Mrs. Smith is now hospitalized, having become ill during the flu season. She was initially diagnosed with severe bronchitis, but that diagnosis has been changed to pneumonia with respiratory failure. She remains cognitively intact and is able to communicate with her children, though only with short conversations. They are deciding if this is the time to ask for a do-not-resuscitate order should Mrs. Smith continue on a downhill trajectory and require intubation and life-support. Both children have been named in her DPAHC, with the eldest daughter as the primary contact and her brother as the individual to give consent should his sister decide she cannot fulfill this role. You are the nurse who has primarily been caring for Mrs. Smith and have spent the most time talking with her, understanding her fears, and knowing her strong desire to live and see her grandchildren as they grow to adulthood. How do you assist the family in coming to terms with this new setback and the real possibility that Mrs. Smith might soon die? Do you encourage then to request a do-not-resuscitate order from the primary physician? What documents or conversations might help them decide to either request the order or request that no such order be written and a full code be called should the need arise?

Mrs. Smith is now hospitalized, having become ill during the flu season. She was initially diagnosed with severe bronchitis, but that diagnosis has been changed to pneumonia with respiratory failure. She remains cognitively intact and is able to communicate with her children, though only with short conversations. They are deciding if this is the time to ask for a do-not-resuscitate order should Mrs. Smith continue on a downhill trajectory and require intubation and life-support. Both children have been named in her DPAHC, with the eldest daughter as the primary contact and her brother as the individual to give consent should his sister decide she
cannot fulfill this role.

You are the nurse who has primarily been caring for Mrs. Smith and have spent the most time talking with her, understanding her fears, and knowing her strong desire to live and see her grandchildren as they grow to adulthood. How do you assist the family in coming to terms with this new setback and the real possibility that Mrs. Smith might soon die? Do you encourage then to request a do-not-resuscitate order from the primary physician? What documents or conversations might help them decide to either request the order or request that no such order be written and a full code be called should the need arise?