|"What does DNR/DNI mean?"|
|DNR/DNI stands for Do Not Recussitate/Do Not Intubate and is a specific physician order. Put more simply, Do Not Recussitate means that in the event of cardiac arrest no CPR or electric shock will be performed to re-start the heart and Do Not Intubate means that no breathing tube will be placed in the throat in the event of breathing difficulty or respiratory arrest. Each of these orders may be given separately, that is, your loved one may be have a DNR order but not a DNI order, or vice versa. Usually, they are ordered together.
Please understand that these orders do not mean that the staff will stop all treatment. All medical and nursing care will be given up to the point of cardiac or respiratory arrest. This means that your loved one will still be given medications, food (if appropriate), and other comfort measures as needed. Your loved one's illness will still be treated as a priority.
Before ordering DNR/DNI the nurses and physicians will discuss the situation with you. As hard as it might be to accept, it is possible that your loved one's situation is not reversible or that continued treatment will only cause more discomfort and prolong the dying process. None of us likes the idea of death, nor do we want loved ones to die. Unfortunately, death is the natural conclusion to life. Consider carefully what the doctors and nurses are saying to you. In the end, the final decision to give a DNR/DNI order is up to you. Also be aware that your decision can be reversed any time you feel it is necessary to do so.
If you have any question about your loved one's prognosis, ask the nurses caring for him or her. Ask directly, as, "Do you think he or she has a resonable chance for recovery," or, "Have you seen patients in this condition recover before?" The nurses are very likely to give you a realistic picture. Be ready for the fact that the prognosis might change in a matter of days or even hours.
Another thing to consider before deciding on a DNR/DNI order is quality of life versus quantity (length) of life. While you may wish that your loved one could live forever, or at least outlive you, ask the nurses and consider how pleasant life will be for him if he survives. Will he have brain damage so severe that he has to live in a nursing home and not recognize any family? Is he going to have to live on a ventillator or have dialysis for the rest of his life? Both are procedures that may cause a great deal of pain or discomfort in the long run. Ask yourself honestly if living is the best option for your loved one, or if the better choice is a quiet, painless death leaving you and your family with loving memories of a full life.
Yet another, perhaps crass, consideration is financial burden. Be aware that only about 15 percent of patients who have a cardiac arrest live to be discharged from the hospital and only a small percentage of those return home -- most end up in nursing homes. While it may be unpleasant to think about, the enormous cost of post-CPR hospitalization and nursing homes usually places a huge financial burden on families that are already hurting from their loved one's pain. Ask yourself if your family member would want you to spend that money keeping them alive in a state that might not be pleasant.
Finally, be aware that unless you have medical power of attorney over your loved one's care, he or she may choose to have a DNR/DNI order against your wishes. It is our duty as nurses and physicians to follow the patient's wishes to the exclusion of opinions from family members. If this upsets you, please consider how you would feel if your family undermined your wishes for medical care against your will.
One request that is frequently made is to give emergency medications that may help the heart, but not to have chest compressions performed. This is often requested because it is believed that the chest compressions would be painful. Please understand that the purpose of chest compressions is to circulate the blood and any medications that may be given. Simply giving emergency medications without chest compressions will not allow the medications to reach their important destinations, and therefore will do no good. For emergency medications to be effective, chest compressions must be performed. You may still request that we do not perform chest compressions, but be aware that this will not help your loved one at all.
This is a very difficult decision to contemplate. If you have further questions, ask your nurse.
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