Assignment
Case Study: Administration of Pain Medication
This case presents a 56-year-old Hispanic male client admitted with the diagnosis of acute myocardial infarction (MI) and cardiogenic shock. The client has a past medical history of severe coronary artery disease (CAD) and has suffered several MIs over the past 3 years. The client has an advance directive and a do-not-resuscitate (DNR) order on his chart.
When the nurse assess the client, he is short of breath and diaphoretic with a blood pressure of 68/30 mmHg and a heart rate of 162 beats/min. His respirations are labored and rapid at 42 breaths/min. The client is mentally alert and states he is having crushing mid-sternal chest pain radiating into his jaw and down his left arm. He is crying and requesting that the nurse give him something for the pain. There is an order for intravenous (IV) morphine sulfate, 2-10mg for pain every 1-2 hours as needed.
The nurse on the departing shift refused to give the IV morphine because of the client's compromised status and the fear of further depressing his respiratory rate and cardiac status. After receiving hand-off report from the evening nurse, you enter the client's room and find his wife and one of his sons. They are very upset and demand you administer the IV pain medication immediately. What do you do?
A. Clarify the ethical dilemma
a. What is the specific issue in question?
b. Who owns the problem and should actually make the decision?
c. Who is affected by the dilemma?
d. Determine the ethical principle or theory related to the dilemma
e. Are there value conflicts?
f. What is the time frame for the decision?
B. Gather additional data: After clarifying the ethical dilemma, more information needs to be gathered. It is important to have as many facts as possible about the situation
C. Identify options: Most ethical dilemma have multiple solutions. The more options that are identified, the more likely it is an acceptable solution can be identified.
D. Make a decision: Think through the options that are identified and determine each option's impact. Ethical principles and theories as well as universal basic human values can help in decision making. Remember, when confronted with an ethical dilemma, a decision should be made. Refusing to make a decision is not responsible professional nursing behavior.
E. Act: Once a course of action has been determined, the decision must be carried out.
F. Evaluate: Determine whether the intended effect was achieved and also identify unintended effects. If the action accomplished its purpose, the ethical dilemma should be resolved. Unresolved ethical dilemma might require engaging in additional deliberation and reexamine alternative options.