Advanced Directive and DNR Status Confirmation for Certified Perioperative Nurse (CNOR)
Included In This Lesson
Outline
Advanced Directive and DNR Status Confirmation
Guidelines:
- Specific desires of the patient regarding care
- Can be completed by family if patient incompetent
- If family, allows for conversations intraop
- Often suspended or modified for surgery
- Get details!
Considerations:
- Suspension of DNI, but what if they can’t wean post-operatively
- Ethical committee present in most hospitals
- If patient competent, usually assign a decision maker for details not included in the advanced directive.
- Anticipate that every surgery could become long term intubation
- Capabilities of code in OR are near limitless, ensure patients understand their decisions with provider
Nurse’s Role:
- Patient interview to verify wishes and presence of advanced directive
- Maintain contact information with decision maker or family
- Often call immediately before or after rolling to establish contact
- Waiting until after intubation to realize you don’t have advanced directive is far too late
- Often call immediately before or after rolling to establish contact
- Patient advocacy
- Elevate concerns as warranted
- Ethical committee, chaplain,tumor board
Pitfalls:
- Suspension of DNR/DNI not clear
- Reversible causes in OR not clarified
- Snowballs over time in ICU
- Nurse turnover
- Physical copy!
- Family definition of“resuscitate”
Examples:
- Patient undergoing epigastric hernia repair has altered rhythm on monitor, with wishes of DNR/DNI (control slowly, consider causes, consider abandoning case for further decisions, cards consult)
- 22F in pre-op for chole has never considered advanced directives or end of life possibilities (physician discussion of risks of surgery, decision maker consideration, anticipate pain may alter competence)
Linchpins (Key Points):
- You cannot speak to your patient under anesthesia, so must understand their plan before induction and advocate accordingly
Transcript
References
- Association of periOperative Registered Nurses. (2022). Guidelines for Perioperative Practice (2022 ed.).
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System