The ambulance was called for a 69 year old female in a nursing home who was havi

Question

The ambulance was called for a 69 year old female in a nursing home who was having difficulty breathing. She has a medical history that includes advanced ovarian cancer, COPD, asthma, anxiety disorder and depression, and severe abdominal and back pain. She was admitted into the hospital and medical records were available for her. Following procedure, it was decided that she should be intubated. Soon she was able to be weaned off the respirator and then moved to the medical floor. Though she was suffering from abdominal and back pain, she was unable to withstand surgery due to her current condition. To treat other conditions she was prescribed Neurontin and Xanax and since she could breathe on her own she was sent back to the nursing home. 24 hours later she was back at the hospital suffering from emesis and nausea along with back and abdominal pain. She was treated with Dilaudid and Darvocet and the oncologist came to see her. Within a few hours she was comfortable. During her first admission at the hospital her family asked for only comfort care and a DNR was signed. The patient gets a grave prognosis as she declines. Her breathing is getting shallow as she is dying. At this time the attending physician has chosen to discontinue giving morphine. The patient stops responding and this causes the family to panic and they want to rescind the DNR. Due to this, the patient is sent to the ICU after intubation. There is nothing listed on the chart that shows anyone realizes that the patient in now in the dying process. After being seen by 15 physicians and suffering various conditions and treatment, on the 51st day of her stay, the family signed a DNR again and she died the next day in ICU. Using critical thought, research and respond to the question below with a minimum of 3-5 sentences.

1. How should have this case been handled? Do you see that there was a plan of care for this patient? Why is a plan of care important?

2. Why did the physicians not coordinate better on this case and how would the care be different if they collaborated on this?

3. Should this case have been brought before the ethics committee? Why or why not? How could it have changed the outcome?

Explanation / Answer

Patient history

1. 69 year old

2. COPD disease

3. Ovarian cancer

4. Anxiety

5. Depression

6. Back pain

1. As you see this case is very critical because she suffered from majority of lethal diseases and in this condition it is very hard to save this lady. Various factors are responsible for this and without a proper planning treatment of this lady is not possible. In your paragraph i didn't find any plan for this patient but it require because she suffered from major diseases like cancer and asthma. Plan is necessary because here we are dealing with the bunch of diseases , so we require one team here for proper care of patient like oncologist, COPD expert and pharmacist with senior nurses. She is old so we have preplan that which medicine should be given and which is not because in old age patient non compliance is more.

2. Physician not cooperated here because they are in state of what to do or what not to be because she is not responding to any treatment. When she got admission in hospital a proper coordination require to treat her with immediate effect like present and future plan for her and if she become serious then what to be done in emergency cases. Then 1st they treat breathing problem here with analgesic treatment because of pain. If she admitted in ICU later on then treatment with oncologist require.

3. I think this case should be brought to the ethical committee because if you see the patient history , this is not a one day disease may from few month or year she suffered from these disease and doctors don't worry about it . If they worry then they have pan that what to be done in this case . Outcome is in such away that at the next level they don't play with anyone life if such cases are come and it built extra Heath care in hospital.

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