Frail pt to ICU Flashcards
64 F recent left hemicolectomy for ca.
Widespread perit mets. Xle comorbids & periop MI.
Now has an acute abd with faecal peritonitis.
Autonomy - Mrs B sufficiently informed of her medical condition to enable her to make choices?
Clear & careful explanation
Counselling
Advice
No win scenario
Sx - likely to die, long post op course
No Sx - she will die
Need to inform her of the options.
Mrs B Overwhelmed & confused
Wish to choose doctor & or family on her behalf
Ambivalent - not wanting to die - not willing to go through intervention.
Explain the option to have operation
Explain the non-operative course ( including palliation)
Ask hw she would like to decide ( prefer to delegate responsibility)
Seek Mrs B values & wishes
Ask Family members
Outline a plan
WHAT DO U KNW ABT WHAT IS GOING ON?
I AM AFRAID THIS IS A REALLY BIG PROBLEM
ANOTHER OP TO FIX THIS UP BUT THR R SOME THINGS TO CONSIDER FIRST
SOME PPL - GO THROUGH LOTS OF DISCOMFORT /SUFFERING & B ON LIFE SUPPORT MACHINE FOR A LONG TIME IN THE HOPE OF RECOVERY
OTHER PPL - THEY WOULDN’T WANT THIS
HOW DO U FEEL?
