Week 10 CC

What are the needs of a complex patient (5)

1. Patient assessment

2. Diagnostic reasoning

3. Prioritisation

4. Intervention and action

5. Reassessment and evaluation

What are the three steps in clinical reasoning

1. Cognitive processes, strategies looking at significance of patient data

2. Identify and diagnose actual or potential problems

3. Clinical decisions enhance patient outcomes

Define duty of care

Legal obligation imposed on an individual requiring that they adhere to a standard of reasonable care while performing any acts that could foreseeably harm others

What are two duties nurses have when a patients presents to ED (2)

1. Duty to evaluate the status of persons who are ill and seeking professional help

2. Duty to implement care needed to stabilize a patient's condition and to prevent complications

Describe the duty of confidence (3)

1. Prevents disclosure

2. The duty does not end when the professional relationship with the patient has ceased

3. Does not end with the death of the patient

What must consent be (4)

• Be informed (the patient must understand the broad nature and effects of the proposed intervention and the material risks it entails)

• Be voluntarily given

• Encompass the act to be performed

• Be given by a person legally competent to do so

Who should make the deicsion on quality of life (1)

• Patient involved if possible

Define medical futility

Continued provision of medical care or treatment to a patient when there is no reasonable hope of a cure or benefit

What is quantitative futility

Where the likelihood that an intervention will benefit the patient is exceedingly poor

What is qualitatve futility

Where the quality of benefit an intervention will produce is exceedingly poor

What are reasons treatment may be withheld/withdrawn

• Reduces unnecessary patient suffering in patients whose prognosis is considered hopeless

• Resources – often limited

Who makes decisions on end of life care (5)

1. Medical practitioner

2. Health care team

3. Patient or his/her surrogate

4. Health care provider and patient/nominated support person

5. Society

Define advanced health directives

Document preferences regarding future healthcare decisions with the onset of incompetence

Describe what can be involved in advanced health directives (3)

1. Instructional (e.g. a living will)

2. Proxy (the appointment of a person with enduring power of attorney to act as decision maker)

3. Some combination of both

What issues with DNR orders (3)

1. Problems concerning DNR decisionmaking criteria, guidelines and procedures

2. Problems concerning the documentation and communication of DNR directives (GOPC in WA)

3. Problems concerning the implementation of DNR directives

What is the coroners responsibility (5)

Legal control over the body of the deceased person and must establish:

1. The manner in which the death arose

2. Cause of death

3. Particulars needed to register the death

4. The identity of the deceased

5. Main function is to detect unlawful homicide

Why would a patient needs a coroners referral (6)

1. Car accident or traumatic circumstances

2. Anaesthetic: previous 24 hours before death

3. Under a custodial order or under State care

4. Accident within a year and a day, which may have contributed to the cause of death

5. Not seen by medical practitioner within the past three months

6. Unknown factors leading to the death