Scenario #1: A 49-year-old woman with advanced stage cancer has been admitted to the emergency room with cardiac arrest. Her husband and one of her children accompanied the
ambulance.
As a primarily ER and ICU nurse, this is a familiar scene. When dealing with the dying
patient, the last part of their healthcare can be difficult for the family as well as the provider. In
this scenario a terminally ill patient arrives in the ED in active cardiac arrest, with family at
bedside. Having the patient’s family, primarily the husband, available allows the medical
professional the ability to assess the patient’s wishes for end of life care. It is our responsibility to
assist the family in this decision (Taylor & Johnson, 2011).
Some questions that should be addressed to the husband: Does your wife have a DNR (do not
resuscitate) order? What events leadup to the patient’s current condition? Who found the patient
unresponsive, if alone, and what time did this occur? When was the last time you saw your wife
responsive and tell me about today? Was there anything unusual or had she had any new
complaints? What type of cancer was she diagnosed with? Does the patient have a DNR or living
will? Do you want to continue CPR? Would you like for our spiritual team to accompany you in
ER?
Health assessment questions: Does the patient have a pulse? What is the EKG Rhythm? What
treatments were given in the ambulance? Does the patient have any signs of trauma? What is the
patient’s GCS? Vitals? Continue ACLS protocol if patient is in cardiac arrest.
These types of emergencies can be less stressful but if handled correctly by ER staff and
providers, can be much less traumatic for the family. As a provider it is our duty to provide the
patient’s family with needed information on treatments available for the patient. Having a strong
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knowledge on how to handle these palliative emergencies can help maintain proper end-of-life
care (Buckley, 2008).
As providers, we should be mentally prepared for the family’s decision and response.
Health care professionals have an to the wishes of the husband and wife.
Patient’s with a defined advanced directive or living will, may have already addressed these
issues and made decisions regarding their end of life care. If no DNR or advanced directive is
available, must be maintained to honor the wishes of the family (Peicius et
al., 2017).
The first and most important peice of information needed is finding out the patient’s and
families wishes. Was the patient hospice? Or is there a DNR? Having this type of information
will make the decision much easier on the family and provider during this situation. The second
thing is providing information to the family regarding patient’s outcome and possible decisions
to be made if the patient does regain a pulse. Keeping the family updated and involved in
decision making is vital.
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References
Buckley, J. (2008). Palliative Care: An Integrated Approach. Chichester, U.K.: Wiley. Retrieved
from https://ezp.waldenulibrary.org/
Peicius, E., Blazeviciene, A., & Kaminskas, R. (2017). Are advance directives helpful for good
end of life decision making: a cross sectional survey of . BMC
Medical Ethics, 18(1), 40.
Taylor, P. M., & Johnson, M. (2011). Recognizing dying in terminal illness. British Journal of
Hospital Medicine (London, England: 2005), 72(8)
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