Case Study Discussion: This week's project is based on the material in Chapter 9, Understanding Family Needs, Roles, and Responsibilities. Read the case study titled "Mrs. M" and answer the following

Mrs. M. was 32 weeks into her pregnancy with twin boys when, during a routine prenatal ultrasound examination, the physician noticed a significant abnormality affecting the heart of one of the boys. Andrew, the twin with the abnormality, had appeared well up to this point; the other twin still appeared quite healthy. After being presented with the

news, Mrs. M. was admitted to the hospital, and she and her husband had to decide what to do next. Over the next several hours additional tests were performed and Andrew’s parents were faced with the following decisions: (1) Deliver both twins via cesarean section in 3 days with the hope that Andrew’s heart could be repaired before any additional damage was done or (2) treat Andrew with medications to strengthen his heart while in utero and allow the pregnancy to continue for a few more weeks. Either option was risky for the other twin due to the risks associated with preterm birth and the risks associated with the medications that would need to be administered to strengthen Andrew’s heart.

Later that night, Andrew’s parents decided the best course of action would be to have the boys delivered the following week. Andrew was delivered first and immediately taken to the heart catheterization lab. His brother was delivered a couple of minutes later and was allowed to remain with his parents for a few minutes before being taken to the neonatal intensive care unit.

The day Andrew was born he spent 12 hours in the heart catheterization lab and undergoing surgery before he was stable enough to be moved to a suite in the pediatric intensive care unit (PICU). Andrew was placed on a ventilator and was kept alive by medications infused into his body by several infusion pumps. Andrew’s heart and the blood vessels exiting the heart were profoundly damaged. Mr. and Mrs. M. were again presented with many difficult choices. Eventually, Andrew’s parents decided to have the vessels carrying blood from the heart repaired to see if the heart could recover. Following another long day in surgery, Andrew returned to the PICU where he was attached to even more machines than before.

Over the next 2 1/2 weeks Andrew’s condition remained the same: He was unable to live without the support of several machines. The hospital staff was very supportive and caring. Once again facing a tough decision, Andrew’s parents decided to remove Andrew from the life-sustaining machines; Andrew died in his parents’ arms a few minutes later.

Andrew’s twin brother spent about 3 weeks in the hospital before going home with his parents. He is currently a happy kindergartner.