Question

A 70-year-old woman has a terminal illness. She decides that she no longer wants life-sustaining measures, including artificial nutrition and hydration.  She is competent, understands the consequences of her actions, is not depressed, and persists in refusing treatment.  Her doctor is adamant that she cannot be allowed to die this way and her daughter, who has the healthcare power of attorney (HPOA), agrees.  The patient is prescribed 4 mg morphine IVP around the clock. (20 points each)

·        Based on the above scenario, who would be the appropriate decision maker and why? Who can the nurse consult to assist the patient and family with this dilemma?

·        According to Kubler-Ross, which stage of grief is this patient experiencing? As the nurse, how can you support the patient and family during this stage?

·        The nurse recognizes that the patient is actively dying. Provide 3 signs of impending death and 1 nursing intervention for each sign

·        After the patient dies, you, as the nurse, have the responsibility to care for the body. Explain how you would perform this task and what step changes if an autopsy is ordered.

Answer 1

Doctors dicision is right.we cannot allow her to die,we have to provide support until her death.

The patient is an acceptance stage,in this stage patient will think like'It s going to be okey.patient will learn to live with it.Inthis stage patient will be calm and stable condition of emotions.

We can support the patient by providing psychological support including emotional and spiritual support.pain management, management of constipation,nausea, shortness of breath,and can support by prayers.

Care and assistance:for all daily acty like bathing ,mouthcare ,dressingfeeding.

Comfort and dignity:may be they feel discomfort and sad ,for avoiding these we can allow the relative to spend time with her,it will provide mental support to her.

Signs of impending death:1)loss of appitite , increased physical weakness,pain.laoured breathing.

Nursing interventions for loss of appetite:provide nutrition by tube feeding,small amount in frequent times.

Increased physical weakness:can provide comfortable position and can chnage the position frequently by avoid pressure and pain,it will provide more comfort to the patient.

Pain:during these stage we have to control the pain and have to provide comfort.for these we can use analgesic or any sedation.

Nausea and vomitting.administer anti emitics and provide mouth care to the patient.

Death care: stiffening of the body that occures about 2_4hrs after the death so we have to pack the body.before that we have to check for any specimen.ask the family about any special requests.remove all lines and tubings from the body ,and if there is any jewellery hand over to the family.clean the body thoroughly,comb the hair,close the eyes and mouth(can provide support )if there is any oosing should keep plaster tovthe site tightly.if there is any dentures it should be removed.absorbent pads can be place under the buttocks.all the orifices should be closed.cover the body with clean white sheet upbto the chin,apply name tag on wrist and chest.allow the relatives to view the dead body.after covering wrap the sheet with body tightly by plaster.after that place the identification outside the wrapper.hand over all belongings to relatives.hand over the body to relatives or send into mortuary.

If there is plan for autopsy there is no need to close the orifices.and can cover the body but should avoid wrapping with plaster.we have to take the consent for autopsy.should place identification band.