A client who has an advance directive designating 'no heroic measures' is admitted through the ED in cardiac arrest. What should the healthcare team do?

ADVANCE DIRECTIVES AND EMERGENCY RESUSCITATION create a complex situation when a client arrives in extremis and the advance directive is not immediately available as a formal medical order. KEY PRINCIPLES: AN ADVANCE DIRECTIVE is a legal document expressing the patient's wishes, but it must be CONVERTED INTO A PHYSICIAN'S ORDER (DNR/DNI order, POLST/MOLST form) to be immediately enforceable in an emergency. A living will in the patient's wallet is not the same as an active DNR order in the chart. IN THE ABSENCE OF A CURRENT MEDICAL ORDER: Standard protocol is to BEGIN RESUSCITATION while simultaneously: verifying the advance directive exists; locating the document; contacting the designated healthcare proxy; the attending physician reviews and makes a decision. WHY NOT AUTOMATICALLY WITHHOLD: (1) The document may be outdated, revoked, or misapplied; (2) 'No heroic measures' is ambiguous — the physician must interpret what it means for this specific situation; (3) Families may have critical information; (4) The legal standard in most states requires a CURRENT physician's order to withhold CPR — not just the presence of an advance directive. POLST (Physician Orders for Life-Sustaining Treatment): POLST/MOLST forms are physician orders that are transportable between settings — these DO have immediate force. A POLST in the chart stating 'DNR' is immediately actionable. NURSE'S ROLE: Know your facility's policy; retrieve any existing orders rapidly; notify the physician immediately; document all actions; communicate respectfully with family.