Case Study Of In-Hospital Cancer Deaths

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

Aitken, L., Williams, G., Harvey, M., Blot, S., Kleinpell, R., Labeau, S., & ... Ahrens, T. (2011). Nursing considerations to complement the Surviving Sepsis Campaign guidelines. Critical Care Medicine, 39(7), 1800-1818.

Great strides have been made to improve end-of-life care through palliative care and hospice programs, but sometimes that’s just not enough. In America, the care that is offered to the elderly and the chronically ill is less than ideal. Statistics show that an

Supporters of palliative care feel that it is against two of the main ethical principles of healthcare to not recognize the suffering of the terminally ill (End of Life Care: An Ethical Overview, 16). These principles are beneficence and non-maleficence (End of Life Care: An Ethical Overview, 16). Beneficence means that the healthcare provider is helping or attempting to help the patient (End of Life Care: An Ethical Overview, 16). Non-maleficence means that the healthcare provider is not harming the patient (End of Life Care: An Ethical Overview, 16). Palliative care includes an around-the-clock pain management schedule. Those who “received early palliative care actually had lower rates of depression and better quality of life than patients who received standard treatment only” (http://www.WebMD.com). According to WebMD, a study was published August 2010 in the New England Journal of Medicine by researchers at Massachusetts General Hospital which compared palliative care to standard care for lung cancer patients. The study found that those patients who received palliative care lived 2.7 months longer than the patients who only received standard care (www.http://www.WebMD.com). They stated that it could be “due to more effective treatment of depression, better management of symptoms, or less need for hospitalization” (http://www.Web MD.com). This study is a great tool to show how important the treatment for relief or

In regards to patient outcomes following Code Blue and MET calls (as a percentage), the change from the provided data indicates that the implementation of the ‘EARLY SAVE’ program has had a positive effect on the number of patients remaining on ward. The change in percentages of the variables ‘Could not be resuscitated (died)’ and ‘Transferred to ICU’ has been allocated to the fourth variable ‘Remained on ward’, resulting in an increase in its percentage. An percentage increase in ‘Remained on ward’, and a decrease in ‘Could not be resuscitated (died)’ and ‘Transferred to ICU’ means that more patients were able to be saved, which is a positive indication (Reinhart et al., 2012).

Do Not Resuscitate, "is a written physician's order that prevents the healthcare learn from initialing cardiopulmonary resuscitation (CPR) in the event that a patient's heart stops" (Earp, French, & Gilkey, 2008, p. 348). It had all started within the year of 1960, Kouwenhoven and his colleagues, were the first to announce closed chest cardiac massage as an efficient way of resuscitating victims when undergoing a cardiac arrest (Yuen, Reid, & Fetters, 2011, p. 791). As a patient advocate, my goal is to be able to provide the upmost care to my patients. DNR policy is relatively what patients need to be aware of because it is their only chance of getting any wishes to be followed through towards the end. Yuen (2011) explains how with DNR there

There are a few lawful and moral problems of the do not resuscitate order. The DNR came about by the misunderstanding of CPR. When a person is in cardiac arrest the emergency team is called to their home to give them urgent medical attention. The emergency medical team’s first response is to give the person CPR to help save their life. If an emergency team doesn’t give there patient CPR they could end up dyeing. “During the last decade, the time from cardiac arrest to start of cardiopulmonary resuscitation(CPR)

patients averaged 6.6 days total length of stay. ICU care was needed for only 30.4% of

It examined 266 patients died from cancer or caused related to cancer, but died for caused related to cancer was excluded. Therefore, there were only 265 patients fit the criteria (Amano et al., 2015). It measured the association between early referrals palliative care which means over three months before death and inpatient hospice utilization. This study also measured the relationship between the timing for referring hospice care toward the aggressive end of life care. In this study, researchers divided participants into two groups. The experimental group was for early referral palliative care and the control grout (Amano et al., 2015). The result of experimental group illustrated that the rate of inpatient hospice utilization was 74 percent which is significantly higher than the control group. Moreover, the statistic data displayed that there were no significant indicators for aggressiveness end-of-life care (Amano et al., 2015). In concluding, the early referrals palliative care would associate with more beneficial on inpatient hospice utilization and less aggressive end-of-life care (Amano et al.,

WEEK 5 PICO(T) QUESTION 1Good Afternoon Class and Dr. Stephenson,In and out of the hospital high quality cardiopulmonary resuscitation (CPR) is crucial to survival of victims of cardiac arrest. This research topic will focus on implementation of in hospital chest compressions in CPR. It will be based on a comparison of the efficacy of manual compressions and automated chest compressions in relation to survival outcomes. The potential attributes and short comings related to manual and automated chest compression will be reviewed. Intensive care unit (ICU) nurses have to be prepared to implement CPR during a cardiac arrest code. In consideration that patients in the ICU are often only marginally stable it is important that ICU nurses are familiar with their patient’s recent and past medical histories.

Six studies were conducted in Midwestern hospitals (Carayon et al., 2007; DeYoung et al., 2009; Harrington et al., 2013; Ludwig-Beymer et al., 2012; Morriss et al., 2011; Seibert et al., 2014). One study was conducted in a western hospital in the United States (Hardmeier et al., 2014), one in New England hospitals (Richardson et al., 2012) and one study was conducted in a hospital in the Netherlands (Van Onzenoort et al., 2008). Two studies were conducted throughout the United States (Koppel et al., 2008; Mims et al., 2009). Of the thirteen studies, eleven were cross sectional observational studies while the remaining two were literature reviews (Keane, 2014; Young et al., 2010).

Considering the high mortality in the intensive care unit in hospitals compared to other units as well as the high costs of inpatient treatment in these units, mortality prediction has long been a concern [3]. In recognition of these problems, various scoring scales have been proposed and validated. However, no score has been used as a gold standard and some are difficult to use [4]. The most commonly used scale is Glasgow Coma Scale (GCS) [5]. Lately Full Outline of Unresponsiveness (FOUR) score has been validated and is being used as an alternative to GCS in evaluation of consciousness in severely brain damaged patients [2].

From my understanding of the textbook, a do not resuscitate order (DNR or DNAR), also known as a “No Code Order”, is a written form that omits a patient from receiving cardio pulmonary resuscitation (CPR) during cardiac or cardiopulmonary arrest. Since a DNR only applies to CPR and not to other life saving measures, patients and surrogates have to be clear on which life prolonging treatments should be withheld from the patient and the circumstances in which they should be given. If there is no DNR document present at the time of arrest, there are only two other reason to sustain from CPR and that is when there is conclusive evidence that the patient is deceased or there is no indicated medical benefit for the patient.

Responsible and coherent decision making between physicians and patients about the preferences of CPR requires that patients be properly educated on all the procedure's risks. When doing this, it is also important that the physician conveys concise probabilities of outcomes and that the resuscitation will be nothing more than an “attempted” rather than a “guarantee” when CPR is used. Documenting the patient’s wishes in verbal and written health care directives will provide support for the decision to write a DNR order and maintain it through the hospitalization. There is a time and a place for DNR orders and they should be implemented with sensitivity. When the order is written, this is the time for the physician to step forward and provide care and compassion to the patients and their families during their final moments.

2. Carr, D. B., Fischer, D. S. & Markman, M. (1994). Cancer: when to focus on palliation. Patient Care, 28, (3), 123–126.