📋 Management of Care · Lesson 3 of 7 · 6 min

Living Wills, Proxies and the DNR That Is Not 'Do Not Treat'

📜 'DNR' does not mean 'do not care'. A client with a DNR order still gets antibiotics, pain control, oxygen and your full attention. The exam tests whether you know what the order actually stops.

💡 Key idea

Advance directives speak only when the client cannot. A DNR stops CPR and nothing else; every other treatment continues unless separately refused.

🧠 Why it matters

A LIVING WILL states what treatments a client wants or refuses if they cannot speak for themselves, such as ventilation or tube feeding. A DURABLE POWER OF ATTORNEY FOR HEALTH CARE (health care proxy) names a person to make decisions when the client cannot. Both take effect only when the client loses decision-making capacity; a client who can still make decisions overrides any document. A DO-NOT-RESUSCITATE order is a provider's order, based on the client's wishes, that withholds CPR in cardiac or respiratory arrest. It does NOT withhold other treatment: comfort care, medications, oxygen, suctioning and surgery can all continue. Nurses ask about advance directives on admission, place copies in the record, and advocate when a family's wishes conflict with a competent client's documented choices.

🏥 In the real world

👨‍👩‍👧 A competent client with a DNR order develops pneumonia. The family says, 'He's DNR, so just keep him comfortable.' The client, alert and clear, asks for antibiotics. The nurse administers the ordered antibiotics. A DNR is not a refusal of treatment, and a capable client's voice beats the family's interpretation of a form.

📌 Takeaways

Living will: what I want; proxy: who decides for me
Directives apply only when the client lacks capacity
DNR withholds CPR only; all other care continues

📖 Terms in this lesson

Advance directive: A document stating a client's treatment wishes or naming a decision-maker for when the client cannot decide.

Do-not-resuscitate order (DNR): A provider's order to withhold CPR in cardiac or respiratory arrest; every other treatment continues.

✅ Test yourself

A client with a DNR order is admitted with a hip fracture. Which statement by a new nurse requires correction?

'We will still manage the pain aggressively.'
'Surgery can proceed if the client consents.'
'If the client's heart stops, we do not start CPR or call a code.'
'We shouldn't bother with antibiotics since the client is DNR.'

Answer: D · 'We shouldn't bother with antibiotics since the client is DNR.'

A DNR applies only to resuscitation in arrest. Antibiotics, surgery and comfort measures are not affected.

An alert, oriented client refuses dialysis. The client's health care proxy insists it be given. Whose decision stands?

The provider's, as the medical expert
The family majority's, since relatives know the client best
The client's; the proxy acts only when the client cannot
The proxy's, because the document was signed and notarized

Answer: C · The client's; the proxy acts only when the client cannot

A proxy has authority only when the client cannot decide. A competent client's own choice controls.

Which document names another person to make health care decisions?

Last will and testament filed with an attorney
Living will stating treatment preferences in advance
DNR order signed by the provider
Durable power of attorney for health care

Answer: D · Durable power of attorney for health care

A durable power of attorney for health care (proxy) appoints a decision-maker; a living will records treatment preferences.

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