Revamp NURS 642 Questions and Answers
Common Indications for Ethics Consult
-Informed consent
• Advanced directions
Informed consent
- Barriers- poor coordination, fragmentation of care, adaption to choices
- imposed responsibility on both patient and hospital
- relies on trusting doctor patient relationship
- must be given risk, benefits, and any and all alternatives
Advance Directive
-70% seriously ill patients are unable to make decisions
- Preferences communicated through living will or designate surrogate (POA, health care agent,
proxy, or if no surrogate -spouse, child, parent sibling, friend- state determines hierarchy)
-patients expressed wishes
-substituted judgements (can override patients wishes if can prove decision was previously
made based on factual, conceptual or clinical error)
-Best interest (legally required to make decisions patient would choose for themselves)
-sudden onset of pain, can lead to sensorimotor loss
-requires emergent intervention
-initiate heparin bolus and drip and consult vascular
-Testing: CTA abd with bilateral runoff
-Time frame: revascularize within 3 hours is best
-intermittent claudication, rest pain, tissue loss
-Testing: ABI w/ toe pressures, CTA vs angiogram
-Consult podiatry and vascular
, - Acute on chronic is when patient has history of intermittent claudication but presents with
sudden onset of severe paint/sensorimotor loss
Normal 1.0-1.3 (some reference 1.4)
</= 0.9 PAD
0.71-0.9 -mild
0.41-0.70 -moderate
</= 0.40 - severe
>1.30: DM, CRF, very old
-use alternate method to assess for PAD such as toe-brachial index
Vascular lab
-Toe-brachial index
-Segmental limb pressures
-Segmental plethsmography pulse volume recording (PVR)
-Doppler ultrasound
-Duplex ultrasound
-Exercise testing
Radiology
-MRA (non-invasive, preferred)
-Multidetector CT angio (with contrast)
-Angiography (invasive, higher risk, with contrast)
-May have atypical leg symptoms, rather than the hallmark intermittent claudication
symptoms. Limb heaviness, numbness, soreness, attributing symptoms to co-morbidities such
as arthritis/normal aging
-Incidence increases with age
Age>65: 10-20%
Age>75: >25%
Common Indications for Ethics Consult
-Informed consent
• Advanced directions
Informed consent
- Barriers- poor coordination, fragmentation of care, adaption to choices
- imposed responsibility on both patient and hospital
- relies on trusting doctor patient relationship
- must be given risk, benefits, and any and all alternatives
Advance Directive
-70% seriously ill patients are unable to make decisions
- Preferences communicated through living will or designate surrogate (POA, health care agent,
proxy, or if no surrogate -spouse, child, parent sibling, friend- state determines hierarchy)
-patients expressed wishes
-substituted judgements (can override patients wishes if can prove decision was previously
made based on factual, conceptual or clinical error)
-Best interest (legally required to make decisions patient would choose for themselves)
-sudden onset of pain, can lead to sensorimotor loss
-requires emergent intervention
-initiate heparin bolus and drip and consult vascular
-Testing: CTA abd with bilateral runoff
-Time frame: revascularize within 3 hours is best
-intermittent claudication, rest pain, tissue loss
-Testing: ABI w/ toe pressures, CTA vs angiogram
-Consult podiatry and vascular
, - Acute on chronic is when patient has history of intermittent claudication but presents with
sudden onset of severe paint/sensorimotor loss
Normal 1.0-1.3 (some reference 1.4)
</= 0.9 PAD
0.71-0.9 -mild
0.41-0.70 -moderate
</= 0.40 - severe
>1.30: DM, CRF, very old
-use alternate method to assess for PAD such as toe-brachial index
Vascular lab
-Toe-brachial index
-Segmental limb pressures
-Segmental plethsmography pulse volume recording (PVR)
-Doppler ultrasound
-Duplex ultrasound
-Exercise testing
Radiology
-MRA (non-invasive, preferred)
-Multidetector CT angio (with contrast)
-Angiography (invasive, higher risk, with contrast)
-May have atypical leg symptoms, rather than the hallmark intermittent claudication
symptoms. Limb heaviness, numbness, soreness, attributing symptoms to co-morbidities such
as arthritis/normal aging
-Incidence increases with age
Age>65: 10-20%
Age>75: >25%
