Mrs W has multiple co-morbid conditions and her current diagnosis is Aspiration Pneumonia. Every time she is suctioned she pleads with staff to leave her alone and cries. When staff attempt to get her out of bed she cries that she is uncomfortable and asks that they just leave her alone or help her to be comfortable.
Her physician decides that Mrs. W needs nutritional support and orders Intravenous Total Parenteral Nutrition. The Advanced Directive is specific in it's prohibition of TPN use. When the daughter speaks with you she informs you that while she knows that the TPN violates her mothers advanced directive, that the physician has informed her that it is a "Comfort Measure" so she has agreed to it's use.
What do you do and why?
