Mary Lou Warning, a widow of age 73, was admitted to the emergency department (ED) after her oldest son, Tom, found her disoriented and confused. He had taken her refilled prescriptions to her house on his way home from work. The ED physician and her primary provider agreed that they could not rule out stroke and therefore wanted to admit her “observation only.” Tom thought, “This seems minor enough!” So, Tom went home to rest for the night once the papers were signed. She was admitted to a regular room. During the night, alone in her room, her stroke extended, and, when the nurse-on-duty made one of her visits, she found Mrs. Warning breathing but unresponsive to commands and pain. She immediately called the ED physician to check her and asked another nurse to call her primary physician and her son. Mrs. Warning had five sons and one daughter, all of whom lived out of town except Tom. An occlusive stroke was diagnosed after CT and MRI scans. Treatment was probably not going to be helpful because of the degree of damage. The ED and primary physicians were making preparation to send her to the intensive care unit (ICU) and were preparing themselves for how they were going to approach Tom. The primary physician informed Tom that she might not live, but, if she did, he and his siblings has to make some decisions about whether or not they wanted her to be on a mechanical ventilator, if it came to that decision. Also, he told Tom that at the present time she was in an unconscious state, which could an indefinite existence, and they needed to think about what types of treatment, if any, they wanted for her. The physician thoroughly explained the treatment options and the siblings’ options to withdraw or withhold treatment for their mother. He explained to Tom that her prognosis was poor and that, if she lived, she probably would never regain consciousness. Meanwhile, Tom frantically called all of his siblings to tell them to “come fast” and that decisions should be made “now” regarding their mother’s end-of-life care. Tom was pacing back and forth with distress and fear because no one in his family had ever discussed these issues among themselves or with his mother. When all of the siblings arrived the next day, they made a decision for the physician to withdraw all medications and intravenous fluids and requested no treatments of any kind. A DNR order was put in place. Given the presented data, the following salient points are addressed: 

1. What is the role of medical futility plays in this situation and in the family’s decision? 

2. The primary physician mentioned to Tom his mother could need a mechanical ventilator at some point. Explain this statement by relating it to the difference in the two levels and significance of death of the brain. Discuss nursing ethical implications involved with both types. 

3.What ethical role could you as a nurse to take to help support Tom and his siblings? 

4.What type of nursing care does Mrs. Warning need to receive? Explore the ethical issues that you as a nurse must face.  explain your answer. 

5.On which principle will surrogate decision making be based in Mrs. Warning’s case? Please define this principle and discuss why this particular principle is best for this particular patient?

Answer rating: 100% (QA)

Q 1 In this case the role of the medical team is to identify all available options including those that can try to save Marys life and those that can ... View the full answer