Introduction.
The incident involves a patient being managed for Alzheimer’s disease and stroke going into deep unconsciousness because he had been overdosed with Lorazepam and Tylenol. The patient had already given standing orders that he does not want to be resuscitated if there is a need to do so. Also, the nurse that managed the patient during the previous shift had administered medications to the patient in excess of the dosage that was prescribed by the attending physician.
Attention was drawn to the patient's condition by his family members who noticed that the patient had become deeply unresponsive to arousal. A closer look at the patient showed that the patient had received more than the usual dose of prescribed medications for the previous shift. A fact that should also be mentioned is that the patient has left instructions that he is not to be resuscitated in case he needs resuscitation.
Interpreting
The situation of the patient can be interpreted as having lapsed into deep unconsciousness because of the overdose of medications he has had in the previous shift. An overdose of Tylenol (Acetaminophen) and Ativan (Lorazepam) made sure that the patient's activities were blunted by the effect of the drug(Drugs.com, 2013). Benzodiazepines, which Lorazepam is an example has been shown to have sedation and reduction in stability as some of its side effects (Loring et al, 2012).
Responding
In responding to this patient, one could have assumed that the patient was dying and since he had left a standing order, there was not much that could be done to resuscitate him if the fact is that he is dying (CNO, 1999). A decision was made by the nursing staff to attend to the call of the family members to see the man who was not responding. It was during this process that it was noticed that the man had been given an overdose of his medications in the previous shift.
Reflecting
A number of ethical issues are raised by the above scenario.
In assessing the situation, in the first instance, the man had left standing instructions that he should not be resuscitated. This raises an ethical dilemma to intervene in this situation. However, the intervention only included a quick assessment of the patient to reach the right diagnosis. This is in accordance with the American Medical Association protocol on managing patients that do not want to be resuscitated (AMA, 2013), (Santonocito et al, 2013).
Moreover, another issue that must be addressed is the issue of the family members calling the attention of the nurses on duty to the fact that the patient had become unresponsive. Knowing full well that the patient did not want to be resuscitated, the family members should not have been agitated that the man was unresponsive since he had left instructions that he should not be resuscitated.
Furthermore, I think t he nurse that took the previous shift overstepped her professional jurisdiction by administering multiple doses of the prescribed drug at different times which gave the patient an overdose of the drug and which led to the patient becoming unresponsive.
If not for the quick assessment that the nurses on duty made, they could just have dismissed the alarm raised by the family members based on the premise that the patient does not want to be resuscitated. The family members were also right to have noticed that the medications the patient has received by the patient in the previous shift was faulty.
In conclusion, this above case study has brought to the fore, some important ethical issues that need to be addressed. The issue of attending to the needs of a severely ill patient who does not want to be resuscitated and also the extent to which a nurse can use his/her discretion to administer medications outside the ones prescribed by the attending physician.
References
AMA (2013). Opinion 2.22 - Do-Not-Resuscitate Orders. American Medical Association. Retrieved from <http://www.ama-assn.org//ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion222.page> on 7th of June, 2013
CNO (1999). PRACTICE guideline. Culturally Sensitive Care. College of Nurses of Ontario CNO.
CNO (1999). PRACTICE guideline. Conflict Prevention and Management. College of Nurses of Ontario CNO.
CNO (2008). PRACTICE Standard. Medication, Revised 2008. College of Nurses of Ontario CNO.
C Tanner et al (1993). The Pnenomenology of KNowing the Patient. IMAGE: Journal of Nursing Scholarship. Volume 25, Number 4. GeorgeTown University 1993
C Santonocito et al (2013). Do-not-resuscitate order: a view throughout the world. Journal of Critical Care (2013) 28, 14–21.
D Loring et al (2012). Acute Lorazepam Effects on Neurocognitive Performance.Epilepsy & Behavior 25 (2012) 329–333. Elsevier.
Drugs.com (2013). Tylenol. Drugs.com. Assessed from http://www.drugs.com/tylenol.html
Drugs.com (2013). Lorazepam. Drugs.com. Assessed from http://www.drugs.com/lorazepam.html
