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Discuss the legal ramifications, the ethical issues surround
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Discuss the legal ramifications, the ethical issues surrounding this case, and point out the issues that brought you to the decisions you have made, such as poor communication and collaboration with the physician, or lack thereof. The nurse to nurse communication, and how it could have been better to resolve the situation before it became an emergent situation. the Write a paper reflecting the legal issues surrounding this case. Incorporate ethical principles of beneficence, nonmaleficence, autonomy, and justice, as needed since law and ethics go hand in hand. Be thorough with the response. Identify what legal actions the family has, what the nurses did or did not do, and how a professional nurse would have handled the situation differently. Discuss the legal ramifications, the ethical issues surrounding this case, and point out the issues that prompted the decisions that were made. Such as; poor communication and collaboration with the physician (or lack thereof) and the nurse to nurse communication and how it could have been better to resolve the situation before it became an emergent situation. CASE STUDY: H was a 71-year-old long-term resident of a skilled nursing facility. Her medical history was significant for severe malnutrition, pneumonia, urinary tract infection, and brittle diabetes mellitus. She was unable to ambulate and required assistance with multiple activities of daily living. She had a history of variable cognitive deficits and of refusing treatment and medications, including her insulin. Most of her 6-year residency was uneventful, with a handful of hospitalizations for shortness of breath and diabetic ketoacidosis. She was full-code status as far as goals of care. One evening at approximately 1:00 . Mrs. H was noted as having a hard time breathing. Her oxygen saturation was 80% on room air, according to the nursing note; she was placed on oxygen at 2 liters per minute by the nurse. No other documented action was taken at that time. At 2:00 ., Mrs. H was documented as being “coherent,” with no further vital signs or oxygen saturation documented at that time. She was asked if she wanted to be hospitalized, and she declined. Nursing took no further action to either call the physician or notify the family of her change in condition. At 3:00 ., Mrs. H’s oxygen saturation level had dropped to 70%. Her oxygen flow rate was raised to 3 liters per minute which increased her saturation to only 72%. Again, the nursing staff did not document that the physician or the family was notified of Mrs. H’s low oxygen. At 4:00 ., Mrs. H’s oxygen saturation level had dropped between 61% and 62%. She was asked again if she wanted to be hospitalized. Instead of responding verbally, she was documented as shaking her head “no.” The nurse still believed Mrs. H was “coherent” and competent to make her own decisions despite her low oxygen levels. The chart again did not reflect any attempt to notify the physician or the family about her deteriorating oxygen saturation levels. At 6:30 ., Mrs. H was scheduled for a blood sugar check; however, the medication administration record did not show that the check was performed. No reason was provided for failing to perform the blood sugar check at this time. At 7:15 ., one of the daughters was notified of Mrs. H’s change of condition. By 7:30 ., she was noted to be unresponsive to verbal stimuli with decreased blood pressure and elevated heart rate. The nursing staff called the on-call physician. The call was not returned until 8:30 ., when a nurse called from the physician’s office. There was no documentation in the nursing home chart as to what information was exchanged during this telephone call, but no immediate orders were received. At 9:15 ., Dr. M was in the facility doing rounds. He gave a verbal order to transport Mrs. H to the local emergency department. Mrs. H was finally transported an hour later at 10:15 . Mrs. H died 7 days later in hospice care. The cause of death on the death certificate was hyperosmolar/diabetic ketoacidosis for days, protein calorie malnutrition for months, and diabetes mellitus for years.
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