At this time, Mrs. W was 21 weeks pregnant with her second child. She had a four-year old son. Her husband completed a palliative care sheet three weeks after admission, requesting no CPR. The patient had no previous advance directive. Mrs. W's husband recently requested that if the child should be delivered, that it not be resuscitated.An ethnic consult was called by the ICU nurse in conjunction with the chief resident caring for this patient.
The patient was being cared for by the family-medicine teaching service of the hospital. Present during the consultation were the social worker, attending physician, the chief resident, and neonatologist, the patient's primary care mute, the nursing director of the unit, the hospital attorney and the pastoral care worker.
Under normal circumstances the family would be permitted to request the withdrawal or withholding of life-sustaining treatments when the patient no longer could speak for herself. However the patient's pregnancy seemed to place a different light on the case, especially for the hospital attorney.
The hospital attorney contended that according to the state's living will law, all effort must be made to provide for the birth of a viable infant. In other words, advance medical directive and the right to forgo life-sustaining treatment do not apply to pregnant women. He stated that the code status established a week ago was invalid and that the patient should be full code until the infant become viable outside the mother's womb.
The social worker and primary care nurse contended that the patient's husband and son should not have to bear the consequences of the life others may choose to maintain for them. The neonatologist believed that the infant would probably reach viability by 25 weeks of gestation, but this number could be wrong by several weeks in either direction. Because he believed it would violate the patient's dignity, the resident caring for this patient did not feel he could morally "push on the women's chest" despite the fact that she was pregnant.
1.What is the medical indication such as presenting problem, diagnosis, history, prognosis, care goal, Tx alternative and tx benefit/ burdens
2. What is the patient preference such as competency decisional, capacity maturity of judgment, stated preferences and advance directive and known values.
3. How to solve this problem.
This material may consist of step-by-step explanations on how to solve a problem or examples of proper writing, including the use of citations, references, bibliographies, and formatting. This material is made available for the sole purpose of studying and learning - misuse is strictly forbidden.1. On admission, the patient presented with shortness of breath. She was diagnosed with several conditions, each of which will be taken up and described.
Pneumocystis carinii pneumonia (PCP), now known as Pneumocystis jiroveci pneumonia (PJP): Of some relevance to this case is the fact that PJP “is the most common opportunistic infection in persons with HIV infection” (Bennett, 2014). Prior to the HIV epidemic, PJP was quite rare and occurred in patients who were immunosuppressed, such as cancer patients receiving chemotherapy. Before the standard use of prophylaxis for PJP, and before the “use of highly active antiretroviral therapy (HAART), PJP occurred in 70%-80% of patients with HIV infection” (Bennet, 2014). A complication with PJP in HIV-positive patients is that it “tends to run a more subacute indolent course and tends to present [late], often after several weeks of symptoms” (Bennet, 2014). The patient likely reported progressive exertional dyspnea (exertional breathlessness), fever, nonproductive cough, chest discomfort, as well as weight loss and chills. Physical examination likely resulted in findings of tachypnea (rapid breathing), fever, and tachycardia (elevated heart rate). Treatment consists of antibiotics, either TMP-SMX or intravenous pentamidine, in conjunction with...