Explain the impact of negligence, malpractice, and litigation on the relationship between patient and provider.

Joan is an 85 y/o female recovering from a right total hip replacement. Her injury occurred when she tripped over a scatter rug in her living room and fractured her hip. She lives alone in a private home and anxiously tells you she is afraid of falling again, not being able to call for help and ‘dying alone on the floor’.

Her problems include decreased strength in both lower extremities (BLE) and some pain and stiffness in both hands which limits how long she manages her walker. She also has difficulty preparing her meals due to decreased standing tolerance. She enjoys painting, reading and participating in her book club

Joan is an 85 y/o female recovering from a right total hip replacement. Her injury occurred when she tripped over a scatter rug in her living room and fractured her hip. She lives alone in a private home and anxiously tells you she is afraid of falling again, not being able to call for help and ‘dying alone on the floor’. Her problems include decreased strength in both lower extremities (BLE) and some pain and stiffness in both hands which limits how long she manages her walker. She also has difficulty preparing her meals due to decreased standing tolerance. She enjoys painting, reading and participating in her book club.

1. Name two occupations would she have difficulty performing besides her ADLs or IADLs.

2. Name one ADL that she would have difficulty performing.   Why/How So?

3. Name one IADL that she would have difficulty performing? Why/How So?

4. Name a performance pattern that would be affected? Why

5. What intervention, strategy would you recommend for Martha?

Which approach is considered to offer few individual benefits but might yield collective population value?

a. Social marketing

b. Policy approaches

c. Health communication

d. Community-based prevention marketing

T.H., a 57-year-old stockbroker, has come to the gastroenterologist for treatment of recurrent mild to severe cramping in his abdomen and blood-streaked stool. You are the registered nurse doing his initial workup. Your findings include a mildly obese man who demonstrates moderate guarding of his abdomen with both direct and rebound tenderness, especially in the left lower quadrant (LLQ). His vital signs are 168/98, 110, 24, 100.4° F (38° C); he is slightly diaphoretic. T.H. reports that he has periodic constipation. He has had previous episodes of abdominal cramping, but this time the pain is getting worse. Past medical history reveals that T.H. has a "sedentary job with lots of emotional moments," he has smoked a pack of cigarettes a day for 30 years, and he had "two or three mixed drinks in the evening" until 2 months ago. He states, "I haven't had anything to drink in 2 months." He denies having regular exercise: "just no time." His diet consists mostly of "white bread, meat, potatoes, and ice cream with fruit and nuts over it." He denies having a history of cardiac or pulmonary problems and has no personal history of cancer, although his father and older brother died of colon cancer. He takes no medications and denies the use of any other drugs or herbal products.

. 1. Identify four general health risk problems that T.H. exhibits.

2. Identify a key factor in his family history that might have profound implications for his health and present state of mind.

3.The physician ordered a KUB (x-ray study of the kidneys, ureters, and bladder), complete blood count (CBC), and complete metabolic profile. Based on x-ray and laboratory findings, physical examination findings, and history, the physician diagnoses T.H. as having acute diverticulitis and discusses an outpatient treatment plan with him. What is diverticulitis? What are the consequences of untreated diverticulitis?

4.While the patient is experiencing the severe crampy pain of acute diverticulitis, what interventions would you perform to help him feel more comfortable?

5. What is the rationale for ordering bed rest?

T.H. is being sent home with prescriptions for metronidazole (Flagyl) 500mg PO q6h, ciprofloxacin (Cipro) 500mg PO q12h, and dicyclomine (Bentyl) 20mg 4 tomes per day for 5 days.

6.For each medication, state the drug class and the purpose for T.H.

7.Given his history, what questions must you ask T.H. before he takes the initial dose of metronidazole? State your rationale

8.What is a disulfiram reaction?

9. What are the signs and symptoms of an allergic reaction

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  1. A) Obesity

  B) lack of exercise

  C) hypertension

  d) malnutrition (low fiber diet)

  2.There is history of colon cancer which is running down his family tree(father $ elder brother) .it maybe an Autosomal disease

  3.Diverticulitis: diverticulum is small out pouches in small intestine, it's inflammation is called diverticulitis ( ulcer / abscess)

  Complications of untreated diverticulitis : peritonitis ( inflammation of peritoneum)

  Fistula formation, abscess ( collection of pus)

  4.intramuscular injection of pain killer ( diclofenac)

  5. Bed rest: it helps less bowel activity and helps in healing  

  6.Metronidazole ( belongs to imidazole group of drugs) and ciprofloxacin(fluoriquinolone group of antibiotics) are antibiotics for the inflammation.

  Dicycloamine is antispasmodic, it reduces the crampy abdominal pain

  7. History of any drug reaction , alcohol ingestion

  It can produce disulfiram reaction

  8.Disulfiram reaction :when alcohol is ingested which is associated with flushing and hypotension

  9.Symptoms: itching, urticaria, breathing difficulty

  Symptoms : wheeze on chest auscultation, hypothyroidism, tachycardia,

Describe the legal responsibility health care professionals have in relation to risk and the prevention of injury within their scope of practice.

Which of the following is an effect on the pulmonary system due to the aging process?

Question 3 options:

Look up a nursing educational video that explains the types of shock. Post the video link. Write a summary/ review of the video (at least 5 sentences.) Then watch at least two of your classmates videos and post a comment.

Answer the following questions. Your answers should address all parts of the questions and be approximately 300-400 words each. Make sure to thoroughly support all answers with accurate details and relevant evidence from the textbook and other resources.

1. Several coworkers are in the lunchroom on their lunch break. Sam and his friend George are having a rather loud conversation about the party they attended over the past weekend. George relates a joke that he heard at the party; it is a very sexually oriented joke with several words that offend Sally (who overhears the conversation). Sally is upset and complains to them about the nature of the conversation that they are having and how it is offensive to her. George and Sam tell her that she is overreacting and dismiss her complaint. Is this considered sexual harassment? Is Sally just overreacting to the situation? If Sally reports the incident to her supervisor, what (if any) actions should the supervisor take to follow up on this incident? 2. Sandra is a nurse in a physician's office and she has just assisted the physician with a suturing procedure. As she is cleaning up afterwards, she is cut by the suture needle and it penetrates her glove. What procedures should be followed? Is the employer responsible even though Sandra made the mistake? How does this incident affect the patient whose blood is on the suture needle? Can the patient be forced to have HIV testing? Be sure to reference OSHA guidelines. 3. A medical assistant is at a local store and notices a patient who had been in the office that morning. The patient is with her husband, and the medical assistant greets the patient and congratulates her on the “good news.” The patient is upset, and the medical assistant realizes not only that the patient had not yet informed her husband of the pregnancy but also that the husband had previously undergone a vasectomy and was not the father. What could happen to the medical assistant for this incident? Would this be considered a mistake rather than an actual violation of HIPAA? Would the employer be responsible for the medical assistant's violation? Consider how respondeat superior and any previous employee HIPAA training might factor in. 4. During an office visit, Mr. H, who smokes cigarettes, is diagnosed with bronchitis. His physician wants to prescribe Levaquin because this is usually the best antibiotic treatment, and it is especially most effective for smokers with bronchitis. However, the physician knows that most insurance companies will not cover this expensive antibiotic. What should the physician do? 5. Susan is diagnosed with early-stage Alzheimer's disease and she finds her son and daughter disagreeing on who should provide her care. She disagrees with both their ideas. Assume she lives in your state and those state laws apply. She’s asked you, her physician, for advice about how to prepare for the time when she will no longer be able to make her own healthcare decisions. What should you tell her? What resources would you provide? 6. A nurse on your unit has a confidential personal code that allows her to view the medical records of patients on her unit, because she clearly has a legitimate need to view these records. However, one day she browses the records of patients on other units in the hospital while she is on break. She explains that she is bored and wants to see if she recognizes the names of any of the other patients. Describe legal and/or ethical issues involved here.

Ms. Van Dorn, a 19-year-old female student from Holland, visits the college health center for “being tired all the time.” The nurse notes that she is pale with cool skin, mucous membranes are pale and moist, and lungs are clear. Ms. Van Dorn states that she does get short of breath climbing the stairs or walking uphill. Laboratory results;

RBC 3.8 million µL

HGB 9.8 g/dL

HCT 37%

MCV 70 fL

MCH 25 pg

MCHC 300 g/L

WBC 6000/mm³

Her blood smear is abnormal

1.    How should the nurse interpret these findings?

2.   What questions should the nurse ask Ms. Van Dorn to help in differentiating the type of anemia?

3.Are there any other lab results you want to know?

The physician ordered furosemide 2.5 mg/kg q8h for a child who weighs 28 lb. The safe dosage range is 3 to 6 mg/kg q8h, How many milligrams of furosemide should the nurse administer for each dose? Round to the nearest whole number.

A 60-year-old homeless man, “Jesse”, is found confused and in distress by a passerby who calls 911. Paramedics bring the man to the hospital. Jesse’s feet and legs are swollen and covered in ulcers and dead tissue—diagnosed as osteomyelitis, or infection of his legs. His past medical history is established to include chronic obstructive pulmonary disease (COPD), chronic foot infections, alcoholism, and tobacco use. In addition to this, clinicians find a mass in Jesse’s lung that could either be TB or cancer. Physicians recommend a biopsy. The infections in this patient’s legs are so severe that a double amputation is recommended, also.

Jesse says “No!” to amputation, but reluctantly agrees to a biopsy of the lung mass. Then a psychiatric consultation leads to an opinion that the patient actually lacks capacity for healthcare decisions. Jesse had been able to identify his location in a hospital but not why, or what could happen as a result of not going along with medical recommendations for treatment. He had stated to the psychiatrist that he just wants to leave the hospital and die. But does he? Maybe. In a previous hospital admission, the chart indicates that Jesse had refused surgery as treatment for recurring infection in his legs, and physicians believed he had done so with decisional capacity.

Jesse’s support system initially seems to consist only of a couple recent acquaintances at the homeless shelter (who don’t have telephones and cannot be reached) and a dog that Jesse says is his very best friend. A hospital social worker searches for any next of kin, someone who knows Jesse and might be willing and able to make decisions as a surrogate. Social work eventually finds an out-of-town brother and an estranged sister. Neither have seen their brother in many years, and anyway are unwilling to make decisions on his behalf. The attending physician wonders aloud what should be done for Jesse now, and who can decide?

An ethics consultation is requested and received. An ethics note placed in the chart later that day offers several recommendations following a summation of the situation. This is a case seen by Ethics as one involving an unrepresented patient without advance directives and a care team with beneficent intent and insufficient information to know exactly what actions would constitute respect for the patient’s autonomy, such as it is, or his best interests otherwise. Ethics recommendations include:

• convene a multidisciplinary patient care meeting to foster communication amongst multiple care teams
• periodic reevaluation of the patient’s capacity given that it could be an acute rather than chronic state
• continue to update Jesse on his situation so as to respect whatever autonomy he retains or regains
• consider whether there might be other sources of infection, such as TB, that are contributing to his recent loss of decisional capacity and impeding recovery
• reiterate with nursing staff the need for infection control for the safety of care providers and other patients

Jesse is stabilized and remains hospitalized for another week. The lung biopsy shows evidence of a lung cancer that is treatable but not curable. Reevaluation of capacity for decision-making indicates that the patient has regained capacity sufficient for decisions for or against treatment of his cancer and infections. Jesse chooses to leave the hospital without further treatment. Upon discharge, he refuses also to be taken either to a homeless shelter or the nursing home placement that Social Work had found as the recommended discharge option. Jesse is discharged to the street, as he wishes.

Questions for Discussion:

• Is Jesse making the right decision to leave the hospital without treatment? How would we know what the right decision is in this case?
• How should the patient’s medical history, including his history of treatment refusal, impact decision-making during the period when he lacked decisional capacity?
• What justification might have been found to do the recommended amputations over Jesse’s incapacitated objections?
• Might that course of action have been justified if the leg infections were determined to be the primary cause of his acute decisional incapacity?
• What other recommendations might have come from ethics consultation?
• Treatment refusals—whether reasonable or unreasonable (and how would Jesse’s be categorized?) can be emotionally difficult for members of the care team. What should be done to support this care team in light of Jesse’s decisions?

Health Rationale: A Program for Sexually Transmitted Infections

1. Title this health rationale and state in broad terms what the problem is.
2. Propose a solution to the problem of sexually transmitted infections (e.g., name and purpose of the proposed health program). Here, you will give a general overview of your proposed program.
3. State why the program will be successful.

A child weighs 95 lbs and has an order for IV tobramycin. The order is for 3mg/kg/day in three divided doses. How many milligrams of medication should be administered per dose?