Professional nurses need to be able to recognize the regulations and scope under which they practice and apply ethical principles in decision making.
Case Study:
As a staff nurse in an intensive care unit you accompany Dr. K to assess the condition of a patient Mr. E currently in the emergency department. The nursing home where Mr. E resides has brought him to the hospital because of lung congestion. The medical notes indicate that Mr. E is a 67-year-old white male with diabetes high blood pressure poor vision and hearing difficulties and is mildly developmentally delayed.
After assessing Mr. E?s condition Dr. K determines that Mr. E has pneumonia secondary to aspiration. Mr. E is dyspneic on exertion and is running a fever of 101o F. He has a blood oxygen saturation level (SpO2) of 88% on room air. Dr. K determines that Mr. E will need to be placed on a ventilator and admitted to the intensive care unit. When Dr. K explains the situation Mr. E shakes his head and says ?Go away! No! No! Take me home.? Knowing that Mr. E is developmentally delayed and hypoxic Dr. K is concerned that Mr. E does not understand the situation.
Dr. K notes that without the ventilator Mr. E will continue to aspirate and likely die. Dr. K asks you to look at Mr. E?s file to determine whether there is anyone else who might have responsibility for Mr. E. The chart indicates that seven years ago Mr. E checked himself into the local nursing home. When he entered the nursing home a patient advocate helped him fill out an advance directive which stated Mr. E?s medical wishes. Mr. E clearly indicated that he did not want a ventilator or cardiopulmonary resuscitation. No family member signed the advance directive and it is unclear if any family members were involved. Mr. E has also filled out a medical power of attorney which states Mr. E wants his younger brother Mr. Y to make medical decisions for him in the event he is no longer able to do so.
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