Symptoms And Treatment Of Intravenous Antibiotics And Fluids Were Started

Symptoms And Treatment Of Intravenous Antibiotics And Fluids Were Started

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Recently, a frail, elderly woman was admitted to the medical unit with a diagnosis of aspiration pneumonia. This would be her third hospitalization in a short period of time for the same diagnosis. A mild stroke several years ago left her with swallowing issues. She was not in good underlying health with a number of comorbidities. She required additional care at home and her closest relatives were adult children who lived in another state. Widowed for several years; she was lonely and had survived many of her longtime friends. She was quite ill when she arrived on the unit with an elevated white count and abnormal blood gases. She required a large facial mask to deliver oxygen via BiPAP. She was assessed to be oriented to person, place and time on admission. At that time it was also determined her code status to be a “Full Code”. Intravenous antibiotics and fluids were started. With her underlying Congestive Heart Failure (CHF) it was evident she would need to be monitored closely for fluid overload. Given her age, diagnoses and lack of improvement the physician asked to meet with the patient and family at the bedside to discuss the situation, the patient’s wishes and the course of action. The patient’s daughter confirmed that the patient was to continue as a “Full Code” and asked that everything be done knowing if her mother’s condition should deteriorate she would likely be transferred to the Intensive Care Unit and placed on a ventilator. The patient wearing her mask “nodded in agreement”.
The patient survived the night and stabilized slightly although, little improvement was evident. At the bedside the patient expressed to the nurse that she did not like all the lines and contraptions attached to her and that s...


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...he story above is not uncommon in our profession and offers up many ethical questions. The ANA code of ethics “is the definitive framework for ethical and decision making for RN’s across all practice levels, roles and settings” (ANA Code of Ethics, 2016). The nurse in the scenario above is driven by provisions one through four in the code which addresses respect and dignity for the patient, a primary commitment to the patient’s interests when there is not an agreement with clinicians or family, advocacy for the patient and an obligation to provide the best possible care. (ANA Code of Ethics, 2016). Clearly the RN is struggling with how to meet the needs of the patient and family and yet meet her obligations within the code of ethics and possibly her own belief system. The patient is dealing with her own battle between her own wishes and those of her daughters.

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