Aclient in a long-term care facility has signed a form stating that he does not want to be resuscitated. he develops an upper respiratory infection that progresses to pneumonia. his health rapidly deteriorates, and he is no longer competent. the client’s family states that they want everything possible done for the client. what should happen in this case?

The client signed the DNR form before developing pneumonia and becoming incompetent. DNR Forms are signed in the presence of a legal adviser, doctor or witness, which means the patient was in complete mental health and stability when signing the form. The patient's wishes should be respected, the family is no longer responsible for this client after him becoming incompetent since he, on his own will decided he did not want to be resuscitated. He can however be treated for the pneumonia, and upper respiratory infection, if he does, fall into respiratory or cardiac arrest then there is nothing anyone can do, but since the patient did not sign a do not treat form, he can be cured, but not resuscitated should he need it.

    however, coronary heart disease , or chd, is actually a result of coronary artery disease, or cad, said edward a. fisher, m.d., ph.d., m.p.h., an american heart association volunteer who is the leon h. charney professor of cardiovascular medicine and also of the marc and ruti bell vascular biology and disease program at the nyu school of medicine.

  with coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. view an illustration of coronary arteries. this is also called ischemia. it may be chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle. or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot.

    the traditional risk factors for coronary artery disease are high ldl cholesterol, low hdl cholesterol, high blood pressure, family history, diabetes, smoking, being post-menopausal for women and being older than 45 for men, according to fisher. obesity may also be a risk factor.

    “coronary artery disease begins in childhood, so that by the teenage years, there is evidence that plaques that will stay with us for life are formed in most people,” said fisher, who is former editor of the american heart association journal, atvb. “preventive measures instituted early are thought to have greater lifetime benefits. healthy lifestyles will delay the progression of cad, and there is hope that cad can be regressed before it causes chd.”

  living a healthy lifestyle that incorporates good nutrition, weight management and getting plenty of physical activity can play a big role in avoiding cad.

    “coronary artery disease is preventable,” agreed johnny lee, m.d., president of new york heart associates, and an american heart association volunteer. “typical warning signs are chest pain, shortness of breath, palpitations and even fatigue.” if you feel any of these symptoms, don’t delay — call 9-1-1.