Question

Mrs Schmidt is a 65 years old woman who has been staying at an acute care facility for over 30 months now. She has been suffering for several years from chronic obstructive pulmonary disease and was placed on mechanical ventilation last fall. She was initially admitted to your facility for a weaning .Last night ,the physician informed her that she was to leave the acute facility, connected to the mechanical ventilation ,and that no further trials will be initiated. This morning you asked Mrs .Schmidt about her preparations for leaving the facility. In response, Mrs Schmidt starts crying dramatically and asks to see the attending physician. She is extremely upset, stating that “no one told her about this” .She is adamantly asking for an extension of her stay and for another weaning trial. However, she is still has a Foley catheter (a thin, sterile tube inserted into the bladder to drain urine) in place, which she refuses to let go, saying that, she “cannot be without it.”

1. What are the following potential challenges for communicating with Mrs Schmidt?
2. How would you assess for these challenges?

3. What are some following explanations for the communication difficulties described in this vignette?
4. Is there anything that should have been done differently?
5. How would you explain Mrs Schmidt’s miraculous ability to wean?

How would you explain Mrs Schmidt’s refusal to” let go “of the Foley catheter?

Answer 1

Ans 1:- The following potential challenges for communication with Mrs Schmidt :

A) She needs to told thoroughly regarding her current situation.

B) Counseling of Mrs Shmidt is of paramount importance.

C) Physician must prepare her report and then consultation with Mrs Shmidt is must.

Ans 2 :- A) The health team needs to be prepared for any extreme situation.

B) Physician must be called immediately.

C) Mrs Shmidt must be made mentally prepared for any upcoming adverse situation.

Ans 3:- A) Communicating with her is difficult at the moment,due to her current situation.

B) She do not want to leave the acute facility, so according to this scenario she is difficult to handle.

Ans 4 :- Things which are needed to done differently:

A) She needs to be permitted for her stay in hospital care for few days.

B) Mrs Shmidt should be taken with care and patience, seeing her current situation.

Ans 5:- Mrs Shmidt miraculous ability to wean suggests that as in respiratory therapy, there is decrease on dependence on assisted ventilation until the patient is able to breathe spontaneously. So her weaning ability was good.

Ans 6 :- Mrs Shmidt's refusal to let "go of the Foley Catheter" means that she is not good without that, because that is must for her that a sterile tube must be inserted into her bladder for the proper functioning of her Urinary System.