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Medical-Surgical Nursing

What Should the Nurse Do?

Medical-Surgical NursingWhat Should the Nurse Do?

What Should the Nurse Do?

1 .

Charles, an 80-year-old patient with congestive heart failure, has been a home care patient for six months; during this time, a personal care assistant has helped Charles with bathing, dressing, and grooming. This care enables Charles to live at home independently. However, several months ago Charles had a stroke, and he still has not regained use of his dominant right hand and arm. Recently, he has been experiencing severe pain in his right arm and shoulder, as well as decreased endurance and shortness of breath. The provider has informed Charles that his pain will likely not improve and in fact might worsen due to the decreased mobility in his right arm and hand. Notwithstanding his recent decline, Charles still believes that he has several good years left and looks forward to seeing his grandson graduate from college.

What type of care would be most appropriate for Charles’s nurse to recommend at this time? Where would this care be provided?

Chris, a palliative care patient, has recently had a second stroke, leaving him unable to walk. He has not recovered the use of his right arm and hand from his first stroke last year. Chris’s congestive heart failure has worsened, resulting in a significant decline with a poor prognosis. Chris has a documented ejection fracture of less than 20%, is symptomatic at rest, and has uncontrolled edema that has resulted in a total inability to complete his ADLs independently. Due to his significant decline, Chris will be discharged to a long-term care facility.
2 .
With Chris’s decline and poor prognosis related to his congestive heart failure, what type of care would be most appropriate for him at this time?
3 .
Due to Chris’s present health status, what types of legal documents should his nurse suggest Chris complete to ensure that his health-care directives are followed?
4 .
At this juncture in Chris’s care, while discussing his end-of-life care and directives, what is another very important item that Chris needs to decide?
Charles has been in a nursing home for a few months following two strokes and worsening congestive heart failure that have significantly impaired his mobility. Now, he is unresponsive and can no longer communicate his wishes. The family has been informed that medical tests, physical therapy, and vital signs monitoring will be stopped as they are no longer providing a benefit to Charles’s comfort or health status. Most recently, Charles has developed pneumonia. His family is asking about having him admitted to the hospital.
5 .
What is the best response for the nurse to provide to his family?
6 .
The family asks the nurse when Charles will die. How should the nurse respond?
7 .
Mimi was diagnosed with pneumonia a few days ago. Her family has been vigilant since her recent diagnosis, visiting frequently and ensuring that she is not left alone. What are some things the nurse can do to ensure the family is also cared for during this time?
8 .
You are working with a team that includes members with varying attitudes toward death and dying. How would you foster a collaborative environment that respects diverse perspectives and supports effective communication about end-of-life issues?
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