I’m working on a nursing question and need guidance to help me learn.

Sonia, a nurse working at a skilled long-term care facility, has reviewed the test results for Pedro, a resident. The report of the modified barium swallow test explains that food and liquid are clearly going down the trachea into the lungs, not just the esophagus, every time Pedro swallows. The test results explain the choking and throat clearing that she and the speech therapist had noted, confirming dysphagia.

Sonia knows the test result indicates Pedro will get pneumonia and that Pedro will die from this pneumonia if he continues to eat through his mouth. It is not a question of “if” he will get pneumonia; he will. Food and liquids contain bacteria and fungi that will colonize in the lungs. Pedro’s physician has explained the results to Pedro and recommends that Pedro get a PEG tube (stomach tube). This would allow Pedro to be fed directly into his stomach and bypass the esophagus, preventing pneumonia. Getting the stomach tube would allow Pedro to continue to live.

The physician places Pedro on “nothing by mouth”/ NPO order and the kitchen stops serving Pedro food. The physician explains that legally he and the facility will not accept the responsibility of feeding him and giving him pneumonia. The institution does not have a dysphagia waiver that Pedro can sign; they no longer use them. The physician explains to Pedro’s family that they can bring food and feed Pedro, but the institution will not.

Pedro is competent to make decisions and fully competent to make medical decisions. Pedro refuses to have the stomach tube. He says he would rather eat normally and die of pneumonia than have to give up apples, oranges, and all food.

1. What principle gives the patient the right to refuse the stomach tube?
2. What is the nurse’s role in supporting the patient?
3. What is the nurse’s role in supporting the family?