Question

The Case of Grace: Why Are They Doing All This? Grace H. has spent all her life teaching high school English in Pine Junction. She retired ten years ago when she began to suspect that she was suffering the early stages of dementia. Shortly after she retired, Grace, who has never married, sold her home and moved into Happy Valley Nursing Home where she has slipped into what the doctor agrees is Alzheimer's disease. Grace has lived at Happy Valley for nine years and appears to be content. Grace is now 82 years old. Before the dementia progressed, she could be found wherever a group had gathered and her laughter could be heard above the others. But the progress of the disease has been relentless and Grace has become more withdrawn. She has been spending more time in her room, communicating with fewer and fewer words. Last month, the staff began to notice a marked change in her. Before, she would be found sitting in her chair when she was in her room; now, aides find her back in bed, complaining of being "tired." She is eating less, often is reluctant even to go to the dining room, and appears paler than usual. The Director of Nursing at Happy Valley has consulted with her staff and they decided that Grace should be taken to Pine Junction Community Hospital to see what is causing her listlessness. Tests at the hospital show that her platelet count is abnormally low, but they admit they do not have the technology to discover why it is so low. Her attending physician calls the director of nursing at Happy Valley to say that he recommends sending Grace in an ambulance 35 miles away to City Hospital. The head nurse talks with the administrator of the facility and the latter contacts Grace's brother, her only living peer whom Grace has named as her durable power of attorney for healthcare decisions. He says, "Well, we have to find out what's wrong with her, don't we?" and consents to Grace's being transferred. She has been in City Hospital for six days now, having had numerous blood drawings, a CAT scan, and a bone marrow test. It is clear that the abnormal functioning of her spleen is causing the problem. She is receiving an experimental drug which, though it will not directly influence the condition of the spleen, does allow it to produce some platelets, and she is receiving supplemental nutrition through an indwelling IV, but this has resulted in swelling in her arm making it twice its normal size and it is painful. Her brother comes to visit and asks the nurses, "Why are they doing all this?" Questions: Please answer each question with a thoughtful response of at least five full sentences for each question. Please examine your own values when doing so. This assignment is worth 15% of your grade. Answers are to be typed written and without grammatical error. If you use any citations within your answer, please cite in APA format.

Should the judgment, "Grace is not dying," determine the course of treatment she receives?

How should the nurse respond to: "We have to find out what's wrong with her, don't we?" At what point in Grace's journey would you argue that "caring" for Grace would suggest a different turn of events?

Grace's brother makes two statements in our story. One implies that gaining knowledge is a sign of "caring." What does the second statement imply?

Is it compassionate care to stop any aggressive treatment and just keep Grace comfortable? What does this case tell us about interpreting an advance directive?

Answer 1

1. Grace was diaganosed with Alzheimer's disease almost 10 years before and was staying in Happy Valley Nursing home for nine years. She was satisfied with her present situation. But due to physiological problem she started feeling unwell. Thr main problem is her spleen is not working properly thats why her platelet count is less.

As she is 82 years old in that condition the treatment depends on the judgement that "how much she is going to recover?" Towards the end of life, physicians face dilemmas of discontinuing life-sustaining treatments or interventions. In some circumstances, these treatments are no longer of benefit, while in others the patient or family no longer want them.

So, the judgement that Grace is not dying is very important in determining the course of treatment she receives.

2. This sentence shows love and responsibility of Grace's brother. As well as worry about Grace's future, was also revealed. So as a nurse, I should convince him that the cause of the disease needs to be figured out. We will be able to begin treatment accordingly as soon as possible after the cause becomes known.

3. Grace is 82 years old. Due to illness she is going through aggressive invasive procedures. Many times family members becomes upset after seeing the sufferings of the patient. Grace's brother cares for her. His statement shows his affections for her. Doctors have started their treatment but if family started caring in that way no aggressive invasion is need then that  "caring" for Grace would suggest a different turn of events.

4. Grace's brother, her only living peer whom Grace has named as her durable power of attorney for healthcare decishows cares for her. His first statement shows caring. The second statement shows sorrow and pain after seeing his Sister's sufferings.

As she is receiving supplemental nutrition through an indwelling IV, and this has resulted in swelling in her arm making it twice its normal size and it is painful. Makes her brother to think the necessity of this treatment.

This sentence shows doubt about the necessity of the on going treatment.

5. Yes, it is compassionate care to stop any aggressive treatment and just keep Grace comfortable. The second statement shows that he is very much disappointed regarding her invasive care.

6.In many industrialized countries ethicists and lawyers favour advance directives as a tool to guarantee patient autonomy in end-of-life-decisions. It is A written document (form) that tells what a person wants or doesn't want if he/she in the future can't make his/her wishes known about medical treatment.

In this case Grace's brother, her only living peer whom Grace has named as her durable power of attorney for healthcare decisions. Authority have taken permission from him before doing invasive diagnostic procedures. Grace is receiving supplemental nutrition through an indwelling IV, but this has resulted in swelling in her arm making it twice its normal size and it is painful. So her brother shows interest in providing compassionate care to stop any aggressive treatment and just keep Grace comfortable. But as Grace is staying on supplemental nutrition then stopping of this can cause death of grace. But as her brother has power of attorney for healthcare decision the hospital is maintaining his orders.