Please read theorginial scenario and questions. Then read the response left by t

Please read theorginial scenario and questions. Then read the response left by two classmates. Response to each class mates discussion post with a minimum of 100 words. No sources is necessary. Responses should be thorough and complete thoughts that contribute in a significant manner to the discussion (who, what, when, where, how), not short sentence of agreement or disagreement.
Mr. M is a 66-year old male who was brought into the Emergency Department for heart failure and an exacerbation of chronic obstructive pulmonary disease. Upon arrival, Mr. M. was in respiratory distress and had altered level of consciousness. Mr. M. went into cardiac arrest. Subsequently, he was intubated. He was successfully revived and admitted to the Intensive Care Unit where you are working. Due to COVID, only one visitor is allowed in the ICU per day. The patient’s wife is at the bedside and is upset. Mrs. M explains to you that “my husband would never want this ventilator. He always told me to never let this happen to him. No one notified me he was being intubated and I feel terrible.”
Mr. M is on no sedation and only responds to painful stimuli. The medical provider speaks to Mrs. M and explains that her husband is in critical condition and has a poor prognosis due to his COPD and heart failure. Mrs. M explains that her husband did not want resuscitation or to be placed on a ventilator. The physician attempts to convince Mrs. M to wait and see how her husband responds. The medical provider feels in a few days Mr. M may recover or show signs of improvement.
Mrs. M. comes out to the nurse’s station and speaks to you. She states she feels “sick to her stomach” and could not get the doctor to understand her husband’s wishes. She states that “we often discussed with each other what we would or would not want if something happened. My husband always said he would never want to be on a ventilator. I feel like I have betrayed him.”
Questions that was to be answered:
1. How would you respond to Mrs. M as the nurse in this situation. What might you say to her? What are some strategies to enhance communication?
2. What are your priorities in this scenario?
3. What ethical principles are relevant in this situation?
4. What resources can you use if the medical provider will not listen to Mrs. M?
5. Suppose Mrs. M withdrawals life support on her husband and he is terminally weaned from mechanical ventilation. What action would you take as the nurse? What nursing interventions might you use to support the patient and wife?
Reply to Classmates Reponse: (B.J)
I would provide Mrs. M with a comfortable space to be able to talk freely and express her concerns. The families of patients in ICUs are often very stressed and anxious. Providing them with all information, scenarios, and involving them in the care may help alleviate some of their stress. Another way to assist Mrs. M would be to allow her to stay with the patient and assist with care. I think one of the priorities in this situation would be to confirm that Mr. M did not have a DNI, DNR, or advance directive in place. If not, talking to the spouse about the legal aspects is the next option to take. Mrs. M may need further explanation on how, if there is no advanced directive in place, the medical provider’s duty is then to provide care for the patient. Fidelity is very relevant in this situation. Fidelity has to do with adhering to the patient’s wishes. Patient autonomy is also relevant. Autonomy is having respect for the patient’s wishes. The medical provider does not seem to be practicing autonomy or fidelity in this situation by providing care that the patient may not want nor respecting the spouse’s concerns with wanting to discontinue care. The medical provider should be open to hearing out the wife instead of “pushing” care that he will get better. A bioethics committee would be useful for Mrs. M to consult with. Hospital ethics committees help relinquish ethical challenges that arise by using a comprehensive look at all aspects of the patient and their situation (Hajibabaee, F., et al. 2016). With my patient withdrawing from life support I would ensure that the patient is comfortable and not in any pain. Along with turning off any devices that may sound once the patient is taken off. I would also allow the wife to express any feelings she may be having, and ask if there was someone I could call to provide her with further support.
Reply to Classmate Response: (J.D)
First thing I would do as a nurse is take Mrs. M to an area where we could sit down and talk about the current situation. I would try to calm Mrs. M down so we could talk open and honestly. I would aske her to express her concerns about her husbands condition and care. I would then ask her what her husband would exactly want done in this situation. I would then try to find out if her and her husband had ever put their wishes down in an advanced directive. I would explain to Mrs. M that any type of advanced directive would be able to direct Mr. M’s care toward to direction that he wishes. Advance directives are written, legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself. Advance directives guide choices for doctors and caregivers if you’re terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life (Mayo Clinic, 2020). I would then begin helping Mrs. M with the process of becoming Mr. M’s legal surrogate so she could be able to make his decisions for him. The priorities in this situation are to make sure Mrs. M knows fully about the current situation, to calm her down, support her emotionally, and help provide her with anything that she needs. Helping Mrs. M with Mr. M’s plan of care as her legal dedicated surrogate. Advocacy is an essential ethical principal in this situation. Using veracity would be beneficial in this situation. If the doctor still refuses to follow Mrs. M’s wish you can employee the help of the charge nurse or the unit manager. If the discussion needs to go further then legal actions through the hospital or a personal lawyer can be brought forth. I would prepare Mrs. M for what is about to happen and that when it is time the staff is not going to intervene. I would provide Mrs. M and her family with privacy to spend time with Mr. M. I would provide Mr. M with medications that he would need to pass peacefully with no pain. Providing the family with emotional support and answering any questions that may arise is also part of things that will need to be addressed.

Post navigation

Leave a Reply

Your email address will not be published.