TREATMENT Dilemma
Transitioning to Comfort Care
STUDENT Worksheet
John Peterson, 75 years old
Overview
Death is inevitable. When it becomes apparent that aggressive medical treatment is no longer a treatment
option, it is not uncommon to find that some members of the family cannot accept this grim prognosis, but insist
that everything that can be done must be done. How can the nurse support both the patient and a grieving family
is the essence of this dilemma.
© 2015 Keith Rischer/www.KeithRN.com
This study source was downloaded by 100000840725322 from CourseHero.com on 01-28-2022 15:12:22 GMT -06:00
https://www.coursehero.com/file/74983249/STUDENT-Treatment-Dilemma-Transitioning-to-Comfort-Caredocx/
, Clinical Dilemma Activity: STUDENT
Transitioning to Comfort Care
I. Scenario
History of Present Problem:
John Peterson is a 75-year-old who has a history of ischemic cardiomyopathy with an ejection fraction of 20%, atrial
fibrillation, mitral regurgitation and chronic kidney disease. He has been hospitalized three times in the last two months
for heart failure exacerbation. He was admitted two weeks ago for SOB and heart failure exacerbation and has been
aggressively managed in the ICU with furosemide, dopamine, and dobutamine intravenous drips. His creatinine has risen
from 1.8 to 2.7 in the last 24 hours. John is not a surgical candidate to repair his mitral valve that is contributing to his
need for hospitalization.
John has openly expressed his desire to family members that he wants to stop all treatment and that he just wants to
die. The physician changed his code status from full code to DNR-DNI but did not stop all other supportive therapies.
When the oldest son, Steve, arrives later that day and finds out that his code status has been changed to DNR-DNI, he
becomes angry and insists that it is too soon to give up. He pulls Ruth, the primary nurse aside and tells her, “Nobody
asked me about this. I insist that you call the doctor and change this!”
Personal/Social History:
John has been married for 52 years and has a son and daughter. The family is consistently present in John’s room and at
his bedside. His wife and younger daughter are in agreement with John’s desire to have his code status changed to
DNR/DNI but are not willing to withdraw medical treatment and support. They feel he is not thinking clearly and may be
delirious from his illness so they insist that everything continue to be done.
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
1.Patient has a history of ischemic 1.Gives a picture of the patient’s medical history and can be used to
cardiomyopathy, Atrial Fibrillation, Mitral determine progression and course of action.
Regurgitation and Chronic Kidney disease
2.Has been hospitalized three times in the last 2 2.Patient’s health and qualityof life as declined as chronic illnesses progress
months for heart failure exacerbation
3.Admitted 2 weeks ago for SOB and
Heartfailure exacerbation. 3.Patient has pulmonary congestion from progression of Heart failure
4.Has been Aggressively treated in the ICU with 4. Patient’s medical regimen can be evaluated and plan of care revised
Furosemide, Dopamine, Dobutamine, Iv drips
5.Creatinin has risen from 1.8 to 2.7 in the last 4.Progression of Kidney failure
24 hours
6.John is not a surgical candidate to repair his 5.No plan for surgical repair
mitral valve that is contributing to his need for
hospitalization
RELEVANT Data from Social History: Clinical Significance:
This study source was downloaded by 100000840725322 from CourseHero.com on 01-28-2022 15:12:22 GMT -06:00
https://www.coursehero.com/file/74983249/STUDENT-Treatment-Dilemma-Transitioning-to-Comfort-Caredocx/
Transitioning to Comfort Care
STUDENT Worksheet
John Peterson, 75 years old
Overview
Death is inevitable. When it becomes apparent that aggressive medical treatment is no longer a treatment
option, it is not uncommon to find that some members of the family cannot accept this grim prognosis, but insist
that everything that can be done must be done. How can the nurse support both the patient and a grieving family
is the essence of this dilemma.
© 2015 Keith Rischer/www.KeithRN.com
This study source was downloaded by 100000840725322 from CourseHero.com on 01-28-2022 15:12:22 GMT -06:00
https://www.coursehero.com/file/74983249/STUDENT-Treatment-Dilemma-Transitioning-to-Comfort-Caredocx/
, Clinical Dilemma Activity: STUDENT
Transitioning to Comfort Care
I. Scenario
History of Present Problem:
John Peterson is a 75-year-old who has a history of ischemic cardiomyopathy with an ejection fraction of 20%, atrial
fibrillation, mitral regurgitation and chronic kidney disease. He has been hospitalized three times in the last two months
for heart failure exacerbation. He was admitted two weeks ago for SOB and heart failure exacerbation and has been
aggressively managed in the ICU with furosemide, dopamine, and dobutamine intravenous drips. His creatinine has risen
from 1.8 to 2.7 in the last 24 hours. John is not a surgical candidate to repair his mitral valve that is contributing to his
need for hospitalization.
John has openly expressed his desire to family members that he wants to stop all treatment and that he just wants to
die. The physician changed his code status from full code to DNR-DNI but did not stop all other supportive therapies.
When the oldest son, Steve, arrives later that day and finds out that his code status has been changed to DNR-DNI, he
becomes angry and insists that it is too soon to give up. He pulls Ruth, the primary nurse aside and tells her, “Nobody
asked me about this. I insist that you call the doctor and change this!”
Personal/Social History:
John has been married for 52 years and has a son and daughter. The family is consistently present in John’s room and at
his bedside. His wife and younger daughter are in agreement with John’s desire to have his code status changed to
DNR/DNI but are not willing to withdraw medical treatment and support. They feel he is not thinking clearly and may be
delirious from his illness so they insist that everything continue to be done.
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
1.Patient has a history of ischemic 1.Gives a picture of the patient’s medical history and can be used to
cardiomyopathy, Atrial Fibrillation, Mitral determine progression and course of action.
Regurgitation and Chronic Kidney disease
2.Has been hospitalized three times in the last 2 2.Patient’s health and qualityof life as declined as chronic illnesses progress
months for heart failure exacerbation
3.Admitted 2 weeks ago for SOB and
Heartfailure exacerbation. 3.Patient has pulmonary congestion from progression of Heart failure
4.Has been Aggressively treated in the ICU with 4. Patient’s medical regimen can be evaluated and plan of care revised
Furosemide, Dopamine, Dobutamine, Iv drips
5.Creatinin has risen from 1.8 to 2.7 in the last 4.Progression of Kidney failure
24 hours
6.John is not a surgical candidate to repair his 5.No plan for surgical repair
mitral valve that is contributing to his need for
hospitalization
RELEVANT Data from Social History: Clinical Significance:
This study source was downloaded by 100000840725322 from CourseHero.com on 01-28-2022 15:12:22 GMT -06:00
https://www.coursehero.com/file/74983249/STUDENT-Treatment-Dilemma-Transitioning-to-Comfort-Caredocx/
