DNR means what???

5 HI!!!!

So Im not a newbie, but Im FARRR from being a veteran...
Im in LTC, great facility, great nurses.


Like all night shifts, we basically avoid calling the MD unless its necessary.
However last night...pt was having some resp distess/possible seiz activity with a stoke high bp and low 02's.

pt was a "DNR"

ER nurse has the gall to ask ((after I spill into report and then state "active DNR"))
and just what are you sending the pt over for....

mmmmkkkkay....let me repeat myself LOW 02, HI BP, RESP DISTRESS, and SEIZ ACTIVITY!!!!

Of course, I didn't say that. I repeated it all back in a very kind-but-snippity manner and then stated "doctors orders" Do you ever fee like some Doctors/Hospitals/EMTs take DNR to far?

I say it like this DNR means EXACTLY that. Its not an excuse to not treat someone wether activily passing or in an acute situation. W/W does not mean not treat. If a pt's family didn't want treatment...they'd say so. Otherwise, its our responsibility as well as everyone involved in their care. Can I get an Amen???

Anyone have any stories/advice related to this? Last edit by cloverleafLPN on Sep 29, '11
"DNR" is vague term. Why DNR forms need to be more specific. However, IMHO, most people who sign a DNR form, do NOT want to be sent a acute care facility to be resuscitated - it violates the spirit of patient's desire. We're just going to have a lot more court cases to set precedents and I'm sure it will end up with a 25 page DNR form that has to be renewed every 48 hours! Every case is different, but if your patient were my mother who expected to die in her bed in the nursing home, I would never allow her to be sent to hospital. Do you expect the hospital to discharge this patient in better shape?

DNR means no action is to be took during a cardiac/pulmonary arrest. Which includes Chemical, Mechanical, and Physical treatments. DNR doesn't mean do not treat, but usually DNR= Comfort care Advanced , and Directive means= Do not code, and prbly do not intubate it depends on the patients wishes. Your facility may have different policies though.

in this case did the patient also have DNH? Do not hospitalize? If not than you did the right thing and sent patient to the ED.

A DNR means to allow their natural death if death is imminent. It does not mean that we allow a person to suffer and die from inadequate medical care.

I agree that DNR does not necessarily mean do not treat. But I do wish that LTCs and patients' MDs would be much more frank with patients and their families to draw out what their wishes really are.This comes from my ER/ICU background ... but in my experience too many patients are sent to the hospital to die. The reasons for this are many. LTC staffing. Lack of clarity about DNR status. Incomplete information given to patients/families about what scenarios are likely to occur given the patient's condition, and what the options are to treat or not treat those scenarios. Etc. Etc.I have simply done too many septic workups on shivering, contracted, 85+ year olds with stridor you can hear down the hall ... and while we may spare them the indignity of an actual code ... they spend their last hours being transported out of their LTC home, in an ambulance, to a bright, noisy ER while strangers poke & prod them with needles and catheters and monitor leads ... all for naught.

Better shape...neh. Its inevitable we are all going to die. Maybe not now...maybe not in ten years. Comfortable...yes...maybe exchange and review meds, of course. That to me is what the hospitals job is, to provide care and acute assitance. I was adviced that DNR meant DNR....which I completely understand. No CPR. I just don't see that as a legit excuse to just chock it up to the good Lord to suffocate somone. Which is in essence what would have happened. I just dont understand why other healthcare workers who you collaborate with take offense to DOING their job!! By all means, every person and family has a right to refuse and like it or not we have to abide. I just don't understand the concept of not treating acute cases just because they are DNR. Especially when the said PT isn't relieved by other efforts and options before having a MD evaluate personally. We all know Hosp. have much more access to things than LTC does. Its not right....but thats how it is.

Quote from cloverleafLPNThat to me is what the hospitals job is, to provide care and acute assitance.

Quote from AltraBy this logic, all declines in, say, respiratory status (increased O2 needs, worsening lung sounds) are "acute" situations. What I'm saying, and literally begging you to consider, is that not all of these "acute" situations should be treated by transferring the patient to a higher level of care. Not every LTC death will be a patient passing quietly while sleeping, and it is unreasonable to expect otherwise.

Quote from AltraNot every LTC death will be a patient passing quietly while sleeping, and it is unreasonable to expect otherwise.

You are right. The patient deserves medical care and relief from suffering.

Quote from AltraI agree that DNR does not necessarily mean do not treat. But I do wish that LTCs and patients' MDs would be much more frank with patients and their families to draw out what their wishes really are.This comes from my ER/ICU background ... but in my experience too many patients are sent to the hospital to die. The reasons for this are many. LTC staffing. Lack of clarity about DNR status. Incomplete information given to patients/families about what scenarios are likely to occur given the patient's condition, and what the options are to treat or not treat those scenarios. Etc. Etc.I have simply done too many septic workups on shivering, contracted, 85+ year olds with stridor you can hear down the hall ... and while we may spare them the indignity of an actual code ... they spend their last hours being transported out of their LTC home, in an ambulance, to a bright, noisy ER while strangers poke & prod them with needles and catheters and monitor leads ... all for naught.

Quote from ckh23That's interesting. I just read an article in the philadelphia inquirer the other day about a local hospital that has place a palliative care nurse in the ER and she works with a physician that is board certified in both emergency medicine and palliative care. I found the article to be quite intriguing. http://articles.philly.com/2011-09-2...s-nursing-home