Question

CASES FOR ANALYSIs 1. Joe King contracts bilateral pneumonia. He is treated with antibiotics and put on a mechanical respirator. After a few weeks, the pneumonia improves and the physician starts to wean loe from the respirator. Even with a gradsu approach, the weaning fails and Joe demands to be put back on the respirator when he becomes terrified at being short of breath. The physician feels that the ultimate chances of weaning Joe are now no more than 2o percent. with a gradual Joe, 8o years old and accustomed to being in control, becomes discour- aged and increasingly unable to bear the painful medical procedures (con- stant feedings via a tube inserted into his stomach, frequent needle punctures for arterial blood gases, suctioning, etc). After three weeks of unsuccessful at- tempts, he refuses to cooperate. He asks that the respirator be disconnected. "I want to die," he states. Despite the pain, Joe is alert and aware and is, in the opinion of the staff, fully competent. His wife and one son keep begging the physicians and the nurses to do something to help Joe to recover fully. Does Joe have a right to refuse treatment on the respirator? Do the phy- sician and the nurses have a right or duty to help him psychologically and pharmacologically to overcome his anxiety when taken off the respirator? Do the wishes of the family have ethical or legal weight in such cases? Physi- cians are often sued for keeping a person on a respirator. There is only one where the doctor was charged for removal from the respirator and it was thrown out of court. Is the mere fact that the family may sue a justification for not following the expressed wishes of a competent person?

Answer 1

Answer :

Problems of Mr. joe king :

* bilateral pneumonia

* treated with antibiotics and put on ventilator that means artificial respirator.

* after few days he recovered by wean off and again he got shortness of breath and put on ventilator.

* now on nasogastric tube feedings. For nutrition supplementation.

* arterial blood gas analysis to know oxygen and corbondioxide levels, on the blood through this we can identify metabolic acidosis or alkolosis and respiratory acidosis or alkolosis.

* it is useful to wean off mechanical respiration levels.

* he is having only pain while doing procedures.

For that only he is not able to tolerating, other wise he is alert and awake.

- Joe have right to refuse treatment, but as a nurse and physician or a medical professional we must have to provide psychological support and emotional support to Joe.to continue treatment.

_ after seeing or doing continues examination of abg analysis if he is having capacity to maintain respiration on his own and if Oxygen saturation level is above 95% the physicians can extubate the client and they can use the treatment pharmocologically.

- and also it is one of ethical issue because the client is having only 20% chance.

- so what ever the step should be performed by staff they must have taken consent from family members.

- like dnr (do not resuscitate).

- so by these we can prevent legal complications.

So above the steps must be followed by staff.