Directions
The provided case study illustrates the case of one Mr. Red Smart, a hospitalized, elderly diabetic patient who equally suffers from hypertension and a host of other medical conditions. Mr. Red uses crutches due to an earlier fall and he experiences a sharp pain at home and falls unconsciousness and upon the doctors diagnosis, Myocardial infarction (MI) is detected. He is admitted to the hospital for three weeks but he considers to return home contrary to his family opinions. He also suffers from memory lapses.
Scenario
Red is a 60 year old man who lives with his elderly wife aged 58 years in the upcountry. He suffers from diabetes and has been admitted severally to the hospital before. He also has high blood pressure and he uses a crutch after suffering from a fall while walking in his farm yard. Red also suffers from episodes of memory lapses which started after his fall o he farm. He is under medication for the management of the hypertension. He is also under a nutritional regime to cut down on the high cholesterol intake, and increase his dietary fiber intake. He has also been advised to quit smoking. Red and the wife have two grown daughters who also live in the same state. One day, Red feels a sharp pain the chest and collapses in his house and is rushed to the hospital. Although this has happened before, Red demanded to recuperate from home.
The doctors examine Red and diagnose him with Myocardial infarction (MI). He is admitted and immediately put on IV aspirin and also nitroglycerin is administered. Due to the delicacy of the matter, the doctor’s advice Red to stay in the hospital for 5 weeks as he stabilizes. However Red demands a discharge after only two and half weeks of admission.
Patient assessment at admission
Succinct patient description:
Gender: Male Age: 60 Race: Latino
Weight: (280 pounds)
Height: 170cm (42 inches)
Religion: Catholic
Patient’s Major Support: Michel (Daughter) Phone: 987-545-3112
Allergies: no known allergies
Immunizations: Hepatitis 5 years ago
Past Medical History: Diabetes Type 2 diagnosed August 24th (2012), high blood pressure
History of Present illness:
The Patient experienced a sharp chest pain, collapsed and passed out. Daughters rushed him to hospital and patient was diagnosed with Myocardial infarction (MI). Aspirin was administered as well.
Social History:
Two daughters live in the same state, has an elderly wife whom they stay with.
Primary Medical Diagnosis:
Heart problem
Surgeries/Procedures & Dates:
Surgery of the pharynx – 22 years ago;
Nursing Diagnoses:
Compromised Mobility
Compromised heart functioning;
Ineffectual general Health Care;
Ineffectual Self Health Management
Needs
The first need is the patient’s age. Being an elderly citizen at 60 years, Red is predisposed to numerous age related complications such as susceptibility to falls, which he eventually suffers from. There is also an educational need for the patient in order for him to understand his disease prognosis and nutritional requirement on how to take care of themselves. For instance, the patient seems not to understand the severity of his condition (MI) and how his diet contributes to its furtherance Furthermore, the patient needs to be educated further on the dangers of smoking and emphasis needs to be laid on its correlation to her diagnosed condition. Red also has a memory problem which may hinder his taking of medication and following of the given instructions. This places him at a high risk of readmission due to drug non adherence.
Discharge level of care and destination
At discharge, the patient needs both therapeutic management and cardiac rehabilitation. Cardiac rehabilitation involves a total lifestyle overhaul so as to present the occurrence of the condition. Activities here may entail uptake of exercise regimes, management of stress levels and social support. Aspirin and nitroglycerin are the recommended medications for Red. The recommended care is essential for Red in mitigating further adverse effects on his health. The proposed recommendation is a proposal by the healthcare providers to Reds family on how to best offer care at the community level.
Discharge
Discussion
Having episodes of dementia, Red may not be in a position to make sound decisions regarding his discharge. The suggestions by the healthcare team to retain him for 5 more weeks, which is backed by his family thus need to be adhered to by Red. The wife’s unwillingness to have him home in his current condition is also a cause for concern which should be considered. With his MI condition, exiting from a hospital setup may lead to readmission and development of adverse conditions.
Ethical reasoning and action
Various ethical issues surface from Reds case. First the ethical rule of patient autonomy comes to the fore. As a principle, a patient’s right of self-determination must be upheld whereby the patient can determine what needs to be done to them. In this cases, Red bears the right to determine whether he wants to stay in the hospital or be discharged. However, since the family holds reservations to this view based on his mental capacity, an ethical dilemma surfaces. Red suffers from memory lapses and his capacity to make a decision regarding his care in highly incapacitated. Consequentially, the family may hold a sway on which way the decision to discharge him goes. Citing the ethical principle of beneficence, the family must ensure to act to the patient’s best interest as Sandman, et al., (2012) opines. However, Red’s case still presents more dilemmas since he is not an invalid and his ability to make sound decisions is not entirely affected. Red’s case presents typical day to day issues in health care whereby patients with adverse conditions presenting also with mental issues offer their own suggestions to the care they should receive and which is contrary to that which their families want. In such dilemmas, an informed consent must be administered to the patient so that they can make an informed decision regarding their care (Wolf-Braun, et al., 2015). Alternatively, the health practitioners can also try to persuade the patient regarding the best possible cause of action concerning their care but ultimately, the decision is the patient’s due to patient autonomy. Paternalism in this case, is overrun by informed consent and patient autonomy.
References
Sandman, L., Granger, B. B., Ekman, I., & Munthe, C. (2012). Adherence, shared decision- making and patient autonomy. Medicine, Health Care and Philosophy, 15(2), 115-127.
Wolf-Braun, B., & Wilke, H. J. (2015). [Patient autonomy and informed consent-ethical and legal issues]. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS, 50(3), 202-210.
