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Dnr Case Study Nursing Care Plan

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Ms. Long has been admitted to a skilled nursing home after four months in the hospital, and has been assigned a public guardian since she is no longer able to make life decisions on her own. The guardian is faced with the problem of deciding whether maintaining/sustaining life-giving care or palliative/hospice care is appropriate for their charge. With the medical team, and a personal assessment, the apparent choice would be palliative or hospice care. Comfort care at this stage becomes the basic concern. The palliative care plan should be the consideration for the do-not-resuscitate (DNR) provision. The guardian should also consider the alternatives of artificial nutrition and hydration, as well as cardiopulmonary resuscitation and the option …show more content…

From USLegal.com: “The term terminally ill in the context of this case study and generally in all health care refers to a person who is suffering from a serious illness and whose life is not expected to go beyond 24 months at the maximum.”
It is important to note that severe dementia is a terminal illness, that is increasing in occurrence. According to the World Health Organization, “ 47.5 million people have dementia and there are 7.7 million new cases every year’’ (WHO media center 2016). Severe dementia is recognized as a leading cause of death in the USA. In a study of 323 nursing home residents, 85.8% developed an eating problem, while 39.1 % experienced pain in the last few months of life. Eating problems are among the most frequent complications suffered by patients with advanced dementia and is associated with the last few months of life. These factors along and her severe diabetes, history of stroke, diminished kidney function indicated that Ms. Long can be considered terminally ill. Distressing symptoms such as pain, pressure ulcers experienced by Ms. Long indicates increased closure to end of

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I spoke with the patient 's wife via phone, The wife states that she needs additional assistance for the patient. She states that she is aware that the patient 's health is declining and that she wants him to be comfortable at home. I discussed hospice services with the patient and the wife. The wife states that she would like hospice to evaluate the patient, the patient also agree for hospice to evaluate. Case reviewed with the patient 's nurse, the charge nurse, case management and hospice.

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This happened on May 24, 1984. This took place in the Fifteenth Judicial Circuit of the State of Florida, West Palm Beach, FL. Issue: This issue was regarding a comatose and fatally ill patient who has completed a written document entitled mercy will and Last Testament, is it required that a court appointed guardian of his person get the approval of a court of capable jurisdiction before ending extraordinary life support systems in order for accepting family members, the hospital staff involved in his care that to be relieved of civil and criminal liability.

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SDLA 4: Activity 1 Palliative care continues to evolve in providing better end-of-life care and so does nursing care. Thus, nursing practice is enhanced to satisfy the demand of the palliative care. A nurse provides complex care and fulfils the needs of the patients. Nursing involves in caring work, which focus on patient experiencing agony in palliative and haematological cancer care. Nurses worked in a taxing environment, that can be highly stressful, and often they experience physical, psychological and spiritual exhaustion.

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An Integrative Review. JAN Journal of Advanced Nursing, 1744. Karlsson, M. B.-F. (2015). A Qualitative Metasynthesis From Nurses’ Perspective When Dealing With Ethical Dilemmas and Ethical Problems in End-of-Life Care. International Journal for Human Caring, 40-48.

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Risk for Infection Next, by implementing the VAP bundle, it did help to prevent further decline. All aspects of the bundle should be continued; the Heparin, sequential compression devices, oral care, Pepcid, and all other bundle activities. Having the head of the bed up was essential to prevent VAP, but it did end up making her body move to the foot of the bed. Pillows were used to help keep her further up and off the side of the bed.

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Mencap (2008) suggest palliative care and end of life care for people that are experiencing non-curable conditions such as Alzheimer. This is a delicate issue to discuss. Staff discussing this issue has to be comfortable to discuss this with John and they have to be some John is used to. This should be discussed in the way John would understand it.

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The study was performed on a group of nuns whom volunteered to physical and mental exams during the remaining years of life. The study proved that a healthy diet, emotions, and strokes all correlate to the amount and severity of symptoms a person will go through during their adulthood. The study did have some disadvantages, such as that the test subjects did not represent the regular population. This made the research only relevant to individuals of similar lifestyles to the nuns.

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One of those comorbidities is dementia. According to Alzheimer’s Association’s alz.org article, Dementia is associated with decline in memory or other thinking skills that causes a person to lose his or her independence in activity of daily living such ability to walk or eat independently. Deterioration of physical and cognitive functions is an unavoidable progression of dementia. Yet the Center for Medicare and Medicaid Services allows an automatic 100 days of Medicare Part A coverage to prolong their beneficiaries’ lives without medical necessity or reasonable benefit in skilled nursing facility

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The American Nurses Association created a revised position statement in 2020 regarding Nursing Care and Do-not-resuscitate (DNR) Decisions. The position statement from the ANA emphasizes the crucial role of nurses in actively engaging in discussions regarding the choice of a DNR code with not only the patients themselves, but also their families and the interprofessional healthcare team members. The statement mentions that care for patients with a DNR order should be no different from care for any other patient. Nurses should respect and advocate for the patient’s preferences and values, promote their well-being, and work to alleviate their suffering. The ANA asserts that “Patients with do-not-resuscitate orders must not be abandoned, nor should these orders lead to any diminishment in quality of care.”

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The best interest need to be used for those resident who lacking mental capacity, according to the Act, for some significant decisions, which requires the contribution of opinions from their family members. For example, when it comes to the end of life care, the main concern for care staff in the home is to ensure resident is pain free and preserve their dignity. So one of the issues to be discussed between care staff and family at that stage of resident’s care is whether to have ‘Do Not Attempt to Resuscitate (DNAR)’ form in place. For those resident who did not have advanced decision regarding the issue or those who lacked the mental capacity to make the decision, their family member will be consulted. A best decision will be made based on resident’s best interest.

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It is nearly impossible for the patient to rely on another person to make the best decision that they would have made for themselves, particularly when it involves personal interests such as profiting from a will. If there is something to gain, the family members’ motives seem questionable. If the patient falls ill, then there lies a possibility that their heirs will hope for the patient’s death so that they could receive their inheritance. The inability to confirm whether the family actually has the patient’s best interest in mind supports the argument that any form of euthanasia is unethical. Moreover, health care costs for terminally ill patients, including nursing homes, prescription drugs, and home health care deserves consideration.

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Hospice and End-of Life – Dispelling the Misnomer While virtually everyone has heard of Hospice care, far fewer people fully understand exactly what hospice does. Of course, a big part of the Hospice mission involves easing the passing of terminally ill people who are facing impending death. For this reason, the general public often confuses a hospice referral with a death sentence. This misperception can cause a lot of problems when it comes to caring for the terminally ill.

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Social workers in the geriatric or end-of-life care field are essential because they are crucial for elderly clients in helping them transition properly to the final stages of their lives. The training that each social worker receives and the resources that they provide are important in helping the clients and their families through the ending stages of life and provide diverse ranges of assistance. Role of The Social Worker in Helping Plan End-Of-Life Care The role of each social worker when helping clients plan for end-of-life care is to address the client and their family’s needs in areas of “counseling, religious and cultural resources, reassurance of patient care, and a plan of care” (McCormick, Curtis, Stowell-Weiss, Toms, & Engelberg,

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While it is known that adequate water and nutrition is needed for survival, many health professionals are currently going through the dilemma of whether it is ethical or not to provide artificial tube feeding for patients with terminal diseases. Family and Consumer Science professionals, such as dietitians, know the benefits and risks associated with artificial nutrition and hydration (ANH) and have the ability to suggest the most ethical decision to this controversial issue. Recent studies have demonstrated that artificial nutrition provides higher risk of medical complications, increases pain, and false hope of health recovery. Over the years, this historical debate has changed the way the community supports or opposes ANH on terminal disease cases, (Brody et al., 2011) however the justice for each patient is different depending on their diagnosis (Best, 2010). To further demonstrate the intensity of this issue, the research of Hartshell and Williams (2010) indicates that this emotional decision is better made by the patient themselves.

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