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Patient C is a 70 year old man who is recovering from a mild CVA and is currently admitted for severe exacerbation of his COPD with dyspnoea on minimal exertion. He has moderate dysphagia and dysphasia.

Patient C is a 70 year old man who is recovering from a mild CVA and is currently admitted for severe exacerbation of his COPD with dyspnoea on minimal exertion. He has moderate dysphagia and dysphasia. During the last 48 hours he has spiked a temp at night and has been more listless and less inclined to interact with family, staff and other patients. He appears to be mildly confused and is refusing food and his medications. You encourage him to take them, but he becomes agitated and very dyspnoeic
Case scenarios:

 Patient A is a 16 year old boy who has acute lymphoblastic leukaemia (ALL). He has undergone several rounds of chemotherapy without successfully going into remission. His treatment now is focused on palliation. He is refusing to have any further chemotherapy. His parents insist that he does.
 Patient B is a 36-year-old woman, admitted with a drug overdose that was an unsuccessful suicide attempt. You are assigned to care for her and during handover you learn that her condition is the result of surviving a murder -suicide where her two young children died as a result of drugs she deliberately gave them. You don’t want to look after her.
 Patient C is a 70 year old man who is recovering from a mild CVA and is currently admitted for severe exacerbation of his COPD with dyspnoea on minimal exertion. He has moderate dysphagia and dysphasia. During the last 48 hours he has spiked a temp at night and has been more listless and less inclined to interact with family, staff and other patients. He appears to be mildly confused and is refusing food and his medications. You encourage him to take them, but he becomes agitated and very dyspnoeic.
Enteral feeding is discussed and this will also enable antibiotic therapy. When you and the doctor discuss it with Mr. C he indicates that he doesn’t want the naso-gastric tube. His wife is happy for health care staff to do “anything that needs to be done.” The resident comments that antibiotics and the feeding tube aren’t really extraordinary treatment and queries whether or not Mr. C is competent to decide because of his condition and recent CVA. He asks you to go ahead and organize for naso-gastric tube insertion.
 Patient D is a 44-year-old accountant. She has two young children, and is the family’s main bread-winner. She has been admitted to the Emergency Department (ED) with a cardiac rhythm problem. RN Z has drawn up two syringes, one containing normal saline to flush the patient’s IV line and the other potassium chloride (KCl) to add to a burette. RN W has checked the ampoules, but the ED is busy and she does not accompany RN Z to the cubicle to confirm correct administration. RN Z mistakenly injects the KCl as a bolus into the IV line and Patient D has a cardiac arrest.

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