The licensed practical/vocational nurse was caring for a client ...

[Mr. Wonderful]

The licensed practical/vocational nurse was caring for a client in a nursing home who has end-stage cancer and recently had a debilitating stroke (brain attack). On several occasions, nurses reported the client stated he wished he was dead.
 
  One night the client arrested. The client was a full code. When the licensed practical/vocational nurse found him, she called a code blue. The staff took their time to respond and even longer to call 911. Which exemplifies the third step in the process of ethical decision making for this situation?
  A) A client is at the end of his life and has verbalized that he wished he was dead.
  B) Is a slow code acceptable when the client stated he wished he was dead, or should he have made the choice known and secured an order for do not resuscitate, and since he did not, the nurses are bound to resuscitate quickly?
  C) Facts: the client has end-stage cancer and a debilitating stroke decreasing quality of life. Hearsay: In several occasions the client has stated he wished he was dead. Rumors: The man deserves to join his wife in heaven; he has no family left. Emotional components: The nurses feel they would want to not be resuscitated if they were in the client's shoes.
  D) Action A: Slow code and call 911 late into the codeclient dies; nurses feel guilty because of legal/ethical obligations. Action B: Perform the code quickly and client may liveno change in quality of life; may have ability to secure a do not resuscitate order in future. Action C: Perform the code quickly and client may dieclient ends poor quality of life.

Question 2

A licensed practical/vocational nurse was caring for a pregnant client who underwent genetic testing and was positive for being a carrier of Huntington's disease (HD).
 
  She has a 50 chance of delivering an infant who will have HD. Symptoms of HD usually don't develop until the person is 35 years or older. The woman wanted help reaching a decision. Her religious beliefs forbid abortion. She also knew that her child could suffer a debilitating neurological disease and die from it. The nurse wishes to use the process of ethical decision making. Based upon the client's view, which step should the nurse take first?
  A) Is it right to end an unborn life because of 50 chance to develop a debilitating disease and die early in life? Is it wrong to end an unborn life because of the risk for HD when the person will have up to 35 years or more of quality life before developing symptoms of HD? Is it wrong to end the unborn life because 50 will not have HD?
  B) Action A: End the pregnancy. Advantages: Help prevent potential suffering. Disadvantage: Not allow the person to enjoy several decades of life, or abort an unaffected fetus. Action B: Don't end the pregnancy. Advantage: Provide life to unaffected fetus, or up to several decades of life for the affected fetus and potential for a cure to stop the disease.
  C) Religious beliefs: sanctity of life; no abortion; personal valuesfollow teachings of the church and provide the best quality of life for an individual; personal moral principlesit is not right to take a life of an unborn child; laws: not illegal for abortion; society's beliefsboth right to life and right to choose.
  D) The situation is genetic testing is not 100 accurate and provided that the mother is positive as a carrier, but the father is not a carrier and does not have HD. The mother has firm beliefs in not aborting the fetus, but also wants what is best for her unborn child's future. The mother could receive additional fetus testing to determine if the fetus actually has HD or not to help her make the decision, if she wants.

[allisonblackmore]

Answer to Question 1

Ans: B
Feedback:
After understanding the components or ethical decision making, the first step and describing the situation, the second stepAnswer A, the nurse should describe the dilemma, the third stepAnswer B. After this, information should be sorted, the fourth stepAnswer C, options identified, the fifth stepAnswer D, and a decision made, the sixth and last step. A code blue is not the time to make a decision about an ethical dilemma, so nurses must advocate for clients with their end-of-life decisions and secure the decisions before a code blue happens.

Answer to Question 2

Ans: C
Feedback:
The first step of the ethical decision-making process is understanding the components involved to make the decision, which is included in answer C. Answer A is the description of the dilemma, the third step. Answer B is possible courses of action, the fifth step. Answer D is the description of the situation, the second step.