A client has chosen to discontinue hemodialysis, but the client's ...

[Zulu123]

A client has chosen to discontinue hemodialysis, but the client's family is not supportive of the decision. The nurse who uses the theory of principles-based reasoning would make which statement?
 
  1. This client is of sound mind and is capable of making independent decisions regarding health care. It really is the client's decision to make..
   2. I need to try and help the family understand the client's decision so they can work through this situation together..
   3. This client's health is so deteriorated that the treatment is not saving the client's life. It is prolonging the ultimate outcome, which is death..
   4. The client understands the decision and the advanced stage of the disease. If the client quits treatment, the client will die..

Question 2

The nurse is taking care of a client who states that he ignores the urge to defecate when he is at work. Which of the following responses by the nurse would explain why this practice should be changed?
 
  1. If you continue to ignore the urge to defecate, the urge is ultimately lost..
   2. It is better to suppress the urge than to suffer embarrassment at work..
   3. This is a common practice, and it will strengthen the reflex later..
   4. You will get the urge later; don't worry..

[mcni194]

Answer to Question 1

1. This client is of sound mind and is capable of making independent decisions regarding health care. It really is the client's decision to make..

Rationale:
Principles-based theories stress individual rights, like autonomy. The client has the ability to make the decision, and it is his right to autonomy to do that. Trying to help the family understand the client's decision is an example of a caring-based theory in practice. Caring theories, or relationship theories, stress courage, generosity, commitment, and the need to nurture and maintain relationships. Caring theories promote the common good or the welfare of the group. Considering the client's condition and the outcome of treatment is an example of consequence-based reasoning, in which the nurse looks at the outcomes of the client's decision. The client's understanding of his decision and its consequences does not address the client's right to make a decision autonomously.

Answer to Question 2

1. If you continue to ignore the urge to defecate, the urge is ultimately lost..

Rationale:
When the normal defecation reflexes are inhibited, these conditioned reflexes tend to be progressively weakened. When the urge to defecate is ignored, water continues to be reabsorbed, making the feces hard and difficult to expel. Ignoring the urge repeatedly will eventually cause the urge to be lost. Embarrassment, while unwarranted, is preferable to losing the urge to defecate. Ignoring the urge will not strengthen the reflex later; it will weaken it.

[Zulu123]

Excellent

[bdobbins]

Thanks for the timely response, appreciate it