Almeda is an 84-year-old gay, Latina female who lived a reti

Almeda is an 84-year-old gay, Latina female who lived a retired… Almeda is an 84-year-old gay, Latina female who lived a retired life with no family and few friends. She suffered a disabling stroke three years ago and has been confined to bed in a nursing home. Almeda has lost decisional capacity and left no advance directives. Isabella, her long-time friend, has been her unofficial substitute decision-maker. Almeda has developed a stage IV sacral decubitus, now colonized with multiple resistant staphylococcus aureus and pneumonia with heart failure. She is now in the intensive care unit. For two weeks, Alameda has been on the ventilator and fed with a gastric feeding tube. During this time, she has been treated with high dose cardiovascular drugs and Vancomycin antibiotic. There has been no progress in the heart failure or pneumonia. Although stoic, Almeda shows clear signs of pain when moved about for care.  The nurses and attending physician have approached Isabella on numerous occasions to raise theabout stopping aggressive curative treatment, and moving toward palliative care.  Isabella has always insisted that she sees more potential in Almeda’s condition. When asked what the right goal for Almeda ought to be, she answered, “It would be good if she could sit up and watch a little television.”  Almeda’s renal function has now become seriously impaired with a serum creatinine rising to levels requiring renal dialysis. With the prospect of dialysis, the nursing staff asked for a meeting with the attending physician and Isabella to discuss treatment redirection from curative to palliative care.  The nurse considers the following s: s to Address:Does it make a difference which stakeholder raises theabout treatment redirection? What would have happened if Isabella had raised objection to the course of treatment? The nurses, doctors, or Almeda herself?Does the absence of advance directives complicate or simplify the treatment redirection process?Is Isabella an appropriate substitute/surrogate decision maker to consent to treatment redirection to palliative care? Should some “official” or “legal” action be taken in order to proceed with a treatment redirection process? What would Almeda prefer if she were able to contribute to the discussions Isabella’s statement of a goal for Almeda adequate to justify continuing aggressive curative treatment?Is there evidence from the case text that the attending physician has been active enough in trying to inform and persuade Isabella to consent to treatment redirection?What is it about the prospect of renal dialysis that stimulates the raising of the treatment-redirection process? Why not when the gastric tube was inserted? Or when the ventilator was started?Does race, culture and/or sexual orientation impact this scenario?  What should the nurse consider?How could racism, sexism and/or classism impact this situation?What would YOU do to help with this situation? Health Science Science Nursing NURSING N117

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