What ethical considerations can be seen here with this situation or case study?

1. Explore your response to being given a terminal diagnosis. What coping mechanisms work for you? With which awareness approach would you be comfortable?
2. Describe the priority nursing actions related to a dying person and their family when they are especially protective of one another.
3. Describe and strategize how you would bring up the topic of advance directives.
4. What advance directive related to end of life is legally recognized in your state?
5. Describe how you would introduce the topic of dying with a patient who is critically ill and not expected to live.
AT CLINICAL: Ask a nurse about the policy surrounding a death at the clinical facility.
What is the process after the body dies?
What events occur prior to the death?
What does the facility do to facilitate a good death?
Does the facility have a contract with Hospice services? What does that entail?
POST CLINICAL:
What is an ethical dilemma?
Describe or provide details of either a real or fictitious ethical dilemma you have experienced or could experience.
What were the choices or responses that caused it to be an ethical dilemma?
What was the end result?

Case Study
Mrs. Arroyo, 78 years old, is in a hospice for end-stage dementia. She lies in bed curled in the fetal position. She is on a pureed diet with nectar thick liquids. Over the last year, she has been treated for aspiration pneumonia four times. Her weight is steadily declining. Six months ago, she weighed 115 pounds (BMI 18.56 kg/m2) and yesterday she weighed 103.5 pounds (BMI 16.70 kg/m2). Her vital signs are 88/44 mmHg, heart rate of 60 beats per minute, respiration rate of 10 breaths per minute and irregular, and her temperature is 94.2°F. Her albumin level is 2.2 g/L. Over the last day, the nurse has documented the presence of a stage 2 pressure injury measuring 5 mm × 2.5 mm × 2 mm on Mrs. Arroyo’s coccyx; the wound base is pale. Her skin is cool to touch and purplish on her hands and feet. She had one wet under pad in the last 24 hours. She is occasionally restless but is not responding to stimuli and is no longer eating or drinking. The nurse has called the family to come to the bedside, telling them death is approaching.
To facilitate a good death, which nursing actions should be implemented?
What ethical considerations can be seen here with this situation or case study?