What is the first step the nurse should take for an older adult woman with end-stage heart disease who refuses heroic measures?

In situations involving an older adult with end-stage heart disease who refuses heroic measures, the appropriate first step is to obtain a Do Not Resuscitate (DNR) order. This order is crucial because it legally formalizes the patient's wishes regarding resuscitation efforts in the event of a cardiac arrest or respiratory failure.

The patient's autonomy and right to make decisions about her own healthcare are paramount, especially in end-of-life scenarios. By obtaining a DNR order, the healthcare team can ensure that the patient's preference to avoid aggressive interventions is respected and followed. This step not only honors the ethical principle of autonomy but also provides clarity to the healthcare team regarding the course of action in emergencies.

Ensuring a DNR order in this context supports the patient’s goal of receiving comfort care rather than aggressive treatments that may not enhance quality of life. Once the DNR is established, the healthcare team can proceed with appropriate palliative measures to ensure the patient's comfort and dignity.