The client has metastatic cancer, and a living will on record indicates that the client does not want cardiopulmonary or pharmacologic resuscitation. The client is brought to the emergency department with respirations of 4/min and a heart rate of 20/min. How should the nurse handle the situation at this time?

Question

The client has metastatic cancer, and a living will on record indicates that the client does not want cardiopulmonary or pharmacologic resuscitation.  The client is brought to the emergency department with respirations of 4/min and a heart rate of 20/min.  How should the nurse handle the situation at this time?

Quizplus · Accepted Answer

The 2 most common forms of advance directives are living wills and durable power of attorney for health care (health care surrogate/proxy). These take effect when the client cannot self-advocate. A living will represents the client's wishes regarding actions to be taken in specific situations. A durable power of attorney is an individual who decides actions to fluid situations according to an understanding of the client's wishes. The client was lucid when indicating wishes. Ordinary care is usually considered fluids, oxygenation, analgesics, and antibiotics. The client has a terminal illness, and aggressive interventions would probably be futile over the long term. The client's wishes should be honored. (Option A) Artificially ventilating a client is part of cardiopulmonary resuscitation. The client has indicated not to be resuscitated. However, nasal cannula oxygen can be given for comfort. (Option B) If the client indicates a change of mind, it should be honored. However, a client with respirations of only 4/min and a heart rate of 20/min probably does not have adequate perfusion and oxygenation to the brain to make the best decisions (if alert and oriented). The client's wishes were indicated when the client was able to think clearly, and these wishes should be honored at this time. (Option C) A durable power of attorney takes effect when there is no living will indicating what actions to take on the client's behalf. Educational objective: Two common advance directives are a living will (dealing with specific events/issues) and a durable power of attorney for health care (eg, an individual who can make decisions on the circumstances in light of the client's wishes). A client's specific wishes as indicated should be honored.

The Client Has Metastatic Cancer, and a Living Will on Record