Reference no: EM133309358

Topic: Joleen Wright, an 87-year-old woman, living in a nursing home, had been pleasantly convivial and moderately demented for some time. No family or friends were known. It was tough to discern her preferences, as she lived in the present and did not trouble herself about future possibilities. She had chronic hypertension and hearing and motion deficits. Over a few weeks, she gradually started doing poorly, walking less, eating less, and seeming more distant. Over the next two weeks, a comprehensive evaluation in her nursing home setting turned up very little. Blood tests, physical exams, and chest x-rays were all normal, but she then became short of breath and was hospitalized. By the time she arrived at the emergency room, her blood pressure had declined to dangerous levels. She had mild problems with oxygenation, probably due to pulmonary edema, and was started monitoring and careful fluid balance. Within 24 hours, she had multiple interventions (e.g., IV, cardiac monitor, urine catheter) for monitoring and treatment and was restrained in bed to keep the connections in place. Her skin was breaking down on her shoulder blades. She indicated yes or no to questions about her comfort but showed little insight or attention. No definite reversible diagnoses surfaced despite appropriate work-up. Her condition worsened, and she faced the need for mechanical ventilation. The care team anguished over whether to continue intrusive care in the intensive care unit to establish a precise diagnosis or shift toward a primarily palliative approach. Her condition continued to deteriorate, and she became minimally responsive. After a team meeting, the care team decided to institute hospice-type care and not seek a court's involvement in getting a guardian. Joleen Wright died comfortably 36 hours later. Because no consent to autopsy could be obtained, the diagnosis remained a mystery. Initial Post Requirements .

Question 1: Should age be a deciding factor in the provision of care? Why or why not? .

Question 2: Should we allow people to die from aging without knowledge of a primary terminal disease process? .

Question 3: What care would you want if this were you? How do your personal values influence your preferences? .

Question 4: What role could a nurse play in addressing the ethical issues in this case? Each member of the group will discuss this case, respond to the questions, and participate in the initial post.