Flaherty E. & Resnick B. (Eds.). (2014). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (4th ed.). New York NY: American Geriatrics Society.
Case Study 1..
Mr. Wiggins is a 78-year-old African American male with chronic kidney disease which requires dialysis. The etiology of his renal disease was multifactorial?long-standing uncontrolled HTN and DM nephropathy. He has been on hemodialysis for the past 10 years and has done relatively well. Four weeks ago he had a major CVA and is minimally responsive. His condition is not expected to change and the family is having a difficult time with his recent health changes. Advanced directives were discussed with them and his wife is a durable power of attorney for his health care. The wife hates to see her husband this way and understands this is not how he would want to go on but their children and many of the family members (his brothers and sisters) think the patient will return to himself. They want everything done in terms of life support measures?full code status. His family wanted a feeding tube placed and he is now receiving 24-hour tube feedings. You are the NP caring for Mr. Wiggins. You have known and cared for him and his wife for several years. The wife pulls you aside shares her dilemma and asks you to make the decision regarding continuing medical care/support for her husband. How will you respond?
Case Study 2.
Mrs. Adams is a 96-year-old Caucasian female who has recently been diagnosed with colon cancer. She was admitted to the hospitalist service through the ED with dehydration and rectal bleeding. The bleeding resolved and she received 2 units of PRBs and fluid/electrolyte replacement. She is stable and ready to be discharged home.
Mrs. Adams is in remarkably good health and other than arthritis and mild HTN she has no significant medical or surgical history. She is able to carry out all of her essential daily living activities. She pays her own bills is competent and has good functional abilities. She was driving up until last year. Now she has neighbor?s assist with weekly shopping and transportation to church. Her sensory functional and cogitative abilities were evaluated this admission and remain intact. She has been offered palliative surgical intervention but deferred all treatment. Her only son is in agreement with his mother?s decision. Her parents and husband are deceased. You have been asked to obtain advanced directives. What will your discharge treatment plan be for Mrs. Adams?
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