MunoRN 35,331 Views
Joined Nov 18, '10.
Posts: 7,735 (69% Liked)
Being the patient's next-of-kin POA, the husband can choose to withdraw treatments including artificial feeding on behalf of the patient. Declining medical treatments that artificially prolong life are not unusual in cases of advanced dementia, as it's not a particularly pleasant condition.
I wouldn't necessarily assume you can't do CPR. I have the same condition you referenced, among others, which are more commonly known as just a "bad back". I see a physical therapist regularly and one of the first things we worked on was common movements at work including CPR. With the right technique, it's possible to produce high quality CPR even with a delicate bad back.
Unfortunately if the job requires that you be able to do CPR then you can't get out of that with ADA accommodations, accommodations are only available for things that don't really affect your ability to do your job. And while it helps that there is usually someone else available to do compressions, single person compressions are not nearly as effective as when two responders are able to rotate compressions.
I think in general, night shifters would like to get to bed as soon as possible, preferably before the sun comes up, the bigger question is how many day shifters would want to start at 3 AM?
I don't think it's unreasonable to pay less for a product that falls well below average quality.
What the HCAHPS survey essentially asks patients is whether or not the facility is staffing properly for their workload and providing the necessary support to provide adequate care; Did the staff have time to teach you about new medications, discharge teaching, answer call lights, etc.
The way HCAHPS surveys work, is that even if your scores are "poor", you don't lose any reimbursement as long as they are about as poor as everyone else's, if a facility is doing a significantly worse job at providing patient care, then they get paid less, I don't see any reason why they should get paid the same as those providing a better, or even just average product.
There's certainly some improvements that could be made, but as a basic premise I don't see a problem with payers providing financial incentive for facilities to provide more support for those providing care.
I know there is supposedly increased risk of postoperative respiratory complications in patient's who have received bleomycin, and that it's usually associated with excessive supplemental oxygen peri and postoperatively, so that may be the concern. I guess the main question in an outpatient surgery would be how quickly this becomes apparent after surgery, my impression is that it's immediately obvious post-op, but if a patient could appear to be in-the-clear in first few hours after surgery and then go into respiratory distress more than a few hours later then I could see the anesthesiologist's concern in doing this as an outpatient, where they won't be monitored anymore a few hours after surgery.
Risk factors of anesthesia and surgery in bleomycin-treated patients. - PubMed - NCBI
The signs of ischemia that we would be using a 12 lead to look for don't vary based on electrolyte levels. They can be obscured by electrolyte levels that are severely out of range, for instance if severe hyperkalemia (greater than 7 or 8) was causing an idioventricular rhythm then the 12 lead could not be read properly, although if that's the case then you've got bigger problems than a hard to read 12 lead. If the ability ischemic changes on an EKG had to be corrected for electrolyte levels then no 12 lead would be useful without taking simultaneous electrolyte levels and adjusting for them, which isnt' how it works.
I've never had a doc hesitate about putting in a central line just because they were on VTE prophylaxis heparin. They prefer the IJ to a subclavian if the INR is elevated and might like some FFP to be hanging while they're placing the line if it's critically high, but they've never just not placed one.
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