A hospice patient is unable to tolerate food or fluids and has advance directives that indicate that he does not want IV fluids or tube feedings if he is unable to take oral feedings. His family is concerned that he will be very uncomfortable without food or fluids. The nurse should tell them that:
IV fluids or tube feeding would likely make the patient more uncomfortable, and dehydration has been shown to decrease pain and discomfort.
Once the patient is unconscious, his health care proxy can order IV fluids or tube feedings to prevent dehydration.
IV fluids or a tube feeding would make the patient much more comfortable, and they should try to talk him into accepting them.
dehydration is painful, and medication can be given to overcome any pain.
The Correct Answer is A
A. This response aligns with best practices in hospice care, which prioritize comfort and quality of life for terminally ill patients. Dehydration is a common occurrence at the end of life and is generally not associated with discomfort when managed appropriately. IV fluids or tube feedings may cause discomfort, contribute to fluid overload, or lead to complications such as aspiration pneumonia.
B. While the healthcare proxy may have the authority to make decisions on behalf of the patient, the focus should be on honoring the patient's wishes as expressed in advance directives. If the patient has clearly indicated a preference against IV fluids or tube feedings in their advance directives, this should be respected.
C. Encouraging the family to try to talk the patient into accepting IV fluids or tube feedings goes against the principles of patient autonomy and informed decision-making. The decision regarding medical interventions should be based on the patient's preferences and comfort.
D. While dehydration can be uncomfortable in some circumstances, providing adequate symptom management, including pain medication, is essential in hospice care. However, IV fluids or tube feedings are not typically used to manage dehydration in patients who are at the end of life, as they may not improve comfort and can lead to complications.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Informing his primary care provider of his desires: While it's important for the primary care provider to be aware of the patient's wishes, simply informing the provider may not ensure that these desires are respected in the event of a medical crisis. The primary care provider may not be immediately available during an emergency situation.
B. Filing an advance directive with the health care facility: This is the correct response. Advance directives allow individuals to specify their healthcare preferences in advance, including decisions about life-sustaining treatments such as resuscitation, ventilation, and artificial nutrition and hydration. Filing an advance directive ensures that the patient's wishes are documented and legally binding, providing guidance to healthcare providers in the event that the patient becomes unable to communicate or make decisions.
C. Including these desires in his will: While a will can address matters related to the distribution of assets and property after death, it typically does not cover healthcare decisions or preferences regarding end-of-life care. Healthcare preferences should be documented in an advance directive or similar legal document specifically designed for healthcare decisions.
D. Signing a do-not-resuscitate/do-not-intubate (DNR/DNI) request: While a DNR/DNI request specifies the patient's wishes regarding resuscitation and intubation, it may not cover other aspects of end-of-life care such as the use of IV fluids or feeding tubes. An advance directive provides a more comprehensive framework for expressing end-of-life care preferences beyond just resuscitation and intubation.
Correct Answer is C
Explanation
"Bringing on your death in this manner would be a subject you should discuss with your family and primary care provider" (Option A): While discussing end-of-life wishes with family and healthcare providers is important, this response does not directly address the ethical issue at hand. It may be appropriate to encourage open communication and advance care planning, but administering a deliberate overdose is not ethically permissible.
"Let me have a while to consider your request" (Option B): Delaying a response to the patient's request for deliberate overdose could potentially lead to confusion and distress for the patient. Additionally, this response does not address the ethical concerns raised by the request.
"I cannot ethically give you a deliberate overdose" (Option C): This response aligns with the ethical principle of nonmaleficence, which obligates healthcare providers to avoid causing harm to patients. Administering a deliberate overdose to hasten death would violate this principle and go against the nurse's ethical obligations.
"I can contact the primary care provider and request an order for a drug that could be used as you request" (Option D): This response suggests a willingness to facilitate the patient's request for deliberate overdose, which is not ethically permissible. Administering a drug with the intention of ending a patient's life is contrary to the ethical principles of beneficence and nonmaleficence.
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