A patient with end-stage renal disease states, 'If my heart or breathing stops, I do not want to be resuscitated.' Which action should the nurse take first?

• A. Place a Do Not Resuscitate notation in the patient’s care plan.
• B. Invite the patient to add a notarized advance directive in the health record.
• C. Advise the patient to designate a person to make future health care decisions.
• D. Ask if the decision has been discussed with the patient's health care provider.

Answer: (D)

The essential step is to confirm whether this resuscitation preference has been discussed with the health care provider. A nurse respects the patient’s wishes best when there is clear medical input and a formal plan in the chart. If the provider has already discussed prognosis and options, a physician order will typically be needed to document the code status (such as a DNR) and to implement it. If the discussion hasn’t happened, the nurse should facilitate or initiate that conversation with the patient and the provider to clarify goals of care, prognosis, and feasible options.

Any action to place a DNR note or to create an advance directive should follow after that discussion and appropriate documentation by the clinician. Noting a DNR or designating a surrogate or obtaining a notarized directive are important steps, but they rely on first having an actual discussion with the health care provider and having an official order or directive in the medical record.