D.N.R.

DNR:

It's a term that a lot of people have not heard before and may not understand. It is commonly used in hospitals and nursing homes to designate patients who don't care to receive "heroic measures" to sustain life. The non-abbreviated term is "do not resuscitate."

Typically this status is implemented with the knowledge of a terminal disease process. It's also not uncommon to see it in very aged patients.

The only problem with this is, at the moment some patients bodies take to the process of expiration there have been distressed family members that have demanded CPR on the 92 year old cancer patient.

The prospect of a DNR is providing the patient the chance to die peacefully and comfortably. Quite unlike those patients that expire despite best efforts to revive them with CPR.

CPR is a live saving measure—do not take this blog as my disapproval. I want it to be taken into account that when that 70-, 80-, 90-, 100-year-old person is lying there that what we are about to implement is also a trauma to the body as well as a life saving act.

Even the healthiest adult sustains a few fractured ribs within the first five compressions of CPR. To healthcare workers, this is a noticeable sign that CPR is done correctly. With aged, frail patients it is more likely that all ribs connected to the sternum are broken, increasing the risk of a punctured lung. If the patient should happen to live, it also increases chances of pneumonia afterward. Patients with broken ribs do not sustain adequate lung expansion to prevent such an illness, as the pain causes them to breathe shallow.

I'm sure everyone has seen it on TV at some point: "Set to 200 joules. Charged. CLEAR!" At which point a patient gives a little jerk and the process continues with increased "joules." Joules are electrical impulses applied to the heart by means of a defibrillator. The heart on its own is a "generator" of electrical impulses that result in the heartbeat. However, there are only so many times and only so many joules a patient can receive without doing further damage to the heart muscle. The necessity for the "CLEAR!" is that the joules can not only restart the heart that has stopped but it can stop beating hearts as well.

I have seen family members that have been more traumatized by the process of CPR than those that watched as their loved one simply slipped away and their last breath eased from their body.

Yes, ultimately the patient's family does have a say in what steps are implemented; however, the desire of the patient should be taken into consideration. The processes of CPR and after-effects are explained to patients who sign DNR forms. They are given the choice. Why would we deny them the respect of passing on in a quiet room surrounded by loved ones, feeling no pain or experiencing no trauma, while providing their family with the opportunity to say their goodbyes and receive the closure they need, sparing them the thought of the last moments with their loved one being those of shock and guilt?

I am a supporter of comfort measures for dying patients and DNR status for those who so choose. As a health care provider, we are taught to treat holistically...to consider the spirit as well as the body. To me, that would include peace at this, of many, important stages of the life process.