In what circumstances are medical treatments NOT indicated?

A forty-eight year old white female presented to the
office of a vascular surgeon with complaints of left foot pain and ulcer. The
patient’s foot appeared to be necrotic and the patient underwent a guillotine
amputation day of admission. In addition to her foot wound, the patient had
multiple abdominal wall abscesses and ulcerations, one of which was debrided in
the operating room. Labs revealed the patient had a worsening of her chronic
kidney disease 5. Due to her multiple medical conditions, she was admitted to
the hospital for additional workup and treatment. At the time of the exam, the
patient was in PACU, still somewhat sedated but with no complaints.
Past Medical History: Chronic kidney disease 5,
chronic anemia due to renal insufficiency, bilateral Charcot foot, and diet controlled
type 2 diabetes mellitus, hypertension, diabetic neuropathy. Prior left lower
extremity deep venous thrombosis, on Coumadin in the past; discontinued six
months prior to this admission.
Past Surgical History: Significant for left below the
knee amputation done today. Prior to the left below the knee amputation, the
patient had left fifth and fourth toes amputated several years ago.
Social History: The patient is widowed. Has an
autistic son.
Physical Exam: Obese, multiple ecchymosis on abdominal
wall, multiple necrotic lesions with scab formation on her abdomen, some of
which are quite tender, noted drainage. The patient has an umbilical hernia,
which appears to be reducible, although it is hard to assess due to her
obesity.
During the first week of treatment, a diagnosis of
Calciphylaxis was made.
YOU are the Director of Clinical Ethics. You have been
contacted by the floor and providers as they are starting to have conflict with
this patient. Your assignment is take the above information and apply the
Medical Indications box to this case. Use the first chapter of the book and
research to understand her medical issues.

Submit a paper answering the following questions.
1. What is the patient’s medical problem(s)? This
patient has many; can you separate what is chronic versus acute? Some times you
can have both in one diagnosis.
Are the problems acute? chronic? critical? reversible?
emergent? terminal?

2. What are the goals of treatment?

Can this patient be cured of each and every diagnosis?
If not cured, can the patient be managed? How does the diagnosis affect her
functional status? What kind of support (education and counseling) may pt
benefit and need for this? Would treatment harm the patient further by chance?

3. In what circumstances are medical treatments NOT
indicated? What are the probabilities of success of the treatments?

4. Can this patient be benefited by medical care? Is
this a long term situation or a short term situation?

5. What actions might YOU as the ethics resource need
to take to understand and assist with this case?

Think of this as your foundation of an ethical issue.
With this you need to substantiate what is this person’s ethical issues and can
they be treated? Cured? Is there a diagnosis that does not have a great
survivability rate?

As you start this week and trying to figure out how to
start the capstone, here are some suggestions: This week I want to center in on
the first chapter where you need to understand the patient’s medical issues.
Look up her diagnosis and go through the questions. For example: we know the
patient has diabetes. Is that long-term…yes it is. Can it be cured? NO it
cannot be but it can be managed and a lot of people manage it. What does that
take to manage? Is this patient able to give herself shots, take her blood
sugar level, etc.
Then the next diagnosis. Although in a real life
example, you will get to consult with others, for this case, I want you to
apply those questions to what we know the patient is dealing with medically.

USE resources! Cite those at the end please.

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