C
Perceived loss, such as loss of youth, of financial independence, and of a valued environment, is experienced by the person but is intangible to others. Answers A, B, and D are actual loss and can be recognized by others as well as by the person sustaining the loss; for example, loss of a limb, of a child, of a valued object such as money, and of a job.
a, b, c.
A nurse's role in terminal weaning is to participate in the decision-making process by offering helpful information about the benefits and burdens of continued ventilation and a description of what to expect if terminal weaning is initiated. Supporting the patient's family and managing sedation and analgesia are critical nursing responsibilities. In some cases, competent patients decide that they wish their ventilatory support ended; more often, the surrogate decision makers for an incompetent patient determine that continued ventilatory support is futile. Because there are no guarantees how any patient will respond once removed from a ventilator, and because it is possible for the patient to breathe on his or her own and live for hours, days, and, rarely, even weeks, the family should not be told that death will occur immediately. Counseling sessions may be arranged if requested but are not mandatory to make this decision.
variety of many things
Mechanical ventilation, CPR, artificial nutrition, vasopressors, percutaneous cardiopulmonary support, artificial liver support, dialysis, antibiotics, active fluid resuscitation, hygiene, and medicine
Based on quantitative futility, who will survive a code?
19 yo male paraplegia in with sepsis from pressure ulcers. H/H 4/10, refuses blood (fears will
get HIV)
44 yo female hep + end-stage liver failure, clotting cascade no longer functioning, bleeding out every orifice, BP decreasing, GCS 3
48 yo male PO gastric bypass surgery, developed abscess and sepsis, BP marginal on CRRT, intubated but needs sandbag to ventilate (when moved, goes into Vtach and receives shock), receives about 20 shocks/day
89 yo male, very frail, in with syncope from 3rd degree heart block
America's History for the AP Course
9th EditionEric Hinderaker, James A. Henretta, Rebecca Edwards, Robert O. Self
961 solutions
America's History for the AP Course
8th EditionEric Hinderaker, James A. Henretta, Rebecca Edwards, Robert O. Self
470 solutions
U.S. History
1st EditionJohn Lund, Paul S. Vickery, P. Scott Corbett, Todd Pfannestiel, Volker Janssen
567 solutions
The Language of Composition: Reading, Writing, Rhetoric
2nd EditionLawrence Scanlon, Renee H. Shea, Robin Dissin Aufses
661 solutions
NO, not the same.
Maryland MOLST is a portable and enduring medical order form covering options for
cardiopulmonary resuscitation and other life-sustaining treatments.
include your proxy.
Medical order of life sustaining treatment.
Filled out by 2 doctors prior to the last hospital, when going hospital to hospital. What would you want under certain circumstances?
OURS IS NOT AN ADVANCED
DIRECTIVE. Although it includes it.
Can the patient communicate? CPR- include this. Intubate? or do not intubate? Cpap or bypap? THink of masks over your face...
palliative- not cure only comfortable like hospice,
quality of life not quantity
Artificial ventiliation, blood transfusion, hospital transfer, medical workup, antibiodics, artificially adminster fluids and nutrition, dialysis is invasive, or supportive care...02? ..................
VS THE LIVING WILL..... POLST is in
pennsyvania it isnt the state its just different.
a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive.
State specific
MD states that certification of incapacity is required by
two physicians, one being the attending physician, within two hours of examining the patient before the orders related to healthcare, including the withholding or
withdrawing of life-prolonging treatments, may be honored. The law also provides a suggested outline for a living will.
Maryland Medical Orders for Life-Sustaining Treatment (MOLST)Patient's Last Name, First, Middle InitialDate of Birth□Male□FemaleThis form includes medical orders for Emergency Medical Services (EMS) and other medical personnel regarding cardiopulmonary resuscitation and other life-sustaining treatment options for a specific patient. It is valid in all health care facilities and programs throughout Maryland. This order form shall be kept with other active medical orders in the patient's medical record. The physician, nurse practitioner (NP), or physician assistant (PA) must accurately and legiblycomplete the form and then sign and date it. The physician, NP, or PA shall select only 1 choice in Section 1 and only 1 choice in any of the other Sectionsthat apply to this patient. If any of Sections 2- 9 do not apply, leave them blank. A copy or the original of every completed MOLST form must be given to the patient or authorized decision maker within 48 hours of completion of the form or sooner if the patient is discharged or transferred.CERTIFICATION FOR THE BASIS OF THESE ORDERS: Mark any and all that apply.I hereby certify that theseordersareentered as a result of a discussion with and the informed consent of: ________ the patient; or ________ the patient's health care agent as named in the patient's advance directive; or ________ the patient's guardian of the person as per the authority granted by a court order; or ________ the patient's surrogate as per the authority granted by the Heath Care Decisions Act; or ________ if the patient is a minor, the patient's legal guardian or another legally authorized adult.Or, I hereby certify that these orders are based on: ________ instructions in the patient's advance directive; or ________ other legal authority in accordance with all provisions of the Health Care Decisions Act. All supporting documentation must be contained in the patient's medical records. ________ Mark this line if the patient or authorized decision maker declines to discuss or is unable to make a decisionabout these treatments. The patient's or authorized decision maker's participation in the preparation of the MOLST form is always voluntary. If the patient or authorized decision maker has not limited care, exceptas otherwise provided by law,CPR will be attempted and other treatments will be given.1CPR (RESUSCITATION) STATUS:EMS providers must follow the Maryland Medical Protocols for EMS Providers.________ Attempt CPR:If cardiac and/or pulmonary arrest occurs,attempt cardiopulmonary resuscitation (CPR). This will include any and all medical efforts that are indicated during arrest, including artificial ventilation and efforts to restore and/or stabilize cardiopulmonary function. [If the patient or authorized decision maker does not or cannot make any selection regarding CPR status,mark this option. Exceptions: If a valid advance directive declines CPR, CPR is medically ineffective, or there is some other legal basis for not attempting CPR, mark one of the "No CPR" options below.] ____________________________________________________________________________________________________________________________________________ No CPR, Option A, Comprehensive Efforts to Prevent Arrest: Prior to arrest, administer all medications needed to stabilize the patient. If cardiac and/or pulmonary arrest occurs, do not attempt resuscitation (No CPR). Allow death to occur naturally.________ Option A-1 , Intubate: Comprehensive efforts may include intubation and artificial ventilation.________ Option A-2 , Do Not Intubate (DNI): Comprehensive efforts may include limited ventilatory support by CPAP or BiPAP, but do not intubate._______________________________________________________________________________________________________________________________________ _______ No CPR,Option B, Palliative and Supportive Care: Prior to arrest, provide passive oxygen for comfort and control any external bleeding. Prior to arrest, provide medications for pain relief as needed, but no other medications. Do not intubate or use CPAP or BiPAP. If cardiac and/or pulmonary arrest occurs, do not attempt resuscitation (No CPR). Allow death to occur naturally.SIGNATURE OF PHYSICIAN, NURSE PRACTITIONER, OR PHYSICIAN ASSISTANT(Signature and date are required to validate order)Practitioner's Signature Print Practitioner's NameMaryland License # Phone NumberDatePatient's Last Name, First, Middle InitialDate of BirthPage 2 of 2□Male□FemaleOrders in Sections 2-9 below do not apply to EMS providers and are for situations other than cardiopulmonary arrest.Only complete applicable items in Sections 2 through 8, and only select one choice per applicable Section.2ARTIFICIAL VENTILATION 2a. _______ May use intubation and artificial ventilation indefinitely, if medically indicated.2b. _______May use intubation and artificial ventilation as a limited therapeutic trial. Time limit______________________________________________________________________2c. _______ May use only CPAP or BiPAP for artificial ventilation, as medically indicated. Time limit______________________________________________________________________2d. _______ Do not use any artificial ventilation (no intubation, CPAP or BiPAP).3BLOOD TRANSFUSION3a. _______ May give any blood product (whole blood, packed red blood cells, plasma or platelets) that is medically indicated.3b. _______ Do not give any blood products.4HOSPITAL TRANSFER4a. _______ Transfer to hospital for any situationrequiring hospital-level care.4b._______ Transfer to hospital for severe pain or severe symptoms that cannot be controlled otherwise.4c. _______ Do not transfer to hospital, but treat with options available outside the hospital.5MEDICAL WORKUP5a. _______ May perform any medical tests indicated to diagnose and/or treat amedical condition.5b. _______ Only perform limited medical tests necessary for symptomatic treatment or comfort.5c. _______ Do not perform any medical tests for diagnosis or treatment.6ANTIBIOTICS6a. _______ May use antibiotics (oral, intravenous or intramuscular) as medically indicated.6b. _______ May use oral antibiotics when medically indicated, but do not give intravenous orintramuscular antibiotics.6c. _______ May use oral antibiotics only when indicated for symptom relief or comfort.6d. _______ Do not treat with antibiotics.7ARTIFICIALLY ADMINISTERED FLUIDS AND NUTRITION7a. _______ May give artificially administered fluids7c. _______ May give fluids for artificial hydration and nutrition, even indefinitely, if medically as a therapeutic trial, but do not giveindicated. artificially administered nutrition.7b. _______ May give artificially administered fluids and Time limit_________________________ nutrition, if medically indicated, as a trial. 7d. _______ Do not provide artificially administered Time limit__________________________ fluids or nutrition.8DIALYSIS 8b. _______ May give dialysis for a limited period.8a. _______ May give chronic dialysis for end-stage Time limit_________________________ kidney disease if medically indicated. 8c. _______ Do not provide acute or chronic dialysis.OTHER ORDERS___________________________________________________________________________9____________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________SIGNATURE OF PHYSICIAN, NURSE PRACTITIONER, OR PHYSICIAN ASSISTANT(Signature and date are required to validate order)Practitioner's SignaturePrint Practitioner's NameMaryland License # Phone NumberDate
Sets with similar terms