Case Scenario: A 75-year-old woman is in for her yearly exam. She states that sleep is challenging as she has pain in her upper back. She has been in good health other than the pain from her back. She has led an active life as a tennis player and states her activities are diminished by the pain. The doctor diagnoses osteoarthritis.

Question: Explain risk factors for osteoarthritis, detailing who might be at most risk for the disease. Support your answer using specific facts, data, examples, and other information

Case Scenario: A 72- year old woman presents with shingles. The blisters began near her spine and have continued around her rib cage. She is in pain and states nothing helps. She is the primary care giver for her aging mother and a grandson.

Question: Make a starting treatment plan for this patient. Support your answer using specific facts, data, examples, and other information drawn from the textbook

From a political-economy perspective, identify 5 distinct potential determinants of access to/use of health services. Briefly explain how/why each of these factors is likely to drive healthcare use. Then, determine how each of these factors would be classified under Andersen’s behavioral model of health service utilization.

From a political-economy perspective, explain the emergence of publicly-funded, centrally-financed, universal healthcare systems in Europe and Canada.

CASE 101: Social Networks and Medicine

Kevin D. Zeiler The Riverbend Hospital, a hospital located in a rural area of the state, recently purchased laptops for all employees of the hospital system, as well as emergency responders. The goal of the purchase was to streamline medical treatment and information in real time so that patients could receive more timely care. The program has been in place for just over three months with most of the employees feeling that the new system has been a real time-saver. However, a recent leak of patient information has put the program in jeopardy.

Because the laptops are provided with Internet access, many of the hospital’s employees have been using them for personal web browsing, social network updating, etc. Ambulance crews have been uploading photos from crash sites, shootings, etc., so that physicians and nurses can be made aware of the mechanism of injury and such. However, an employee in the system recently posted some of those photos to a social network site that many members of the local community share, and it has brought to light an abusive relationship that is taking place in the small community. The photos clearly show the patient and most, if not all, citizens in the small community know her. Furthermore, other providers have started to post comments about her treatment, follow-up care, and other medical conditions. The female patient is currently seeking legal advice and the future of the hospital’s new computer system has been compromised.

USE INFORMATION FROM CASE TO DO A WRITE UP (PLEASE INCLUDE DETAILED EXPLANATION AND COMPLETE ALL 6 STEPS)

1 - Write a background statement

2- What are the major problems and secondary issues?

3- Your Role

4- Organizational Strengths and Weaknesses

5- Alternatives and Recommended Solution

6- Evaluation

THEIR IS AN EXAMPLE BELOW OF HOW THIS SHOULD LOOK!!!!

Case Write-Up

Background Statement

A Wiccan patient who visited a nondenominational community hospital was discussing her religious beliefs with her primary care nurse, Penny Baker, when suddenly another nurse, Ruth Goose, walked into the conversation and rudely stated, “Thou shalt not suffer a witch amongst you.” The Wiccan nurse felt offended and complained that she was discriminated in the hospital because of her religious beliefs.

Major Problems and Secondary Issues

The major problem is that the two nurses, Penny Baker and Ruth Goose, made the patient feel unwelcomed in the nondenominational community hospital because of her Wiccan religious beliefs. The secondary issues that the nondenominational community hospital may face is that the Wiccan patient is threatening to go to the media. This means that there may be news coverage that your hospital engages in religious discrimination. This may make people, especially Wiccans, look down on your medical services.

Your Role

In this case, I am the Vice President of Nursing Services. As stated in the text, it writes, “You are the Vice President of Nursing Services in a nondenominational community hospital, and you receive a complaint from a patient, who is a Wiccan.” The advantages of this role are that I can sit down with Penny and Ruth to let them know that religious discrimination is not to be tolerated while we are caring for the patients. The disadvantages of this role are that I must decide how I am going to discuss this matter with Penny and Ruth because they’re passionate about being against the Wiccan patient. I need to let Penny and Ruth know that our patient’s care matters above everything else, not what religion they practice.

Organizational Strengths and Weaknesses

As the Vice President of Nursing Services, my strengths are that I can hold a training on racial, ethnic, and religious diversity. This training can supplement nurses with the information they need to work in a diverse environment. Nurses need to know that they must treat their patients justly despite their identity. The weaknesses I may face are that the two nurses are very religious themselves. They may not listen to what I have to say about religious discrimination because the two nurses try to justify their act by saying, “She did the right thing. We don’t have to pray with witches. They worship Satan. It’s blasphemy. What’s next? Human sacrifice?”

Alternatives and Recommended Solution

As a solution for this problem, I will make sure to provide all the nurses working in the hospital with diversity training. It is important that I sit down with the nurses and make it clear that discrimination will not be tolerated while they are working in our hospital. I can also offer every patient visiting the hospital with a survey. The patient can fill out the survey to let us know how they felt about their stay. Nurses who’ve been accused of any sort of discrimination, will have to speak with management. We would keep these incidences of discrimination in a file, and it the dilemma does not change, I would have to begin writing up the nurses. Discrimination would not be tolerated while the patient is in the hospital trying to recover from a medical condition. I would also recommend Penny and Ruth write an official letter of apology to the Wiccan patient before she decides to go to the media. Writing the official letter of apology would be my first recommended solution to Penny and Ruth, so that the patient does not feel unwelcomed to our hospital’s services in the future.

Evaluation

If there are enough surveys to prove that our medical treatment is getting better and there are less patients coming from the patients about discrimination, then I would know that the instances of discrimination have stopped. The goal is to aid in the medical recovery of patients. Patients must also feel welcomed to our hospital services despite their identity. By getting fewer, or even better, no discrimination complaints, I would know that my diversity trainings and meetings have worked.

Discuss the roles of federal, state, and local public health agencies in the development of standards for informatics in healthcare.

Describe how pain is a subjective physical and psychosocial experience? How does the endocrine system affected when pain is present? I would like to know the answers explanation. Thank you.

A 65-year-old male admitted to the unit with a severe asthma attack. He has been experiencing shortness of breath since admission several hours ago. An ABG is ordered with these results:

Patient: Test Patient 1

Date:      April 10, 2007          1000

pH                   7.20

PaCO₂             58

HCO₃^-             24

Patient is in _____________________________________

Interventions may include: ________________________________________________

Classify and differentiate at least four types of stroke

Explain the pathophysiology and common clinical manifestations of Diabetes Mellitus Type 2

Case Study 139- Selecting a Birth Control Method

Difficulty: Beginning

Setting: Office or clinic

Index Words: contraception, birth control, oral contraceptives (OCs), injectable contraceptives, intrauterine device (IUD), natural family planning, condoms

Giddens Concepts: Reproduction

HESI Concepts: Sexuality/Reproduction

Name _________________________________       Class/Group _______________       Date _______________

Scenario

You are working in a busy obstetrics/gynecology (OB/GYN) office. The last patient of the day is P.B., a 27-year-old who is being married in 2 weeks. She wants to use birth control but is not sure what to choose. Her fiancé and she are both in graduate school and have limited health insurance, so she is anxious not to become pregnant right away. She asks you to review the various methods and help her explore what is best for her.

1. What factors influence the choice of the most appropriate method of birth control?

2. What past medical information will you need to obtain from P.B. and why?

3. What lifestyle information will help you aid P.B. in choosing a birth control method?

4. P.B. asks you about the effectiveness rating of available birth control methods. Describe the term efficacy.

5. What factors influence how effective a contraceptive method is?

6. Match the available contraceptive methods according to their efficacy ratings:

7. P.B. asks you to review the main advantages and disadvantages of the hormonal birth control methods first.

8. After reviewing the hormonal methods, you choose to discuss intrauterine devices. How would you describe the copper and levonorgestrel (Mirena) IUD systems to P.B.?

9. Next, you steer the conversation to barrier methods. What will you share with P.B. about the use of a diaphragm or cervical cap and condoms?

10. The major advantage of using a condom for birth control is that condoms:

1. Do not require monthly injections
2. Are easy to obtain and inexpensive
3. Reduce the risk for acquiring infections
4. Come in assorted styles, shapes, and textures

11. Describe what you would tell P.B. about the natural family planning method.  

12. P.B. wants to know about the associated costs with each method because she is on a tight budget. How would you respond?

13. She asks you which method you would pick. What do you tell her?

CASE STUDY PROGRESS

P.B. comes back in a week and tells you that she can get a low-cost oral contraceptive (OC) through a local store. You convey this information to the nurse practitioner, who examines P.B. and writes a prescription for a biphasic 28-day pill pack containing ethinyl estradiol and norethindrone. You are asked to discuss the use of the OC pill with P.B.

14. Explain how biphasic OC pills work.

15. When should P.B. take her first OC?

16. You tell P.B. that is does not matter what time of day she takes the OC, just that she takes it at the same time each day. Describe 3 suggestions you can offer to help her remember to take her pill.    

17. What should you tell her about missed pills

Amnah is a 55-year-old female patient who has been admitted to the medical ward with acute shortness of breath, chesty cough, wheezing and chest discomfort. Amnah’s vital signs were: SpO2 82% on room air, BP 150/90 mmHg, Pulse 110 beats/min, RR 28 breaths/min, and Temperature 38.7 °C. Amnah has a history of COPD and hypertension for 15 years. She was also diagnosed with heart failure 2 years ago. While doing the physical examination, the patient seemed to use her accessory muscles and have cyanosis in the lips and nose. She also started to get mixed up during the nursing assessment as she could not figure out that she was in the hospital. Amnah also complaint of weakness and fatigue and her lower limbs were very edematous. After a medical review, ABG was taken, CXR was done and venous blood samples were sent for complete blood count, chemistry and culture and sensitivity. Amnah’s lab results were as follows: Chemistry Potassium Chloride BUN Patient Value 148 4.4 68 streptococcus pneumoniae 7.8 Normal Values 136-146 mmol/L 7-22 mg/dl ABG & CXR Sodium pH 7.25 PaO2 49mm Hg PaCo2 58mm Hg HCO3 27mEq/L 106 3.5-5.3 mmol/L 98-108 mmol/L Creatinine 1.66 0.7-1.5 mg/dl Blood culture and sensitivity 8.9-10.3 mg/dl CXR: opacity of right lower loop with consolidation and pleural effusions with cardiomegaly Calcium Phosphorus 10.4 Hemoglobin 321 14.5 2.6-6.4 mg/dl Alkaline Phosphatase 30-110 IU/L 14-17 gm/dl Based on the medical review and the diagnostic tests results, Amnah was mainly diagnosed with impaired respiratory functions. She was also found to have some cardiac and renal abnormalities. The doctor ordered immediate treatment and requested very close monitoring of Amnah.

1. Suggest one main medical diagnosis for Amnah and give one rational behind your suggestion.

B. Explain why would you have chosen to use this treatment?

C. Identify two clinical symptoms that support the ABG results of Amnah.

4. Amnah was diagnosed with health issues other than respiratory.

Identify two of these issues and give one diagnostic finding for each.

4. You are the nurse looking after Amnah. Explain five immediate nursing interventions.

5. Name three complications that Amnah must be monitored for.

You are a nurse on an inpatient psychiatric unit. J.M., a 23-year-old woman, was admitted to the psychiatric unit last night after assessment and treatment at a local hospital emergency department for "blacking out at school." She has been given a preliminary diagnosis of anorexia nervosa. As you begin to assess her, you notice that she has very loose clothing, she is wrapped in a blanket, and her extremities are very thin. She tells you, "I don't know why I'm here. They're making a big deal about nothing:' She appears to be extremely thin and pale, with dry and brittle hair, which is very thin and patchy, and she constantly com-
plains about being cold. As you ask questions pertaining to weight and nutrition, she becomes defensive and vague, but she does admit to losing "some" weight after an appendectomy 2 years ago. She tells you that she used to be fat, but after her surgery she didn't feel like eating and everybody started commenting on how good she was beginning to look, so she just quit eating for a while. She informs you that she is eating lots now, even though everyone keeps "bugging me about my weight and how much I eat." She eventually admits to a weight loss of "about 40 pounds and I'm still fat."

1.Provide two nursing diagnosis and interventions along with objective data and short term and long term goals.

2.sbar

Disciplinary Process File Complaint Include in detail the process of filing a complaint. Process of an Investigation Describe in detail the process of the investigation. Process of a Hearing Describe in detail the process of a hearing. Types of Disciplinary Actions Do not simply list the types of disciplinary actions but include an explanation and/or example of each. New Mexico Board of nursing.