dnr - target99

[ArchivalUser]

is dialysis included in DNR?

if a pt who has opted for DNR needs a dialysis than do we go ahead with it

plz be convincing and support ur answer
tx

[ArchivalUser]

No dialysis nt included in DNR it refers only to CPR.
DNR dsnt mean to terminate t/t or refrain from health supporting procedures.

[ArchivalUser]

Hi Target,
Per uw - Dialysis is included in DNR
3 components for DNR are-
1) NO intubation / Mechanical ventilation.
2) NO defibrillation
3) NO IV drugs for terminal rythm.
So, Dialysis is included in 3rd one.

[ArchivalUser]

dialysis is not included in DNR..

dbhansali, no iv drugs for terminal rythm means no epinephrine or atropine iv or intracardiac to resuscitate patient..

CPR is done when heart stops beating... dialysis is not a part of CPR

[ArchivalUser]

Raji -
Isnt dialysis a artificial manipulation requiring use of created arterial graft to delay terminal rythm.
I would still believe dialysis is a part of DNR, as also seen clinically

[ArchivalUser]

5. You have a pt with severe MS that is advanced & progressive who now develops renal
failure secondary to DM, the pt is alert & has elected to put DNR order in place at her
own discretion. The pts K levels are now elevated at 8 meq/l.
Which of the following is most appropriate?

a.dialysis cannot be done because of the DNRorder
b.you can do the dialysis if the DNR is reversed for the procedure
c.go ahead with the dialysis, ignore the DNR order
d.Give kayexalate until DNR status is discussed with the family.

[ArchivalUser]

Ans: c.go ahead with the dialysis, ignore the DNR order
A DNR order is very specifically defined as refraining from CPR efforts such as chest
compressions ,anti arrythmics medications, or electrical cardioversion in the event of
cardiac arrest.

A DNR order has nothing to do with any other forms of care.You should pretend the
DNR order does not exist while evaluating the use for dialysis.

Hyperkalemia is life threatening. It is illogical to use an inferior therapy such as
kayexalate.

The pt;s family is not relevant in making the decision if the pt has the capacity to
understand his or her own medical problems.

[ArchivalUser]

Thanks Raji!
This definately clears misconception, which is although contradictory to what the practice is.
But, I guess for mle we go by the ideal.

[ArchivalUser]

Hey raji you are GREAT man !!!!

[ArchivalUser]

Great is too much drhope , i did ethic questions few days back, so it is still fresh in my mind..