CPM Summer 2018 - 11

daup h i n c m s .o rg

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bstract: With the average life
expectancy increasing to 78
years old in the U.S according
to the CDC, many patients
have chronic progressive illnesses that
may or may not improve with medical
management/hospitalization. Discussing
goals of care is important for every person,
so they can manage their illness in certain
circumstances. The National POLST
(Physician Orders for Life-Sustaining
Treatment) Paradigm is "an approach
to end-of-life planning that emphasizes
eliciting, documenting and honoring
patients' preferences about the medical
treatments they want to receive during
a medical crisis or as they decline in
health." Many states utilize these forms
and may be worded differently, however,
essentially have the same information.
We present a case scenario for an encephalopathic patient who had previous
advanced directives indicating, "Limited
additional interventions," "no antibiotics,"
and "no hydration/artificial nutrition
by tube." The surrogate, however, did
want intravenous (IV) nutrition. The
question is, does Total Parental Nutrition
(TPN) coincide with the patient's wishes
given the statement on the POLST form
mentions "no artificial nutrition by tube?"
Should our POLST forms be revised to
include the forms of artificial nutrition
(IV or PEG) to avoid ambiguity?
Continued on page 12

Central PA Medicine Summer 2018 11



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Table of Contents for the Digital Edition of CPM Summer 2018

CPM Summer 2018 - 1
CPM Summer 2018 - 2
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