The DNR (Do Not Resuscitate) discussion strikes fear in the hearts and minds of patients, physicians and nurses. So what does it really mean to be a DNR? Will I still be able to receive treatment if I become a DNR? What exactly will the hospital do or not do if I am a DNR?
A DNR order tells medical personnel not to perform CPR. CPR (cardio-pulmonary resuscitation) involves anything from mouth-to-mouth resuscitation and external chest compression to electric shock, injection of medications and insertion of a tube into a patient's airway.
CPR is not always successful. About 15% of patients in hospitals who have CPR survive to be discharged from the hospital. Many things impact whether or not CPR will result in a patient's heart beating again and them returning to their previous lifestyle. If a patient is seriously ill or terminally ill, CPR may leave them brain-damaged or in a worse medical state than before their heart stopped beating. CPR has been shown to have a 0% rate of success in patients with septic shock, acute stroke, metastatic cancer or severe pneumonia. There is a 4% survival rate in patients greater than 70 years of age. There is a less than 2% rate of survival for those who are dependent on others for their care or live in a nursing home.
CPR is also not without its complications. A patient's ribs could be broken and a lung or spleen punctured because of the force applied during CPR. If too much time has elapsed since the patient has been without oxygen, there can be brain damage. A patient may be placed on a breathing machine even though he/she may not have wanted it.
A common misconception is that DNR means Do Not Treat. This is absolutely false. A DNR order means that in the event the patient were to stop breathing and the patient's heart were to stop beating the physician would allow natural death to take place. A patient will still continue to get tests and treatments as before. Things such as antibiotics, dialysis and transfusions will still be performed if needed. Palliative care to keep a patient comfortable can also be given.
It's important to have conversations about a DNR order with your family and physician before you are too sick to be able to make the decision. While no one has a crystal ball and can predict if someone will survive CPR, your physician can give you his/her best educated guess about your chances. Let your family know under what circumstances you would or would not want to be resuscitated. This will help them make the decision in the event you cannot. If you do sign a DNR order, you can always change your mind at any time.
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