I'm a bit confused about this. Please tell me what you think?

This topic contains 2 replies, has 3 voices, and was last updated by  Nadia Foster, MSN 1 month ago.

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  • #73157
    AZ RN
    AZ RN
    Participant

    I’ve always thought that DNR-CCA means do not resuscitate. I know that to mean that if a patient is in cardiac arrest then you treat them as you would a full code, using pressers. But if they are actually in cardiac arrest then you just do palliative care to make the patient comfortable, using morphine and midazolam or ativan.

    I’ve had a couple of nurses tell me that there we have to still give pressers and atropine to patients who are extubated, even if they are totally circling the drain in the 48 window of withdrawal.

    I’d like to know if other facilities and physicians expect this?

    I'm a bit confused about this. Please tell me what you think?

     

     

  • #73158
    funky Chick
    funky Chick
    Participant

    DNR means that you only do palliative or comfort care and that wouldn’t include and atropine, pressers. At my hospital, this usually means “comfort measures only” and we would not use pressors to maintain life. We might use IV fluids gently, or oxygen for comfort. We would give morphine and

    Oxygen is not used to prolong life, instead it’s used to make the patient comfortable during their transition. If necessary we would also use fluids, but again this is for palliative care only. At my hospital, this usually means “comfort measures only” and we would not use pressors to maintain life. We might use IV fluids gently, or oxygen for comfort. We would give morphine and

    Morphine and Ativan are both given if ordered and needed. At my hospital, this usually means “comfort measures only” and we would not use pressors to maintain life. We might use IV fluids gently, or oxygen for comfort. We would give morphine and

    We don’t have any time protocol like your 48 hour window either. We allow the patient’s condition and the family’s wishes to dictate the care we give.

    We sometimes call in a palliative care team if the patient isn’t expected to pass for some time. If their condition is deteriorating rapidly then we do talk to the family and if they agree then we go ahead and end any prolonged care and artificial assistance. We extubate, stop pressers and fluids and allow them to go, just making them comfortable.

     

  • #73159

    Nadia Foster, MSN
    Participant

    Well first of all DNR doesn’t ever mean “do not treat.”  DNR-CC means make the patient comfortable but do not do measures to prolong their life, unless that measure will allow them more comfort, like oxygen.

    .DNR-CCA means we will provide medical care to the patient until they are in cardiac arrest, or respiratory arrest.

    Most physicians are pretty specific on their orders. The order should specify exactly what they want. In our facility, you would continue pressers if the patient is a CCA until they lose their pulse

     

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