After studying the course materials located on Module 7: Lecture Materials & Resources page, answer the following:

  1. Cure / care: compare and contrast.
  2. Basic care: Nutrition, hydration, shelter, human interaction.
    • Are we morally obliged to this? Why? Example
  3. Swallow test, describe; when is it indicated?
  4. When is medically assisted N/H indicated?
    • Briefly describe Enteral Nutrition (EN), including:
      • NJ tube
      • NG tube
      • PEG
    • Briefly describe Parenteral Nutrition (PN), including:
      • a. Total parenteral nutrition
      • b. Partial parenteral nutrition
  5. Bioethical analysis of N/H; state the basic principle and briefly describe the two exceptions.
  6. Case Study: Terry Schiavo (EXCEL FILE on Module 7: Lecture Materials & Resources page). Provide a bioethical analysis of her case; should we continue with the PEG or not? Why yes or why not?
  7. Read and summarize ERD paragraphs #:  32, 33, 34, 56, 57, 58.

Submission Instructions:

  • The submission is to be clear and concise and students will lose points for improper grammar, punctuation, and misspelling.
  • If references are used, please cite properly according to the current APA style. 

 

Read

Watch

  • Cioffi, A. (2018, March 24). BIO 603 3 24 18 [Video file]. Retrieved fromBIO 603 3 24 18
     

Sheet2

1963 BORN 3-Dec-63
Theresa (Terri) Marie Schindler is born in Pennsylvania.
10-Nov-84
1984 MARRIED Terri Schindler, 20, and Michael Schiavo, 21, are married at Our Lady of Good Counsel Church in Southhampton, Pennsylvania. The union is now among the “celebrity marriages” featured at About.com, a Website about marriage.
(20 Y/O) 1986
The couple move to St. Petersburg, where Ms. Schiavo’s parents had retired.
25-Feb-90
1990 COLLAPSE Ms. Schiavo suffers cardiac arrest, apparently caused by a potassium imbalance and leading to brain damage due to lack of oxygen. She was taken to the Humana Northside Hospital and was later given a percutaneous endoscopic gastrostomy (PEG) to provide nutrition and hydration. Police report
PEG 12-May-90
(26 Y/0) Ms. Schiavo is discharged from the hospital and taken to the College Park skilled care and rehabilitation facility.
18-Jun-90
Court appoints Michael Schiavo as guardian; Ms. Schiavo’s parents do not object.
30-Jun-90
Ms. Schiavo is transferred to Bayfront Hospital for further rehabilitation efforts.
Sep-90
Ms. Schiavo’s family brings her home, but three weeks later they return her to the College Park facility because the family is “overwhelmed by Terri’s care needs.”
Nov-90
Michael Schiavo takes Ms. Schiavo to California for experimental “brain stimulator” treatment, an experimental “thalamic stimulator implant” in her brain.
Jan-91
The Schiavos return to Florida; Ms. Schiavo is moved to the Mediplex Rehabilitation Center in Brandon where she receives 24-hour care.
19-Jul-91
Ms. Schiavo is transferred to Sable Palms skilled care facility where she receives continuing neurological testing, and regular and aggressive speech/occupational therapy through 1994.
May-92
Ms. Schiavo’s parents, Robert and Mary Schindler, and Michael Schiavo stop living together.
Aug-92
1992 1/4 M AWARD Ms. Schiavo is awarded $250,000 in an out-of-court medical malpractice sett

NUTRITION and HYDRATION

CURE / CARE

BASIC CARE:

• NUTRITION
• HYDRATION
• SHELTER
• HUMAN INTERACTION

SWALLOW TEST (THICKENED FLUIDS)

MEDICALLY ASSISTED N/H

ENTERAL NUTRITION (EN) (GI TRACT)

NUTRITION / HYDRATION (N/H)

PARENTERAL NUTRITION (PN) (LINE; PORT)

ENTERAL NUTRITION (TUBE FEEDING):

• NASO-GASTRIC TUBE (NG TUBE)
• NASO-JEJUNAL TUBE (NJ TUBE)
• PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG)

EXAMPLES
OF

ENTERAL
ACCESS

NPO = NOTHING PER ORAL (6-12 HRS)

PURPOSE:

• PREVENT ASPIRATION PNEUMONIA

• UNDERGO GENERAL ANESTHESIA

• WEAK SWALLOWING REFLEX

• GASTRO-INTESTINAL BLEEDING OR BLOCKAGE

PARENTERAL NUTRITION (INTRAVENOUS = IV):

• PARTIAL PARENTERAL NUTRITION (PPN)
• TOTAL PARENTERAL NUTRITION (TPN)

VASCULAR ACCESS
TO

PARENTERAL
NUTRITION

(VENOUS CIRCULATION)

TPN solutions :

• Concentrated
• can cause thrombosis of peripheral veins
• central venous catheter usually required

TPN not used routinely in patients with an intact GI tract

disadvantages:

• It causes more complications
• It does not preserve GI tract structure and function as well (PERISTALSIS)
• It is more expensive

Indications

TPN may be the only feasible option for patients who do not have a
functioning GI tract or who have disorders requiring complete bowel rest.

NUTRITION / HYDRATION

IN PRINCIPLE, ORDINARY CARE

MEDICALLY ASSISTED N/H

ENTERAL NUTRITION (EN) (GI TRACT)

NUTRITION / HYDRATION (N/H)

PARENTERAL NUTRITION (PN) (LINE; PORT)

PEG

ERD 56. A person has a moral
obligation to use ordinary or
proportionate means of preserving
his or her life. Proportionate means
are those that, in the judgment of
the patient, offer a reasonable
hope of benefit and do not entail
an excessive burden or impose
excessive expense on the family or
the community.

ERD 57. A person may forgo
extraordinary or disproportionate
means of preserving life.
Disproportionate means are those
that, in the patient’s judgment, do
not offer a reasonable hope of
benefit or entail an excessive
burden, or impose excessive
expense on the family or the
community.

ERD 58. There should be a
presumption in favor of providing
nutrition and hydration to all
patients, including patients who
require medically assisted nutrition
and hydration, as long as this is of
sufficient benefit to outweigh the
burdens invo