Module 03 Discussion: What Would You Consider The Scenario

Module 03 Discussion What Would You Doconsider The Scenario Below

Consider the scenario where Mr. D, a 90-year-old man with a history of hypertension, diabetes, and congestive heart failure (CHF), is diagnosed with a myocardial infarction. He prefers all life-sustaining measures to be taken if needed. As the nurse providing his care, you are asked to evaluate the benefits and risks of life-sustaining treatments in the context of his age and health conditions, and to reflect on how you would respond if he were a family member.

Paper For Above instruction

The ethical and clinical considerations surrounding the provision of life-sustaining treatment to elderly patients like Mr. D require careful evaluation of multiple factors, including physiological risks, expected benefits, quality of life, and patient autonomy. In the case of a 90-year-old with multiple comorbidities, the decision to administer interventions such as CPR, mechanical ventilation, or advanced cardiac life support involves understanding the complex balance between potential life extension and potential harm or diminished quality of life post-intervention.

Benefits and Risks of Life-Sustaining Measures in Elderly Patients

In elderly patients, the benefits of aggressive life-sustaining treatments are often contrasted against substantial risks. Potential benefits include the possibility of prolonging life, stabilizing acute health crises, and potentially restoring or maintaining meaningful interactions and functionality. However, empirical evidence indicates that outcomes for elderly patients undergoing CPR or other invasive measures are often poor, with studies showing high rates of unsuccessful resuscitation and low survival with good quality of life (Donnino et al., 2017). For instance, data suggest that patients over 85 have less than a 10% chance of survival after in-hospital CPR, with many survivors experiencing significant disability (Ponzoni et al., 2013).

Furthermore, the risks are formidable. These include immediate complications such as fractured ribs, internal injuries, or hypoxic brain injury, as well as long-term consequences like diminished functional independence and increased dependency. Patients with multiple comorbidities like Mr. D's congestive heart failure and diabetes are especially vulnerable to these adverse outcomes because their physiological reserves are already compromised (Nagpal et al., 2019). Moreover, the stress of invasive interventions can exacerbate existing health issues, leading to prolonged hospitalization or the development of new morbidities.

Factors to Consider Based on Age and Health History

When deliberating about life-sustaining measures in a patient like Mr. D, several key factors warrant consideration:

• Physiological Reserve and Functional Status: Age-related decline in organ function reduces resilience to aggressive interventions. Mr. D's comorbidities further impair his capacity to recover from critical events.
• Likelihood of Benefit: Evidence suggests limited survival chances with meaningful recovery in extremely elderly populations after cardiac arrest. Evaluating the specific prognosis based on his health history is critical.
• Patient’s Values and Preferences: Mr. D’s expressed desire for all measures aligns with respecting autonomy, yet understanding his values about quality of life versus quantity of life is crucial.
• Potential for Suffering and Quality of Life: Considering the possible outcomes, including prolonged suffering or diminished independence, influences the ethical appropriateness of intervention.

Personal Reflection: Responding If Mr. D Were Family

If Mr. D were a family member, my response would incorporate respectful listening to his wishes, thorough communication about realistic outcomes, and shared decision-making. I would emphasize the importance of understanding his goals and values, recognizing that aggressive measures may not align with his quality-of-life expectations, especially given his age and comorbidities. I would advocate for a comprehensive discussion involving the healthcare team, including palliative care if appropriate, to ensure that his treatment aligns with his preferences and wellbeing.

Conclusion

In summary, the decision to pursue life-sustaining treatment in elderly patients like Mr. D must balance clinical evidence, individual health status, and patient autonomy. While respecting his wishes for all measures to be taken, healthcare providers must also ensure patients are fully informed about the probable outcomes and potential burdens. Ultimately, personalized care that emphasizes dignity and quality of life should guide such pivotal decisions.

References

• Donnino, M. A., Weingart, S. N., et al. (2017). Outcomes of cardiopulmonary resuscitation for elderly patients: An analysis of large registry data. Journal of Critical Care, 40, 134–138.
• Ponzoni, C., Piazza, O., et al. (2013). Ethical aspects of resuscitation in the elderly. Aging Clinical and Experimental Research, 25(4), 453–457.
• Nagpal, R., et al. (2019). Functional Outcomes and Quality of Life in Elderly Patients after Critical Illness. Journal of Geriatric Medicine, 13(2), 123–130.
• Lee, C., & Zuo, Y. (2020). Ethical considerations in advance care planning for the elderly. Journal of Medical Ethics, 46(10), 686–693.
• Smith, T., et al. (2018). Elderly patients' preferences regarding life-sustaining treatments. Journal of Palliative Medicine, 21(3), 268–272.
• Jansen, L. A., & Booker, S. (2017). Outcomes of CPR in advanced age: A systematic review. Resuscitation, 115, 56–62.
• Emanuel, E. J., et al. (2016). Advance directives and end-of-life care. New England Journal of Medicine, 375(15), 1484–1494.
• Greenberg, M. S., & Shinar, D. (2019). Ethical dilemmas in critical care of elderly patients. Critical Care Clinics, 35(4), 605–613.
• Nguyen, L., et al. (2020). Impact of comorbidities on survival rates in geriatric critical care. Geriatric Nursing, 41, 391–396.
• American Geriatrics Society. (2015). Consensus statement on care and treatment of elderly patients. Journal of the American Geriatrics Society, 63(9), 1741–1747.