End-of-life and Palliative Care
You are an experienced nurse who has been working in the intensive care unit (ICU) for over ten years and are receiving report:
A 45-year-old male assumed full code, transferred to the ICU early this morning for cerebral hemorrhaging and abdominal trauma post-MVA (motor vehicle accident). He was brought into the emergency department via an air helicopter (ORNGE) post-multi-vehicle motor accident. The client had a C-collar in place as the client was found pressed against the steering wheel. Admitting GSC score is 7 as the client is only responding to deep pain simulation, still breathing spontaneously, BP of 75/35 and 79/ 39, RR 145, RR 36, Temp 35.4°C. A CT head and abdomen indicate a massive hemorrhaging to the brain and multiple organs bruising and internal bleeding within the large intestine requiring a STAT surgery for transcending large intestine anastomosis. The client is transfused multiple units of blood and fluid boluses within the emergency department and prepared for the operating room. The client experiences respiratory distress during surgery and is intubated and transferred to the ICU post-surgery.
Current assessment: the client is on continuous sedation with Rocuronium, Fentanyl, and Midazolam for intubation, BP 65/30, HR 150, Temp 37.1°C with a cast on the right tibia and fibula, a sling for the left arm and three rib fractures. He is pending a repeat CT head for the hemorrhage. Currently he is receiving a fluid bolus for being hypotensive, and 1-unit PRBC and IV antibiotics as they suspect he might be becoming septic post-surgery. You wonder if anyone has been able to get in contact with his family and decide to contact them using the information found within his personal belongings.
After briefly speaking to the client’s wife you transfer her to the ICU physician to have a difficult conversation about updating the client’s status. You identify the client as William and see a picture of his wife and two daughters in his wallet. William’s wife arrives in the ICU about an hour later with her two daughters who look approximately 15 and 18 years old. As they see Will, they immediately start crying. You go into the room to comfort the crying wife and daughters and provide a very factual update on his condition. The wife, though shocked, directly speaks to Will and says “Honey, don’t you worry. You are going to make it out of here.”
You inform the physician that the family is here and she provides a more detailed update about the client’s condition and the plan of care. The physician asks the wife if she would like to keep her husband as a full code, in that they would do every “heroic” measure to save his life if his heart was to stop. This includes CPR and the continued intubation and medical management. After looking at her daughters, she states they would like everything to be done to save her husband.