Question

Mr. D

Mr. D is a 90-year-old man who was admitted to the hospital with complaints of nausea, vomiting, left arm pain, and chest pain. An electrocardiogram (ECG) is performed, and he is diagnosed as having a myocardial infarction.

Mr. D has a long history of comorbidities including hypertension, diabetes, and congestive heart failure (CHF). With this in mind, the physician asks Mr. D if he wants life-sustaining measures taken (e.g., CPR, mechanical ventilation, etc.) should he experience cardiopulmonary arrest.

Mr. D tells the physician that he wants all measures taken to save his life.

Imagine that you are the nurse assigned to provide care to Mr. D, and address the following:

1. Considering Mr. D's advanced age, what are the benefits/risks associated with providing life-sustaining measures?
2. What factors should you consider based on the Mr. D's age and health history?
3. If Mr. D were your family member, how would you respond to his decision?

Answer 1

1. In elderly MI patients, their multidimensional health status should be taken into consideration before providing life-sustaining measures. Mr.D may present with

• abnormal clinical manifestations
• changed drug actions in the body
• Impaired perception and functional status of elderly patients

There are some benefits to reperfusion measures, but, because of the presence of comorbidities, the safety, and effectiveness of reperfusion cannot be guaranteed.

2. His advanced age in the 90's and the presence of comorbidities including hypertension, diabetes, and congestive heart failure need to be considered.

3. If Mr. D were my family member, I would not have supported his decision as seeing him alive with us at least for a few more days will be pretty good than allowing him to take up the risk.