Case Study Scenario #1: A 49-year-old woman with advanced stage cancer has been admitted to the emergency room with cardiac arrest. Her husband and one

Scenario #1: A 49-year-old woman with advanced stage cancer has been admitted to the

emergency room with cardiac arrest. Her husband and one of her children accompanied the

ambulance.

As a primarily ER and ICU nurse, this is a familiar scene. When dealing with the dying

patient, the last part of their healthcare can be difficult for the family as well as the provider. In

this scenario a terminally ill patient arrives in the ED in active cardiac arrest, with family at

bedside. Having the patient’s family, primarily the husband, available allows the medical

professional the ability to assess the patient’s wishes for end of life care. It is our responsibility to

assist the family in this decision (Taylor & Johnson, 2011).

Some questions that should be addressed to the husband: Does your wife have a DNR (do not

resuscitate) order? What events leadup to the patient’s current condition? Who found the patient

unresponsive, if alone, and what time did this occur? When was the last time you saw your wife

responsive and tell me about today? Was there anything unusual or had she had any new

complaints? What type of cancer was she diagnosed with? Does the patient have a DNR or living

will? Do you want to continue CPR? Would you like for our spiritual team to accompany you in

ER?

Health assessment questions: Does the patient have a pulse? What is the EKG Rhythm? What

treatments were given in the ambulance? Does the patient have any signs of trauma? What is the

patient’s GCS? Vitals? Continue ACLS protocol if patient is in cardiac arrest.

These types of emergencies can be less stressful but if handled correctly by ER staff and

providers, can be much less traumatic for the family. As a provider it is our duty to provide the

patient’s family with needed information on treatments available for the patient. Having a strong

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knowledge on how to handle these palliative emergencies can help maintain proper end-of-life

care (Buckley, 2008).

As providers, we should be mentally prepared for the family’s decision and response.

Health care professionals have an ethical responsibility to the wishes of the husband and wife.

Patient’s with a defined advanced directive or living will, may have already addressed these

issues and made decisions regarding their end of life care. If no DNR or advanced directive is

available, ethical considerations must be maintained to honor the wishes of the family (Peicius et

al., 2017).

The first and most important peice of information needed is finding out the patient’s and

families wishes. Was the patient hospice? Or is there a DNR? Having this type of information

will make the decision much easier on the family and provider during this situation. The second

thing is providing information to the family regarding patient’s outcome and possible decisions

to be made if the patient does regain a pulse. Keeping the family updated and involved in

decision making is vital.

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References

Buckley, J. (2008). Palliative Care: An Integrated Approach. Chichester, U.K.: Wiley. Retrieved

from https://ezp.waldenulibrary.org/

Peicius, E., Blazeviciene, A., & Kaminskas, R. (2017). Are advance directives helpful for good

end of life decision making: a cross sectional survey of health professionals. BMC

Medical Ethics, 18(1), 40.

Taylor, P. M., & Johnson, M. (2011). Recognizing dying in terminal illness. British Journal of

Hospital Medicine (London, England: 2005), 72(8)

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