A 72-year-old client with end-stage heart failure is receiving mechanical ventilation in the intensive care unit. The client's family, acting as the designated healthcare proxy, has decided to transition to comfort measures only and requests a compassionate terminal extubation. Which of the following nursing interventions should the nurse include in the plan of care? Select all that apply.
- Administer prescribed intravenous morphine prior to the extubation procedure.Cevap
- Apply a prescribed transdermal scopolamine patch behind the client's ear.Cevap
- Discontinue all physiological monitors and audible alarms in the client's room.Cevap
- DPerform deep nasotracheal suctioning frequently after extubation to manage audible gurgling.
- EDelegate the continuous assessment of the client's work of breathing to the unlicensed assistive personnel (UAP).
- FInform the family members that they must wait outside the room until the extubation is fully completed.
Cevap
The correct interventions are administering intravenous morphine prior to extubation, applying a transdermal scopolamine patch, and discontinuing physiological monitors.
In compassionate terminal extubation, the primary goal is strict symptom management and optimizing the psychosocial environment. Administering intravenous morphine proactively manages dyspnea and pain. Applying a scopolamine patch dries up respiratory secretions to prevent the distressing 'death rattle'. Discontinuing physiological monitors and alarms shifts the focus from vital signs to the client's comfort, fostering a peaceful environment for the client and family.
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Anahtar Kavram
Palliative Care and Compassionate Extubation