Ethical dilemmas are often solved by various stakeholders coming together, analyzing the situation and making recommendations.

Ethical dilemmas are often solved by various stakeholders coming together, analyzing the situation and making recommendations.

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Ethical dilemmas are often solved by various stakeholders coming together, analyzing the situation, and making recommendations. In the health care setting, this is the responsibility of an ethics committee. Ethics committees may be comprised of individuals from various roles within the organization, ranging from leadership positions to mid-level patient care professionals.
Instructions:
Scenario:
You are a member of your hospital’s ethics committee. A physician, Dr. Pierce, presents the following case to the committee, seeking a recommendation:
Jane Smith is currently hospitalized, for the seventh time in 11 months, and is suffering from the following conditions: hypertension, atrial fibrillation, and alcoholic fatty liver (exacerbated by continued heavy alcohol consumption). Jane is severely obese and unable to walk unassisted. Jane’s medical condition is stable enough to be discharged, however, Dr. Pierce cannot in good conscience discharge her home, as she is unable to walk, and has no assistance at home. Jane is resistant to transfer to a skilled nursing facility, which is Dr. Pierce’s professional recommendation. Jane is also receiving Medicare benefits.
Briefly summarize the discussion points you would make during the committee meeting, including any questions for Dr. Pierce.
One of your fellow committee members proposes that Adult Protective Services be called. What is the ethical implication of following this course of action, without informing Jane first?
If Jane continues to refuse the skilled nursing transfer, and Adult Protective Services is not involved, could Dr. Pierce and/or the hospital be held liable if Jane passes away at her home due to her lack of mobility? Be sure to include in-text citations to support this response.
In a concise paragraph, provide the committee’s official recommendation, including rationale, for Jane’s case. [Assume answers to your questions for Dr. Pierce]. This recommendation will be legal and ethical protection for Dr. Pierce, and the hospital.
Include a minimum of three references, in APA format, for this assignment.

 

 

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Assignment: the Health History and Medical Information for Mrs J

Assignment: the Health History and Medical Information for Mrs J

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Case Study: Mrs. J.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

Is very anxious and asks whether she is going to die.

Denies pain but says she feels like she cannot get enough air.

Says her heart feels like it is “running away.”

Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

Height 175 cm; Weight 95.5kg.

Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.

Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.

Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.

Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

IV furosemide (Lasix)

Enalapril (Vasotec)

Metoprolol (Lopressor)

IV morphine sulphate (Morphine)

Inhaled short-acting bronchodilator (ProAir HFA)

Inhaled corticosteroid (Flovent HFA)

Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

Describe the clinical manifestations present in Mrs. J.

Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.

Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.

Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.

Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.

Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide.

 

 

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Creating an Evidence-Based Practice for Nurse Educators.

Creating an Evidence-Based Practice for Nurse Educators.

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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

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1. The older diabetic patient discussed in week two project had the following preliminary issues: hypertension, arthritis, and visual impairments. His wellness program hence will provide supervised exercises, patient and family education and support throughout his journey, while also implementing lifestyle changes. The community center was well suited for supervised physical exercises. Supervised physical exercises are effective measures to improve muscle metabolism, and maintain strength (Seene, & Kaasik, 2012). Additionally, exercises have been reported to increase insulin sensitivity and aid in the achievement of improved glycemic control. Other benefits include better weight management, reduced blood pressure, and the risk of cardiovascular disease. Even though exercises are encouraged, the patient will be advised to discontinue boxing and change to non-impact sports due to the ongoing treatment for arthritis.

The patient will be taught about the total cessation of alcohol intake that will help prevent hypoglycemic events. Avoidance of the barbecue and the integration or fresh fruits and vegetables will help achieve good lipid profiles (Khazrai, Defeudis, & Pozzilli, 2014). Since the patient takes multiple medications, the patient and his family will be taught on the importance of keeping a drug schedule, and having well-labeled, color-coded areas for keeping different drugs that will assist in minimizing mixing up of medications and the risk of overdose. Due to visual impairments, the patient’s family will be taught on the importance of increased lighting in the interior areas of the house and the introduction of walking rails. Orthopedic shoes for walking around to prevent the development of backache, and ease tension on the knees will be highly recommended. For emotional support, a close family relationship with his family will be highly encouraged. Since the patient was Hindu, he will be highly encouraged to engage in worshiping together with his family in the community temple. Close family relationships and religious worship will improve emotional health and spiritual growth (Choi, & Hastings, 2018).

The above approach takes into account the physical health, emotional and spiritual health, patient and family education, home safety, community participation, and improved self-care. A holistic approach will not only improve the overall health of the patient but also assist him in attaining confidence in self-management, improved emotional wellbeing, and spiritual growth. This above provides an optimum level of well-being.

References

Seene, T., & Kaasik, P. (2012). Muscle weakness in the elderly: Role of sarcopenia, dynapenia, and possibilities for rehabilitation. European Review of Aging and Physical Activity, 9(2), 109-117. doi:10.1007/s11556-012-0102-8

Choi, S. A., & Hastings, J. F. (2018). Religion, spirituality, coping, and resilience among African Americans with diabetes. Journal of Religion & Spirituality in Social Work: Social Thought, 38(1), 93-114. doi:10.1080/15426432.2018.1524735

Khazrai, Y. M., Defeudis, G., & Pozzilli, P. (2014). Effect of diet on type 2 diabetes mellitus: A review. Diabetes/Metabolism Research and Reviews, 30(S1), 24-33. doi:10.1002/dmrr.2515

2 My subject for the week 2 project was D.K. a 65-year-old female with minimal health conditions. She reported mild hypertension and hyperlipidemia, and chronic neck and back pain due to an MVA in 2001 which required surgical replacement of cervical vertebrae using bone from her hip (D.K., personal communication, August 18, 2020). She voiced interest in attending a gym and increasing exercise. From the questionnaire and assessment, I performed for the project, I discovered the need for D.K. to[AJ1] participate in a consistent exercise program that includes both cardio and weight-bearing exercise. Exercise offers multiple benefits for the older adult such as decreasing the risks of cardiovascular disease, hypertension, diabetes, obesity, and some types of cancers (“Promoting Wellness in Older Patients”, 2017). Chronic back pain can lead to decreased activity and deconditioning of back muscles which can lead to increased back pain (Sturos, n.d.). Weight training can improve back health and pain by improving the function and strength of muscles in the back and core, increasing lean muscle mass and decreasing body fat, and increasing the ROM of the spine (Sturos, n.d.).

My recommendation for her would be to enroll in MCA Health & Fitness Center which is a local wellness center that is run and owned by a cardiology group. They developed this center to provide patients and non-patients with convenient access to a program that is customized to fit their individual needs (“Providers”, n.d.). The exercise plan is customized with a review of medical conditions/ histories, as well as oxygen, blood pressure, and heart rate monitoring (“Providers”, n.d.). The staff there are well trained in kinesiology, exercise physiology, and exercise and fitness management (“Providers”, n.d.). D.K. would receive a program tailored to her physical abilities and limitations with monitoring and education regarding how to perform the exercises safely and effectively. This would not only help improve D.K.’s back health but her overall health as well as it can improve her HTN and cholesterol and lower her risks for other chronic diseases. Exercise is a great way to relieve stress and improve mental health. According to an article by Edith (2014), exercise is a holistic approach to achieve “outstanding health” as it not only reduces risks for disease and boosts metabolism, it also improves mental health. She goes on to state, “It has been demonstrated to improve mood, slow the cognitive decline associated with aging, reduce dementia risks, improve sleep, reduce stress and increase self-confidence” (Edith, 2014).

References:

Edith, J. (2014, January 07). 4 Reasons Why Exercise Is Holistic Medicine. Retrieved from https://www.onegreenplanet.org/lifestyle/4-reasons…

Promoting Wellness in Older Patients. (2017). Retrieved from https://www.nia.nih.gov/health/promoting-wellness-…

Providers. (n.d.). Retrieved from http://montgomerycardiovascular.com/fitness-center/

Sturos, E. (n.d.). Weight Training Effectively Relieves Back Pain. Retrieved from https://www.spine-health.com/blog/weight-training-effectively-relieves-back-pain

3 What is the most important factor that causes caregiver role strain?

Family caregivers are very important in supporting, promoting and maintaining the health of the people they are responsible for that are suffering from a chronic disease. They are responsible to perform activities of daily living that the sick person is not able to do. As a result, the caregiver can experience some negative effects called caregiver role strain. In my opinion, the most important factor that causes caregiver role strain is the severity of the illness. For example, in the case of a wife that is caring for her husband with prostate cancer, she has to spend a lot of time with him and she must also go to work, care for the children.

• How do you assess for caregiver strain?

The quality of life of caregivers usually tends to deteriorate in physical, psychological and social aspects. Honea et al. (2008) said that caregiver role strain can be measured objectively or subjectively. An objective measurement of caregiver burden can be for instance the number of tasks the caregiver performs on behalf of the patient (Bookwala & Schulz, 2000; Gaugler et al., 2005). Several tools are proposed to effectively assess for caregiver strain. The Memorial Symptom Assessment Scale measures the burden related to frequency, severity, and distress of the patient’s symptoms. It is rated from 1 to 4: 1(rarely, slightly severe, no distress at all) to 4 (almost constantly, very severe, very much distress) (Honea et al., 2008).

• What can be done to prevent or decrease caregiver role strain?

Research has proven that certain interventions are likely to be effective in lessening caregiver role strain. Psycho-educational interventions such as teaching problem-solving skills, include patient symptom assessment and management, teaching coping skills. Psychotherapy interventions such as teaching caregivers to monitor their own feelings, helping them challenge negative thoughts that may create issues for them and helping caregivers engage in pleasant activities and positive experiences (Honea et al., 2008).

Reference

Honea NJ, Brintnall R, Given B, Sherwood P, Colao DB, Somers SC, & Northouse LL. (2008). Putting evidence into practice®: nursing assessment and interventions to reduce family caregiver strain and burden. Clinical Journal of Oncology Nursing, 12(3), 507–516. https://doi-org.su.idm.oclc.org/10.1188/08.CJON.507-516

Rueda Diaz, L. J., de Almeida Lopes Monteiro da Cruz, D., & de Cassia Gengo E Silva, R. (2016). Caregiver role strain: bi-national study of content validation. Investigacion y Educacion En Enfermeria, 34(2), 280–287. https://doi-org.su.idm.oclc.org/10.17533/udea.iee.v34n2a07

4. Choose one disease process and discuss the disease process.

Chronic obstructive pulmonary disease (COPD) is an umbrella term used to described respiratory disease characterized by airway obstruction. COPD is a complex mix of signs and symptoms in patients with chronic bronchitis and emphysema with cigarette smoking being an important risk factor. Other factors, such as exposure to indoor and outdoor air pollution, occupational hazards, and infections, can cause COPD (Mannino and Buist, 2007). Although, smoking is the leading cause of COPD, however, not all smokers acquire COPD, and COPD can develop in nonsmokers as well. Sign and symptoms of COPD consist of Cough, SOB especially with physical activity, wheezing, and chest tightness.

COPD is the third leading cause of death by disease in the United State (Burt and Corbridge, 2013). More than 16.4 million people have been diagnosed with COPD, and there are millions of people who have the disease and may not know it. COPD causes serious long-term disability and early death. At this time there is no cure, but with the proper medication and support management, COPD is manageable (American Lung Association, 2020).

Discuss the goals for this disease presented in Healthy People 2020.

According to the healthy people 2020, the goals for COPD include;

Reduce activity limitations among adults with chronic obstructive pulmonary disease (COPD)

Reduce deaths from chronic obstructive pulmonary disease (COPD) among adults

Reduce hospitalizations for chronic obstructive pulmonary disease (COPD)

Reduce emergency department (ED) visits for chronic obstructive pulmonary disease (COPD)

How does the CDC play a role in meeting the goals?

CDC works hard to lower the prevalence of COPD rates by offering smoking and tabacco cessation. They have campaigns that educated the nation on the benefits of quitting. They offer free quit coaching, quit plan, educational materials, and referrals to local resources to those who needs it (CDC, 2020).

Reference

American Lung Association (2020). Retrieved from https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd

Healthy People 2020 (2020). Retrieved fromhttps://www.healthypeople.gov/2020/topics-objectives/topic/respiratory-diseases/objectives

Center for Disease Control and Prevention (2020). Retrieved from https://www.cdc.gov/tobacco/quit_smoking/index.htm?s_cid=osh-stu-home-nav-002

Burt, L., & Corbridge, S. (2013). COPD exacerbations. AJN The American Journal of Nursing, 113(2), 34-43.Pierson, D. J. (2000). Pathophysiology and clinical effects of chronic hypoxia. Respiratory care, 45(1), 39-51.

Mannino, D. M., & Buist, A. S. (2007). Global burden of COPD: risk factors, prevalence, and future trends. The Lancet, 370(9589), 765-773.

5. Thank you for discussing the various stages of Alzheimer’s disease. This is important information to know. In regards to the behavioral therapeutic strategies that can help with the treatment of Alzheimer’s, you had stated “The therapeutic techniques involve physical activities and music therapy which are used as viable and useful treatments”. How are physical activities and music therapy specifically beneficial?