DNR Case Studies

A 65 year old male transferred to Hall 5 from ICU with a diagnosis of s/p code 99. Patient was semi-comatose, orally intubated and on a ventilator. Underwent a tracheostomy, weaned off the vent and placed on 35% oxygen via a trach collar. A DNR order was written and signed by his wife. During his stay on Hall 5, he had labile hypertension, seizures, respiratory distress and recurrent UTI’s. Mr. C. received antibiotics, Lasix and indicated medications for all of his complications that he encountered. Staff discussed ways of maintaining his stability. It was great the way everybody felt they accomplished something when his needs were taken care of. Mr. C was discharged to a nursing home in Michigan, were he died. All who shared in his

A foreseen problem with DNR’s is whether to treat the patient or not. I feel that patients with DNR orders deserve treatment. The emphasis of treatment is a shift from the traditional lifesaving efforts to a treatment of palliative care, Hospice. In other words, a humane and dignified way of approaching the impending cessation of life. As a nurse working on an oncology and renal unit, I encounter patients in different stages of acuity. My greatest fear, is to have a patient who is dying, in pain and to be faced with a vast confusion regarding their treatment. This confusion is faced by all care givers. How and where do we place a DNR patient along with all other demands placed on us? For example, A dying patient shouldn’t be a low priority over and admission or over an active GI bleeder. All should receive the same attention and dedication. We can come together and treat each individual case accordingly without compromising

Nurses are with patients all the time. Doctors come assess, order and leave to repeat the same process over and over. Doctors see the pain that patients feel for very short intervals. Nurses sit with patients and allow and hear their pleads for relief of pain, nausea and their anxieties. Allow us to work in cohesiveness and as one unit. Work with us to change the things we can. I have a question with probably has no answer. Why do patients that are terminally ill with poor prognosis receive little or no pain medications and those with chronic back pain, renal calculi, and fractures receive higher doses of analgesics? As times change so must we. We must come to terms with our own feelings in perspective to death. Unified we can help each other. I will do everything within my capabilities, the laws, and within the hospital policies to give my patients the care they deserve, one of hospice or the traditional lifesaving treatment. I leave you with a closing poem used by members of Alcoholics