Would you call a code/MET on a pt. who is a complete DNR?

Posted

Sorry if this is a stupid question, but I'm a new nurse, freshly graduated.

If I walk into the room of a complete DNR pt and he/she is unresponsive, diaphoretic, breathing is labored, should I call a MET/Code?

Thanks...

tyvin, BSN, RN

Specializes in Hospice / Psych / RNAC. 1,620 Posts

Comfort measures only please ... respect the DNR. You have to know what the DNR says about comfort measures as well. Usually O2, suction, and pain meds (morphine for rapid breathing) are the norm but not the standard. Know your patients.

All4NursingRN

All4NursingRN

377 Posts

No. I always try to remember this when a pt is DNR. If you find them in a state which would indicate the need for resuscitation, then you do not call a code. So for example if my DNR pt is:

Apneic

Cyanotic

Unresponsive

Severe (low)vitals

I know DNR can be tricky, even to me still and I've been a nurse for a while. I've had patients who were possible ICU candidates but were downgraded to med-surg because they were DNR/DNI.

I think too often patients that really should be referred to hospice services don't get that priviledge. It's sad to see a patient in terminal state (of whatever disease) have to go through multiple hospitilizations, resuscitation/intubations when it's clear that the patient needs comfort care because it's their last stage of life. Not enough family members are educated about it either. But that's another subject.

casi, ASN, RN

Specializes in LTC. Has 3 years experience. 2,063 Posts

I wouldn't call a code, but I would call a rapid response.

Just because a person is DNR/DNI doesn't mean they are comfort care.

evolvingrn

evolvingrn, BSN, RN

Specializes in Hospice. 1,035 Posts

I would not......but i would treat the symptoms.

2011nursetobe

2011nursetobe

64 Posts

I have a hard time differentiating between something that could be treatable...like just a low blood sugar, and something that would require intubation, etc. Now of course if they are pulseless, or agonal breathing (actively dying), i wouldn't call anyone but the gray area is what concerns me. Would it hurt to call a MET/RR and just let them know they are DNR? Or is it pointless?

nursenotamaid

nursenotamaid

Specializes in SICU, MICU, BURN ICU, Trauma, CTICU, CCU. 37 Posts

DNR does not mean do not treat. I would call the MD, call an RRT and see what can be done. Do they need lasix? Apply some o2. Reposition them. Do they need to be NT suctioned? Have they been recieving narcotics and could they use some narcan?

Theres a lot of things you can do aside from intubating, starting pressors, etc... that can turn a person around. There is a difference between being a DNR and being on comfort care or hospice geared care.

All4NursingRN

All4NursingRN

377 Posts

I have a hard time differentiating between something that could be treatable...like just a low blood sugar, and something that would require intubation, etc. Now of course if they are pulseless, or agonal breathing (actively dying), i wouldn't call anyone but the gray area is what concerns me. Would it hurt to call a MET/RR and just let them know they are DNR? Or is it pointless?

I would have a discussion with the resident and find out if possible family/next of kin is aware of patient's condition and if they were spoken to about comfort care, this is of course after I read through the advance directives. Yes there can be alot of gray area for all health care professionals. Now for instance if I took the BP of a patient who was terminal, DNR/DNI and it was 70/50 I would notify the resident, they may want to order some fluids to increase the BP (depending on the patient's PMH) or if fluids are a detriment (which they would be anyway to an actively dying person) then the most you can do is document that you notified the doc and continue to monitor BP closely.

If the patient's sugar is 40? Ok maybe an amp of D5 or some glucagon?

If the patient is c/o dyspnea (a typical sign of impending death), do an O2 sat, give oxygen, HOB up, suction, make them comfortable.

You can treat symptoms but on an outright morbid patient, do not call a code. Observe the advance directives (DNR/DNI or both)

athflying

athflying

25 Posts

DNR does not mean do not treat. I would call the MD, call an RRT and see what can be done. Do they need lasix? Apply some o2. Reposition them. Do they need to be NT suctioned? Have they been recieving narcotics and could they use some narcan?

Theres a lot of things you can do aside from intubating, starting pressors, etc... that can turn a person around. There is a difference between being a DNR and being on comfort care or hospice geared care.

Agreed...if there is ever doubt, call the RR. Better to be safe than sorry. As a newer nurse I sometimes struggle with knowing if I am making the right decisions, but I do know I would rather a couple ICU nurses roll there eyes at me then have someone code that shouldn't have.

turnforthenurse, MSN, NP

Specializes in ER, progressive care. Has 7 years experience. 3,364 Posts

So regarding comfort measures...if you give pain medicine to make them comfortable and the patient expires....then what? :eek: I've always wondered this...

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 42 years experience. 4 Articles; 20,908 Posts

So regarding comfort measures...if you give pain medicine to make them comfortable and the patient expires....then what? :eek: I've always wondered this...

It was meant to be.......it was their time.

nerdtonurse?

nerdtonurse?, BSN, RN

Specializes in ICU, Telemetry. 3 Articles; 2,043 Posts

When I have a patient who's a DNR, I gently explore the notion of hospice with the patient or their family. Yes we have hospice patients who are still full codes, but if a person is truly endstage COPD, CHF, renal failure, etc., let's have the discussion as to what we can do to help the person to find comfort and peace their last days on earth, not whip them down to an ICU, shove tubes in every opening, and make sure they are physically and mentally miserable just so we buy them a few extra hours or days that will be a horror to them. If the patient is actively dying, then I get the doc to write me an order for comfort care. I'd treat the symptoms with an eye to comfort, acknowledging that we all reach a point where there is no "better" and there is no "cure."

Let's do the right thing for the patient, the nurse thing for the patient, which is to make them comfortable and give them the best quality of life, not the longest length of life...