Case Study ETHICAL Dilemma Remain Intubated or Withdraw Life Support, STUDENT Worksheet, Joyce Johnson, 58 years old, (Latest 2021) Correct Study Guide

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Scenario History of Present Problem: Joyce Johnson is a 58-year-old woman with a history of atrial fibrillation, COPD, and depression. A friend who had not heard from her for two days became concer... ned and went to her home. She found Joyce unresponsive on the floor of her living room. She had a large left middle cerebral artery (MCA) ischemic stroke. She is intubated and has remained in ICU since she was admitted to the hospital five days ago. She is also in acute renal failure as a result of rhabdomyolysis and requires daily dialysis. Personal/Social History: Joyce is divorced, and has one adult daughter. She is estranged from her siblings and has not spoken to her daughter in five years. She is on disability for severe depression. Depending on how she feels, Joyce inconsistently takesscheduled medications including warfarin. What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: 1) Patient has History of atrial fibrillation, COPD, and depression Patient had a large left middle cerebral artery ischemic stroke and was found on the floor in the living room by her friend that got concerned because she hadn’t heard from her and went and checked to make sure she was ok and found her unresponsive They intubated her and sent to the hospital was admitted to the ICU been there 5 days She ended up getting rhabdomyolysis and because of that she went into acute renal failure which now requires her to get dialysis to help her stay alive 1) The patient past diagnosis is important to the nurse because knowing the patients past can help why she eventually got the stroke. Atrial fibrillation as a correlation with strokes because blood may not be properly pumped out of the heart, which may cause it to pool and form a clot. Which then can travel to the brain and block the blood flow to the brain. Knowing her meds also helps like warfarin because she was probably taking this to prevent blood clots and, on this medication, it has to be takin daily and have labs draws as well. Has a nurse we know she wasn’t takin it as scheduled which didn’t help her situation and could have been some of the reason why. Patient also had breathing problems COPD and sometimes with that you could get upper respiratory infection can cause the lung arteries to narrow or become blocked called pulmonary hypertension and that can lead to Afib as well. Patient being intubated means she is critically ill and needs to let her body rest and recuperate itself. Only time will tell. It’s only been 5 days so they don’t know how long she will be intubated for or if she will remain intubated long term. It’s a day to day process Another significant thing that the nurse would look at how she got rhabdomyolysis. Rhabdomyolysis is a breakdown of muscle tissue that releases a damaging protein called myoglobin into the blood. The myoglobin is what can damage the kidneys. Usually this happens to a person when they are immobile and stay in the same spot without movement for a very long time they say anybody that doesn’t have movement in half a day 12 hours and this patient we don’t know how long she was immobile for but we do know she was not heard from for two days by her friend and was found unresponsive probably stayed in the same spot and position for more than 12 hours which then caused her rhabdomyolysis which then damaged her kidney and the reason why she needs dialysis and the stroke was not due to her getting rhabdomyolysis it was her staying in the same position for a long time RELEVANT Data from Social History: Clinical Significance: Patient has a daughter she hasn’t talk to in five years, Patient has siblings that she been distant from and doesn’t have contact with them and does not have a husband is divorced Patient has severe depression and is on disability because of it. Patient does take meds but is not consistent with mediation ritual like she should be. One of the medications that’s included in her meds is warfarin As a nurse this is a concern seeing she has no support system really affects her treatment and future cares. This is probably why she is depressed and doesn’t put effort to taking her meds. She doesn’t have help or a good support system around her. Someone encouraging her to take her meds or giving them to her for her to take sometimes that makes a great difference. She probably feels what’s the point. Even her being educated on the risks of not taking certain meds might have been useful for her to have as knowledge. She has COPD and gets tired easily which can be another health concern and why she is not compliant with her meds maybe she doesn’t have the energy nor the motivation to get them or take them because of that her not taking her warfarin as scheduled is what probably the cause of her having the stroke. Just seeing how this patient health issue and also psychiatric concerns both a part of her had getting a stroke due to her not wanting to be compliant with meds cause of her depression and her health issues. This shows you how both areas have a part in a persons health its not always o...........................CONTINUED [Show More]

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