The Journal of critical illness
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Consider a do-not-resuscitate (DNR) order when a patient's presumed consent for cardiopulmonary resuscitation (CPR) is in question, the patient has an illness that is terminal or severe and irreversible, or he or she is permanently unconscious or likely to have cardiac or respiratory arrest. The patient with decisional capacity has the right to give or withhold consent for a DNR order. ⋯ Nurses, patient advocates, social workers, and clergy members may help mediate disputes. If necessary, seek advice from an ethics committee on how to resolve the conflict.
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Use the following organized approach to determine whether a patient can be weaned from tracheostomy. Consider airway decannulation only if the original upper airway obstruction has resolved, if mechanical ventilation is no longer needed, and if airway secretions are controlled. ⋯ The tracheostomy button is an ideal weaning device; it maintains the stoma tract and allows the patient to breathe and clear secretions through the upper airway. Monitor the patient for up to 48 hours to ensure tolerance to decannulation.