What is Advance Care Planning?

Advance care planning isn’t just for elderly people. Disease and accidents that may render us unable to make our own decisions when it comes to medical care. Even if you aren’t sick and don’t have a heightened risk for any medical condition, you should still look into advance care planning just to make sure you will receive the care that you would want if you become incapacitated and unable to make your own decisions. [1]

Oftentimes, people in difficult situations find it hard to make clear decisions regarding medical treatment. Don’t wait until you’re the one in the hospital bed to think about how you want your medical care to be carried out. As you read this article, you will learn more about the definition of advance care planning and what choices you may make regarding medical care you can receive.

What is advance care planning?

This type of planning helps you to understand the different medical decisions that may need to be made, deciding what you would like to be done in those situations, and then communicating your desires to your family and healthcare providers. An advance directive contains a compilation of wishes, which is a legal document used in the case of you needing to receive medical care for whatever reason and being unable to speak for yourself.

This document also gives you a way to let your wishes be known regarding end-of-life care. It can be adjusted if you change your mind as a result of new information or a shift in your health condition. [2]

Possible medical decisions

Sometimes, decisions regarding emergency treatment has to be made. They usually relates to cardiopulmonary resuscitation, use of a ventilator, artificial feeding and hydration, and comfort care.

 

CPR.

If your heart stops or beats irregularly, you may be in need of cardiopulmonary resuscitation. When someone applies CPR, they put pressure on your chest with a certain force at a certain speed to get air into your lungs. [3] Sometimes, people experience broken ribs or collapsed lungs as a result of the pressure used during CPR. [4] Defibrillation, or electric shocks, are sometimes used in tandem. Most young, healthy people often can resume normal heart activity after some CPR. However, some older adults with poor health do not.

Ventilator use.

These machines help you to breathe if you cannot yourself. [3] In essence, a tube enters your windpipe to make air go into your lungs. It may involve a cut through the throat or a tube going all the way down the throat from the mouth. Intubation can be very uncomfortable, so patients become sedated while a ventilator has to breathe for them. The process of inserting the tube through a cut in the throat is called a tracheotomy. [5] It is minor surgery that can be done at a patient’s bedside. Usually this method can be used when a patient likely has to be on a ventilator for a long duration.

Artificial nutrition and hydration.

Patients who cannot eat usually get nutrients they need by way of a tube down their nose into their stomachs. People who require tube feeding for a long time often have tubes directly inserted to their stomachs instead. Sometimes, a person can eat food but cannot do it themselves. In that case, assisted oral feeding becomes a better alternative with less risks.

If you cannot take in fluids, a nurse will put an IV line into your vein so you receive the liquid you need.

When recovering from sickness or surgery, artificial nutrition and hydration can be extremely beneficial. [6] If you are nearing the end of life or unable to take in the nutrition anyways, it may have no effect or even be harmful.

Comfort care.

Comfort care is usually employed when death is imminent. It basically eases or reduces your suffering, such as managing breathing, reducing medical treatments, offering counseling, and medicating for pain, anxiety, or any such things.

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References:

1. Larson, Aaron. "How a Power of Attorney Works". ExpertLaw.com. ExpertLaw. Retrieved 4 May 2017.

2. “Advance Care Planning: Healthcare Directives.” National Institute on Aging, U.S. Department of Health and Human Services, www.nia.nih.gov/health/advance-care-planning-healthcare-directives.

3. Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, Cave DM, Jauch EC, Kudenchuk PJ, Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers AH, Berg MD, Billi JE, Eigel B, Hickey RW, Kleinman ME, Link MS, Morrison LJ, O'Connor RE, Shuster M, Callaway CW, Cucchiara B, Ferguson JD, Rea TD, Vanden Hoek TL (November 2010). "Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S640–56. doi:10.1161/CIRCULATIONAHA.110.970889. PMID 20956217.

4. Boland LL, Satterlee PA, Hokanson JS, Strauss CE, Yost D (January–March 2015). "Chest Compression Injuries Detected via Routine Post-arrest Care in Patients Who Survive to Admission after Out-of-hospital Cardiac Arrest". Prehospital Emergency Care. 19 (1): 23–30. doi:10.3109/10903127.2014.936636. PMID 25076024.

5. Molnar, Heather. “What Is a Tracheostomy?” Is There Really Any Benefit to Multivitamins?, 18 May 2017, www.hopkinsmedicine.org/tracheostomy/about/what.html.

6. “Artificial Nutrition and Hydration in Advanced Illness : Journal of Hospice & Palliative Nursing.” LWW, Oxford University Press, journals.lww.com/jhpn/Citation/2012/05000/Artificial_Nutrition_and_Hydration_in_Advanced.3.aspx.


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