case study

Scenario #1: A 49-year-old woman with advanced stage cancer has been admitted to the

emergency room with cardiac arrest. Her husband and one of her children accompanied the

ambulance.

As a primarily ER and ICU nurse, this is a familiar scene. When dealing with the dying

patient, the last part of their healthcare can be difficult for the family as well as the provider. In

this scenario a terminally ill patient arrives in the ED in active cardiac arrest, with family at

bedside. Having the patient’s family, primarily the husband, available allows the medical

professional the ability to assess the patient’s wishes for end of life care. It is our responsibility to

assist the family in this decision (Taylor & Johnson, 2011).

Some questions that should be addressed to the husband: Does your wife have a DNR (do not

resuscitate) order? What events leadup to the patient’s current condition? Who found the patient

unresponsive, if alone, and what time did this occur? When was the last time you saw your wife

responsive and tell me about today? Was there anything unusual or had she had any new

complaints? What type of cancer was she diagnosed with? Does the patient have a DNR or living

will? Do you want to continue CPR? Would you like for our spiritual team to accompany you in

ER?

Health assessment questions: Does the patient have a pulse? What is the EKG Rhythm? What

treatments were given in the ambulance? Does the patient have any signs of trauma? What is the

patient’s GCS? Vitals? Continue ACLS protocol if patient is in cardiac arrest.

These types of emergencies can be less stressful but if handled correctly by ER staff and

providers, can be much less traumatic for the family. As a provider it is our duty to provide the

patient’s family with needed information on treatments available for the patient. Having a strong

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knowledge on how to handle these palliative emergencies can help maintain proper end-of-life

care (Buckley, 2008).

As providers, we should be mentally prepared for the family’s decision and response.

Health care professionals have an ethical responsibility to the wishes of the husband and wife.

Patient’s with a defined advanced directive or living will, may have already addressed these

issues and made decisions regarding their end of life care. If no DNR or advanced directive is

available, ethical considerations must be maintained to honor the wishes of the family (Peicius et

al., 2017).

The first and most important peice of information needed is finding out the patient’s and

families wishes. Was the patient hospice? Or is there a DNR? Having this type of information

will make the decision much easier on the family and provider during this situation. The second

thing is providing information to the family regarding patient’s outcome and possible decisions

to be made if the patient does regain a pulse. Keeping the family updated and involved in

decision making is vital.

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References

Buckley, J. (2008). Palliative Care: An Integrated Approach. Chichester, U.K.: Wiley. Retrieved

from https://ezp.waldenulibrary.org/

Peicius, E., Blazeviciene, A., & Kaminskas, R. (2017). Are advance directives helpful for good

end of life decision making: a cross sectional survey of health professionals. BMC

Medical Ethics, 18(1), 40.

Taylor, P. M., & Johnson, M. (2011). Recognizing dying in terminal illness. British Journal of

Hospital Medicine (London, England: 2005), 72(8)

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NURS 6512: Advanced Health Assessment and Diagnostic Reasoning

Stephanie Nastasi

Week 11: Scenario 2

“A 49-year-old woman with advanced-stage cancer has been admitted to the emergency

room with cardiac arrest. Her husband and one of her children accompanied the

ambulance.”

This is a common occurrence as a fourteen-year oncology nurse. The final aspect of their

medical treatment will be rough on both the family and the practitioner when faced with the

dying patient. In this case, an active cardiac arrest of a terminally ill cancer patient arrives in the

emergency department. With the family present, along with medical professionals, together, they

can determine the patient’s need for end-of-life treatment. It is up to everyone to support the

family and the patient in this decision performed (Rosetti, Rabinstein & Oddo, 2016).

This reflects the legal issue of whether or not and who decides whether to continue or end

CPR. We ought to be advocates for the patient as healthcare professionals. In this case, the

patient’s previous records will be reviewed to get a better understanding of the patient’s health

history. Additionally, medical advance directives must be identified and examined to see if the

patient has any instructions for a DNR (Nelson, 2017). Everyone must conform to what the

patient’s wishes are. It is ultimately up to the patient on how they live and what treatment they

wish to choose to obtain. If no advanced directives are located or of none have been made, the

decision to stop CPR would be left to the family. When explaining to family members about

CPR, the consequences of the discussion are a difficult topic. There are numerous reactions and a

lack of knowledge about what occurs during and after CPR (Nelson, 2017). The family needs to

understand fully how and when to consent to stop CPR to make an informed decision. This is the

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practitioner’s responsibility to educate the family with this knowledge to ensure that everyone

understands what it involves to stop CPR.

End of life conversation should, therefore, be charted in the patient’s chart to make it

known that proper planning and communication with the families had taken place before any

decision had been reached (Johnson, 2016). After the family has commenced, CPR will then

proceed or cease, and proper treatment will then be administered for the patient and the family.

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References

Johnson, L. S. M. (2016). The Case for Reasonable Accommodation of Conscientious Objections

to Declarations of Brain Death. Journal Of Bioethical Inquiry, 13(1), 105–115.

https://doi-org.ezp.waldenulibrary.org/10.1007/s11673-015-9683-z

Nelson, A. (2017). Determining Brain Death: Basic Approach and Controversial

Issues. American Journal of Critical Care, 26(6), 496–500. https://doi-

org.ezp.waldenulibrary.org/10.4037/ajcc2017540

Rossetti, A. O., Rabinstein, A. A., & Oddo, M. (2016). Neurological prognostication of outcome

in patients in coma after cardiac arrest. The Lancet. Neurology, 15(6), 597–609.

https://doi-org.ezp.waldenulibrary.org/10.1016/S1474-4422(16)00015-6

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Week 11 Case Study: my selected patient

A 49-year-old woman with advanced stage cancer has been admitted to the emergency room with cardiac arrest. Her husband and one of her children accompanied the ambulance.

Write a one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient, include the scenario number. Do not exceed 3 pages. If you exceed 4 pages, points will be deducted. Explain how would respond to the scenario as an Advanced Practice Nurse using evidence-based practice guidelines and applying ethical considerations. Justify your resAssignment 1: Lab Assignment: Ethical Concerns

As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?

In this Lab Assignment, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.

To Prepare

Review the scenarios provided by your instructor for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your scenarios.

Based on the scenarios provided:

Select one scenario and reflect on the material presented throughout this course.

What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?

Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.

The Lab Assignment

Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature.