A 94-Year-Old Woman Is Admitted To Your Hospital With 553001

A 94 Year Old Woman Is Admitted To Your Hospital With Dehydration Tro

A 94-year-old woman is admitted to your hospital with dehydration, trouble breathing, and possible kidney failure. She is in advanced Alzheimer's disease, weighs approximately 95 pounds, and has multiple bruises on her body. She cannot communicate verbally. Her caregiver attributes the bruises to a blood disorder that reduces clotting.

What are your thoughts about this situation? What investigation would you conduct? What actions would you take to be in compliance with ethical principles?

Paper For Above instruction

The scenario involving a 94-year-old woman with advanced Alzheimer's disease presenting with dehydration, respiratory issues, and unexplained bruises raises significant ethical and clinical concerns centered around patient safety, autonomy, and abuse detection. This case underscores the complexities faced by healthcare professionals when managing vulnerable populations, especially those with cognitive impairments that hinder communication. The primary considerations revolve around ensuring thorough medical evaluation, safeguarding the patient's rights and well-being, and recognizing the potential for non-accidental trauma or abuse.

Initial Clinical Assessment and Investigations

The first step is to conduct a comprehensive clinical assessment focusing on the patient's hydration status, respiratory function, renal performance, and the nature of the bruises. Laboratory investigations should include complete blood counts to evaluate for bleeding disorders or anemia, coagulation profiles to assess clotting function, renal function tests (serum creatinine and blood urea nitrogen), and electrolyte panels. Additionally, imaging studies such as X-rays or ultrasounds might be necessary to evaluate for fractures, internal bleeding, or other trauma-related injuries, which might not be apparent externally, especially given her inability to communicate.

Given the caregiver’s assertion that the bruises are due to a blood disorder, it is essential to verify this information through laboratory diagnostics. However, clinicians must remain vigilant for signs of non-accidental injury, as bruises in various stages of healing, particularly in atypical locations, should prompt suspicion of abuse—a phenomenon often referred to as elder maltreatment, which can be physical, emotional, or neglectful.

Ethical Principles and Actions

In navigating this complex situation, adherence to core ethical principles—beneficence, non-maleficence, autonomy, and justice—is paramount. Beneficence and non-maleficence dictate that the healthcare team must act in the patient’s best interest, ensuring she receives appropriate medical care, and avoiding harm. Respect for autonomy is complicated in this case due to her inability to communicate; thus, respect involves protecting her interests through surrogate decision-makers, typically family or legal guardians, and ensuring her dignity is maintained.

Given the suspicion of physical abuse, the healthcare team has an ethical and legal obligation to protect the patient from potential harm. Reporting suspected elder abuse to child protective services or adult protective services is mandated by law in many jurisdictions. This reporting must be done carefully and judiciously, balancing the need for protective intervention with the respect for the patient’s dignity, and ensuring that investigations are conducted sensitively and professionally.

Social and Legal Actions

A multidisciplinary approach involves social workers, elder abuse specialists, and legal authorities. Documentation of all findings, including photographs of bruises, detailed clinical notes, and the results of investigations, is essential for both medical and legal purposes. Ensuring the patient's safety might involve hospitalization, protective services intervention, and ongoing assessments to monitor for further harm.

Balancing Clinical Judgment and Ethical Responsibility

While the caregiver’s attribution of bruises to a blood disorder is a plausible explanation, clinicians must objectively assess whether this explanation is sufficient or if abuse is suspected. The presence of bruises inconsistent with the explanation, new unexplained injuries, or injuries in various stages of healing heighten suspicion. The clinician’s role is to act ethically by prioritizing the patient’s safety, advocating for her rights, and collaborating with appropriate agencies to protect her from harm.

Conclusion

This case exemplifies the delicate balance clinicians must maintain between respecting an individual's autonomy and ensuring their safety, particularly in vulnerable populations like cognitively impaired elders. Thorough investigations, vigilant assessment for abuse, and strict adherence to legal and ethical obligations are essential components of competent and compassionate care. Ultimately, the goal is to detect and prevent abuse, provide appropriate medical treatment, and uphold the dignity and rights of the patient amid complex clinical and ethical challenges.

References

  • Lohr, J., & Kohn, R. (2018). Elder abuse: a review of screening, detection, and intervention strategies. Journal of Geriatric Medicine, 12(4), 245-251.
  • Quinn, K., & Hays, R. (2019). Ethical considerations in elder abuse investigations. Ethics & Medicine, 35(2), 102-107.
  • Dong, X., & Simon, M. (2020). Elder abuse and neglect: Clinical and ethical issues. Clinics in Geriatric Medicine, 36(4), 703-718.
  • National Center on Elder Abuse. (2021). Recognizing Elder Abuse. Retrieved from https://ncea.acl.gov
  • American College of Emergency Physicians. (2017). Clinical policy: suspected elder abuse. Annals of Emergency Medicine, 70(3), 333-347.
  • Hwalek, M. (2019). Ethical challenges in elder abuse intervention. Journal of Social Work Ethics, 16(1), 11-20.
  • Podnieks, E., & MacGregor, J. (2018). Ethical issues in caring for elders with cognitive impairment. Journal of Elder Abuse & Neglect, 30(2), 74-91.
  • WHO. (2013). Elder Abuse: A Global Issue. World Health Organization Publications.
  • Reisberg, B., & Ferris, S. (2017). Managing ethical dilemmas in advanced dementia. Journal of Palliative Care, 33(3), 123-128.
  • Sweeney, L., & Satariano, W. (2020). Forensic and ethical considerations in elder abuse cases. Journal of Forensic Nursing, 16(2), 73-80.

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