An elderly male patient in his early 70s is admitted to the emergency department due to a COPD exacerbation.
The patient is having difficulty breathing and the healthcare team is preparing for endotracheal intubation.
The patient’s wife, who is 30 years younger, asks the nurse to halt the procedure and presents the nurse with a copy of the patient’s living will.
What should the nurse’s next step be?
A.
Place a certified copy of the living will in the patient’s record.
B.
Inform the healthcare provider of the patient’s wishes.
C.
Arrange a family meeting with the palliative care team.
D.
Notify the nursing staff of the patient’s do not resuscitate status.
The Correct answer and Explanation is:
The correct answer is B. Inform the healthcare provider of the patient’s wishes.
Explanation:
In this scenario, the patient is experiencing a COPD exacerbation, which is a critical situation requiring immediate attention. The patient’s wife presents a living will, indicating the patient’s preferences regarding medical treatment. In such circumstances, the nurse’s primary responsibility is to ensure that the patient’s wishes are communicated to the healthcare team effectively and promptly.
Informing the healthcare provider (option B) is crucial for several reasons:
- Legal Authority: The living will serves as a legal document outlining the patient’s preferences regarding life-sustaining treatments. By informing the healthcare provider, the nurse ensures that the patient’s rights and wishes are respected and considered in the immediate care plan.
- Immediate Clinical Decision-Making: The healthcare team must be aware of the patient’s end-of-life wishes to make informed decisions about whether to proceed with potentially life-sustaining interventions like intubation. Understanding the patient’s wishes can change the urgency and approach to treatment.
- Continuity of Care: Communicating the patient’s wishes ensures that all members of the healthcare team are aligned regarding the treatment plan, which is vital in emergency settings. It also allows for a discussion on the appropriateness of interventions based on the patient’s goals of care.
- Support for Family: Notifying the healthcare provider can also lead to further support for the family, including arranging discussions with palliative care or social services to address emotional and ethical considerations.
Option A, placing the living will in the patient’s record, is necessary but not the immediate priority. Option C, arranging a family meeting with palliative care, is important but should follow informing the provider. Option D, notifying nursing staff of the do-not-resuscitate (DNR) status, would only be appropriate if the living will explicitly indicates a DNR, and it still requires communication with the healthcare provider first.