The time is 1900 hours. You are working in a small, rural hospital. It has been snowing heavily all day, and the medical helicopters at the large regional medical center, 4 hours away by car (in good weather), have been grounded by the weather until morning. The roads are barely passable. WR., a 48 year old construction worker with a 36 pack year smoking history, is admitted to your floor with a diagnosis of rule out myocardial infarction (R/O MI). He has significant male pattern obesity (beer belly, large waist circumference) and a barrel chest, and he reports a dietary history of high fat food. His wife brought him to the ED after he complained of unrelieved indigestion. His admission VS were 202/124, 96, 18, and 98.2°F. WR. Was put on O2 by nasal cannula titrated to maintain SaO2 over 90%, and an IV of nitroglycerin was started in the ED. He was also given aspirin 325 mg and was admitted to Dr. A’s service. There are plans to transfer him by helicopter to the regional medical center for a cardiac catheterization in the morning when the weather clears. Meanwhile you have to deal with limited laboratory and pharmacy resources. The minute WR. Comes through the door of your unit, he announces he’s just fine in a loud and angry voice and demands a cigarette.…
During a game of chase with his sister Nikki, three-year-old Wes caught her for the first time. Without knowing what do to next, he punched her. His mother Joy’s angry and sudden reaction to him hitting his sister was confusing to him. While Wes hid in his room, he heard his father, Westley, trying to calm his mother down. Westley reminded Joy that Wes did not know hitting a woman was wrong or why Joy felt so strongly about it. Years later, Wes would finally understand why his mother reacted in that way. Bill’s recreational drug and alcohol use became an addiction. Even though they had a child together (Wes’s older sister, Nikki), Joy left Bill after a particularly violent encounter ended with her battered, but determined. Joy met Westley,…
Patient denies dieting. States he does not believe in dieting but does try to restrict the amount of “carbs I eat”. Family History 9. Chronic diseases? 10.…
P: Timothy will reduce the overall frequency, intensity, and duration of anxiety so that daily functioning is not impaired as evidenced by increased participation in daily social activities.…
In this scenario the patient is a 72 year old retired rabbi with mild dementia who is admitted to the hospital for a broken right hip due to a fall at home and is receiving pain medication. After a week of being admitted the patients daughter visits her father and finds him restrained. She also notices a red depressed area over her fathers’ lower back when her father is being assisted to the bathroom and was later informed by the dietary worker about her father receiving a pork cutlet on his dinner tray. The daughter was upset with the care being provided and complained to the physician.…
Libny, I understand that you don’t believe in physician assistant suicide, but have you ever thought about certain situations where it may be better? Seeing loved ones suffering all the time is excruciating painful, imagine how they must feel knowing they are not going to get any better. I believe physician assistant suicide can end the suffering of both parties and have the patient die in peace. After all, that is what everyone wishes for, to die in peace. It is also less expensive than the cost of medical care and can lessen the burden.…
Reagan starts off his Address to the Nation on Defense and National Security by introducing the subject of peace and National security as well as the importance of it. He claims that it is timely because it offers new hope for the children of the 21st century. Note that this is an example of pathos that Reagan uses to begin his method of swaying the audience. Reagan also claims that it is important because it is a decision the nation must make for themselves. He explains a solution he once and why it never came to pass to hint that even someone as influential as he was could not solve this alone.…
In 2014, a 29-year old woman named Brittany Maynard, publicly announced she was going to legally take her own life. She was suffering from brain cancer and chose to move to Oregon to utilize their Death with Dignity Law (Maynard, 2014). Because of her age, assisted suicide was thrust into the media and became a huge talking point. Assisted suicide existed in the media prior to 2014. Dr. Jack Kevorkian, dubbed “Dr. Death”, was an active proponent for physician-assisted suicide. In 1999, he was convicted of second-degree murder for his role in over 130 assisted suicides and hailed as a champion by other right to die activists (James, 2011). In 2010, the television film, You Don’t Know Jack aired on HBO. The film showed a humanistic side to the man people called, ‘Dr. Death’. This…
I believe that the reason physician assisted suicide is such a controversial issue is because people don't make wills that tell hospitals what they want to be done with their body in case certain unfortunate things are to happen to them. This leaves their families arguing amongst each other and the hospitals on what is the right thing to do for the patient. Personally, I don't believe that somebody should be on life support if they can't even feel,think, or eat on their own. All it is, is torchering their body by making it stay in one position at all times. For example, the Terri Schiavo case in Florida, she was on a feeding tube for about 15 years because her family believed that she was still…
Being an intern at a hospice I can imagine can be complex because of the health status of the patients. Special care must be taken not only to ensure the safety of the patient but to their mental and emotional well-being. As Garthwait (2014) explains, social workers must be aware and document all findings when it concerns the patient as this is admissible data that can be presented in a legal case. As you mentioned in your video the patient you spoke of had some injuries and was displeased with the manner in which she was being treated. You also stated that you must follow the written guidelines presented by Goodwill Shepard’s Hospice. Would you classify the fact that your patient receiving chips instead of fruit as a violation of tort law?…
He is 45-year-old. The boodle sugar is 1500, and this creates the need for the patient to be admitted to Intensive Care Unit. The patient is in an insulin glucose tolerance test per protocol. The goal of the treatment is to reduce the blood sugar at 70-200 per md order. The patient has been oriented three times and is alert. During the assessment, I asked the patient about his knowledge about diabetes. The answer revealed that he does not know how to check his blood sugar properly and interpret the results. In addition, the patient is not informed about diet regimes and still does not know about the consequences of uncontrolled blood sugars. Ineffective health maintenance is related to uncontrolled diabetes and reporting the lack of education about diabetes was evidenced by high blood sugar and knowledge deficient about controlled diabetes (Ozcan & Erol, 2007).…
You are working in a community outpatient clinic where you perform the intake assessment on R.M., a 38- year-old woman who is attending graduate school and is very sedentary. She reports overwhelming fatigue that is not relieved by rest. She states that she is so exhausted that she has difficulty walking to class and trouble concentrating when studying. Her face looks puffy, and her skin is dry and pale. She also reports generalized body aches and pains with frequent muscle cramps and constipation. You notice that she is dressed inappropriately warm for the weather. Initial vital signs were 142/84, 52, 12, 96.8®F.…
When asked by Dr K. to look in the chart to determine if anyone was responsible for Mr. E’s medical decision making, the nurse failed to inform Dr K that the patient had an Advance Directive (AD) that…
Patient A is a female white 38 year old G1P0 with Type I diabetes since the age of 9. Due to her high risk pregnancy and history of non compliance with medical therapy she had been coming in since 28 weeks gestation for twice weekly non stress tests. One Saturday as patient A was at the hospital for her non stress test she was found to have elevated blood pressure and proteinuria. Dr. A, an obstetrician (OB), who was on call for the weekend decided to send the patient home on bed rest and to follow up with her primary OB physician, Dr. B on Monday. At her follow up appointment with her primary OB, she was found to still have elevated blood pressures, blood sugars in 200 's, 2+ protein in her urine and had some elevated blood work. Primary OB decided Patient A needed to be induced due to patient A’s unstable condition. Primary OB is not on call this particular Monday and asked Dr. C to induce her patient. Dr. C was not happy about inducing her because of her high risk status but agreed to do so. Dr. D, a laborist and pediatrician, wanted the patient transferred to a higher level of care facility because he felt due to patient A’s history best care for the newborn would be at another facility. Dr. D and Dr. C argued about patient A’s care and disposition at the nurses’ station which was in close proximity to patient A’s room. The nurses who were without a manager at the time were unable to control the altercation between Dr. C and Dr. D. Patient A who overheard the discussion eventually asked to be transfer to another hospital to seek care elsewhere.…
The case manager was given a message by the physician which was to simply contact the family and have they come in for an evaluation. The case manager did much more by giving more information in the parent’s email that was not secured and went on to inquire about other treatment i.e. counseling that the parents were attending. She further proceeded with attempting to suggest the cause of the of the glycemic control problem without even talking to the patient. The CM really over-stepped her boundaries because she made a suggestion…