An 82-year-old client who is unresponsive after a massive stroke is admitted from a nursing home. During hand-off, the nurse learns that the client has a signed living will declining intubation and tube feeding. Shortly after admission, the client's adult child says, "I want you to do whatever it takes, including a breathing machine, to keep my parent alive." Which action should the nurse take first to uphold ethical and legal standards of care?
Initiate intubation immediately and seek a court order to resolve the conflict later.
Activate the hospital ethics committee to decide the appropriate level of treatment before intervening.
Honor the child's request for full treatment until the primary provider writes new orders.
Locate and review the client's advance directive and communicate the stated wishes to the interprofessional team.
The nurse should first locate and review the client's advance directive and share the documented wishes with the health-care team. The Patient Self-Determination Act and professional ethical codes require that legally valid advance directives be incorporated into the plan of care and take precedence over surrogate requests that conflict with the client's expressed preferences. Proceeding with intubation or automatically deferring to the child disregards the client's autonomy. Consulting an ethics committee may be necessary only if the directive cannot be found or remains disputed after verification.
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