Eckman_J_ case study.docx - TREATMENT Dilemma Transitioning to Comfort Care STUDENT Worksheet John Peterson 75 years old Overview Death is inevitable

Eckman_J_ case study.docx - TREATMENT Dilemma Transitioning...

This preview shows page 1 - 3 out of 5 pages.

TREATMENT Dilemma Transitioning to Comfort Care STUDENT Worksheet John Peterson, 75 years old Overview Death is inevitable. When it becomes apparent that aggressive medical treatment is no longer a treatment option, it is not uncommon to find that some members of the family cannot accept this grim prognosis, but insist that everything that can be done must be done. How can the nurse support both the patient and a grieving family is the essence of this dilemma. © 2015 Keith Rischer
Image of page 1

Subscribe to view the full document.

Transitioning to Comfort Care Scenario History of Present Problem: John Peterson is a 75-year-old who has a history of ischemic cardiomyopathy with an ejection fraction of 20%, atrial fibrillation, mitral regurgitation and chronic kidney disease. He has been hospitalized three times in the last two months for heart failure exacerbation. He was admitted two weeks ago for SOB and heart failure exacerbation and has been aggressively managed in the ICU with furosemide, dopamine, and dobutamine intravenous drips. His creatinine has risen from 1.8 to 2.7 in the last 24 hours. John is not a surgical candidate to repair his mitral valve that is contributing to his need for hospitalization. John has openly expressed his desire to family members that he wants to stop all treatment and that he just wants to die. The physician changed his code status from full code to DNR-DNI but did not stop all other supportive therapies. When the oldest son, Steve, arrives later that day and finds out that his code status has been changed to DNR-DNI, he becomes angry and insists that it is too soon to give up. He pulls Ruth, the primary nurse aside and tells her, “Nobody asked me about this. I insist that you call the doctor and change this!” Personal/Social History: John has been married for 52 years and has a son and daughter. The family is consistently present in John’s room and at his bedside. His wife and younger daughter are in agreement with John’s desire to have his code status changed to DNR/DNI but are not willing to withdraw medical treatment and support. They feel he is not thinking clearly and may be delirious from his illness so they insist that
Image of page 2
Image of page 3
  • Fall '16

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern

Ask Expert Tutors You can ask 0 bonus questions You can ask 0 questions (0 expire soon) You can ask 0 questions (will expire )
Answers in as fast as 15 minutes