A 62-year-old female is admitted to the general medical unit upon recommendation from her oncologist because of “low blood counts.” She has had multiple recent hospital admissions for this same condition resulting from Myelodysplastic Syndrome in which the bone marrow does not produce enough healthy cells. She also has had recent valve surgery for aortic stenosis. During this admission, she received Neupogen, a protein to stimulate her bone marrow and white blood counts, with no success. The patient has expressed the wish to die.
She was then transferred to the Psychiatric Unit for close observation and evaluation for the possible diagnosis of Major Depression. On the psychiatric unit, the nurses notice that she has one cousin who comes to visit, but no other visitors have been seen. The patient has verbalized that she is “tired of all the admissions and sometimes wishes she would just die.” You as the nurse come in to assess the patient and find her lying in bed staring at the ceiling. The patient looks at you when spoken to but there is no verbal response. The morning shift nurse tells you that the patient refused to eat breakfast and would not get out of bed to get cleaned up. Vital signs: BP 118/62, HR 62-regular, RR 14, Temp 98.6