A 79-year-old man is undergoing evaluation for hospital admission due to an exacerbation of chronic obstructive pulmonary disease. His wife expresses concern about his health due to multiple hospitalizations over the last year for various complications related to his comorbidities. The patient has smoked cigarettes daily for more than 50 years. Medical history includes coronary artery disease, type 2 diabetes mellitus, and obesity. After performing a thorough history and physical examination, the physician prepares to admit the patient and decides to continue his existing medications for diabetes and heart disease. Admission orders also include supplemental oxygen, bronchodilators, antibiotics, and systemic corticosteroids. Which of the following additional components is most critical to include during the admission process?

Question

A 79-year-old man is undergoing evaluation for hospital admission due to an exacerbation of chronic obstructive pulmonary disease.  His wife expresses concern about his health due to multiple hospitalizations over the last year for various complications related to his comorbidities.  The patient has smoked cigarettes daily for more than 50 years.  Medical history includes coronary artery disease, type 2 diabetes mellitus, and obesity.  After performing a thorough history and physical examination, the physician prepares to admit the patient and decides to continue his existing medications for diabetes and heart disease.  Admission orders also include supplemental oxygen, bronchodilators, antibiotics, and systemic corticosteroids.  Which of the following additional components is most critical to include during the admission process?

Quizplus · Accepted Answer

Advance directives record a patient's personal preferences for health care and treatment if the patient lacks decision-making capacity. During hospital admissions, all patients admitted to the hospital must be asked about resuscitation preferences (eg, full code, Do-Not-Resuscitate [DNR]) and whether advance directives are in place because serious clinical deterioration can happen unexpectedly. Advance directives include the following types of documents: Living will, which specifies the patient's end-of-life wishes and often includes instructions regarding intubation, cardiopulmonary resuscitation, enteral feeding, and other life-prolonging interventions. Given the breadth of medical scenarios that can arise, not all decisions can be accounted for in a living will. A health care proxy, which designates a specific individual (the surrogate decision-maker) to make health care decisions and interpret instructions in the living will on the patient's behalf if the patient is incapacitated, using the principle of substituted judgment (ie, considering what the patient would want). Ideally, advance care planning should take place through a series of open-ended conversations early in a patient's serious illness (eg, chronic obstructive pulmonary disease) in the context of a longitudinal patient-physician relationship. Patients without advance directives at the time of hospital admission should be provided with information and venues for learning about and completing this process. (Choices A, C, D, and E) Each of these components should be addressed during the patient's hospitalization course and discharge planning process. However, they do not need to be completed during admission. In contrast, discussion and documentation of a patient's advance care status must be completed during admission because unexpected clinical deterioration can occur at any time. Educational objective: The admission process must include discussion of whether the patient has advance directives, along with code status, to ensure that medical personnel adhere to the patient's specific wishes should the patient become incapacitated.

A 79-Year-Old Man Is Undergoing Evaluation for Hospital Admission Due