Question

A 45-year-old female was brought to the Emergency Department by ambulance at 8 AM. Upon awakening, the patient's husband noticed she had an unsteady gait and her speech was slurred. When they went to bed the night before, at 11 PM, the patient had no deficits. A head CT was negative for abnormalities. The patient’s condition continued to deteriorate, and she required intubation and mechanical ventilation. TPA was not administered. The patient was admitted to the Intensive Care Unit for a diagnosis of ischemic stroke. On day three, the patient stabilized enough to be extubated and removed from the ventilator. However, she was responsive only to painful stimuli. On day five, the physician ordered a surgical consult for insertion of a feeding tube and to begin tube feedings. The husband is distraught and confused, stating he does not think his wife would want to live like this. On day seven, the Nurse Manager arranges a family meeting with the husband, the patient’s parents, the physician, the case manager and the primary nurse to discuss the patient’s situation and to develop a plan of care in accordance with her wishes. Neither the husband nor the parents ever remember having a conversation about the patient’s wishes regarding artificial nutrition and hydration. The husband and the parents have opposing views regarding what they think would be the patient’s wishes. As the primary nurse, you developed a trusting and therapeutic relationship with the family. You are asked to participate in the conversation to help educate the patient about options.

• Did the patient receive treatment in accordance with best practices for stroke care? Why or why not? (In your response, include identifying best practices.)
• Describe the role of the nurse in advocating for the patient’s rights and needs.
• Identify legal, financial, and ethical perspectives of your stance.

Answer 1

The patient didn't receive treatment in accordance to the nest practice of stroke care

• Because in ischemic stroke the first line of treatment is to administer or initiate anticoagulant therapy(TPA) to ensure adequate blood supply to the brain and prevent further ischemia
• proper cardiac monitoring and care is missing as this condition can greatly affect the function of this system
• Physical therapy has to be initiated to restore gait abnormalities
• Neurosurgeon consultation to get decision regarding endarterectomy to improve patient condition is not done
• Stroke rehabilitation is missing here

The reason for not doing this is because of no progress or poor prognosis in the patient condition

The roles of the nurse are

• To educate about the patient condition and prognosis in earlier to avoid any legal consequences to doing procedure
• To inform the husband and family members regarding the cost of current and future care which can be necessary for the patient
• The ethical stance here is to whether fulfill the wish  of the patient or be responsible to the decision of the parents to have life supporting method to survive their daughter .