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.
