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A.J., an 82 year-old female, was admitted three weeks ago with acute on chronic congestive heart failure (CHF) after presenting to the emergency department (ED) with c/o progressive worsening SOB, leg edema, and fatigue. She has a history of severe CHF, atrial fibrillation, myocardial infarction (MI), renal insufficiency, and hypothyroidism. Since admission, A.J. has needed intubation and ventilation for acute decompensated heart failure due to a massive MI. She is alert when not sedated but has been too unstable for a cardiac catheterization and has needed vasoactive medications to support her blood pressure. Her renal function has declined and plans are being made for hemodialysis. Today when speaking with A.J.s husband, he conveys to you her nurse that she would not have wanted all of this.
1. Discuss the pros and cons of continued therapy and what role nursing can play in helping the patient and family.
2. What are the considerations that must be discussed before responding to the husbands request to stop aggressive treatment?
3. What are advance directives and what are the implications for nursing care?
4. What resources should be considered for this patient and family?
5. Following a palliative care model rewrite this scenario to reflect the philosophy and goals of palliation.
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