...is written to discuss the ethical dilemma we come across when asking our self whether or not we should place a tube feeding in a patient with a history Alzheimer’s or Dementia. Will this prolong the patients’ life or just the inevitable death? Most often a decision needs to be made regarding the placement of a tube feeding. The question is not initiated by the patient themselves. This is the reason why educating our patients are so important. In this paper I will discuss how important the role of the healthcare professional plays in advocating for a patient. To help answer this ethical dilemma several issues will be explored. I will focus on the seven principles of ethics, education, utilitarianism, top-down theory alternate treatment options. Will Tube Feedings Prolong Life? While working with the majority of geriatric population, we frequently come across patients with Dementia and Alzheimer’s disease. The most common problem in these patients is the inability to swallow as well as the patients are failure to thrive. Many healthcare workers and family members become upset when the patient does not have proper nutritional intake. As human beings it is our nature to take care of our loved ones when they are ill, this is our ways of showing love and affection tore’s each other. We often question the situation regarding the need for artificial feeding. Care givers have misconceptions if we provide artificial nutrition it will help prolong their love one’s life...
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...Mortality, February 2005; 10(1): 69 – 81 Tube feeding: Prolonging life or death in vulnerable populations? ELAINE J. AMELLA, JAMES F. LAWRENCE, & SUZANNE O. GRESLE Medical University of South Carolina, Charleston, SC, USA Abstract Tube feeding can be an appropriate and effective means of providing nutrition for individuals who are unable to achieve adequate nourishment orally because of various medical problems. However, the delivery of nutrients by tube feeding can cause ethical dilemmas in cases where the effectiveness of tube feeding diminishes and medical complications increase. The decision to tube feed is often influenced by regional and cultural preferences, as well as the high cost of providing mealtime assistance. The effectiveness and appropriateness of tube feeding has been the subject of much debate as it applies to those with severe cognitive impairments and those who are in a persistent vegetative state (PVS). Recent research shows that in these vulnerable populations, tube feeding alone does not necessarily prevent malnutrition and risk of infection or improve functional status and comfort. While advanced directives allow an individual to make decisions about his or her care at the end of life, court cases and religious doctrine examine the individual’s right to autonomous decision making in opposition to preserving the sanctity of life. As long as the outcome of this debate is largely undecided, the process of dying may be prolonged for...
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...The Feeding Tube 1. Explain how the Patient Bill of Rights applies to this situation. The patients of the country in the United States are provided a particular right. This right is called the Patient Bill of Rights (Kronenfeld, 2002). The Patient Bill of Rights has a significant impact and is essential for the people who are in the health care organization for the purpose of getting treatment properly and easily. In this scenario, June is suffering from anorexia and the doctors feel she may need to be placed on a feeding tube to save her life. June agreed to the procedure but became combative, disoriented and refused to have the tube place the evening before the procedure was to take place. The patient bill of rights applies, as the patient has a right to know what treatment options are available to one and what the possible outcomes may be. The patient has a right to decide one’s medical care. One also has a right to know of any side effects of treatments. June needs to be told what may happen without the feeding tube and what can be expected with the feeding tube. June also has a right to have her health information kept confidential, with information given only to those she designates as being allowed to have her health information (Showalter, 2008). It is noted that in the absence of a progressive terminal disease, the feeding tube may be used to prolong life and since the patient is not dying of another cause, discontinuing the feeding tube would imply a desire to cause...
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...EXPLAIN HOW THE PATIENTS BILL OF RIGHTS APPLIES TO THIS SITUATION. All patients have the right to safe service that respects all of their core values. The purpose of this case analysis is to be able to appropriate the patient bill of rights as it pertains to this situation. The basic rights of human beings, such as concern for personal dignity are always of great importance and the function of patient bill of rights is to help improve patient outcomes by respecting each patient rights and conducting clinical health organization relationship in an ethical manner (Fremgen 2009). The patient bill of rights act was created in 1973 by the American Hospital Association (AHA) and was created to protect the privacy and integrity of patients, doctors and other health care providers (Ehow 1999-2010), this basically means that it is a bill that will help with the communication of skills between all parties to provide best care. Part of the obligation that pertains to the patient bill of rights is that, the patient has the right to be considerate and given a respectful care (Fermgen 2009). The provider has to respect the dignity of the patient by being considerate while giving care, every patient has the right to be informed on any issue that they might be facing unless it is an emergency. In our subsequent discussions in this course, we have discussed basic elements of patient bill of rights and how it applies to consent for treatment and how the patient bill of rights contains several...
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...require some type of tube placed within their stomachs or intestines gastrointestinal tubes provide nourishment to client who cannot eat. First, let’s take a look at which patients may be candidates for tube feeding .Patients with chronic illness or psychiatric or neurologic disorder ,such as alcoholism, chronic depression, or anorexia .Patients who are debilitated because of disease or injury .Patients undergoing maxillofacial or cervical surgery resulting from disease or injury. Patients with or pharyngeal or esophageal paralysis resulting from disease or injury, neoplasm, inflammation, trauma, or respitory failure. Tube feeding are not a one-size-fits- all measurement they have proximal and distal end, their size, construction, and composition vary according to their use. Tubes are measure by using the French scale each number on the scale equal approximately 0.33mm. The larger the number, the larger the diameter of the tube. That is one of the reason‘s why every patients condition is considered individually to determine whether which tube feeding is best for the patients specific condition and needs. Secondly, let’s discussed where the tubes maybe placed any why. Tubes can be identified according to the location of insertion, or there distal end. The choice of feeding route is based on the patient’s medical status, aspiration, and expected duration of feeding. Three types of tube placement are commonly used for tube feeding. An orogastric tube (this tube is inserted at the...
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...Documentation Guidelines Respiratory Problems Respiratory rate, pattern, lung sounds, presence of cough or congestion, sputum, sternal retractions, unequal chest expansion, nasal flaring Skin color: color of lips and nail beds, cyanosis Use of O2, rate, delivery method, frequency of use,SPO2 (on RA on O2, after exertion, at rest) Weaning off O2 Use of Brochial Dialators and other respiratory medications, response to medications, Neb Tx, suctioning, IPPB Activity tolerance Causes of onset of SOB, how long does it take for relief use of high fowlers position Goals set by resident and staff teaching performed, to resident and or family Orthopedic surgery/fracture ADL: describe what they cannot do Assistance needed with what? Bathing, dressing, shaving, oral care, bed mobility, toileting (continent, incontinent, foley, bladder retraining, constipation. Transfer (lift 1-2 assist) Ambulation w/wo devices (walker, cane, w/c, distance in feet) Attending PT, OT - frequency and time, check therapy progress notes and compare to progress on the unit (tolerance) Incision: Intact, well approximated, sign of infection, treatment Cast, splint care: neuro/ vascular checks Presence of PAIN, if present what time of day, durning what activity, relief measures (medications/effectiveness) Abductor pillow, hip precations, CPM, polar ice, ted hose, PAS stockings, Goals set by resident and staff Teaching performed to resident and or family, ability to learn Diabetes Doctor...
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...Background: Nasoenteric tube insertion is a common procedure used in the clinical setting. Often viewed as a safe bedside procedure, there are risks for numerous complications including tracheobronchial insertion, which could lead to deleterious consequences. We present the first case of bilateral pneumothorax caused by the insertion of mal-positioned nasoenteric tube and discuss common pitfalls for diagnostic positioning as well as risk factors that can predispose a patient to improper placement. Case Report: In this case report, we demonstrate a 74-year-old male patient who presents with multiple orthopedic injuries following an auto-pedestrian collision. During his hospital stay, a routine nasoenteric tube was inserted for the purposes of enteral nutrition. Follow up abdominal X-ray revealed the nasoenteric tube misplaced in the left pleural space. After removal of the nasoenteric tube, a follow up chest X-ray revealed bilateral pneumothorax. The patient fell into respiratory distress and subsequent bilateral chest tubes were placed. Over the course of the next three weeks the patient improved, both chest tubes were removed, and the patient made a full recovery....
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...This is a case of a 34-year old woman called June who is suffering from severe anorexia. She agrees to be placed on a feeding tube in order to save her life. On the evening before the tube is placed, June becomes disoriented and physical and totally refuses to have the feeding tube placed. The ethical dilemma sets in when the parents insist that the tube must be inserted despite her refusal, while the ex-husband wishes to uphold June’s final decision which most certainly will lead to her demise. The hospital administrators seek legal counsel in order to save the situation. This case though a sad one, presents with it several repercussions. This paper will explain the various implications that June’s case presents in the contemporary world and the various paths used to derive the elusive “right” decisions on the way forward. The patients’ bill of rights is a document that was developed by the American Hospital Association in order to improve the relationship between the patient, the medical staff and employees in the provision of health care. It enumerates several rights that a patient is entitled to before, during and after getting treatment. While this document is not law; it is very important in ensuring that all activities towards a patient’s health are carried out with consideration for their values and dignity (Maryland Hospital, 2011). The patient’s bill of right gives June several privileges as a patient concerning her treatment. First, she can make her...
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...is also known as tube feeding contains a tube that is placed into the gastrointestinal tract that will supply the patient with a nutrient based formula. Receiving nutrients allows the body to have enough energy so the body can function properly. Nutrients allows the body to start the healing process. Feeding tubes comes in various types and they come in multiple sizes. Feeding tubes may be temporary or permanent depending on the illness but they are the best option for getting...
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...life as a vegetable, it was then that the struggle between her spouse and family would ensue. Once it was determined that there was no hope of a full recovery, Schiavo’s husband made it clear that his wife would not want to live on life support and wanted to have her feeding tube removed. “Schaivo’s husband and legal guardian argued that Schiavo would not have wanted prolonged artificial life support without the prospect of recovery, and elected to remove her feeding tube.” Once Michael, Schiavo’s husband, elected to have the feeding tube removed, her family began the process of trying to keep her alive. “Schiavo’s parents argued in favor of continuing...
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...react to basic external stimuli, but not be conscious about it; and in theory, they can’t feel pain. There are two different possible ways to respond to this case of people being in a vegetative state. One way is that the feeding tube should be pulled because this is no way for anyone to live, or even that somebody wouldn’t want to be alive in these conditions. The other way to respond is that they should be kept alive because...
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...suture is placed through the outer body wall into the distended stomach o scope and suture is recovered and pulled from stomach to the mouth o the stomach tube is tied securely to the suture and pulled into the stomach and out of the body wall o the stomach tube is anchored in place o a cap is placed on the end of the stomach tube Client Education of gastrostomy To feed your companion through the gastrostomy tube, a warmed liquid diet is needed to be given 3-4 times a day with the use of a syringe. If obstruction of the tube occurs, in addition to vomiting or diarrhea, contact your veterinarian immediately....
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...Unfortunately, the then twenty-six year old Terri had suffered irreversible damage due to prolonged lack of oxygen to the brain. Terri is left in a persistent vegetative state and has a feeding tube and requires total care (Schindler v Schiavo, 2005). The next three years consist of her husband, Michael, and her parents Robert and Mary Schindler working together to take care of Terri. During this time Michael was appointed as Terri’s legal guardian without objection from her parents. In February of 1993 Michael Schiavo and the Schindler’s began to disagree about Terri’s care and the Schindler’s attempted to remove Michael as her legal guardian (Cerminara & Goodman, 2005). In May of 1998, Michael Schiavo made his first attempt to petition the court for the removal of Terri’s feeding tube. Michael believed that there was no hope for any sort of recovery or changes in Terri’s persistent vegetative state and had stated that his wife told him that she would not want to live like that (Quill, 2005). The next several years consist of a series of court cases and appeals based on Michael Schiavo’s push to have the feeding tube removed and Terri’s parent’s insistence to keep her alive. The tube is actually removed and reinserted twice during this time. On March 18th, 2005 the feeding tube is removed for the third time in accordance with the court order. This proved to be the...
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...Bouvia vs. Supreme Court The case of Bouvia vs the Supreme Court, is the case in which Bouvia, a patient at a public hospital, wanted a feeding tube removed that was placed in her against her will. In this essay I will give a brief overview of the case, then I will relate the relevance of a couple ethical terms. Thirdly, I will discuss how an act-utilitarian would approach this case and finally, I will give my opinion of this case. The hospital in which Bouvia was in put in, in an effort to get food into her system. Bouvia, who is a quadriplegic and has since birth suffered from a severe case of cerebral palsy, did not want it in because it was very uncomfortable and she didn't want to take measures to prolong her life. Because of the cerebral...
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...family disagreed on how to handle her situation, whether or not to remove her feeding tube. Even though their Terri was in both of their best interest, they could not agree on, would removing the feeding tube be killing her or letting her die? Ethical Importance Terri had left no written instructions as to what her wishes might be if she were no longer able to make her own medical decisions. The only thing that the court and her family had to go on was what her husband and family remembered her saying in conversation over the years. The memories of her husband and family were very different. In the beginning of this ordeal they both agreed that everything should be done for Terri’s survival because at that time there was hope. After a while, when Terri did not appear to be changing, or getting better, her husband believed that the quality of life that Terri had was not the quality that she would have wanted had she been able to voice her opinion. “Michael Schiavo said his wife had said that she would never want to be kept alive in a vegetative state. He asked the courts to allow doctors to remove her feeding tube so she could die.” (Schiavo Timeline, 2005). It was then that the battle became public. Was it ethical for the feeding tube to be pulled to either let her die or was it to help her die? This battle went on for 15 years. According to her husband, she just existed, being fed from a tube, laying in...
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