Discussion: Treating Patients in Specialized Areas of Care

When treating frail elder patients in specialized areas of care, there are various dynamics that might impact patient care plans. From questions about potential outcomes, benefits of treatment, and quality of life to factors such as personal values, families, culture, and religion, decision making can be difficult for patients and their families. As the advanced practice nurse, you must support them through this process.

For this Discussion, you examine the following case studies and consider how you might address the needs of the patients and their families.

Case Study 1

Mr. Wiggins is a 78-year-old African American male with chronic kidney disease, which requires dialysis. The etiology of his renal disease was multifactorial—long-standing uncontrolled HTN and DM nephropathy. He has been on hemodialysis for the past 10 years and has done relatively well. Four weeks ago, he had a major CVA and is minimally responsive. His condition is not expected to change, and the family is having a difficult time with his recent health changes. Advanced directives were discussed with them, and his wife is a durable power of attorney for his health care. The wife hates to see her husband this way and understands this is not how he would want to go on, but their children and many of the family members (his brothers and sisters) think the patient will return to himself. They want everything done in terms of life support measures—full code status. His family wanted a feeding tube placed, and he is now receiving 24-hour tube feedings. You are the NP caring for Mr. Wiggins. You have known and cared for him and his wife for several years. The wife pulls you aside, shares her dilemma, and asks you to make the decision regarding continuing medical care/support for her husband. How will you respond?

To prepare:

• Select one of the three case studies. Reflect on the provided patient information.
• Think about potential outcomes for the patient in the case study you selected.
• Consider how care, treatment, and/or support might be facilitated for the patient. Reflect on how you might also address the needs of the family.

By Day 3

Post an explanation of potential outcomes of the patient in the case study you selected. Then, explain how care, treatment, and/or support may be facilitated for the patient. Include how you might address the needs of the patient’s family as well.

ANSWER

Treating Patients in Specialized Areas of Care

According to the case study, Mr. Wiggin’s condition is at its worst, and the hopes of recovery are minimal. His wife is ready to let go while his children and other family members still want him alive even if he is just on a life support machine. From the wife, he is not the type of man who will enjoy the current state and would not want to be a burden to other family members.

At this point of life, it is always necessary to begin the end of life treatment to patients in such condition. I agree with his wife’s thoughts to initialize the process by helping the family understand its importance. End of life care is a very crucial aspect which should never be avoided in any scenario (Abney et al., 2014). It creates a peaceful environment for both the patient when still alive and the family after their loved one is gone.

Many individuals do not discuss death with their families because of the fear of making them sad, abandonment and others see it as a curse. As a medical practitioner, my services will be to facilitate the discussion between the patient and his family. Creating an environment where they can speak freely about death is always the first concern. The patient gets an opportunity to air out how he needs to be treated in his final stage of life (Brinkman-Stoppelenburg, Rietjens & van der Heide, 2014). On the other hand, families prepare for a proper send-off for their loved ones. A comfortable and peaceful environment is created for the patient enabling him to enjoy his last moments.

Most family members find it difficult to accept that one of their loved ones has no way of recovering and has to die in the long run however much medication is administered (Bollig, Gjengedal & Rosland, 2016). A guiding and educative session is created whose main course is to help them understand the importance of end of life care.  Making an individual realize that medication wasted on an individual whose condition is irreversible can be used to save another person’s life can convince him to accept the situation. During this discussion a conducive environment…