An 83-year-old Caucasian male with a history of advanced colon carcinoma with metastasis to the lungs develops right-sided hemiplegia and dysarthria while at home. His granddaughter calls you at 8:00 p.m., giving you a history compatible with a cerebrovascular event, probably an ischemic stroke. You know this patient from before. He is not a hospice patient, and he has always firmly expressed his decision to not be resuscitated. He has a current, valid DNR (do not resuscitate) order. Which of the following is the most appropriate next step in the management of this patient?

Question

An 83-year-old Caucasian male with a history of advanced colon carcinoma with metastasis to the lungs develops right-sided hemiplegia and dysarthria while at home.  His granddaughter calls you at 8:00 p.m., giving you a history compatible with a cerebrovascular event, probably an ischemic stroke.  You know this patient from before.  He is not a hospice patient, and he has always firmly expressed his decision to not be resuscitated.  He has a current, valid DNR (do not resuscitate) order.  Which of the following is the most appropriate next step in the management of this patient?

Quizplus · Accepted Answer

Explanation: A stroke is a serious condition that requires admission to the hospital for evaluation, stabilization, and brain imaging studies. A DNR order implies the commitment of the physician to not attempt resuscitation if the patient's condition seriously deteriorates (e.g. cardiac or respiratory arrest), and does not imply "do not treat." (Choices C & D)Management at home or arranging for hospice is incorrect. The patient deserves to be treated for his concurrent or new conditions according to standard practice. (Choice A)Pain medication may be needed, but it is not an urgent measure to take, especially if the chief complaint of the patient does not involve pain at this point. Educational Objective: A DNR order implies "Do Not Resuscitate." It does not mean, "Do not treat." If the cancer patient is clinically competent and does not wish to be admitted to the hospital, he has the right to decide to stay home. Otherwise, he deserves to be treated for his concurrent or new conditions according to standard practice.

An 83-Year-Old Caucasian Male with a History of Advanced Colon