+ “nested, mechanical ventilate aa cera lines nserted. Vasopressin and noradrenaline fusions ar Deu. A Foe catheter i placed Sodas lar, ne hs high unleng fever Hee cent receiving recenaire va an tnftion pump tr temperature 38.6 (1022), pulse 113mm and lad renure #90 SO mm ig xameation Shows a sterml wound wath sureunding entra ere sno aschatge om the wound. Cracks re Near Bot ng bases Cardac examination shows an Ss lop. abdorinal examination shows no sbnormatis Foley eaters presents emoglbin concerti i 0.8 ako court 21,700 me an platelet court 165,000 ‘Scrip for lod alr ate aun simultaneous om he ental ine an pepoa Wie lod cares fom te central ne show coaguase-negatve coc i clusters on te 8 pestoperate dys ana thos om te peer venous lee show coaglse-regave ctl CSL on Be LO postoperaue day, Which of We Tang she Met HEN eee ‘nal ine sso blo set neon bewos BE ectenenyutred sé arolte’s ated vod es Reena ere et eeen tat eee oo (arlarpapnercruntusnartenahracti itm ectoel pear oe en se a ent ee ee es acre Ss rei om aera esters Se ee re ee aes cinco copay od os fon ret mans icraes NMI cases moSospocorane ay wi edontay a no cee pen api a, seri mr of mal or ig a nae hosp aqued fection vate eves ae contra Postoperative Fev egkoctoss, an postive sd {Stars of tha sae organs fom ferent sts este that le tea mecharcaly-ventised patent ‘ena ne ad an ndeling eater has most ey developed aboodsveam infection, The dfereral me to pest Is-an portance ordering the source of ection. “a eas oagulse-aeatvesaplococs ey 5 epiermiywhich form a pac of ronal skin fora a the most common cause of Cemallineassocte bloodsueum ifecions- 40% of al CLAUS Ths paver recaved medications wa 2 etal inf he Say preceding the onset of fever A iferental inet pasty greater than 2 Hour (2 dys th per) sates hat the souree of te oloocen neon emt aia central ne = © vertior associated prewmona 2 patient may develop a bondatream fection flung vetlatorsbscatedpreumania VAP). Adferetal ine pouty ‘ypcally caused by coagulase-postvestapyococl (5: aureus) and Peudomonas, th nl 2-5 OF VARS cased by coaguse-reguve saphyococa such a 5 permits@ Ot Dea <0 19> Bi Nosocomial fection patent may develop 2 blonds eam nfcton floning vetzo-assocatedpreurona VAP. Aden Ue wo postty (eater nan 120 minute nace that te agro of «secondary toodeweam ifcton fuel, Mores, VAP Spell eauted by coapulare poste sapycocl (5 au) and Poudomonas, oth aly 2S OF VAs enue By ceagulase-regatve stapmyecec such as 5. 7m Catetr-assocated nary act infection CAUT) can cause blodsteam infection and ee without Csi symptons of Lie, osu, suprapubic pal However aaiferel Ueto post seat than 2 hows (2 da In is pave makes 1 Seconda oloositer fection uke Moreover, CAUT mon often causes by gram-negative organs peal ' cok tebseia ana PSewsomones and Canada ec by Bfam-Doste orgasms Suh a5 ereroCacCh a ongulasenregeve staphylcoc a2 ss common. For person ofthe inestre 3 result of shock can ed to bowel chemi, Although the patent has Features Suggesueof sock, eae of abdonalpalt ah enceares suggests eAierent ages -surpalate nection e.g, mine sternotomy oun infection, mess) can eat m postoperative eer, ound yea ans boodsrear fection trae hore. However, fant ime postive grata than 120 mites, ‘naka tha the gnosis ofa Secondary bid steam nections Ul Moot, most SSIs in he eat ostopetave etd ate cuted by Sarnfacoccus sre whic ls coaglae poste, Se caused by coagulse-neptve Dacia such 4 [Sepirma eles common (- 153 and uualyeccrmore than 10 ays afer surgery.wos <2 i> Siem tee eres ‘ue inracabemidepigestic pt. The pin Mas xen const fer months, but wrseing nthe ast few wee Jape ete mbes aren ig nace long wade 4 mp Ses ape ne of ene Frequency, org Ror tc yt fortes ad. Her other melts incadeventxie and eszopone he ‘ese het moa on, but states She doesn have ary Sula hevgt. Se appa aque and sighty acecie fat trperatre is 28 EEF) pls 10 min and ed pressure 12665 re Ha Phen nanan hows amen the midpigaste region What the nest Bet tap in he management of the patent (@) Dscontmue mydocogare aed buproten, an tar Hatorla at 1S mg Over 1S Seconds (@) sven tom mutocedone 10 moto Msromonnone 2 2 FO (@ Suteh fom eszopionew zim be (© Alow thereon to take ysrocadane ana ibupofn up te every four houswos s <2 i> ‘vera invacae mips pan The pain as been constr fo nts, uc nsering neat fen wees dee theta ht shes aren hing PIEBUO om a pra 400mg She aso us etal istry avon ang fom ice a fortes. er ter mesons nue verse sa ezoptt She {eres er mac sam, uc sesh oes ot have ay ual though She appr ied ad shy Cachet er temperatures 996 O67 pues 100 mn ad ood prsire © T2665 i. hye aminon (TH pte mss ot rc acpi pm heb ae 2a so) continue ocd ad ibupofn, and tart vk a 15 mg over 1 etonds Discontng ercament medcavons, which cade aNSAD ibuprofen tanga erae NSAID Atoreedsnea ‘2(@) sutch rom mdrocodne 10 ma 0 hyéromorphone 2 ma FO ‘hs patents caren pas mesieatonshyeoeadone anibupofe) donot provide er nth enough pin eet Theeore, he need tobe sitched fo a ronger medics scoring tothe Woo analgesic ater. Snes he ne Sr hyrorerphae) "tronger then the fist eshuld be given ata 25-508 loner dose. Adoaly, she shold cominue aking Rupofe, a for (srectve and lance pun eet non-opioid analgesics Should Be used tea step of ager (6) rapona boc of tha catia plus ung iocane ‘atwough neve blocks using local anestencs ea Iocan) may rebeve hs pets pan, are te sul omerDacortmung her cent mediatone, whch nclade 2 NSAI ibuprofen), an tng = ferne NSA tora) en recommended measure, Her pan onl regimen stele be escalated acorcing othe WHO arlgesi ade. ‘ns patent erent pan matieanonshyocedone ad bupofen) donot provid ar nth enough pan ef haere, she ‘ead tobe sutched to a svonger medication a:crang tothe WHO anaes lade, sce te new Sug @yaomorphene 8 Songer man mest shouldbe gen at 25-50% lone dose. uel se shoud Conus aking Bupte,2fo ‘Mfctue and linced pan raf non-opioid alge shouldbe uted nae sap of the Laer ‘aitough nee locks weng locl anette ag Ido) may rebove he pate a hte te sl her pharmacological epmens tha may be ued before teri ts haste nerve Suvtntng nypnates suena fon eeopicine 1 opi) i at recommended mature he panERs same Mee ‘ey de ther unconrtes pa. Increasing te equency of er cer ai mascasors (hydrocodone and bupotr) is ot an ecve strategy she thread el hs tho achiving pan rele. Her event eprom shuld be eessted acorn othe WH anlgeni adewos s Pace ei ef eer eee ene neta terme er re ‘ney esease hypererson, and re 2 cabees melts. He was cagnosed th cue Impalas ekemiat the ape years and was ested witha allogenes stm cal Vanspatation We s H-pstve ar has ace apatlis C rs Gacatas, sofosuvis su aoc and enlap He apeas letter Mis temperature 36° 98.87), pulses 130 min reapraions ara 26min, and lod pressre is 145/90 mn ig Exarration shows sere seman segs and [Nov ntdy and pontine HEV RNA, Hs HV rus oad undeatale snd hc CDS T-Rpey cou 30/9 Sh ‘months ago, is Cbt- 7-hrnphooe eon wa 6. AM ECG of he het shous archi wth Heaven premsre emia contsacns rata ood gs anass on rm a sha. Feo, Glmmig fase excess “12 mEq/L ‘anranacaton for organ donation ns patent (©) Aes tdrey ny (© No abso conainccatonsouns al a ea | s8-yarold man brought to the emergency department because ofconfson tight lot, and aruia Hear chtone (2 ‘ney esease hypererson, and re 2 cabees melts. He was cagnosed th cue Impalas ekemiat the ape years and was ested witha allogenes stm cal Vanspatation We s H-pstve ar has ace apatlis C rs Gacatas, sofosuvis su aoc and enlap He apeas letter Mis temperature 36° 98.87), pulses 130 min reapraions ara 26min, and lod pressre is 145/90 mn ig Exarration shows sere seman segs and or generaaed museulr weakness acta ofthe lung shows cena ls Laboratory staies show postive [Nov ntdy and pontine HEV RNA, Hs HV rus oad undeatale snd hc CDS T-Rpey cou 30/9 Sh a ‘months ago, CDS~ T-hmphocye court was 616/uL. AM ECG ofthe heart Shows ahha With quent premaiore iH emia contsacns rata ood gs anass on rm a sha. honk 5 = Feo, Glmmig Heoy ta meaih ~ fase excess “12 mEq/L poate “The pant ats he ould a te donate organ or asuce nthe css of i death Which ofthe flloang san BER is par ‘Ths pation’ mesial star hast be thacouphl rene fray arable esses of malignancies © “a ‘ hypertension net a contraindication for organ donation. However, my dui the donor for her ransplunatins the hypertension he ete sonar hea aeeaee ana an LE = 30% Fepaiis fect is not an absolut conan er organ donaon, Donor ergars fom hepa C-posine doers ah be tered to hepusC-posne eens, even ie us cn be delat ine blood, an is patent.ouneal Sls a nfecton wat frmary an absolute conameeatan fr organ dation and legal poh indu fom becoming gan donors te US. Ths ale was based onthe prince of nonmalecence, a transplantation of Hoste donor tears may pose nam wo wasnt eapens However, he HV Orgun Foy Eau HOPE] ACE implmerted in November 2015 now allows tanplnttion of organs rom H-ponte donors ta HV-pontive repens, pried the don as an {reercable vl ony no pr hry of tn opportune fen, na ace nga ein ard a CD4 coun ver $00 ‘ely fora month peted pir to dation, Nove of thee rsictons apply tothe pate ints question. This patients ‘story o HV doesnot hereto, ect i gic date organ to HN-pocove ecient, ‘itough incurable or metstate malignancy a aisle contandeton fo orga donation, ths patients Watory of Chdhoed leukemia wth lng ance ffs ntrval doer no prohborgan denon. organ Jonson fom nde wth Jo-aradelocalzed tumrswithow ence of metastasis Is 50 peed ‘Acie key muy neta coneanaeston for organ donation, However, in combination th 1 patent’ ge 50 and Inpertesin, a reainne lvl 21/5 g/t to ey inry would make ts indidl an expended crete done (ED) ee es ere ceeerned loth ces eveeeer erect = ne for pancreas donation ' diabetes melts, Acool use dsorders wala substance se cso 1 as @cnandcaton for ae ging Wer worsplematon ‘Absolute contradictions for organ donation nude makgrancy thats incurable or metastatic eps, warsmissibe Spesnainnes iesniigientes bass Coes tls isn, os ela wari Lase safe edie oe, ibe otOm Deal <2 > {aR /nL fora -romth peed pis dation, Norn of thee resco py the pats nis quartion, Ths pated ‘story a HI as not hereto, fet Ms eit c donate his organs fo HN-poseve ecles 9 ‘trough ncuble or metastatic malignancy san absolute convalndication for organ donate, ths patie Wry of once leukemia wih along arcs tree Irtval does net pron organ nation, Organ donation om nas Wh Towegrate, lesz mrs thou cusane of matatanierseo pet eae kde ny not contsinceation For ogun donation. However, in combination ith th patent age (= 50 and Inpatension, sie lvl = 1-5 mk df ney ir mould mak te indl an expanded ertaria donor) ‘hose organs cama be Wanplated Without the express corset ofthe poten ecpe -Alarosm is orvaneation fo pares donation, bi oto sid otgan donates in gael. Arotercoanetcaton for pancres donation diabetes melt, lecol ue nord well a subtane ue rode i ao 2 cantando or rae eee | Sporaform encephaopaties ea. Crete jako disease and cara rest tha occured before bra death, none of ‘hich appt this patent HV nection nas peiusy an absolute contention fo orgen donation an eg prhibied {chute rom beeing expen donor th tte 2015 HV Organ Py Ext (HOPE at allows ranspantaton of ‘ans fom MIv-postne donors to v-postve ent at artim mstuton. a ia> Ouns a | 2eyareld woman brought othe mergency department foawing high-rpeed moter eke alten in uhh She mas the esvaned drive. Oh ata she has a env alr place ad is uresposive Her wemperatu I 35.7°C (957 pulses 70/mn, and boca pressures 121/76 mm i. Her pul af ated ana nt @acve Hg She is keer, ues nivgen, and rate ate hin the reference ange. Towsley sceenna We negtne, ACT sea of ‘he ead without contast Shows a massive rari lad ar cecal pine nur athe level oF, which of he @ cealoceprac rex est be Eecoencephalograpy (© magne esonance gig phy (©) Tanscraia Dope uvasonograpty (F) Comment ceiectesa c 8 a ouns al < sie > She mas the esvaned drive. Oh ata she has a cervical alr place ad is uresponsive Het wemgeratut I 35.7C (957 ules 70/mn, and boed pressures 121/76 mm i. He PUBISMFEGT a HGCRBEIETONGH Shes eee ues ntvogen, and rate ate in the reference ange. Towtcley sceenna We negtne. ACT sean of ‘he ead without contest Shows+ SNE HB ar cervical pine nur athe lve oF, which of he ‘This pata meets the chica tra fo bran det oss of bran uncon auibable 0 speci cause there coma ue JF ea massieaacranal wed) a was an absence of campliating micing cones eg, elect Sstbarcs) OT bnormal core temperature abaorma stl bled pena, an inaction. Neuolglel examination shows an abet uray ah refx, nating ry othe te mira. The next step nslagrest assessment of damage othe pons. 2a ‘The celocephahe refx isa component ofthe neurloncl eam tats usually gerfomed pro dering bran death Fowevr,aclocpha refx testing ages chy wring the patents head 0 onesie and shoud ne performed in Pens wth C-opine jure. Tes part was tecely na automobile acaent andhs a confred cea ne nays 2 8 @ @ 9 Lcvoencepaloraphy i an ancl tet hat shows abst ban electrcalatrty lt Cin ran death and that maybe jal ns otras to dhapens of bo tat ries Geka semeamcen fe lcapchntoa ge cscs aiseSee roomnes a ‘Necroencephalgraphy ian snl tat tht thaws abet bran elecral act (lat in brain death and that maybe Used o conf the agnosis xan death thecal paufloica examination incoclsve or camer be completed lan Po to performing ths et, Nomeve, I acessary 1 Cpa ical walualon of ran Sat, wich Ras Magnet resonance anglographis an anilary fest nthe assessment of ran deth used to evaluate forthe presence or sbsenceof cerebral Hood No (th the ater being «ig of bain dst the cial examinations inconclusive, Pr to ese hy any ev Nm Hs air es Ao cra cei se eae et Pet Secured. Adionly, braut hapa tubeted an ikl at cata Ine, may be ett parm magratie Fesonance maging because he equipment ataches to he kay cortans meaetic mati ‘agp tandn eines ar ocainaly saan brain-dead patents who hava mat spinal cor ae thas rales de not equ ran acy. Thogh they shoul be ested as pat of te complete neu cecal examination, the presence of Sep ‘endo ees Stoud not be msitrpeted as een of Dante Taio ad aro be sed dagose bai death. “anscanal Doppler wrasonography isan acilarytotin the apsesrme® of rain death ued evaluate the cetera Crclaton the cincalexarnnation 5 inconcste er ant be completed relaby, Peto performing ay ara 5, however this patent eques afl cial evaluation of bran death whch hasnt yt ocure ‘Comeal efx es sniats in is att spar ofa ul euclogewerkyp fr bran death. The accented tena for {is capros ate presence of coma (of know cause, absence of a brat-tlgraig motor fesponse Uscusng espe fo Powous smu canal nerve rte, and apes, Current th patent has ony met tao of these requreetts (ome, ‘Sheet mrponce to nanous cal. The corneal flee on afte bra fees tat mart bed og wt ch 29 teflax, cough reflex, and pupilry light reflex) prior t declaring brain death. If all these reflexes are negative, an apnea testisOm Ds wl Sos + sis petorming ary ae tsts, however, th patent equa al cia elution of tra sth, whch ha ot yt ‘ccured only, Daca his pate snubted and ily as cet ies, may be ict wo paform magnetic ‘esorance maging Secause te equipment aches to he aly Comans magnetic mati Dasp tendon efenes ar occasionally sen in ran=dead patents wo ave nat spina ors 8 thes eens on eq bran att. Though the soul be ested spt ofthe complete neusageal examination, the pevene of esp | WanscranilOopeer irasonarapny san aria et the assessment of bam eat see to evluate the cerebral Cictaton the incl earvnationiconcsive er ann be compieed relay, Pe To prrorming ay aca 5, however, ths patent requves aul cine evaluation of train death wich Has net yet ecu Comeal ies tes sina in his patent spat ot aul euclog workyp fr ban death. The accegted cana for {hs capron ate presence of coma of own cause, absence fa ranting matt rsponse lung respon fo rowousSomul, cane nerve ree, ad anes. Curent ts aden has enly me two of these requrement (Coma, sent respons to noses sul. The corneal ees oe of thease retenes that must be ested ong wth he 929 "ely, ough rete, ar pupil ight rfl) pir fo deciaring brain death al these fens ae gaia sone test pefoned, whch can confem he agnosie B)_lvated itracranial presiute and bein hemiationed ponentsOunss ‘ad heavy vaginal bleeding for 2 how's. She has had no prenatal cre. Her temperate is 37.2 (9.07), pls 5 102/min, ‘eepratons ae sim, ard ood pressures 128/62 em Hs Te aboomen is renende, nd regula Comsactons ae Inet spec ofthe shah, Uraeouns shows compe eetchmen fhe placenta fom tes, ea ear one tt ‘sen n emergent cesarean delivery performed Following the procedue th patent becomes tearful and dsteught ‘ich of flowing ste most appropriate mal rxpone by the pata? a (B) “im omy tr yourloes. Tis st ne etic steton or our be © “Losing baby is if, but ise nenme wovk ONG “Leng a baby aicat can rater you we our gre couneior (c “Losing baby sical but 5 hs everyday, and row youl oe rough (GH) “rm sony or your ss can wie you presiption wo lp with you ensey and geOuns al o onal x sigesboms gotten tii meic coco meeemiedeti ions I Ms Sofas re Gat cee eal ns ernie ecceeene sear ata egetn lo avi eu macau or sr ea 4 ‘medial aspect of the thighs, Ultrasound shows complete detachment ofthe placenta from the uterus. Fetal hear tones are i i sesssne Sateen ogee sear ene cease ee ese ie g ‘cis important for physicians to express empathy and avoid pressuring the patient inthe event of perinatal ss. 2 Isimportan wo express empathy and acknowledge thee a patent experiences fe perinatal 55, Ww regancy lo See ee ee een ese ee ‘Never make promises to paters nan atemor te consol them. Thre may be an undervng condition responsible fora pregnancy os an you cant guarantee that ting wl go ura me Tue, Irisimportan wo give te patent me process her emotions instead of pushing forward with 2 plan faction.‘Zaming ne pain novela Azcuing he moter f inadequate prenatal cra woul nly meester fechnge f Sul ‘Never make promises to patersn an atemot to consol them. There my b an ndervng condition responsible fora pregnancy os and you camet guarantee that hing wl go beer inte fre, Ie isimporant to aye te patient me 0 proces er emotes stad of pushing forward with alan of acton. ‘counselor might be able to elp he patient with hegre but for a primary care ponder important wo prove Never uvalze a patents experencet Ie important to erpatetalysehnouledge the patents sue, but a phim should evr clam to Knon wha patient ve sal experienc, shel ogee procea crate thet me mend to presi eats er hs patieOunss < ris > ‘Ayal pate comes tthe physician becante of 4-month etry of aight as, chest pin, ry cough, and sores of breath on exertion. He worked as a shipbuilder for 43 years an is non vetted Since the death of his wi 2 years ago, he as ed wh Pe auger He tas never smoked is temperature 281° (100.67), pulge 85m, Sed blad pressure 12482 rm Hg Fine endcinsptory rales ae Reta the let ing base; ret sound are absent “tthe nant ing ase. Ct san ofthe eer shows pau thetenng ana art hemethory.Toraccenene contre ‘he agnosis of mesoieicms, The paver ands any a nformad about the poo prognosis of th codon and {sion power of atorey, doesnot agree wrth ts decor. The patent does ot have ava wl ut tts tht Fs ‘ere sops wea, me wants 0 ocevectdopumona sustain, Which of te aloutng squalls the pent Hom ® tek of ving wt (© win tor carcopuimonaryresusctaon (© Uncen covrane by heath surance (©) The sos cect (© Ha he expecany beouns al < ris > ‘Ayal pate comes tthe physician becante of 4-month etry of aight as, chest pin, ry cough, and rox sores of breath on exertion. He worked as a shipbuilder for 43 years an is non vetted Since the death of his wi 2 yeas ago, eas ned wth he Gauges eas never smoke, He tmperure ls 281°C (10.7), pulse 65min, Sed blad pressure 12482 rm Hg Fine endcinsptory rales ae Reta the let ing base; ret sound are absent {tthe nah ng bse. CT scan of he nest shows peu thekenng and aright hemethoran.Thoracocemess corms ‘he agnosis of mesceiome, The pater nds fami ae informed aout te poo prognosis of ths conden and thatthe mean svi time's Iyer The patent states that ewes tree ation He weld als et eee Ie ee ace see eee ear se eee {sion power of atorey, doesnot agree wrth ts decor. The patent does ot have ava wl ut tts tht Fs ‘ere sops wea, me wants 0 ocevectdopumona sustain, Which of te aloutng squalls the pent Hom ar reas | ile hig wl igh be ada a 2 ecordo s patnt' wines egacing NS Care, 5 No FeQueMent Tor hospice In order 0 quay for hospice the patent anc ihe famiy mus texmiate al arate oF e-peesarving vente nett, paiativ tesmente designed a eee suferng ans prove optimal uy of fem patent are enecuraged adkatonm cancer pavers may often be pallatveand not fe preserving, an thus snot neessaniy a comands (0 hospice cae DAs status sna ey equremen fo Rospc ae as ca Sl lec feehe ul resuscation, nding CPRoua Bo Im order o quay for hspice, the paver and ihe family mus termiat al curative oF e-peesarving vestments. nett, patie estmente designed a eee suferng ans prove optimal uay of fem patent are enecuraged adatan in cancer pasene may ten ne plist annot Me poten, ane thut eat neceealyscaneanaeston 6 hospice care De status is nt an ey equrement fr Mosc ae as ca sl lec 1 (eee ul resusctation, nding CPR {sndinebaton, while on Hospice care, fen, he fom Rosie fac will SY nd MS wil core oper ned on ths patents ample story ar ge, shoud ble for caret federal ath marae program | for people who ae 65 and over, Meskare covers hospice car both at home ard im hospce oatet acts. The power of atone the deen-mating proxy the patent aks decision-making Capac of competence 85 CHS ‘ly equtements for nospice ae sate hat pater must be determined wo have a eels, eines a6 a progrsis af 6 months ares he ins rune its ermal course Ths pater hasbeen dagnosed wih condton wh Ines sural time of yar, ani thnetoe not lle for hari eae a etme.ouns al <7 i> {hours He hs ot had bowel rovemes inthe pat 24 hour He apea's i is temperature 37.86 1007 and pulse is 122i txaminstion shows a dstended abdomen, Theres endemes to palpation nthe lower abdomen, Quang He hasbeen acompanted by his 14 year-old erther. The surgeon ecommends an erergency aparcamy, Te Parents le anay dating Hands and cannor be reached Which ofthe flings the most sppropriate nxt Dest Get consent rom the patents broher (© Oban cows ede for surgery (©) Petorm amerseney agsrtomy (© Dea suger un parental consent keouns al <7 i> eee 6 hours. He has not had bowel movements in the past 24 hours. He appears ill. His temperature is 37.6°C (100°F) and pulse & fe pas Geeta ricer nea! oes ark emrvexs prrcoe astese oe arieg ehoundtendenes ae preset. bowel sounds ate deceated. An xray of the abdenen soma ds oop of bowel Heras een “ine surgeon recommends RBREVIGEAORN Te BES hich ofthe lling is the most peop ex Dest ep ZB « Ths patents 14-year-old bother i leplly# mint and even emancipated, othe legal gustan) ans camel coment © hor reiee ns roher® mei eee ‘anor (18 uns of agen moe US sabe) ths pater ean cannot comet i orm kal care Moe can oly Censent te are egal amancpte trough may srace, marge, cour peton they ae sekng ae rearing omacepton, pregnancy, STs or suotance abe, Legal marion ote equeee a miamum age e, 16 yes) a ron-eergent bu utimataly fatal Conon. THs patent's case reaures a promot decison regarding immelate management, ‘hospi ethics commas shu be cneied i pant cannot provid canent and hi or her surogat decon maker ot arable or sou 0 be acing conta) the part’ preferred acson or ages ve pation best rest nm {ime-Seasitvestuace, ancteraprouch inate.Ry W oua "AS a minor (18 yar of ag in most US states, ts patent usualy cant consent ois Onn medical cae, Minor can only id cys nee ny ee psa rele frre clea ontacrplon, reqancy, sso eubetanes abu, Lael smancpnon cian requrer amine ape ey 6 yee) te Fequrements vary alec om sae 0 sae ‘orang 2 cour order se best net ses providing caret a minor's parents ae retsing Me-saving Westman ora ron-aretgent bt ultimately fal coniton Ths patents ase reques «prompt cecion rearing mmeite Manager. "Ard etn ble condi a ptt comet pik set edb ber Sava ecorm les ‘not arable or tought 0 be ang cma tothe pants prfrtad daision a against the patients best ret. nts time-Sesiveshuator, anche approach ates. ‘rough penal consent sualy egued at a umes in mors (= 18 eas OF agen most US sates) Deore receng ‘neical are. infomed content doe at apply in emergey stations wher theres algal Bian to eat ores t ‘tough penal consent yal equed before 2 mor can undergo a medal pocedue or ues hsOunss nie ain. she hs hypertension erctlesttolemia and ype 2 daberes melus she Rad an GON stress inthe it lrtoraescndag artery and 2 sets wee act, inraverousunractonatd hepa was Used ptt Me PoceSUe - ror admison er meciations were epi smastatin and matlormin, Het temperature 237.1 (69.1) pls ie al 102 mun and ood grssie 1 109/75 mm Examination shows a tender lower ébdomer: teres 90 guar or i ‘aiy Marist soprangunal less and endunes,Thare io leding or charge fom the femoral access ‘le aine nfuson'eSegun compete lod cout sow shat of 30% lnukaces cou of 8400 man 2 Bitlet count of 250,000 mm? When of he following the most aporeprite neh step In Managemen? © Aarne proanine state © oman necese ouns al [Bit ste hashypertesion,hypercholestelem, ana ype 2 diabetes melts, She had an B08 stenosis nthe ft arty descending artery and 2 sets wee act, Inraverousunractonatd hepa was Used ptt Me Proce Fort admission er mediators were epi smastatin and matlormin, Het temperature 237.1 (69. pls it 102 mun and blood grssie i 109/75 mm. Examination shows a tender lowerebdomer: teres 0 Ue or "oy Ther | SSS RGEMER hero lading or charge fom te amoral access $e, Curae examination shows no mua, abso galops Femara ad pel pulses ae pupae bate. ‘.b saline fonts begun A corpo cod cunt dr saci 0% kop cot of 840 me, rd Bitlet count of 250,000 mm? When of he following the most aporeprite neh step In Managemen? ‘Togeter wth ower abdominal tendemess and Suprargua fulness and tenderness suggests revopentonea ein, 2a ‘ ‘Abdominal xray commonly performed for vlutngsugal emergencies rach fea orgs of mechanl Bows Ccsructon, However, nts tent, reropetanel leer suspect: even fhe leaing cul be seen on 3a) Inari, nce of eravon of he psoas usc shedou) ths maging edly would ot prow elabe normation ‘asuaton of protamine sates chats Torneparn overdose mno acv leting on Pepa theapy ort 1 ‘ina epurin and everaeitani-eoaglation elects. Ths patent ecanedadove of unfactorated heparn po 02307) and acve bleeang suspected, However untacoonated heparin Ra half Foy 30-50 minutes an hs he ‘emaning eect most ely minor 3 ours afer administration. Additonal, te decton aso whether ras of ‘racouglatons neat in th patent should be beet on the jute of an xpeinced nian and shows neue {etal conniteraon of estan or atoapulation and sow af Eeeing, The agnosis shou therfore be confmed feouns a reuopertonal blsdng i suspected in harochramicly sabe patent, confast-ontances CT ec fhe abdomen 2nd es shou be performed conf te eagrosis and cede on fuer reset. while goer rareretvoperonea hemrenage the most common cause of unexpected mvt ale capresc or ieverional aac cet 2300 {hears ane sititee hemor le not cay sciees Fates donot uly become yrptomai unt anes Baoe loss has accmed hich often let 0 ate agosto he cond, By caine ca ‘opine can be wedi tnt th vaovaglretgone to est braycada Vatouagal responses canbe tggeed by 3 “aero aos ineueng sesso aril ponte te eather Wea vzovanl esponce woul lo resent ith Iypeerson, i would be combined wth brads nd ote acca seen the patent. Te patents symptoms te ‘Mov ely #cmpensetory responce oat bledig ane subsequent hypvslems- ‘An lecrocaiiogram (C6) obtained fr diagno evabation of paints wth unpaid aronarcuar dese. laugh crtemey are (20.18, a myocar infarction possible compleaton te considered in pater after calc Catreterzater. while «mica frien can eesant lc abdominal spins, they usualy present as epgestc pla "ater than inguinal pan Btional this patint hes herodynamic gs of volume los, whch makes confemation ef Suspected bleeng the ory this ate. snidncnendecaeetansnnetie edie’ hoiiedatincemeslontieseensigansrciquemiicemmee sel naeOnns al <5 yi > loess cccuea, an often ek 10 ate agnosis he conan, 9 4 ‘ropine can be wed tnt eh vatovagletpone to west raved Vatouagal responses cap be tggeed by 3 ‘are of facsors,icudng stressor ati puncture the cathe lb Whe vasovaal espnse ould ls present th Iypetersio, would be combined wt bredyearda and notte achcarda seen the poten. Te pats symptoms ate ‘Mow ely #cmpenssony responce io active bleeding an subvequee hypovalemi- tema af (50.182 myocardial infarction possible complication to be corsdeed in pate after cla Careterzator wie a myaca/l ftcion can ean ch abdominal sypioms, they usualy present as epgestc pla ‘ater han gurl pam. Adeonal this patent has emodynamic ugh of vous lov, which make confematon ef Suspected bleeng the ror th pate. ‘ower tresient rte catheter lab shold be soetlred na emery ett tet wth actin ‘evopetonea teeing ta doesnot espond to supportive eaten fd, monitoring, Mid vesuscatin, bleed ‘fanstsion, stant placaret or ia-ataralembolzation maybe used Wy to stop Memo aging. However, 2s saenaa eur day ter beng horpalze, nubs nd mechanical vale, 2 20-yard man ha no cough rezone ‘nile is moh sing soctoned He was involved i a motr veil clision and was obtunded on ava tthe ‘regency sepaimer: The vera’ sa aA, of 100% al volume of 920 ml, and postive er expratr pressure |sSemHs0 He carenty essing veopresors i al gn ate nthin nt ets. The pups ate late en enreacove ot. Cornel ga, an ocaovestoviarrexes ae eset Thee sn fal oF Upper enemy esponse {o nsieus stm, he lowe extemiies show 2 ipl lexion response to osious Stina, Sem concen oF ‘Two day go, aC san of th ha showed lft ntracraral amarhage wth mass fic The apne etc pst, Which oie flowing ste most appropriate ex steph management? “a sth coma ‘cereal aniorap hy ‘cour oer forte manapeent 2D & Etecoenceptaostay 410 bea ouns al eur day ter beng horpalze, nubs nd mechanical vale, 2 20-yard man ha no cough rezone ‘nile is mou sing soctoned He was involved i a motr veil clision and was obtunded on ava tthe ‘regency sepaimerc The verlator sa aA, of 100% al volume of 920m, ad postive er expratn pressure Ss SemHi0 He caren receingvespresos i al gn ate nthin nal ees. The ereacoe fie “Thee no flo upper exremy response {o nosis small, lower extenies sow 2 ipl exon response to osious Stina, Sem once ation oF ‘ecoes un ceanne and lure are ita the letene ange. tral ed ge shows Srsauraton 99K ‘Two day go, aC sano th ha showed lft nacre amarhage wth mass fic he SEER. hich oie followings se ost appropriate nex sep in managenene “te abeenes of brantan flue 2 cmatae patent wih pote anes teat nthe absance fey este ‘auses lamest of bran deat “a ‘An thes commits consul esa tpn the management of pti who lc decien-maling cacy there Cenficamons fay members or surogstes eperding goals care. However, thes consuls ae oly Utz fe ng atm, regulss a orgs (Chk angirphyi nn et e ng brin detbystesng ered ed Wise en the ‘enced sins sarinatio cannot be peronmea ors ineoneutne Sut thi pee akes hs concise since rin eaoua al atta! angiograpy is an ancy et ud 0 agnse brain death by assessing for cerbral lag low, rs usd when the anded inal examination cannot be erormed ots neoncusie but ths pet akead has concise eines of rin 2 court ace for farther management maybe inccate fhe patient Ick decion-maingcapscty and doesnt have = famiymember or sos to make dec on hehe oohal Howser, the Hep tony saul heater eng ven vith a poe prognosis 665 an anary test used wo cagrose bran cea by assessing for eleccal acy nthe Bai wed when Te En el ee me petal ea wet ciel ceca er ese. ‘cna required to agnoze Bran death are com (ath aeoun aut the abeance of rain tem eleven a poxthe once est This patent meets alee of ese cer confirming the cagnet Im patents wth conmed bran death 0 onsent is equied to Yemove any form oie Suppor Tettoe, he verity shoul be eves ‘tepat CT scan of te Read may be inated ng pales with Nene waunao assess or mr progression, but isouns a < wri > ae ‘vehicle olson, On ara, she i unconcous He alse 140i spain are 12/min ana shallow, ad blood Pressures 76/55 mm Hg 0.9% Sale sion I begun A Tocsed assessment wth sonography shows iced te et a ‘ove he patent te operat Yom for an emergent explorative lpsofomy, Packed red boo¢ call anshusion : ‘tered pir to sgay. Hower, and f the pation ans fr the transfstn tobe held sth pata sa hoveh's (© Aan donot starch (©) Tansusion of packs ed eood cls Ww (D) Adminis high-dose son cean (© recede to suger wthout ranstsion> & ouns ul < wri > | 20-yard woman brought othe amcrgencydepatiment 20 minutes ser bungie nz high-speed motor rox ‘ehicl colsion, On ara she i unconscous He alse 140i spain are 12/min ana shallow, ad lood pressueis 0.0 sine ntusion is Depu. a foceed assesment wth sonograhy stone Blood a eet ‘ove the patent te operat Yom for an emergent explorative lpsofomy, Packed red boo¢ cal anshusion rere por wo sugary. Howe aed ofthe patin aSk forthe transfusion oe eld the pert “he patents there no documentation showing her fetsal of led warstans. ‘sen hough th pater nd las the patents alehouhs wanes there no documentation vy ths clam UF sorber snes uner tes creamstances In such emergent stuatons without Suitable surogst deasion-maker, Me ON Gozcr can make decision based Sle on the patients safety and welt-beng. “a -ysronety starch ea volume expander ermal in patent requing elu resurtation. Forde patient in need of Crergency mei trenton, ther therapeutic opeon re more frase chances of url While a surrogate econ make, sch ab farly member, can make teatant decisions onthe pain’ behalf wheut Alocumertaton 2 end is usualy roan appropri surrogate m some sates, 2 "lose fend” may be considered as & Srrogate. Pysicians must make ther eons wth consideration fra paves preferences, Howsve, xs patents flame of = fond the poten in shock fom intra leding an wantin wth Ra's the Bott mee ef eto ‘elume ane tabiizing the patent BB rics of medical lw aneOns a < writs > = ‘regency medi irtrvenion, ther therapute pan te tel t ners chaneat of art While asuraoate cei make, sua amy member, can make eatment decisions onthe pan’ weal woneut focumetatin = fiend ic sual not an appropriate surrogate oa sae, 2 ‘lose rand” may be considered 22 Surrogate. Pysigans must make thar dion we consideration fra pavers references, However, 35s patents petrerces ae nat Cay documante, ovle be appropriate o wild ie Swng resent base on he urvsTabe lame of end This patent nin shock fom internal lending ana Wansfusion with PRC's athe best meas festering yc of ma fw andes Consung th host ets commits cen be useful m navigating ti confctsbateen prose, patent fais, end {hela However ths pate is cial condion ad ang ego vemnentfor «const cou endanger the pave eon apy ia patents wn avanic aera ca lp promote eryegenes. on Mou ot prone ay bane 2S {teaentdeisons onthe patient’ behal econ shuld sl be mace wth consideration Co the Sater reerences and ‘he best interests of hs pate AS hs pte’ preferences ae ot Cat documented wuld be aspopae © ed Me-sevagtentment bated onthe clams of strogte tha cant be verted and ray resulta the pane’ death [Feo and coadianae | roar tage Noten | ayOunss ‘00-year-old man call dial spc clic nd atk 0 speak ta physica abowt arate ears ‘ordered because of -morth istry of ebdonnal fulless an generalized faiqe. The referral note shows that he was ‘ansped forthe presous Week. Hi sbdornal examinauon Nad shown seri, ad 27 ha Wega, entender mass nas plpbie or etal examination es clanoaeopy report evel slow atv ceumereil etl lesion MR fhe pei shone recta mas wth imovemrt othe rote and tia vee, Aon ein oe ‘cults shows that endoscope Biopsy conf thecal iagnoss of advanced veal adenocarcinoma. abortion dies reveal serum level of eacowminyone antigan f 2.0 ng/mL ermal < 25), The pyc tasked ith "Your ab vers show tat you ave «aly sovanced rca adenecarcnome Would you thet know alte deat of your agnos, o wuld you prefer ust expan f you wha our covers ae” (©) Wee s your urdestancing of he reasons we ca clonscopy and ops” (©) may need wo refer you to a cancer specs because of your eaaness You may need chemetheapy er adtheepy, whi ve ae noc equipped fxaos al a ‘00-year-old man call dial spc clic nd atk 0 speak ta physica abowt arate ears ‘rdered because of 3-month istry of ebdoinafulhess ang generalized fae. The eel ote shows that he Was ‘anetued forthe previous week Me ebdorinalexaminaon hed shown terion, and 47h ar, wegen, entender mass nas plpbie or etal examination es clanoaeopy report evel slow atv ceumereil etl lesion. MR ofthe pes Shows areca mas with mvent ofthe prostate and serial vies, Abr evi OF the ‘cults show that endoscope Biopsy cots the cial anos: HE TEAERAENBEAINO. abo oy dks reveal serum level of eanowminyore antigan f 2.0 ng/mL formal < 25}, The pysoan a tasked ith srt 2a ‘Ts saement very Bunya, herelore,nappopratly sents he agnoS to the part Dscosng he dagnsis san Important part of delivering sous us bt the aghot should be conwmaniaes na tep-by. step mate hat ree Fevewng the examination aa lagnosvc finns wih the patent and ensurog het ese understands wats bing st ee tp. Tecnica ems Such a5 ocaly avenced”‘aenocarnom shld We explained ns way hatte ynan “hdeatnds Moecrer the hagnoss shuld oly coed ater obtaning the patent's aim a cana Sskng the a Patents permet so deer he dagrol rode an importa clue ot Row much the patent wants too Thc om the avert canals reduce the physica’ araety a eetingSerous news ‘he sme, san the pants armisson to deliver the hagnoss. an mportan pave omruncsng senaue ‘ews, Hower san opening sateen the proces afore the dagnonis has buen deer, is nappropia. Sch = ‘uztion shold ony be ake ale the nerve as been propel prepared andthe peben’sprcgton afer stuton| at been sesieaAststing the pairs peteeon tear bang he potent nation prone am opportunity for ‘issna up mtconesnons ana gauaig th ptens reaction. tfurtermre halos detemne the natre ae ame ot lnrormasonreauved te delve te diagnosis and comtmuncate 2 management lanomns al < uri > ‘he semantics he fst tp ofthe SPIES protoal(S = setng up the ntere, in partela managing te onsvar,ensunna tat rrptons wl net cer, ara oferng tev another person en amy nother cre Pevie)acatona spect to conser ths est Step ae metal eating the epptrre reviewing 2 veriving te lies formation, ranging or privacy. iting dom et the pate and connecting wth he patent establoh app g Bh ovrew of paltane medicine “This statement assesses the patent petention of his statin, wich san Important arto vein serous news. Honey, such a statement shou only e made ae appropriate steps hae bea akc Se up the tere. NO cong 50 ttoy ed to mieten of pricy. fae to each rapport ihe patent, cles commer the Grnry and consequences ofthe stuaton tthe patent anda settram which the patent els uncomfortable ano ma Not ‘eee the opporunty fo ask questions. ‘he semantic summary of the management tay Ian erportat pt of delberng scious news House, Such statement soul only be made after denverng the agnosis, escussng te proaneis, anaadeessina the pater’ teracone wan enpathic respons: tggred by the news the patent mace hack anget, rs, Sn at not Ts semen, which asses he pavers emovos san ampere pat of devin Seo aus. However, making uch {tse before fling the pe ster degre /progpess, wall oly tigger anes and deen|4.72:yarold woman wth metatae ovarian aner ie brought othe pian by her on because nian in and resi the ie, Ona 10-poit scale, she fates the ain 5 a6 9, One week ago dein to St Palla cae was made ate he fale to reson o 2 years of multe chemetheapy raiment. She snot [hersherapy drug an as been in hospice ae Current mediation include 2 mg morhine ravenous ety hour andoso ma of actanghen avery «to enous The eons concerneaoecnie he rat line that eres the ‘ove of morphine woul endanger her breathing, Which fhe allowing Is the most appropriates tp in managemen Ince dorage of morphine rte pana adowerapy (© change morpine to a non-oled eles: (© Fertor vanscventos elec stimulation (©) cove pate and conan aw oped dove> & ouns al < eri > eee See eee ee eee ry Manic eee oes cc came” Feb sne ere cea as rete car meee ee and 850 ma of acetaminophen eer 406 Rous The son|s concerned because he ead on hat meresing the ‘ose of morphine woul endanger her besthing, Which of he allowing the most appropiate ext tp in manageren “Ths horpcs patente eminey ila petting wth overs pln Focus should remain om pala management nd aio if 5 She receving pai cae. 2a < ‘a create he doa of rept he bast wry to rote sma el for spate’ pat le appropri ciminsaion of eps can case respaterydepesin, hs part snot crtentrecevng a suicent dose. To mehinize {he nsk of espiatoy capresso, te ncease shoud be done a aon SOs evry 24 Rows unl he dested ses shied altbough tvs poten so i conerned abou pot aeveree affects of resing har ops doe, adequate pan onvolforatermnay patent kes precedence. alae radiotherapy can be use for cancer paints whe ae experiencing ign symptoms detour bare, sch 2 spina cord mpingement or bel obstactor. Ths patent's pa Is net pacar lecaledf speci re ut rather (generazes Moreover, the ar ear ways oat het pala opimal edicl therapy hes ot yt bee ached ‘according to me WHO aalesic adr, weatment of gan should tar Ww a or-opod analgesic ana canbe escalated tor ong opted ax an n-on therapy. ha ths patente aeny eng 2 cmtintion of non-op nage ard Sm opio, a change oe nor-epiodanalgeis would be a e-eseation of este. Ths pater I in par whchFalse raoterapy can be used for cancer pins whe ae expevencng signfican symptoms dust tumor bare, sch 2 spina cord impingement or bowel obs actor. Tis pater’ pan is net parcel lecaled fo a speci re but ater (ereraizes Moreover, thet ar ase ways oat herp ahd optima ele apy hs ot yet bee aed. ‘ld of strong opioids a an add-on tharapy. As the patient is alteady rcaiing 2 eambanation of 3 non-oplo\s anaigete and topo a change ora rar-opod analgesics would be a -escaaton of estar. This patie sil pat, which eqs an escalation of eaten Cognit behaviors therapy maybe helpful for sme paints a8 an adjune heap n reducing anaey ha aggravates pan Forth termenclyil patent on Rspiee cre, her anges egen souls be evaluate determine a oflctneness nore loking ware dune herp ‘Transcuaneeus eecriclnene stimulation (TENS te use ofeecme current produced by adc to slate te rere. (dows nachave suicneevance acon acy nay typeof conic painting anced pat, “This atin ot eching adequate pan management on he cutee alas regen Couseng the patent and Cmznumg on fe sare opto dove would abe epproprite theracy, a would ot prone SuMCAst elt of spain’a < ari > or ‘o-poit scala eves the pain 3&9. The abdominal pains worst nthe upper quadtet He hase Teton aa nyperifigea is emperaures 28.7 (L017, pass 11m, aa lod pests Batpaen nll quzorants with quardna, tne recound. Murphy’ Signs stv Wht upper auacanturasoune Shows nicking ofthe gatbadce al suding in the galblader, and pera at sanding. He said or acute heestts and grants permianon fr cholecytetemy. ha we aia healnear power of ttorey (FOS), bu hes at ttown an 2 buars np ee ecampati ode by he brother. er ncn at anesthe, the surgeon eave ‘he gals bt ss snd a pornon ofthe smal znneenecrote eo Inge troreaembalem oeusng § Dianch of suparn meseitcatey. The earant is aeivonal surgery mit sal bowel econ an (@) Deceas he pases eden unl babe give consent (©) Aske pavers oomer ne wang oom to concent (© comactthe pen’ heatcareFOA to consent be< w> 18-poie scl, vate the pin at a6 9. The abdominal pains worst nthe Qh upper ade He hes aa Teton aa nyperifigea is emperaures 28.7 (L017, pass 11m, aa lod pests ‘ows thickening of the galbadde wall sloging nthe galadde and pecal et sanding es adie for a ‘everystisand grants a wt sha Healers poner attorney POA) but she out ttown on 2 boners np ee accompanied oce by he brother. er cto a anesthe, the surgeon eave _ Sec inns or oe RR renner be Soe tee der at ate Ga pec rng we 2a |= (B) estes the patents sedation util be abl fo ge consent because ats 2 ife-ovestenng shustionrequingemegercy Ueber, ceasing he patent's sedation dung ebdonita s@) recs win deol suse wetting consent Informed consent ia one of he most base ag conceps that pps oll physicians mal el of asin. Moment ater whe s unconsaous for whatever reason Including aeses the Mees for fl informed consents waned "Sueions where here is a tea immada arn othe pain fhe or shes nt eaad ad the probaly of arm de rguoninedonaly dacovrs ate mesenarechera Al Rater than wating fo obtain informed comet Fram the patent rhs hates FA te necotibowel soul be eed mmm te esters fhe patent totheOO Desral e tauma | Informed consort i one of he most base lag conceps tha pps ol phyinans mal fal of mins. Homor, pater ahs unconscious or whatever reason ncloing anesthesia the ee fo fl informed consents weed Stuntons where ere isa eearof immediate arn ote pat he She snot weatea ae poze ef am due {oars to treat grater thant tret of tar om th rete lt tpt undergengeelaryetecomy, Surgeon inedertay covers act meserenc schema (AM ater than warn oobain informed consent From the pate or his hathae PO te necoc bowel should be env immed the best erat of te patent uf the BS Pcie of meatal aan eis Iwi th patent acs cecsion-making capa. he paves hata FO canoe be reached afer aeasondle efor, ‘heabcare decison surrogate (eis patent’ brotha maybe designate, Las regadng who akes prvi ab 2 In on-emergent tution where apatet lacks desien-making capac, cnsen for procedures shuld obtained fom ‘he patantscesgnated neithear9 POA. Hewavr, i megan susions suchas hs ns th surgeon should nt wast recous ume inan attempt te contact he FOR. becuse AM ga Me-vestenirg shun which egures imme action, losing te pal vo, waking hm Wo, andOunss < uri > 2 hours Se had previous elses of abdominal pam ht ates for 70-15 mines andrexaved wth aac She ne eh et aught and graces. She ced Net husbuns aya. Sh alert and tied. He emetaute S| BP-YC(OS. 14), pulses 124 an and blood presure 60/70 mm ig The abdomen gi and die tere “carding ard reaun tencemers re perrt, Rect exarnston shan colaptd eco. intson of 0.2% nee tegun and «CT ofthe abdomen shows inex perforation The surgeon dacsses he nex or emergent explora He espns terse of ao perorming te surgery te her ana she indicts she undesange bin seaman soos not Proceeding win surgery. ic of te falwing she mest appropri next stepim management? ‘Coninue wth emergency ife-sevina surgery be a G o 4ouns al < wri > o ¢ eee ae a ee oe SE eee cenen ae ce om canna ere) Sine sero pecans ntaseee a cana Sea eaccesm acces . Bo Gj Se ee ee a sade) cae nce Pao petomrac eee i eae . a ee g fraceecing with surgery. which af the flowing ie the most anproprate next tep mn management? ¢) Meoenenemaetochamtatamense 2 SS) 2a =e ee = Corsa heh his comate wel be point heater wey crete ad thre a ort ee ee Se ee ee ee . a Canceling te surgery the mon approptnte next sep nthe management of hs pile. The patently gee informed consent forthe recedare meaning ta the ysl dy eetermned sre ha decsion-making capac re was en Suffer nfrmaton by the pian, and she made 2 voluntary deson. though his deon was documenta eonecty, {he paents when evn verbal expressed) vette her pict consent a anytime before and even cing the procedure, "suring the requirments for normed cance or athar famed rafal mel paren BB icp of mesial wathOm Deal ‘ering the equines Gr fared conse, other freed esa aes presen Bo ‘Cnmning with emsrgenyif-sevng sugary would be appropatsna patent who wat not capable of making an informed ein, na suaton requiring imple corset. Tis pave wave, shons no igs of decreased deton-makng| ‘pany Comming te procs th tne despe he patents eur woud be seg Conse fom a person ether than the patent must be obtained if the peter oes not have eal competence of ecsin-matingcapaciy a ese cases, asutogate edion make must decde stad ofthe pat. Ts patents ‘luplcy woul be her suropntc the poet wer fo become compere we ad ne ance et, ower a tis time ase on her nderstanaing and conmuntston of ear eson, he patent has decson-makng cap. Inthe absence ofan avancedrecne th falloving Sequence determines he prio of srogates: (1) spouse, 2) act ‘hides (2 pret, adult slings. ad (5) ote lates or enc, Treo, th pes ex-husband, wn ls ote furvnt saute wuld not beth urogse,natdton wuragatedecion aker ony aeded if he pate = Incompetent wees hs moran appears 0 understand the mss and anes of he procedie and voles aclear Lessing emergency surgery cn be performed witout informed consent in unconscious patient nthe case of ped onsenc, However, th pen was tepely competent on sila well a wen se evoked informe consent. Wang ut the ett umcaractos and the proceeding th ergencysrgey wold ere Be gy nettOunss < sri > sweling on nis Back 7 moths ag. He has 2 Mistry of wsng navenous eon but has wot ose drugs forte past. 2 mori Taro petsonal or ay Mott of Series les. Val igs af wth oral ei. Sxaminaion shows 122-ce sf leeds mete cling on the ight ie of is upper beck. Te macs lips smo the ges whe ‘soe ae palpate. Hsles rack mare ae present nthe laters cub forse Tne patent tat he mse om i ack isos ely a ipa, ang mass consisting of fat tess that doesnt eae ary farther eaten He suare atenescounrsesreering he potent benef anak othe excsion ad ha tere chars of eeaenc. He aes ake can rt perm ih ove eH SE on REN ee Wet Aske penenftow ypin § ments be (© eer to me nospual eos comme (D) feter nites mason ce> ouns ul < sri > ‘swelling on his back 7 months age. He has @ history of using inwvavenous heroin but has not used illicit drugs for the past & inns hres no pessoa ht els sss wan oral ts Sminatonsho a eae ee ee ee ‘Scant ats is presente inert fre Tn pen ade mat ee ee ee eee Phynan to romove bt tha phlean refed ta perform he process snc he id hot conor neratay. The Biers counseed regarding the potent benefits ana sks ofthe exesion and hat teria chace of ecuence. Ms ues ak he pysioan nto perform be excision, Homer, the ZALES On undergo Te ECE. ME of fi « Delaying surgery ould Be nde he patient ad a comrainaeaton to argery ul the tne of follow-up (63. athe Inc drag use, exacerbation of won es) Th pain sm good heath out atv Contandeatons 0 SUaRN 50 avin surgery sox need “This patent san adult (18 years le and eppers wo have no act sues that would compromise his deston-mking aoany fe, mera ers, conicton, meaning he abet provid nflormed consent for Ms own mela cae cudng Sleeve procures sucha thi oe 9 BPs of meatal aan etic, efertal os hospal ees cores generally nated in ceria dumances hen a pete acs capac 2 make ther enn decisions (a, no saga can be ound, surrogate desion reno nthe bes ners ofthe pater TNS teresa edule with decsior-matng capaci 50 no ets commie eqiresofa al < s+ iis > ‘Delaying surgery would nce fhe pater hada conanicaton to surgery unl the me of follow-vp ea athe Ic drag se exacerbation of onic ess) Ths pat good heath tout ave corandcaon open £0 eying surgery ot nests ‘Ths pauen san aul > 18 yes ol) an apes o nae no ace sues ha would compromise Ms decsion-making pany (ng. metal ee, oieton meaning he et provi informed contnt for ohn media ae neladng thecve procedures sucha is ne Refeal1e a hestal eis cores generaly tated incerta reumstances when a patent acs capacy to make ther om decisions fen saga ce be ound, surogate decison tenon the bes ares fhe pater TMS Pent an adult th dection-mshng capacity, 0 noes commie i eis Menage etn resumen option or physical ado oop wave eympem picid winders symptoms peal reso tha 1D ys of ut drug uae v0 thn patents wtharawal oymgtoms souls hve resoies etre pryensteray aa or foupteray caus veconmenaesta iene, au ony by patent reuse fs pcan were < 18 yes ol the consent of his patents woud be ened for poma excision. The consent of mines purer requved wh nia few exactions (9 sees Meth treatment acon Ueutmen However, pate ve De ge of 18 yeas th capac dono equie penal or urogue consentaa < ris > ae more fen than usual Tvee week a0, he underwent surgery or an carers henia Wie recovting He devloped Septic shock end was ieated in theese care ui He Was shurgea djs a9. He as aMstory ot hypearson. Cerrent mediators incladeamidpine and anyeadane He appar aroun temperate 37.6 (1007, pulse = S/n ane bea prseure i 122 50 rm a. bxanaton shows tenceres to plnmon ate uprapubiearano : ‘guarding is present. There's awel-beal sui sca nthe ight ngial eon Teresa cosovareral angle enerness, Una how: tee 22s het ich of flowing weld have most kay prevened tis complcaon? 2a 2) mere eatereneaton| Prophact rlprotoxacin “Topical maprocin applcaon (© tes hyphae catherer (© screening tor bacteriuria< ris > ouns al a ona a cmc: ae sepucshod anaes eas charged © dps ge He as stony pees, = {rem meses ete emesis sn neon appr ann eerie 2731007 pe qj Simm ani pesre 12220 mn xenon shoe = {nog present rea mel-beae sug ear ntherght gual eon Tee smo envenetcl ange " nen Ua sow = =e 2 wh oe folowing woul ae most ey preemption? “Te man has developed a UT post-ateterzaton because he most hkl had an idling catheter whe nthe CU, w in atlows beter ener he wreta fcotanaed. The bate aatere wo te sua of e device an ee ‘opel roublesome because they develop «etn tha rte them fam antibtieand the imme te 2a Incite catheterization consis ofthe inserion and removal of unary catheter several res 2 dato mow he lade tis an aerate to an indweling cnet and is esoclte wth ene caer asso ulna aceon, Beye CCproflonacin not ued routine forthe prophlacsof inary act nfectons Im genera thi patent would not eg prophylactic antsonetheroy 9omnw Intamiten athetezation const fhe nero and ramoval of wary cater vvral masa dy to empty the ‘ede an aeratve tan indwling catheter and 5 sso wth ewe caer associated unary ac infections, ‘protoxacin not used routine forthe propyl of nay Lact nfectons genera ths paler woul not eg Prophylactic anisote thera pir used forthe west of bacterial skin infections ea folic, npg) and n pans who ae nasa carers SERA any ect etc e a eel by prreaerc cine sore ce ines eas croe Topical muprcindoeenothave ole he prevention of ater -srocted unay fae estore ‘Ahysrooiic eter has aspecal coaona tat alos smoother and ear sero no the artis asocted wth ss wedatiataneratior ane therefore ess pater discomfort, but i Jos ot cue the sk of catheter esocoed ay at asynpomate bacteria commen cg arong unary cate! ust, but Srening o wating soy ata ia regant women and patie wh ll undergo alge procedures such a anurthal secon the prostate.or ea < vis > 2 70-year-old woman brought othe pysten by har daughter for evaluation of popes cogne dein and 1-year history ofmconnence. she was hagnosed wth deren heme ype 8 yeas ago “he davahter has oes ‘ate past 2 yar, et mote asad ncreaingWorS-ning Teutes an orgies She Was preouly She has had decesse6 aopente, poor ofl intake, and sometimes regurattes her food Durina th time, se has had 12-hg (26-1) weight oss, She was weed aie for aspiration pcumaia and row her de may cosas of pared {hat she would nt want ay feurcton or e-sutainng ments ifthe nea woe, The angie wart to ctnae ‘aking cae of her mother ut is cncemed about her ay 0 ao 5 The pater has hyerersion and hyperipgem ‘Curren meciatons tude amodipne and torvastatn, Vl igs ar hn not! Ls he appeaswalrouhes uta welngroored, The peenis evened to aefand recognizes het daughter by ame, bt she uamnare he ace eyes ins ana stat amination saree 17/20. Ps aneurin esaminatans shou no ther sbnoraie 2 complete blood coune and serum concentrations of cratinn, urea nivogen 73H, and vain 2 evel ae within he feerece rage Her Stu album 29/3. Liat Shows vo abnormal, Which oe alow te most (© Baaation for aerate methods of fea bea aos al < vis > 70-yard woman brought othe phystcn by har daughter for evaluation of propreteiecognte deci and 2 She was dzgnesed with deren, lzeine” ype, 5 ya go. The daughter has nocd ‘atin Be past 2 yas, et mete Pas Wad neato a torgetuness. she mas peiusly She has nad decreases appeot, por ofl itake, nd sometimes ‘Dann ts time, se has had 12g 26-0) wight oss. She was Ute tice fr drow Ne det may consists of pura TIE vd orov.Ton Gane wat corti ‘along care offer mote tis concered about Per ety 005 The pater has hyerersion and hyperipgem ‘curren mediators itdude amide an startin, Vl signs ar rin orl Hi, Se peas uta welngroored, The seenis evened to aefand recognizes het daughter by ame, bt she unmnare fe ace eyes ins ana stat amination saree 17/20. Ps aneurin esaminatans shou no ther sbnoraie ‘compl blood cue and ser concentrations of cesinne, usa maven, 73, and vanin eel ae within the feference range Her stun albumin 2 g/L. Gayle shows vo abnormal, cho te folowing tte moet ppoprate nse tapi management ke “Ts pale as andy nad advanced semen as alae by he Speech robles, wa Twtona dependence, food eee ae eae eee Ls monts; the patents estimated fe expectancy kely <6 Monts Short-term retabitaton i gereallynacated for pats wh requ ehaliton ano Ther metal cae, Bt wo a0 longer requte inpatient cae ea patent rated fer paeumanla korea fom hospalation thse fection curec- Tis patient's Azhemers seas Is severe, chron, progressive, ar curable 50 ehabiatin wou not be bene. ‘pls (e.g oxycodone ar maicated to eat pan paterts wh termina ness (a Sone pn in pant wth reasate cance Wes pater as 2 emia ess, theres 9 evidence at She pa so epods ae not< vei > Tonge fequtewpaten ae (ea paver ated er paeumania Whos weak om hospalzatan bu whose mieten ‘ure. Th paints cheer dean severe, crane, progress and ncurae 20 ehabitain woud not be beset pled (es oxycodone at nccated to eet pan in patents wth ermal nee (2. Bone pln = ptt wh reas cancer Wheater as 2 ermal nes, thr Is no evaence at She spa 30 eps ae nek ‘hs patents malnourshe, has advanced zheine! deme, ands almost complete dependent al atts of Considering ht rife expectancy Hal under 6 months she qualifies fr hospice cae Wes pate lcks ecion-making capacty ats ume, she eagressed a She woul nt want eswetation of Mesasrgprededures athe Bi Overview of plate Progressive aeenagais one of me hlinar of advances demerca, Once dementia patents ave ATi feeding, optons Inclide ether comming orl tae tolerated or pacerent ofa ein ute EL tbe). Tab feeding has At sow tr long-tnem bene for putes wth advanced dared A, ths palent sprsted tat he would nt wet ltesstaning procedures performed. Inpaver palate cares nacate or patents whose symptoms anno be adequately consoled ouside of he hsp ‘While ose ae ndcted, ths patent symptoms de at equ an inpate® lvl of manager [Feo and coadianae | roar tage Noten | ayOunss < sri > ain avs long the am and oper aw The ate 0 reports dfieuy breathing and rouse sweating He hs hypertension and ype 2 davies malius. He has roked one pack of cares day ft te ast 35 years. Hs ‘eieatans nude enlapl and metformin. Hs tamperatren 37°C (98.57, pubes 110mm, eaprations ae 20 (min and blood pressure 1 90/60 mm Han EC Shows ST elevation the ds and AVF. wate and mephie are ‘inter and oxen suppemetation and fd escaton we bagun. Shor fe the pate becomes unstable ‘he flowing te most aporopate mex Steph management of hs pen? (© | sas eeepc aia oary ae a (© Obtain courcordar to voke women advance ce (D) Reperroxm resuscation when needed (© comactthe pavents est chid> & ouns al < sri > -A.s.ysar-ld man brought to th smargenc deparman fora ealnon of severe ches pain or thtanihou the (UG ain avs long the am and oper aw The ate 0 reports dfieuy breathing and rouse sweating He hs hypertension and ype 2 davies malius. He has roked one pack of cares day ft te ast 35 years. Hs ‘eieatans nude enlapl and metformin. Hs tamperatren 37°C (98.57, pubes 110mm, eaprations ae 20 (min and blood pressure 1 90/60 mm Han EC Shows ST elevation the ds and AVF. wate and mephie are “domintered and oxen supplementation and fd esusaton ar bun, Shor after the pate becomasunsabe. ‘re flloming is the most apnropite next step m management of tis patent? aaa ae 2a ‘ {ire phyinan hae further ein aeterminng he coe of ston ues te prmiry ear ys hasbeen Gesgnted at {he rae meal power oratory. Im Some instances «cour orto legly eerie 2 surrogate decision-maker may be obtained bythe hyscian fhe el {hat he medica decision made yeh heathcare pry lot i the best nee te pale: However, tes no Raton ‘sn(©) supporve care oly v Suppor aes he most ppp ements patent as acl documented do-no-eswcnate Oe eens hich supersedes he was of it mel power of anor FOS. Acuabe mesic FOA cen vere & i& not OO al < wr iis > - are mea sn mae eet ony thee mea ne pte Hone er man a Supports cae the moe appropiate Weston athe palen hat 2 clearly documented do-notrensc ate order, ai ‘ould be inappropriate ogo aginst is ishs with fer resuscaton efforts. Hs ONR ode epresets the whe ofthe Palen mst hich supersedes he wishes ois mic pone! of taney POA. A durable mesial POA can override & ines approprate to perform i enscation inthe rergncy ating who knowlege f ths patents ONR atts Now thats acvance arecove hasbeen nae, would be naperoprit To reperfom resuscaton, the pater was unable TO Imakehis wishes know, and vo acurention nas iene, hs we 5 medial poe of toney, would be responsible Fo ‘hsv hs bean sradyWeified 2 the mada power of ator, thre wasn information aout the patient's bes forms medical eestmert, hs power of atomey woul be the st enti as the decor make. ‘A thes commas can be constdhen shee ro sutrogatedactlon-maler fo the part orhen there ate ttssrcemems Gewesn decion-makarsof equal pty (ue two sibling) There sno need © cont the es ‘commen ts stvaton as he egal precedent nas cea been exubisnes, Ts patents advance recive generally [Feo and coadianae | roar tage Noten | ayOunss < wri > es froma peripheral blood sear taken during is easton at incaive of posible cit myeloma, tne trarowaspraton and eiteequenerogenetc tude con te dagnost, e pldan ste ade en Sppormed Cree ete cee ee et gene ee Regt ae {rcouragea to ang someone slong one appartment Fhe wanted He cme to your office she appanes tne it his daughter te appentsrelned th aul ange of fet. Which ofthe folowing Is the mest appropri opening za BD) 7 may need to refer you toa bioed cancer speci because of your dagnss, You may need chemotherapy oradotherap vic eae oc eae fo (©) Your ta epors show hat you have acute melo levkarat (© Would you ew know al he dts of your deans, or would you prefer ust explain wo you what our options ae” beouns ul < wri > > Result from a perpeal blood smear taken during his evaluation ae indicative of posible rmtrowaspraton snd subsequent cogent tas corm edad. Me ysl _ aque ofce tif im bout the agron and acs a options He has Been a ‘ercouaged to ong someone along tote appartment Fhe waned He comes to our office tte append time th = his daughter te appentsrelned th aul ange of fet. Which ofthe folowing Is the mest appropri opening e [aT “a “ W Ths sean, whic summary of he manageren strategy an wrpetat pu of delivering seus ens. Howse, ae faions wer empathic responses tere by he news. the patents ratios hock anger, gre, Sena ar ot essa, me pte may become estan {0 ay information tat provided rearing Pan of marageme ee ser e/a el ao ice me Irtaaeny su too as roa ae Samo: antalya nay siete alcool be oti wt wy een Sat eoeeeee maaan amaearpee neeeie ee ee ee een eee [ppg incre carson or& omnes wl < + sis > ‘he satemant very buy an heelr,nappopritly dene he aghast the pata Duconng the dag ean Impotaepart of delivering serious ews bt te alagnoss shoul be cormmurcaes na step-by-step mene hires ‘ire earinaon a Sues ee en ering Date re tas al Eg Sa Unaertnae Mersover the sitgnose shoud ony be Score ser ootanng the pets maton fa ici secng the Patents permission we deve he dagnesprondes an impotent cue on Now much the patent wars to ow TS cue OM "he patent an als eda he physica’ rsey a eneting serous Nena ‘he saementatctos the patents peeepton af stuator uhh the secon ep in dlbaring aris nes econg tothe shes protocol ~ Perception afer appropri steps hav ean tent se up the MEIN (= 5 ASSESSING te Patents perception proves an opportunity for easing up misconceptions and gauging the pets teaten I urthrmore Felpa determine the atte ad amount of famation rete o deer te gnosis and commana a management uh. £5. Overview of pltative medicine “This statement wich obtains he patens pain to delve the diagnosis an importa par of communicating ses ‘ewe, However, ean opening stern in te proce foe te gneiss been deverd, i nappropri. uch & ‘urstion shold ony be asked after he ere as been propery prepared and he patent's prcepton ofr stuston| hasbeen sesezee “This statement adresses he paves emotions, wich san important pat of deneting Serious news Howes, apr fom {einaperapate tone, mating such 2 Statement btoe lige plete gross rogron, Mou ony wget sen an ete