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* The following vignette applies to the next 2 items
 #841885  
  vuyyuru - 06/19/17 03:56
 
  The following vignette applies to the next 2 items.

You have been treating a 5-month-old child in the neonatal intensive care unit (NICU). He was delivered at 26 weeks' gestation by cesarean delivery because of premature rupture of membranes. The mother is 18 years old and is unemployed. There are two other children in the home. The father is not living with them, and he has not been in contact with the mother. The mother rarely visits the NICU. The infant had severe respiratory distress syndrome at birth and required dopamine for blood pressure support. His condition progressed to pulmonary interstitial emphysema and bronchopulmonary dysplasia by 4 weeks of age. At 4 months of age he required a tracheostomy and medication for control of his blood pressure. Now, at 5 months of age, the boy has a cardiac arrest requiring resuscitation and placement of chest tubes. He then develops seizures that are eventually controlled with medication. The neonatologist feels that the child will always require life support. The mother refuses to discuss the possibility of withdrawing life support. Her insurance is Medicaid. The hospital bill for this child is now $350,000.

Item 1 of 2

1. To guide further treatment at this time, it is most important to assess which of the following?

A) The extent of neurologic injury

B) The financial impact on the family

C) The mother's level of understanding of the child's prognosis

D) Whether another family member is better suited to make decisions about the patient's care

E) Your state's law regarding futile care

Item 2 of 2

2. One week later the mother and the attending physician are unable to reach an agreement on the management plan. Which of the following is the most appropriate next step?

A) Ask the court to appoint a guardian

B) Defer major decisions until the father can be located

C) Have the social worker contact Medicaid regarding further coverage

D) Involve the hospital bioethics committee

E) Maintain the patient on a respirator but transfer him out of the NICU
 
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