Question

The client has a documented advance health care directive that indicates that no resuscitative measures should be employed in the event of a respiratory or cardiac arrest. The client begins to exhibit severe dyspnea and air hunger and says, Please do something, I cant breathe. What action should be taken by the nurse?

Answer 1

The nurse should provide comfort measures that align with the client's advance directive and, if the client expresses a desire to reverse the DNR order, the healthcare team should be immediately informed. The patient's current wishes should guide any potential action, while respecting the legal and ethical considerations of the existing directive.

Step-by-step explanation:

If a client has a documented advance health care directive indicating that no resuscitative measures should be employed in the event of a respiratory or cardiac arrest, the nurse faces a complex ethical dilemma when the client is in distress and asks for help. The nurse must balance respecting the client's previously expressed wishes for no resuscitation (as outlined in the DNR) with the current request for help. In such a situation, the immediate action would be to provide comfort measures and support that do not contradict the directive, such as administering oxygen if it's not part of the DNR restrictions, repositioning the patient for better breathing, and offering reassurance.

However, if the client is clearly indicating a desire to reverse the DNR order, the healthcare team should be notified immediately so that the appropriate steps can be taken to evaluate and, if necessary, update the patient's care preferences. Ultimately, the goal is to respect the patient's autonomy and current wishes, while also navigating the legal and ethical boundaries of their advanced directives.