eyerolling, I posted because hospice deals with DNR often (I guess I need to throw in an FYI too). I offered some situations in order to help you understand because you seem to be fundamentally confused. You seem to need to put your own modifiers on things. You have no autonomy in this.

You have no choice but to follow the law if you want to avoid penalty of the law, as many others have noted in previous posts. It is what it is.

mappers · Dec 25, 2010

...and that is when I would answer:
"Mr. Smith signed a DNR because he had terminal liver cancer but was alert and oriented x 3 until he swallowed a piece of bread that was lodged in his trachea and he turned blue. Mr. Smith signed the DNR WITH THE UNDERSTANDING that it would be cancer-related complications leading to his death...he never signed the DNR believing he was going to slowly aphyxiatiate to death from eating which can take as long as 3 to 4 minutes which causes an insurrmountable amount of suffering which is INCONSISTENT with how liver-cancer patients usually die. Therefore, I full stand behind my decision to fully code this man who was NOT ready to die from the illness FOR WHICH THE DNR WAS SIGNED."

Wrong, wrong, wrong. The lawyer would go after you in a heartbeat. How can you presume to know what "assumptions" Mr. Smith had when he signed the form? Can you read minds? (Unless his AD specifically states, "do not resus only if it is my cancer causing my death.")

And, Patients don't sign DNRs. They have Living Wills or Advanced Directives. A DNR is a doctor's order.

Blackcat99 · Dec 25, 2010

My 87 year old mother was in the hospital for a broken hip. She was a DNR. She started choking on some liquids and then went into cardiac arrest. The nurse called a full code blue. Thank God I as her POA was standing next to my mothers bed. I stopped the code team from even entering her room. Thank God I was with my Mother when she needed me the most.:heartbeat

Darknights · Dec 26, 2010

It is often said that when an elderly patient codes due to a progressive illness, or old age, nothing will bring them back.

For those who are 70 and above:

"Outcomes predominately reveal that a mere 3% to 5% of patients are surviving CPR to discharge, and a survival rate of 0% has been reported.3–6 The emerging consensus is that CPR may not only be inappropriate therapy for some patients, it may constitute medical futility in many cases."

Interesting about lifting a DNR for surgery. Does this reflect a requirement to notify the Coroner if the pt dies within 24 hours of receiving an anaesthetic? That used to apply here and I've seen desperate attempts to keep patients alive until after 24 hours.

carolmaccas66, BSN, RN · Dec 26, 2010

This is a very interesting and thought provoking legal and ethical discussion. I hope a lot of students are reading this.

I was standing next to the doctor once when she was explaining to a terminal ca patient re the DNR order. The doctor went thru all the options and scenarios related to this & she also said no matter what ur arrest is caused by, we won't resuscitate. They always gave the patient time to think about it, but this patient later signed the order.

I didn't realise there were so many different interpretations to this scenario.

Keep the thoughts coming!

Darknights · Dec 26, 2010

Twice I've overheard a young doctor speaking to a relative about obtaining an NFR. In Australia these are discussed with family when they are available. I've never seen an Advanced Directive.

Both times the patient was extremely close to dying, within hours, and the doctor was desperate to get the NFR. Overhearing him I realised he presented a case that made it very obvious that to request resuscitation would be the worst outcome. Both times he said resuscitation would result in the patient becoming a 'vegetable.'

I suggested to him that he didn't really know that and it wasn't really appropriate to say it. Stating that resuscitation would rarely prolong life in the pt's situation might've been a bit more appropriate.

Darknights · Dec 26, 2010

And how many have heard 'old' nurses advise young ones that when an elderly or terminal patient codes without a not for resuscitation order just don't notice, shut the door and walk away?

I've heard it said quite a few times. I haven't seen it done.

netglow, ASN, RN · Dec 26, 2010

I'd suggest everybody search the web for their state's forms and explanations for DNR, and advanced directives. It's easy information available for the public and very much in detail for my state at least, in laymans terms, lots of "what if" questions are answered.