A PSW reports a 97-year-old patient who is breathing shallowly, feels cold and clammy, and has blue feet. The patient has an advance directive that states comfort care only and is designed as a DNR. What should the nurse instruct the PSW to do?

• A. Provide comfort measures as outlined in the plan of care
• B. Initiate rapid resuscitation if signs worsen
• C. Move patient to intensive monitoring
• D. Notify family about aggressive treatment

Answer: (A)

When a patient has an advance directive for comfort care and a DNR, the care focus shifts to relieving distress and keeping the patient comfortable at the end of life. The symptoms described—shallow breathing, cold and clammy skin, and blue extremities—are common as death approaches, and they signal that the goal is comfort rather than curative treatment.

The nurse should guide the PSW to provide comfort measures as outlined in the care plan. This includes practices that ease distress and support dignity, such as adjusting the position for comfort, keeping the patient warm and dry, assisting with oral care and mouth comfort, and reporting any signs of pain, shortness of breath, or restlessness so medications or other comfort measures can be given per protocol. These actions align with the directive and avoid interventions intended to revive or aggressively treat the patient.

Actions like initiating rapid resuscitation, moving to intensive monitoring, or discussing aggressive treatment with the family would not fit a comfort-focused plan and are not indicated here. The emphasis is on soothing symptoms and honoring the patient’s wishes.