Question

Mr. Wiggins is a 78-year-old African American male with chronic kidney disease, which requires dialysis. The etiology of his renal disease was multifactorial—long-standing uncontrolled HTN and DM nephropathy. He has been on hemodialysis for the past 10 years and has done relatively well. Four weeks ago, he had a major CVA and is minimally responsive. His condition is not expected to change, and the family is having a difficult time with his recent health changes. Advanced directives were discussed with them, and his wife is a durable power of attorney for his health care. The wife hates to see her husband this way and understands this is not how he would want to go on, but their children and many of the family members (his brothers and sisters) think the patient will return to himself. They want everything done in terms of life support measures—full code status. His family wanted a feeding tube placed, and he is now receiving 24-hour tube feedings. You are the NP caring for Mr. Wiggins. You have known and cared for him and his wife for several years. The wife pulls you aside, shares her dilemma, and asks you to make the decision regarding continuing medical care/support for her husband. How will you respond?

Post an explanation of potential outcomes of the patient in the case study you selected. Then, explain how care, treatment, and/or support may be facilitated for the patient. Include how you might address the needs of the patient’s family as well.

Answer 1

A durable power of attorney for health care designates a person to make health care decisions if and when the client is no longer able to make decisions on his behalf. This patient is appointed to make health care treatment decisions based on the client's wishes. The ethical doctrine of autonomy ensures the client has right to refuse medical treatment. In that cases, the court balance the client's interest with the state's interest in protecting life, preserving medical ethics, preventing suicide, and protecting innocent third parties. Children are generally considered innocent third parties.

As Mr Wiggin's is a 78-year-old, and he is the risk of developing a number of chronic diseases. Particularly, uncontrolled HTN, DM Nephropathy, and a major CVA increase the severity of physiological and mental health function. The power of attorney was empowered in medical decisions. If his wife is in dilemma, The nurse practitioner has the responsibility to discuss the various item with his wife and his family in the decision of comprehensive health care. This includes

• The client activities towards the life.
• The client loss of control towards the health and independence.
• The client overall health status, and the illness.
• Explain his wife and the family members how the client condition becomes worse, treatment options, sustaining of life, and prognosis of his condition with or without treatment.
• Ensure the client wife and family members choices of advanced care directive plan.
• Explain the family members the purpose of the advanced directive care plan.

The Nurse practitioner has to prepare for the advanced directive plan. The Nurse practitioner has to keep in mind about the end-of-life-care decisions, the risks, the benefits, and the cost involved. The advanced directive should include the specific decisions to be made in the client's decisions. The NP should respect and support the family members emotionally. The DNR order should be written consent, but not verbally. The DNR order should be written in the client's chart. It is especially important, the NP should understand the patient's cultural belief when advanced directive has taken care. The NP must aware of the patient's values and goals. As the client is suffering a lot, the advanced directive not only minimizes his suffering but also provide autonomy and control over his death.