Explain potential outcomes of the patient in the case study you selected and how you would facilitate the discussion of end-of-life care with this patient’s family.

Explain potential outcomes of the patient in the case study you selected and how you would facilitate the discussion of end-of-life care with this patient’s family.

Case Study 3: is the one that I selected…. Mr. Marley, age 91, is admitted to the intensive care unit following a stroke. The stroke progressed from mild hemiparesis and difficulty speaking to complete unresponsiveness and an inability to swallow. His daughter feels certain, based on prior explicit conversations with her father, that he would not want to have any treatment that would prolong his life and leave him in a severely disabled state. Mr. Marley’s oldest son disagrees with his sister’s assessment of their father. The son claims that their father still has a strong desire to live, and that he has been very active in his church until this stroke. Because Mr. Marley cannot swallow, he cannot be fed. The family is asked about insertion of a feeding tube. It is explained to the family that without food and fluids, their father will die fairly quickly. There are no existing advance directives or a designated health care decision maker noted for Mr. Marley.

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Answer:

Facing end-of-life is not that easy for anyone. We should establish a good nurse practitioner-family relationship and initiate paths for them to express their own doubts, anxiety’s, and emotions. Every single person in the family has its own reaction about end-of-life, so we have to consider each and every one of them when discussing end-of-life. In case study #3, Mr. Marley was already 91 years old and became unresponsive due to progressive stroke. Mr. Marley had a severe stroke that could worsened his neurologic status and leave him in a severely debilitated state. Prior to his debility, Mr. Marley claimed that he did not want any procedure to be done if he is gonna leave him in vegetative state. Though the patient has no actual advance directives or written living will, the surrogate decision maker or next of kin should consider the patient’s wish when making decision for him. In the absence of discussions about or documentation of preferences for care, surrogates are inaccurate in their predictions of what type of care a loved one would want (Holroyd-Leduc & Reddy, 2012). Emotional support is vital when discussing about end-of-life care, and as a nurse practitioner we are the influential component in providing support to patient and families at this challenging times. The daughter or son should consider and respect Mr. Marley’s wish that he would not want to prolong his life if he will just be in severely disabled state. As his nurse practitioner, I will discuss to them the pros and cons of a procedure and present to them the reality or the potential outcomes once Mr. Marley had the peg placement. He would have the feeding, he would have the nutrition, but his neurological status and debilitated state will stay the same and might get worse in the near future. Because of his unresponsiveness and functional neurological debility, he is prone to acquire more complications like pressure ulcers, pneumonia, or brain death which is a life-threatening complication of stroke. Unnecessary procedures that will only gain a minimal benefit for the patient will just prolong his agony and suffering (Flaherty & Resnick, 2013). All older adults should be offered the opportunity to document advance care plans because trajectory of illness is often unpredictable, and many lose the capacity to make decisions at the end of life (Holroyd-Leduc & Reddy, 2012).

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