¶ … Life Care Difficult Situations as a Nurse Practitioner

The scenario for the nurse practitioner centers on Angela Smith and her family. Angela is a 55-year-old who suffered a stroke and admitted after neighbors noticed some really odd behaviors. The situation was further complicated when Angela suffered a respiratory arrest and required mechanical ventilation and after a second CT scan the team found that she bleed into the ventricles and brainstem which may have caused irreversible brain damage. Her condition is quite serious and there must be a decision made about how to proceed with the care for Angela. It is likely that she will need long-term ventilation and PEG and the neurological team suspects that the brain damage is irreversible.

The most difficult aspect to this scenario is that there is no advanced directive and the family is being indefensibly optimistic regarding the potential for recovery. In fact, the patient's family, her two daughters, have stated that they believe that God will provide a miracle cure and that their mother would somehow beat the odds with divine intervention. While it may be good to have a sense of optimism through a difficult period, it is also necessary to temper these impulses with objectivity. Furthermore, as a nurse practitioner, it is critical to provide the family with an objective interpretation of the patient's situation and have a conversation about the best way for the family to proceed under such trying circumstances. This analysis will identify some of the themes that a nurse practitioner will want to address in their conversations with the family and try to guide them towards a consensus about treatment goals and their options.

End of Life Care

This case deals with one of the most important aspects to nursing. End-of-life care encompasses a broad and sensitive...

Generally, the family will be emotional throughout this transition and great care must be taken to comfort them in the grieving process. Yet it is equally important to be truthful and honest about the challenges that lie ahead for them. Mechanical ventilation and PEG has advantage of giving the patient more time to live when determining the likelihood of the patient's condition improving. However, the patient's odds for improvement are extremely low and by needlessly waiting she will suffer significantly. If there is not hope, prolonging the inevitable will lead to more pain for the patient.
Advanced directives are a set of requests that the patient has made beforehand in the event that they cannot speak for themselves. Nurses can use advanced directives to guide the treatment plan for the patient based on their plan that they have previously created before they lost the mental capacity to do so. Having set of advanced directives is the ideal means of deciding treatment options in such situations. Without advanced directives, it can complicate the situations because of the emotional factors that nurses must consider but also there are many legal considerations to be made.

Once the diagnosis of the terminal condition is made, the family can create a palliative and end-of-life plan that can guide the treatment plan that the team will use during the patient's last phase of life. Patients who are terminal should have the ability to die with dignity during the final stage of their life and sometimes families can strip their loved one's of this right based on emotional factors. The palliative care plan is a compressive plan that may include spiritual care, social workers, hospice care, and many other parties to address the patient's fears, provide support, and…