Patient C is a 70 year old man who is recovering from a mild CVA and is currently admitted for severe exacerbation of his COPD with dyspnoea on minimal exertion. He has moderate dysphagia and dysphasia.
Patient C is a 70 year old man who is recovering from a mild CVA
and is currently admitted for severe exacerbation of his COPD with
dyspnoea on minimal exertion. He has moderate dysphagia and
dysphasia. During the last 48 hours he has spiked a temp at night
and has been more listless and less inclined to interact with
family, staff and other patients. He appears to be mildly confused
and is refusing food and his medications. You encourage him to take
them, but he becomes agitated and very dyspnoeic
Case scenarios:
Patient A is a 16 year old boy who has acute lymphoblastic
leukaemia (ALL). He has undergone several rounds of chemotherapy
without successfully going into remission. His treatment now is
focused on palliation. He is refusing to have any further
chemotherapy. His parents insist that he does.
Patient B is a 36-year-old woman, admitted with a drug
overdose that was an unsuccessful suicide attempt. You are assigned
to care for her and during handover you learn that her condition is
the result of surviving a murder -suicide where her two young
children died as a result of drugs she deliberately gave them. You
don’t want to look after her.
Patient C is a 70 year old man who is recovering from a
mild CVA and is currently admitted for severe exacerbation of his
COPD with dyspnoea on minimal exertion. He has moderate dysphagia
and dysphasia. During the last 48 hours he has spiked a temp at
night and has been more listless and less inclined to interact with
family, staff and other patients. He appears to be mildly confused
and is refusing food and his medications. You encourage him to take
them, but he becomes agitated and very dyspnoeic.
Enteral feeding is discussed and this will also enable
antibiotic therapy. When you and the doctor discuss it with Mr. C
he indicates that he doesn’t want the naso-gastric tube. His wife
is happy for health care staff to do “anything that needs to be
done.” The resident comments that antibiotics and the feeding tube
aren’t really extraordinary treatment and queries whether or not
Mr. C is competent to decide because of his condition and recent
CVA. He asks you to go ahead and organize for naso-gastric tube
insertion.
Patient D is a 44-year-old accountant. She has two young
children, and is the family’s main bread-winner. She has been
admitted to the Emergency Department (ED) with a cardiac rhythm
problem. RN Z has drawn up two syringes, one containing normal
saline to flush the patient’s IV line and the other potassium
chloride (KCl) to add to a burette. RN W has checked the ampoules,
but the ED is busy and she does not accompany RN Z to the cubicle
to confirm correct administration. RN Z mistakenly injects the KCl
as a bolus into the IV line and Patient D has a cardiac arrest.
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