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

Ans1)

Since the patient is already with past history of COPD asthma anxiety and depression so intubating could further add infections and COPD requires controlled level of oxygen supply so I think instead they should have gone to deliver oxygen by venturi mask and see the condition (may be its acute attack of asthma).
As they intubated directly and again weaned off and no other precautions taken for surgery so I think there was no proper plan of care.
Plan of care is important so as to prevent adverse conditions and its easy for other staff for take over in shift changes.

Ans2)

Sincethe patients attendant already signed a DNR may be its the most probable cause for poor coordinations.   

If they had collaborated then the patient could have been treated priority basis by referring to various departments and could have been diagnosed much better for treatment.

Ans3)

Yes, this case must have been brought under ethics committee, since casualties were shown by the physicians. They must have understood the depth of the case and then act with responsibility. Counselling must have been done to discuss about patient's condition prognosis and a plan must have been made accordingly.

This might have saved the patient's life.

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