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A.J., an 82-year-old female, was admitted three weeks ago with acute on chronic congestive heart failure (CHF) after presenting to the emergency department (ED) with c/o progressive worsening SOB, leg edema, and fatigue. She has a history of severe CHF, atrial fibrillation, myocardial infarction (MI), renal insufficiency, and hypothyroidism. Since admission, A.J. has needed intubation and ventilation for acute decompensated heart failure due to a massive MI. She is alert when not sedated but has been too unstable for a cardiac catheterization and has needed vasoactive medications to support her blood pressure. Her renal function has declined and plans are being made for hemodialysis. Today when speaking with A.J.'s husband, he conveys to you her nurse that "she would not have wanted all of this." "
Discuss the pros and cons of continued therapy and what role nursing can play in helping the patient and family.
This case deals with one of the most important aspects to nursing. End-of-life care encompasses a broad and sensitive aspect of the nursing practice in which the nurse must deal with death and the dying process. Generally the family will be emotional throughout this transition and great care must be taken to comfort them in the grieving process. However, great care must also be taken to be truthful and honest...
Continued therapy has the advantage of giving the patient more time to live. However, the con is that the quality of life of the patient will be extremely low and she will suffer significantly. Prolonging the inevitable will lead to more pain for the patient.
2. What are the considerations that must be discussed before responding to the husband's request to stop aggressive treatment?
There are not only emotional factors that nurses must consider but there are also many legal considerations. For example, it will be relevant whether there was an individual who was legally appointed as the patient's representative through this process. This individual would be able to make a final decision rather than just a recommendation.
3. What are advance directives and what are the implications for nursing care?
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 type and quantity provided to the patient based on requests that they have previously created.
4. What resources should be considered for this patient and family?
The end-of-life can be a traumatic time for the patient and their family and…
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