Reference no: EM133384822
J.P was a staff nurse in the coronary care unit (CCU) of a large medical center. Upon arrival for his shift, he was informed he would be receiving a new admission from the recovery room (RR) soon. The client, a 66-year-old male with a known history of myocardial infarction (MI), and cancer of the prostate. This hospital admission was for a transurethral resection (TUR), which had been stopped in the operating room when the patient developed cardiac changes following spinal anesthesia. The client had been transported to the RR with the diagnosis of possible MI and was being transferred to the CCU for management and evaluation.
J.P went to the RR to pick up the client. When he arrived, the patient was coding. Apparently, he had gone into ventricular tachycardia/ventricular failure (VT/VF) in the RR and had required countershock ×3, CPR, intubation, lidocaine, and vasopressors to maintain his blood pressure. A Swan Ganz catheter was put in place to measure the client's hemodynamic status. Recovery rhythm was sinus bradycardia to sinus tachycardia, with occasional pauses. The patient was acidotic, in pulmonary edema by chest x-ray, showing poor ventilation on a ventilator.
During the events of the code, an attending cardiologist (Dr. Diamond) passed by, observed the code, and informed the RR staff and the CCU resident that he took care of the client during his last hospitalization a month ago and I believe he has an advance directive. While the client was being stabilized, Dr. Diamond called the client's relative, who happened to work in another part of the medical center. The relative also expressed the belief that their relative had an advance directive and did not want to receive extraordinary support measures. Dr. Diamond relayed this information to the other physicians, and there was general agreement that conservative measures to ensure support were indicated while the advance directive was located.
The CCU resident and J.P transported the client to the CCU. When admitted, the patient's systolic blood pressure was in the 70s while on dobutamine, 8 micrograms per kg and dopamine, 26 micrograms per kg. The patient occasionally responded to verbal commands, opened his eyes, gripped J.P's hands, and responded to pain in the upper extremities (his lower extremities were still under the effects of the spinal anesthesia). Cardiac monitoring showed that the patient was still having sinus tachycardia (130), with improvement to oxygenation.
At this point, the CCU resident and an intern approached J.P and informed him that they believed the present treatment of the patient was cruel. In reading the medical record chart, they had learned that the patient had been designated "do not resuscitate" (DNR) on his last admission. In addition, the patient was supposed to have an advance directive, although it was not yet located. They told J.P to slowly turn off the IV drip of dopamine and dobutamine. What should J.P do in this situation?
Questions:
1. What is an advanced directive and why is this an important component in providing patient care?
2. Based on data provided in the scenario, what went wrong in the case of the client? What would you have done differently?
3. Would having an advance directive on the chart have made a difference in planning care for J.P's client? Why or why not?
4. With the information provided, what would you expect J.P. to do next? Why?