在OR中的DNR. 复苏作为一个操作风险
1Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33612-4799.
JAMA
|November 6, 1991
概括
在息手术期间,应遵守"不复苏" (DNR) 命令. 这尊重患者的自主权,使他们能够在没有医生的干预的情况下权衡手术的好处与复苏风险.
科学领域:
- 医学伦理 医学伦理
- 手术瘤学手术瘤学
- 抚慰性护理是一种缓解性护理.
背景情况:
- 在缓解性手术之前,经常会撤销不复苏 (DNR) 命令.
- 这就造成了患者的愿望和外科手术之间的冲突.
- 现有的DNR政策忽视了手术内复苏的伦理困境.
研究的目的:
- 论证遵守内部DNR命令的允许性.
- 为医生在息性手术期间解决伦理方面的考虑.
- 探索患者自主权和医生责任之间的平衡.
主要方法:
- 对患者权利与医生关切的伦理分析.
- 与类似情况进行比较 (例如,耶和华见证人).
- 双重效应学说的应用.
主要成果:
- 患者拒绝治疗的权利至关重要.
- 医生的道德担忧可以通过道德框架来减轻.
- 在息性手术期间的手术内死亡可以被视为双重效应.
结论:
- 应该遵守在手术期间的DNR命令.
- 在息性手术中尊重患者的自主权至关重要.
- 伦理考虑支持尊重DNR命令来维护患者权利.
相关概念视频
01:18Methods of Documentation I: Source-Oriented Records
Source-oriented records, or SOR, are medical record-keeping organized by the data source. The SOR system was first developed in the mid-1900s to organize the growing patient data in hospitals and other healthcare facilities.
In an SOR, each discipline involved in patient care maintains a separate medical record section. This record-keeping method enables easy tracking of patient progress and ensures healthcare staff have access to up-to-date information.
Key Attributes include the following:
In an SOR, each discipline involved in patient care maintains a separate medical record section. This record-keeping method enables easy tracking of patient progress and ensures healthcare staff have access to up-to-date information.
Key Attributes include the following:
01:25Aortic Regurgitation III: Medical Management
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
01:17Aortic Regurgitation IV: Nursing Management
A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
01:25Dysrhythmias VII: Nursing Management of Dysrhythmias
Nursing management of dysrhythmias involves the following:AssessmentSubjective Assessment:The initial step involves gathering patient-reported symptoms such as dizziness, palpitations, and chest discomfort. It is crucial to collect a detailed history, including previous heart conditions, current medication use, and lifestyle factors like caffeine and alcohol consumption.Objective Assessment:This involves observing clinical signs such as jugular venous distention, cool and pale skin, and...
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
01:22Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...