medium · NCLEX-RN management
The nurse is caring for Arthur, a 78-year-old client with end-stage chronic obstructive pulmonary disease (COPD) admitted in acute hypercapnic respiratory failure. Arthur's arterial blood gas (ABG) shows a pH of 7.24 (reference range: 7.35-7.45) and a PaCO2 of 68 mm Hg (reference range: 35-45 mm Hg). Arthur is currently somnolent and unable to make decisions, but has a verified, legally executed living will that explicitly refuses endotracheal intubation and mechanical ventilation. Arthur's daughter is highly distraught and demands that he be intubated immediately, stating, 'I am not ready to lose my father, and I will sue the hospital if you let him die.'
Which action should the nurse take first?
- Administer a high-dose intravenous sedative to Arthur to relieve his respiratory distress before obtaining the daughter's written consent for intubation, for this client.
- Request an emergency court order to determine Arthur's capacity before deciding whether to honor the living will, in this situation, based on the current findings.
- Immediately prepare the equipment for endotracheal intubation to avoid the threatened legal action by the family.
- Withhold intubation to honor Arthur's verified living will, continue noninvasive oxygenation, and notify the provider to facilitate an immediate family conference.
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