Question

Mr. Diaz is a 68-year-old man with basal cell cancer is admitted for evaluation and treatment of a fever. He has been DNR for the last six months. After the chest X-ray, urinalysis, and blood culture are done he still has a fever of unknown etiology. When you ask the resident why he hasn't done more tests, the response is, "Well, we will get to it, but there isn't much of a rush, after all, the patient is DNR." What do you tell them?

A. Conduct further tests to determine the cause of the fever
B. Respect the patient's DNR status and provide comfort care
C. Seek the family's opinion on further testing
D. Consult the hospital's ethics committee for guidance

Answer 1

Mr. Diaz's DNR status does not affect the need for medical care regarding his fever; further tests should be conducted to identify its cause and provide appropriate treatment.

Step-by-step explanation:

The situation presents a scenario where Mr. Diaz's DNR status is being conflated with the urgency of care for his current medical issue. The fact that a patient has a DNR order does not mean that they should not receive prompt and thorough medical care for unrelated health issues. A DNR (do not resuscitate) order indicates that no resuscitative efforts should be made in the event of cardiac or respiratory arrest, but it does not apply to other medical treatments.

In this case, it is important to communicate to the resident that Mr. Diaz's DNR status does not affect the need for diagnostic work to determine the cause of his fever. It is necessary to conduct further tests to identify the etiology of the fever, and treatment should be administered as per the findings to address Mr. Diaz's current health issue. Providing comfort care is also important; however, it should not preclude diagnostic efforts. Consulting the family may be necessary if questions arise about the extent of care, but the primary focus should remain on Mr. Diaz's expressed wishes and clinical needs. If ethical concerns continue, then consulting the hospital's ethics committee could be an appropriate step.