Question

Case Study

Joe is a 92 yo with end stage dementia. He has been living in an assisted living residence and has been falling nearly every day. It is becoming more difficult to encourage him to eat or drink fluids. After his last fall, the staff call the ambulance because they suspect he may have fractured his arm. A fracture is ruled out, however, the physician orders a chest x-ray that show pneumonia. Joe is admitted to a medical unit of the hospital.  

Joe has a Living Will and his daughter has been named as the Durable Power of Attorney for Healthcare. You are the nurse admitting Joe. You ask her for the advanced directives. She states they have not been updated for many years and indicate Joe wishes to receive aggressive interventions if he is hospitalized. Due to Joe's inability to eat, the physician is planning to place a feeding tube the next day and begin a tube feeding for Joe. After you complete your nursing admission assessment, Joe begins to be more lethargic and his respiratory rate increases to 40. Joe's oxygen saturation level is 80% on 6L of oxygen. The team is asking the daughter to make a decision to proceed with the procedure.

• How would you respond to Joe's daughter who states: "I feel like I am killing my father."   How can you explain to her what is happening to her father as his health declines quickly.

Answer 1

Answer: Due to severity of the disease, Joe is suffering as well as the age of Joe lead to increase the complications. The patient is becoming more lethargic and unable to breathe properly. At this age, the pneumonia causes increased inflammation in the airways which leads to fluid accumulations. Hence the gas exchange process is not taking place properly. If certain treatment or action would not be taken on time, there could be chances of renal failure. So, instant action is required for this patient. The health is declining due to poor blood circulation, insufficient oxygen reaching to the lungs etc.