A patient tells a nurse that she has prepared a living will (LW). ...

[javeds]

A patient tells a nurse that she has prepared a living will (LW). The nurse understands that a liv-ing will: (Select all that apply.)
 
  a. is an advanced directive that is used in the situation of a person who is unable to speak for herself or himself.
  b. is a legally binding document in all states and territories of the United States.
  c. appoints a proxy to uphold the patient's wishes.
  d. includes the provision that the patient's next of kin have more authority than the appointed proxy.
  e. can be revoked by the patient at any time in either writing or verbally.

Question 2

A 78-year-old patient who is dying of colon cancer with metastases to the liver is refusing to eat or drink. He is alert and oriented, and states that he has no desire to eat, which is causing the family great distress.
 
  In order to best address the client and family, the nurse should:
  a. explain the family's concern to the client.
  b. educate the family that this is normal be-havior in this situation.
  c. contact the physician for an order for en-teral feeding.
  d. contact the dietitian for feeding supple-ments.

[AngeliqueG]

Answer to Question 1

ANS: A, C, E
The Patient Self-Determination Act (PSDA) recognized a Living Will (LW) as an advanced di-rective that is specifically related to a situation in which a person is facing a terminal illness and unable to speak for herself/himself. It is a morally and, in some jurisdictions, legally binding document in which adults could express their wishes regarding end-of-life decisions for some future time when they were unable to do so for themselves. The exact requirements for a living will and the associated laws around it vary from state to state. The patient appoints a proxy to uphold his or her wishes when he or she is no longer able to do so. As the proxy is selected by the individual, the legal assumption is that a designated person has more authority than the next-of-kin. The patient can revoke an LW verbally or in writing at any time for any reason.

Answer to Question 2

ANS: B
The nurse should educate the family that this is a normal part of the dying process and should not pressure the client, contact the physician for enteral feeding, or contact the dietitian for feeding supplements. Because the patient is expressing a desire not to eat, his wishes should be honored. Essential to the facilitation of self-esteem is the premise that the values of the patient must figure significantly in the decisions that will affect the course of dying. Whenever possible, the nurse can have the person decide when to groom, eat, wake, sleep, and so on.