Case Study X
Mbinglo Peter
Lakeview College of Nursing
N309, Nursing of the Gerontological Client
 July, 22, 2011

Case Study X
	As the evaluating nurse, I would want to reference any power of attorney, advance directive, living will, do not resuscitate order, allow natural death, and any of the five wishes or all of them before I make any decision in order not to act contrary to the patient’s wishes (Mauk, 2009). I would also want to find out if this information had been discussed amongst the family, and whether any decision reached was entered into the patient’s record. I would most of all, get the family head or representative to confirm the information I asking (Taylor et al, 2010).
	The condition in which Mary is makes it difficult to obtain any information from her. However I would assess her level of consciousness and determine whether we can communicate using sign like nod for yes and no for closing her eyes. I would then go ahead and question her about a living will, a DNR or who to contact. But in this position I would want to talk to one of her family members or whoever ever is her direct representative or power of attorney for more input regarding care for Mary. (Mauk, 2009)
	I would provide a listening ear to Sue as she voices her frustration over her actions which were contrary to her mother’s wishes (Arnold & Boggs, 2011). I would ask her whether she was aware of such a document and whether she and her mother had ever discussed anything with regards to end of life care. I would ask the last time she saw her mum and whether her mother had a power of attorney. Nonetheless I would remind her that her actions were geared at doing the best to her mother if she happen to not know what her mother’s vision was with respect to end of life care. 
	I would assess respiratory system, her gastrointestinal system, her brain function, anxiety and delirium, nutrition and hydration status (Mauk, 2009). Pain is a very important and I would need to assess that to improve her level of comfort. With regards to her nutrition status, I would suggest that the nasogastric tube be left in place so that she can continually receive her food in the hospice care. With her respiration, I would assess her for apnea, dyspnea or shortness of breath (Taylor et al, 2010). This is very important because if the airways are not open and no exchange of gas implies a gradual end to life (Taylor et al, 2010). 
Personal reflection
	This uncomfortable situation could have been avoided if Mary has been checking on her mum regularly but most of all asking her some of her wishes as she gets to the close of her life. I can understand that most people would rather avoid a topic in that regard because they last thing is losing a love one. But then life is continuum and thus death is a part of that continuum (Taylor et al, 2010). I would suggest that Mary start the conversation with her daughter, especially if she had done a power of attorney, living will or DNR alone or with a lawyer, so that they do not have conflicting views like they just did (Mauk, 2009). During the conversation, she would need to provide the document and give her daughter a copy to keep and carry with her all the times in case something happens and there was need for the document. It is generally better for the family to sit and agree on what will be done base on the document at hand. In that way there is less disagreement when it is time for end of life care. In Mary’s case, she only had a daughter to discuss this with but it appears that never happened. 
	As a nurse I would have asked Sue if the tube placement would not be contrary to her mother’s wishes. On the contrary if there was no document on hand backing my point, then it would make no sense. I guess it is better to carry a document like DNR or power of attorney with one every time so that it can be presented when asked. 

References
Arnold, E. C. & Boggs, K. U. (2011). Interpersonal relationships: Professional communication 	skills for nurses. St. Louis, MO: Elsevier Saunders.
Mauk, K. L. (2009). Gerontological nursing: Competencies for care (2nd ed.). Boston, MA: 	Jones & Bartlett.
Taylor, C., Lillis, C., LeMone, P., & Lynn, P. (2010). Foundation of nursing: The art and 	science of nursing care. Philadelphia: PA. Lippincott Williams & Wilkins.