Mrs. Schmidt is a 64-year-old woman who has been staying at an acute care facili

Question

Mrs. Schmidt is a 64-year-old woman who has been staying at an acute care facility for over 3 months now. She has been suffering for several years from chronic obstructive pulmonary disease and was placed on mechanical ventilation last fall. She was initially admitted to your facility for a weaning trial from the mechanical ventilator. For the past 3 months, she has failed several trials of weaning. Last night, the physician informed her that she was to leave the acute facility, connected to the mechanical ventilation, and that no further trials will be initiated. This morning, you asked Mrs. Schmidt about her preparations for leaving the facility. In response, Mrs. Schmidt starts crying dramatically and asks to see the attending physician. She is extremely upset, stating that "no one had told her anything about this." She is adamantly asking for an extension of her stay and for another weaning trial. Two weeks later, Mrs. Schmidt is completely weaned from the mechanical ventilation. However, she still has a Foley catheter (a thin, sterile tube inserted into the bladder to drain urine) in place, which she refuses to let go, saying that, she "cannot be without it." 3: What are some of the potential explanations for the communication difficulties descri re some of the potentia explanations for the communication difficulties described in this vig ette 4: Is there anything that should have been done differently? : How would you explain Mrs. Schmidt's miraculous ability to wean? 6: How would you explain Mrs. Schmidt's refusal to "let go" of the Foley catheter?

Explanation / Answer

4. An alternative way could have been approached. Use of non-physician-run protocols produces much better improvement and faster weaning from the mechanical ventilator than the usual care.

5. Mrs. Schmidt's miraculous ability to wean can be explained due to the following reasons :

Spontaneous breathing and avoided exhaustion.

Respiratory demand decreased.

Carrying capacity and oxygenation increased.

6. Mrs. Schmidt's refusal to "let go" of the Foley catheter is a symptom of being obsessed psychologically.

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