A pt with an extensive history of ACS is admitted with an acute exacerbation of heart failure. Data are as follows
Bp 90/60, HR 120, O2 sat 90% on 4l via nasal cannula
She has diffuse crackles throughot all lung fields. The physician has ordered diuretics and insertion of a central line for dobutamine administration. Her husband favors withdrawal of treatment but the pt has indicated she wants to continue treatment even if its painful and possibly futile. She is oriented to person and place but disoriented to time and year. The nurse should recognize
A. the pt wishes should be supported under the ethical principle of autonomy
B. the pt should be educated that comfort can be maintained for her even without further treatment
C. the pt cognition may be impaired because of hypoxia and decreased blood pressure, and the husband should make medical decisions
D. that the spiritual care should be consulted before healthcare decisions are made