LDR 711A UOPX Week 7 Code of Ethics Discussion Responses

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Read and response to the student questions in 250 words for each response

Question 1:

People develop a personal code of ethics and a definition of what is right and wrong based on early life experiences with role models, such as parents, teachers, and others. Reflect on the significant relationships in your life as a child, and develop a genogram or any pictorial image of those significant relationships. Search the internet for resources on how to create a genogram, such as How to Make a Genogram.

Write a 250- to 300-word response to the following:

  • How did important people in your life demonstrate ethics and morality, and what did you learn from observing their approach to ethical and moral decision-making? How might your early experiences impact your ethical decision-making as a leader?

Student response:

Ethics and morality have been introduced into my life by my parents and grandparents; I grew up under a strict family code of ethics based on trustworthiness, respect, responsibility, fairness, and caring.

Also, religion has been part of the moral education I received. I learned from the Catholic faith the ten commandments that are fundamental normative guidelines for behavior. Understanding what is right and wrong and knowing the difference and the consequences of not following the moral standards have helped me today in my leadership role and the business decision-making, keeping in mind other peoples’ cultural perceptions of ethics and morality and understanding each organization’s system.

According to Raiborn and Payme (1990), “Four fundamental ethical principles can be used to create a foundation for basic decisions concerning almost any moral/ethical question” (“Universal Moral Values | Value (Ethics) | Business Ethics”). The four principles are integrity, justice, competence, and utility.

Integrity represents moral correctness, honesty, and vulnerability; justice considers equitable, exactitude, conscientiousness, and promise; competence define as competent, trustworthy, and highly-skilled, and utility provides the best for the most substantial number.

Our leadership role should be based on these principles and every decision made in the organization. My early experience has impacted my ethical decision-making as a leader. However, at the same time, I work together with the organization’s code of ethics, including the individual’s participation in the development and promulgation, and be coherent with ethical principles and the organization’s commitments responsible for the creation, implementation, and administration of the codes.

References

Schwartz, Mark S. (2005). Universal Moral Values for Corporate Codes of Ethics. Journal of Business Ethics, 59, 27-44. 10.1007/s10551-005-3403=2.

Northouse, P. G. (2019). Leadership: Theory and practice (8th Ed.). SAGE Publications, Inc.

Question 2: Leaders are challenged to make high-stakes decisions that affect business results. Good leaders use both reason and emotion to make decisions that have an impact on employees and customers and often establish the ethical atmosphere of the organization.

Write a 250- to 300-word response to the following:

  • What does it take for leaders to make sound and ethical business decisions?

Student Response: Good Leaders will never compromise on the quality of performance and on the satisfaction of their followers and organization strategy and objectives. Leaders stay concerned towards the team members, consider the stakeholders interest and provide high quality services to the customers. When Leaders have clear purpose, ethical standards, and capabilities, they will take sound decisions with minimal harm to any individuals.

Leaders have to consider ethical and moral values while making any decisions. To make sound and ethical business decisions, it requires more experience, high ethical values and self confidence. An effective leader considers the practical issues, use their analytical thinking power, apply ethical values and come up with a decision that brings positive results.

Ethical decisions are made when the leaders are confronted with ethical dilemma. The ethical decisions are made within the framework based on personal values of leaders. These frameworks guide efficient project leaders to make decisions on crucial to progressing project for its success.

As cited by Gottlieb and Sanzgiri (1996), “Leaders with integrity demonstrate consistency between vision and action that promotes trust, regularly concern themselves with developing moral standards, and are proactive agents of change in an increasingly complex world. Organizational cultures that support dialogue suspend judgments and increase their capacity to think together towards new levels of understanding. Ethical concepts evolve in these organizational cultures, and actions are informed and responsible. Organizations that reflect on their actions engage in “double loop learning” so that the time taken to reflect on the past and present leads to a more judicious and ethical future”.

For sound and ethical business decisions, the leaders should be able to

  • Identify and evaluate the fundamental approach to optimistic ethics
  • Communicate and discuss cases of existing cross-cultural issues involved in ethical decision-making
  • Identify ethical aspect of complex business and examine this from multiple approaches
  • Conduct logical and ethical debate with people from diverse culture on complex issues
  • Transform business organization through strategic leadership
  • Gaining knowledge, taking guidance from mentor and problem-solving skills for making ethical decisions
  • Skills for making appropriate usage of capabilities in efficient group members
  • Skills to plan strategies and tactics for dealing with ethical dilemma in organization

References:

Gottlieb, Jonathan Z, & Sanzgiri, Jyotsna (1996, Dec). Towards an Ethical Dimension of Decision Making in Organizations. Journal of Business Ethics, 15(12), 1275-1285. 10.1007/BF00411813

Darling Health Care Benchmark and The Legal Issues Case Study

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Read the “Darling – Health Care’s Benchmark Case,” located in Chapter 8 of the textbook. Write a 500-750 word essay that addresses the following:

Describe two legal issues presented in this case.

Describe how the hospital failed in its ethical duty to the patient.

  1. Describe the role and importance of the credentialing and privileging process. 
  2. Discuss the application of the credentialing and privileging process to this scenario.

Darling—Health Care’s Benchmark CaseIn 1965, the landmark case Darling v. Charleston Community Memorial Hospital9 had a major impact on the liability of healthcare organizations. The court enunciated a “corporate negligence doctrine” under which hospitals have a duty to provide adequately trained medical and nursing staff. A hospital is responsible, in conjunction with its medical staff, for establishing policies and procedures for monitoring the quality of medicine practiced within the hospital.Darling involved an 18-year-old college football player who was preparing for a career as a teacher and coach. The patient, a defensive halfback for his college football team, was injured during a play. He was rushed to the emergency department of a small, accredited community hospital where the only physician on emergency duty that day was Dr. Alexander, a general practitioner. Alexander had not treated a major leg fracture for three years.The emergency department physician examined the patient and ordered an X-ray that revealed that the tibia and the fibula of the right leg had been fractured. The physician reduced the fracture and applied a plaster cast from a point 3 or 4 inches below the groin to the toes. Shortly after the cast had been applied, the patient began to complain continually of pain. The physician split the cast and continued to visit the patient frequently while the patient remained in the hospital. Not thinking that it was necessary, the physician did not call in a specialist for consultation.After two weeks, the student was transferred to a larger hospital and placed under the care of an orthopedic surgeon. The specialist found a considerable amount of dead tissue in the fractured leg. During the next two months, the specialist removed increasing amounts of tissue in a futile attempt to save the leg, until it became necessary to amputate the leg 8 inches below the knee. The student’s father did not agree to a settlement and filed suit against the emergency department physician and the hospital. Although the physician later settled out of court for $40,000, the case continued against the hospital.The documentary evidence relied on to establish the standard of care included the rules and regulations of the Illinois Department of Public Health under the Hospital Licensing Act; the standards for hospital accreditation, today known as the Joint Commission; and the bylaws, rules, and regulations of Charleston Hospital. These documents were admitted into evidence without objection. No specific evidence was offered that the hospital had failed to conform to the usual and customary practices of hospitals in the community.The trial court instructed the jury to consider those documents, along with all other evidence, in determining the hospital’s liability. Under the circumstances in which the case reached the Illinois Supreme Court, it was held that the verdict against the hospital should be sustained if the evidence supported the verdict on any one or more of the 20 allegations of negligence. Allegations asserted that the hospital was negligent in (1) its failure to provide a sufficient number of trained nurses for bedside care of all patients at all times—in this case, nurses who were capable of recognizing the progressive gangrenous condition of the plaintiff’s right leg—and (2) failure of its nurses to bring the patient’s condition to the attention of the hospital administration and staff so that adequate consultation could be secured and the condition rectified.Although these generalities provided the jury with no practical guidance for determining what constitutes reasonable care, they were considered relevant to helping the jury decide what was feasible and what the hospital knew or should have known concerning hospital responsibilities for the proper care of a patient. There was no expert testimony characterizing when the professional care rendered by the attending physician should have been reviewed, who should have reviewed it, or whether the case required consultation.Evidence relating to the hospital’s failure to review Alexander’s work, to require consultation or examination by specialists, and to require proper nursing care was found to be sufficient to support a verdict for the patient. Judgment was eventually returned against the hospital in the amount of $100,000.The Illinois Supreme Court held that the hospital could not limit its liability as a charitable corporation to the amount of its liability insurance.[T]he doctrine of charitable immunity can no longer stand … a doctrine which limits the liability of charitable corporations to the amount of liability insurance that they see fit to carry permits them to determine whether or not they will be liable for their torts and the amount of that liability, if any.10In effect, the hospital was liable as a corporate entity for the negligent acts of its employees and physicians. Among other things, the Darling case indicates the importance of instituting effective credentialing and continuing medical evaluation and review programs for all members of a professional staff.Ethical and Legal IssuesDescribe the legal issues in this case.Describe how the hospital failed in its ethical duty to the patient.

 

LSSC Electronic Health Records Can Help Healthcare Providers Discussion

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Response posts to two peers (Minimum 250 words each) who answered a different prompt than yours.  The response posts should add new information, challenge ideas presented, or synthesize related ideas posted by the group. Each response post must be supported by the module readings AND one current (within the past five years), peer-reviewed journal article with a focus on the United States.

Post # 1

K-P: The Administrative Simplification Compliance Act of 2001 requires that all Medicare claims be submitted electronically. What are some of the vulnerabilities to the protection of electronic health information?

Dana Peterson

Electronic health information and electronic medical records were considerable advancements in medicine. Those advancements made it easier for information to be transferred and stored. Even if patients have records from a different hospital system, a simple release waiver can be signed and we could easily have everything from their previous hospital visits available to us, helping to connect the dots of their medical history. As nurses, we have a huge responsibility to be good stewards of sensitive patient information and ensure we are not putting our patients at risk of being taken advantage of. Daily I try to do what I can to protect sensitive information by not leaving papers around with patient information on them, logging out of my computer when I walk away and making sure I ask for the patient’s privacy code when speaking to anyone about the patient. This past year my hospital system got hacked into, and we had to function on downtime for over a month. I can tell you it was one of the most challenging things I have had to do at a job, especially considering I was working in the intensive care unit, taking care of multiple critical patients. We are now in the process of switching over electronic health records software companies to a program that is more secure. The Administrative Simplification Compliance Act (ASCA) was created to improve efficiency and reduce the cost of processing Medicare claims. Although it streamlines the process of Medicare claims, anything done electronically has risks associated with it, including susceptibility to data breaches. According to Feeg et al., patient portals and the use of mobile applications increase the risk of breaches (2020). Inappropriate disclosures could be disastrous. Mobile devices can easily be lost or stolen landing sensitive information into the wrong hands. In fact, non-paper based breaches of over 500 or more people reported by CMS are mostly due to mobile devices (Feeg et al., 2020). It seems like with every advancement we make as a society, there are still considerations that need to be addressed and the use of electronic health information is no exception.

Reference

Feeg, V.D., Withall, J., & Weiner, K. (2020). Health information technology and the intersection of health policy. In D. Nickitas, D. Middaugh, & V. Feeg (Eds.), Policy and politics for nurses and other health professionals advocacy and action (3rd ed., pp. 371-401). Jones & Bartlett Learning.

post # 2

A-J: Hospitals experience financial stress as it relates to accessing capital. Without adequate capital, hospitals cannot replace or modernize outdated facilities, respond to changing demands such as technology and equipment, but getting capital is sometimes difficult forcing some hospitals to close, or to be purchased by multi-hospital systems. Which of the organizational structures are most vulnerable to having problems accessing capital, and why?

Amanda Jones

Since hospitals were first introduced in the United States, they have gone through several transformations over the years with finances becoming a primary factor for success. Originally, the funds that paid for hospital care and staff were donated by wealthy leaders of society. Care was provided by mostly volunteers and was viewed more as a charitable organization. Over time, hospitals became more modernized and developed into a business, which increased spending and healthcare costs. As a result, many hospitals suffer financially and are forced to close or sell to larger hospital networks (Caress and Aries, 2020).

The hospitals most at risk to shut down or being sold are non-profit community hospitals, especially rural hospitals or urban hospitals that serve low-income populations. These hospitals that serve areas with a large amount of unemployed, underinsured, undocumented immigrants and Medicaid patients are not reimbursed properly for their services. Even though the government provides relief using tax funds, it is still not always enough capital to keep the organization running. While for-profit hospitals have the ability to sell stocks and bonds, non-profit hospitals rely on tax-exempt revenue bonds to meet their capital needs (Caress and Aries, 2020).

Unfortunately, several more challenges prevent non-profit hospitals from meeting monetary goals. As healthcare services and technology growth have increased, there is less need for extensive inpatient hospital stays. The average number of days for inpatient services has decreased. Services previously offered in the hospital setting, such as procedures and testing can now be done in outpatient centers. Hospital payments for services had changed from pay per day to payment based on diagnosis-related bundles. Due to all of these shifts, the hospitals have increased bed availability and lack funds to purchase advanced equipment or modernized technology (Caress and Aries, 2020).

Reference

Caress, B., & Aries, N. (2020). Hospitals: Consolidation and compression. In D.M. Nickitas, D.J. Middaugh, & V.D. Feeg (Eds.), Policy and politics for nurses and other health professionals: Advocacy in action (3rd ed., pp. 291-311). Jones & Bartlett Learning.

NURS 6512 BSU Wk 8 Assessing the Musculoskeletal System Case Study

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  explore how to assess the musculoskeletal system.

Learning Objectives

Students will:

Evaluate abnormal musculoskeletal findings

Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the musculoskeletal system

Evaluate musculoskeletal X-Ray imaging

Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

  • Review the following case study:
  • Case 2: Ankle PainLast name that ends with H-OA 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?Discussion: Assessing Musculoskeletal Pain
    Photo Credit: Getty Images/Fotosearch RFThe body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.To prepare:
  • By Day 1 of this week, you will be assigned to one of the following specific case studies for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

  • Review the following case studies:
  • Case 1: Back PainPhoto Credit: University of Virginia. (n.d.). Lumbar Spine Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/5lumbar/01anatomy.html. Used with permission of University of Virginia.A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?Case 2: Ankle PainPhoto Credit: University of Virginia. (n.d.). Lateral view of ankle showing Boehler’s angle [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/8ankle/01anatomy.html. Used with permission of University of Virginia.A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?Case 3: Knee PainPhoto Credit: University of Virginia. (n.d.). Normal Knee Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/7knee/01anatomy.html. Used with permission of University of Virginia.A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?With regard to the case study you were assigned:
  • Review this week’s Learning Resources, and consider the insights they provide about the case study.

Consider what history would be necessary to collect from the patient in the case study you were assigned.

Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

 

Claflin University Nursing Essay

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Use the following scenario for this discussion: You are a community health nurse in a small, rural community assigned to visit the home of Malcolm, an 8-year-old boy, to check on the home situation and his safety. Your agency was asked to make a home visit by the school principal. She was alerted by Malcolm’s teacher who became concerned about changes in Malcolm’s behavior and bruising on his upper arms. The teacher mentioned that he has been increasingly withdrawn over the past few weeks becomes angry if addressed, has difficulty paying attention, and his grades are slipping. Yesterday (Monday) he came to class with a resolving black eye that he explained as being caused by a fall at home.

Since you are unsure of the family dynamics, your main purpose of the visit is to assess the home environment and concerns over Malcolm’s safety. Your plan is to focus on the concerns expressed by Malcolm’s teacher regarding the changes in his classroom behavior and not address the bruising – at least not initially.

When you arrive at the home a diminutive black woman opens the door, invites you in, introduces herself as Keisha, and seems friendly. She gestures to a woman sitting on the couch with a baby on her lap and says, “That’s my partner, Miranda, and our daughter Reyna. She’s 6-months old”. Miranda is a white woman with very short hair, styled in a crew cut, and dyed blond. She is wearing a t-shirt with the sleeves cut out revealing tattoos covering both arms. On her lap sits a little girl, sucking on the fingers of one hand. Reyna appears to be biracial, with light black skin, curly light brown hair, and blue eyes. The baby appears clean and is wearing a diaper and a t-shirt, appropriate for the temperature of the room.

Miranda does not speak but glares instead. She soon turns her attention to the baby, cooing at her and bouncing her on her knee. Malcolm is at school but should be arriving home any minute. You take a seat in a chair in the living room facing the couple on the couch. Reyna looks at Keisha and smiles. Keisha takes her from Miranda and places the baby on her lap. The small apartment is fairly clean with somewhat tattered furniture. You attempt to engage Keisha in conversation about Malcolm, but she seems reluctant to answer your questions. She does talk openly about Reyna when asked about her. You learn that Keisha was inseminated with donor sperm to conceive Reyna, which was a mutual decision between the two women. 

When Malcolm arrives home, you notice that he appears healthy. His t-shirt is full of food stains, but he appears clean. As he starts to walk toward the kitchen, he trips over the corner of the rug and his backpack goes crashing to the floor, hitting the coffee table, and sending a plastic glass of water to the floor, startling Reyna who begins to cry. Miranda jumps to her feet and grabs Malcolm by the back of his t-shirt and brings him to his feet, scowling at him, and saying, “Now look what you have done!” in a raised voice. She also raises her fist as if to threaten to hit the boy. Malcolm cowers, breaks free of her hold on him, runs into his room, and shuts the door. Miranda continues to berate Malcolm in a raised voice toward the closed door, which seems to escalate the volume of Reyna’s cries. Keisha appears unnerved, as well. You ask Keisha where you can find a rag to wipe up the water and proceed to take care of the spill. While you are wiping the floor, Miranda leaves the apartment, slamming the door. After she is gone, you calmly say to Keisha, “I remember being a bit clumsy as a child, and I know boys will be boys. Was Miranda’s reaction to this accident typical for her?” Keisha mumbles, “I guess – she often gets mad at Malcolm. I had him before we got together, and I think Miranda doesn’t like that”. Your next question is one you must ask. “Has she ever hurt Malcolm?” Keisha averts her gaze and does not answer you.

Just then, Miranda stomps back into the apartment and quietly asks you to leave. You gather your things and comply.  In your discussion please address the following questions:

o   Family is defined in many ways. Based on your personal beliefs, the families you are assigned to visit may not meet your definition. How do you come to terms personally with the various family structures you may encounter during home visits?

o   You learned to start a plan by identifying each family’s strengths. What are the strengths of this family?

o   Because your visit was so brief, the main question about potential child abuse remains heavy on your mind. You suspect that Miranda has been rough with Malcolm and possibly hit him to cause the bruising. What is your plan of action? What is your duty to report when confronted with potential child abuse? What agency drives your course of action?

FIU Unit 7 Pain Management Discussion Response

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Unit 7 Discussion

1. Some questions I would ask to explore the need for palliative care would be:

Do you have easy access to the bedroom and bathroom for the patient?

Can the patient be mobile on his own?

Is the patient able to shower on his own or get assistance showering?

How often is the pain?

What is the severity of the pain?

Is the pain intermittent or constant?

Is the patient on oxygen?

Are there any stairs in the home? If so, is there handicap accessibility?

Is the patient going to be alone at home?

Those are just some, however I think sometimes it is hard because patients in this scenario can deteriorate quickly changing their status for the need for palliative care.

2. Total pain management entails caring for the patient in a way that is different from the hospital and clinic setting. The concept of access to pain management as a human right has gained increasing currency in recent years (Brennan, Lohman, & Gwyther, 2019). It is very hard to watch a family member be in extreme pain because you feel bad for them and want to take it away for them, at least in my opinion. Typically, we worry about kidney damage, liver damage, and damage to other organs when giving pain medicine if given in higher doses. In Mr. Browns case he is in extreme pain and is going to need a lot of help now and in the future. Palliative care does not speed up the process of dying, however it does provide comfort to the family and patient by helping them to tolerate the pain in a more manageable way (Croson, 2018). This is also important to explain to the family as well because emotionally they may be distraught and need time to come to terms with Mr. Brown’s diagnosis. Many people think “death” immediately when they hear the word hospice or palliative care, but it is not always the case. Yes, Mr. Brown will have an eventual death from this disease process but by providing total pain management it keeps him from being miserable until he passes in a more peaceful manner.

3. Addressing Mr. Browns spiritual well being helps him to come to terms with and cope with his disease prognosis. Understanding the relationship between spiritual coping and psychological symptoms, especially depressive symptoms, could help healthcare teams better address patients’ needs (Gryschek et al., 2020). If a patient is at peace with their life and their religious beliefs, I have found that they pass on easier. I have unfortunately seen many people die, patients as well as close friends and family. And I am a strong believer in the patient being at peace with their psychologically and spiritually. It’s a part of total pain management because people can be suffering inside/emotionally if they are not in a good place spiritually and or psychologically. It is sad in my opinion.

4. Opioids can be extremely deadly if they are not taken as prescribed or abused. Mr. Brown’s daughters’ worries should be addressed by simple patient and family education. Explaining how the receptors in the brain work and how they can help her father not be in excruciating pain during this process may help ease her mind. Also, explaining that the things she hears on the news are usually people who abuse the medications. In Mr. Browns scenario the medication will not be abused, nor will he be receiving the amount it would take to kill him. Explaining to her how taking too much of the medication can depress the respiratory system and that he will be monitored during the administration to ensure that does not happen would also be beneficial in educating her.  I learned in nursing school that we don’t only treat the patient; we treat the family as well and this still holds true in this situation.

5. During palliative care the patient is going to experience many symptoms as end of life gets nearer. However, patient education as well as family education should have already occurred, so the family is aware of the progression, so they are not caught off guard. Dyspnea, a sensation of shortness of breath, often is managed with opioids in a palliative care context (Croson, 2018). However, this patient is also confused and anxious so we must consider using a sedative or antianxiety medication as well typically Ativan in this scenario. Administration of oxygen can be used, but only if it does not cause the anxiety to worsen by constricting a face mask on the patient face (Croson, 2018). This also hinders the family from not being able to be with their loved ones in their last moments which helps with coping, spirituality, and psychological factors.

Brennan, F., Lohman, D., & Gwyther, L. (2019). Access to Pain Management as a Human Right. American Journal of Public Health, 109(1), 61–65. https://doi-org.libauth.purdueglobal.edu/10.2105/AJPH.2018.304743

Croson, E. (2018). The Medical-Surgical Nurse’s Guide to Understanding Palliative Care and Hospice. MEDSURG Nursing, 27(4), 215–222.

Gryschek, G., Machado, D. D. A., Otuyama, L. J., Goodwin, C., & Lima, M. C. P. (2020). Spiritual coping and psychological symptoms as the end approaches: a closer look on ambulatory palliative care patients. Psychology, Health & Medicine, 25(4), 426–433. https://doi-org.libauth.purdueglobal.edu/10.1080/1…

St Thomas University Urinary Tract Infection Response

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  • Elizabeth Varona-Martin

Alteration in mental status is seen in people with different medical conditions, especially the elderly. They’re linked to various complicated underlying medical issues and can be challenging to diagnose. In patients with cognitive impairment, systematic investigations and clinical trials are challenging to conduct. Additional subjective data should include if there is an alteration in awareness and the ability to focus, maintain, or deflect attention. Ask for any sudden and unexpected change in the patient’s behavior, such as increasing disorientation, agitation, or withdrawal, including memory loss, language, and communication difficulties  (Francis, Jr & Young, 2020). The timing, duration, and intensity of symptoms should be included in the history. Also, a list of medications, antidepressants, diuretics, bronchodilators, and antihistamines have been linked to lower urinary tract symptoms( LUTS ). The causes of urinary incontinence should be identified, and patients should be asked about any previous neurologic symptoms, injuries, or diseases (McVary & Saini, 2021).

  • Ask the staff and family members if they notice any perception issues. Patients may mistake the caregivers for someone else or believe that objects or shadows in the room are people. Vague fantasies of injury frequently accompany these misperceptions. We should check for any visual, auditory, or somatosensory hallucinations and assess loss of insight because it generally accompanies them: the patients believe they are real. Simple hallucinations, for example, shadows or shapes, and complex hallucinations, such as people and faces. Simple noises or hearing voices with clear words are examples of sounds (Francis, Jr & Young, 2020).

Family members can provide some historical indications of the underlying etiology, for example, recent febrile illness, history of organ failure, a medication list, history of alcoholism or drug abuse, or current depression.

Does he have fever, nausea, or vomiting? Is the urine cloudy? Any change in his oral intake, is he drinking and eating properly?

For additional objective data we should examine the patient for any tenderness in the costovertebral angle, flank or suprapubic discomfort, and costovertebral angle tenderness.Asses him for any dehydration signs, such as dry mucous, slow skin turgor, decreased urine output, tachycardia, and orthostatic blood pressure (Francis, Jr & Young, 2020).

Considering the patient history of recurrent urinary tract infection (UTI) and the use of an indwelling catheter while in the hospital, we should consider the possibility of UTI. Another possible diagnosis is delirium; diverse factors might cause delirium, including bladder catheters, polypharmacy, infection, dehydration, immobility, and restraint use (Francis, Jr & Young, 2020).

Laboratory tests will help to rule out some of the differential diagnosis includes serum electrolytes, creatinine, glucose, calcium, complete blood count, and urinalysis and urine culture

Additional diagnostic studies:

Brain Computed tomography (CT) may be ordered if no apparent cause of delirium is found during the initial evaluation.

Renal/bladder Ultrasonography

Contrasted computed tomography (CT) scanning of the kidney or helical CT scanning (currently preferred by most experts)

Preventing strategies include reducing factors known to cause delirium; orientation protocols; environmental modification; early ambulation and minimizing physical restraints; and visual and hearing aids. Low-dose haloperidol (0.5 to 1 mg orally or intramuscularly [IM]), however, psychotropic medicine should be used only when necessary to treat severe agitation or psychosis that has the potential to cause harm (Francis, Jr & Young, 2020).

Once the primary acute condition that causes delirium is diagnosed, the most effective way of resolving the delirium is to treat that condition.

Antibiotics such as trimethoprim-sulfamethoxazole, ampicillin, amoxicillin, erythromycin, vancomycin, doxycycline, aztreonam, nitrofurantoin, rifampin, are effective in treating UTI (Pasternack, 2019). Providers should avoid indwelling catheters on this patient and look for an alternative like a condom cath.

Sedation and hypotension are uncommon side effects of haloperidol.

Antibiotics can cause nausea, vomiting, and diarrhea; Antibiotic allergies are frequent. Even if they have never reacted to an antibiotic before, they can develop an allergy, and antibiotic resistance develops due to overuse (Pasternack, 2019).

When a cause for acute delirium or disorientation is not immediately apparent, healthcare providers should do a toxic blood and urine screen. They should know that several common medicines are not tested in conventional laboratory tests. As a result, negative toxic screen findings cannot rule out an overdose of these medications (Francis, Jr & Young, 2020).

Delirium is more common in older people who have many medical problems or take a lot of medications, have another brain illness like dementia, or have vision or hearing impairments. Delirium is most likely to happen in the hospital, especially if someone has just had surgery or is in pain.

Referral to a urologist may be most beneficial for patients with recurring infections because they may be related to underlying anatomic abnormalities. 

References

Francis, Jr, J., & Young, G. B. (2020, February 11). Diagnosis of delirium and confusional states. UpToDate. Retrieved April 13, 2022, from https://www.uptodate.com/contents/diagnosis-of-del… 

McVary, K. T., & Saini, R. (2021, May 11). Lower urinary tract symptoms in males. UpToDate. Retrieved April 13, 2022, from https://www.uptodate.com/contents/lower-urinary-tr… 

Pasternack, M. S. (2019, November 12). Approach to the adult with recurrent infections. UpToDate. Retrieved April 13, 2022, from https://www.uptodate.com/contents/approach-to-the-… 

St Thomas University Adult Week 6 Gerontology Discussion Reply

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Description

  • All replies must be constructive and use literature where possible.

Elizabeth Varona-Martin

Module 6

We should ask the patient if he has difficulties  reading road signs or fine print or driving at night due to glare from approaching headlights . We need to figure out if he has any risk factors, such as diabetes or steroid use, or any significant eye trauma in the past, or if he noticed any difficulties with dark adaptation, fluctuating vision, presence of floaters, flashes of light (photopsia), defects in the field of vision. (Jacobs, 2022). 

Determine if he has any pain, differentiate between ocular and head pain, any related ocular symptoms like red-eye, discharge, atypical appearances,  or systemic issues, for example,  headache, other neurological problems, generalized malaise.

During a non-dilated fundus examination with a direct ophthalmoscope, check for lens opacity, opacities within the red reflex, or obscuration of ocular fundus detail. Look for the presence of cupping in the fundus examination. Cupping is called a hollowed-out look of the optic nerve. Glaucoma is indicated by a cup with a diameter of more than 50% of the vertical disc diameter (Jacobs, 2020). Thinning or notching of the disc rim, progressive change in the size or form of the cup, and asymmetry of the cup-to-disc ratio between the eyes are all signs of glaucoma on fundus examination.

Macular degeneration, glaucoma, diabetic retinopathy, and cataracts are the most common causes of vision loss in older people.

Macular degeneration is the most prevalent cause of significant vision loss in adults aged 50 or older. This condition affects the center of the vision. It’s crucial to note that it’s rare for people to go blind (Seltman , 2021).

Glaucoma is a collection of ocular disorders that damage the optic nerve over time, resulting in visual field loss and eventual blindness.  The most frequent types are primary open-angle glaucoma and primary angle-closure glaucoma. Ocular hypertension, or high intraocular pressure, is common in glaucoma patients, although optic nerve injury can also occur with normal intraocular pressure. 

Diabetic retinopathy is a complicated condition caused by several interconnected variables that result in two fundamental abnormalities in the retinal vessels: inadequate permeability and vascular occlusion with ischemia and consequent neovascularization. Nonproliferative and proliferative diabetic retinopathy are distinguished by the lack or presence of aberrant new blood vessels emerging from the retina (Fraser & D’Amico, 2020).

Cataract is a clouding of the eye’s lens that can result in impaired or distorted vision, glare issues, or, in the most severe cases, blindness (Jacobs, 2022).

Laboratory tests ordered CMP, HbA1c, CBC.

The visual field exam can help a provider detect early signs of disorders like glaucoma, which gradually deteriorate vision. There are two types of visual field tests, the Amsler grid and the confrontation visual field.

A CT scan is frequently used in eye care to image the bony orbit and determine the anatomic position of the extraocular muscles . Whenever a patient appears with orbital injuries, a non-contrast CT scan of the orbit can be helpful (Suhr & DelGiodice, 2015).

The orbital soft tissues and the brain can also be imaged with MRI. The benefit of MRI is that it provides better clarity between different soft tissues, making it the procedure of choice for imaging the brain and orbital soft tissue (Suhr & DelGiodice, 2015).

Surgery is recommended if the symptoms of a cataract make it difficult for the patient to meet their daily demands. Outpatient surgery is usually performed under a local anesthetic with closely monitored sedation (Jacobs, 2022).

Surgery is usually well-tolerated; uncommon complications include endophthalmitis, lens malposition or dislocation, cystoid macular edema, and retinal detachment (Jacobs, 2022).

Patients are seen on the first postoperative day, one week after surgery, and one month after surgery. Most providers recommend limiting physical activity for a few days to weeks.

Smoking and ultraviolet light exposure have both been linked to increased cataract formation. It is fair to advise older patients to limit their exposure to ultraviolet radiation and to quit smoking whenever possible. Smoking has also been connected to a significant risk of vision loss due to age-related macular degeneration.

A history and examination can disclose multiple causes in the primary care context, but an ophthalmologist may be required for confirmation, diagnosis, and therapy of the disease.

References

Fraser, C. E., & D’Amico, D. J. (2020, October 26). Diabetic retinopathy: Classification and clinical features. UpToDate. Retrieved April 19, 2022, from https://www.uptodate.com/contents/diabetic-retinop… 

Jacobs, D. S. (2020, August 4). Open-angle glaucoma: Epidemiology, clinical presentation, and diagnosis. UpToDate. Retrieved April 19, 2022, from https://www.uptodate.com/contents/open-angle-glauc… 

Jacobs, D. S. (2022, April 12). Cataract in adults. UpToDate. Retrieved April 18, 2022, from https://www.uptodate.com/contents/cataract-in-adul… 

Seltman , W. (2021, November 22). Macular degeneration (AMD): Symptoms, causes, treatment, prevention. WebMD. Retrieved April 19, 2022, from https://www.webmd.com/eye-health/macular-degenerat… 

Suhr, C. L., & DelGiodice, M. (2015, October 1). Neuroimaging 101 for the Optometrist. Review of Optometry. Retrieved April 19, 2022, from https://www.reviewofoptometry.com/article/neuroima… 

UMGC Health Care Improvement Act of 2020 Legislative Letter

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Letter to the Legislator (20 percent of final grade)

Assignment Information

This assignment provides you with the opportunity to use a specific political advocacy strategy: communication with a legislator via a letter. Expressing your support or lack of support for proposed legislation (bills) can be a powerful way to speak up about an issue. In this assignment, you will identify a proposed bill and voice your support for, or argument for not, passing that particular bill.

Completion of this assignment will demonstrate your achievement of the following course outcomes:

  • describe the impact of health care policies on nursing practice and health care work environments to determine the financial and regulatory influences on patient care
  • evaluate the political advocacy process to identify opportunities for nursing professional involvement
  • delineate strategies that nurses can use to engage in advocacy for health care policy to support equity, access, affordability, and social justice for consumers and in support of the nursing profession

Assignment Guidelines

  1. Select a piece of legislation proposed either in your state or at the national level.
    1. Go to www.Congress.gov to find a piece of national legislation
    2. Go to your state’s .gov site to find a piece of state legislation
  2. Identify your state representative at the level of the bill—this will be either your state, House of Representatives, or Senate representative, depending on the bill that you selected.
  3. Conduct a literature review to identify evidence pertaining to the issue addressed in the bill. Find at least three sources.
  4. Develop a letter to send to your state legislator. This letter should integrate the evidence supporting your position. The following websites offer templates, examples, and/or guidelines for letters to legislators that you may want to consider.
    1. National Council of the State Boards of Nursing Template Letter to the Legislator https://www.ncsbn.org/APRN_formletter_Legislator_web.pdf
    2. How to write to your legislator: http://allnurses.com/general-nursing-discussion/how-write-your-402285.html
    3. Purdue Owl: Writing the Basic Business Letter: https://owl.purdue.edu/owl/subject_specific_writing/professional_technical_writing/basic_business_letters/index.html

Grading Criteria

Follow these guidelines in writing your letter.

  1. Write the letter in a business letter format.
  2. Include the following:
    1. introduction of self and professional position
    2. overview of the bill you want to address
    3. clear argument in support of or not in support of the bill
    4. integration of evidence from scholarly literature to support your position
    5. legal name, credentials, and contact information
  3. Proofread the letter so that it is free of grammatical, spelling, and syntax errors.

Test yourself on what you just learned. You’ll read a case study and answer questions based on it.

This self-assessment is ungraded; you can take it as many times as you like.

This activity aligns with:

Course Outcome ? 6. Delineate strategies that nurses can use to engage in advocacy for healthcare policy to support equity, access, affordability, and social justice for consumers and in support of the nursing profession.

AACN BSN Essential V.11: Participate as a nursing professional in political processes and grassroots legislative efforts to influence healthcare policy.

AACN BSN Essential V.12: Advocate for consumers and the nursing profession

AACN BSN Essential VII.12: Advocate for social justice, including a commitment to the health of vulnerable populations and the elimination of health disparities.

Week 6 Learning Resources

To access the readings, right-click the hyperlinks and open in a new tab:

Below are the required learning resources for this week.

Special Interest Groups by Nursing Specialty

Take time to review the special interest group which best aligns with your professional practice:

Influencing Health Care in the Legislative Arena

As you read this article, consider how much nurses need to know about the political process in order to succeed in their advocacy efforts. What has this course taught you about this process, and how much more do you think you need to know?

The Responsibility to Advocate – and to Advocate Responsibly

As you read the following article, consider how you have used advocacy skills in working with individual patients and ponder what your role in political advocacy on a larger scale might entail.

Social Advocacy: A Call for Nursing Action

As you read this chapter entitled Social Justice, Nursing Advocacy, and Health Inequities: A Primary Health Care Perspective, consider the relationship between social justice and political advocacy and how social advocacy has evolved in nursing.

FIU Palliative Care Discussion Response

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Please respond to discussion below using APA 7th edition. Please use 3 peer reviewed journal references dates less than 4 years and 1 interactive question.

Introducing patients and their families to palliative care can be complex for healthcare providers, especially when it involves someone you know and respect. It can also be difficult for the patient and family members when the decisions have been made to not continue with treatment and face the course of the disease. The most devastating part of dealing with the inevitable fact is that untreated cancer ends with death and does not come without pain and suffering for the patient and the loved ones feeling not physical pain but mental pain. Advanced practice nurses (APRNs) should incorporate some training in palliative care (Ferrell et al., 2020).

Some important questions should be addressed when helping patients and family members decide on palliative care. What is the understanding of where things stand with your illness? Can you tell me about your wishes at this stage in your disease? How is your family coping with your condition? How important is it to you to make sure your family is involved in the next care steps for you? Tell me about the pain you are feeling at this point? Examining the answers to these questions can steer the conversation to the patient’s needs while involving the family members at the patient’s request. It is of utmost importance to fulfill the patients’ needs, but understanding the level of family involvement is crucial to transitioning to palliative care. Research suggests that incorporating palliative care as soon as possible can improve the patient and family’s stress (Philip et al., 2021).

It is unfortunate, but the pain is a component of dealing with cancer toward the end of life. It is crucial to develop an appropriate pain management plan tailoring it to the needs of the individual. Management of pain should not just involve pharmacology management but should also incorporate spiritual, culture, and alternative therapies. Pain management for terminally ill patients should evaluate the pain by determining the area, how often, intensity, and the patient’s wishes on appropriate pain management. This plan should also include whether the patient and family would like the care to occur in the home or a facility is a vital aspect to explore. Once the evaluation part of the plan has been established, the next step is to determine multi-modal pain management medications that will effectively reduce pain sensations and decide the appropriate alternative therapies to enhance the reduction in painful feelings (Sholjakova et al., 2018). Also, when faced with developing a proper treatment plan for pain management, it is crucial to include the patient’s spiritual aspect, which involves a person meaning, purpose, and how they connect with others to improve the quality of life during this transition (Røen et al., 2021). It would be appropriate to address with the patient and family members that the end of life is sadly inevitable. As the disease progresses, it is reasonable to provide education that the most important aspect is ensuring the patient is getting adequate pain relief while placing less worry on addiction to certain medications. When the disease progression results in increased anxiety, confusion, and dyspnea, these conditions should be shifted to more frequent and potent medications to combat these symptoms and provide adequate relief. At this stage in the disease, oxygen, benzodiazepines, and morphine should be incorporated to manage the patients’ symptoms effectively. During the evaluation stage, the patient and families should be educated on hospice, and the availability of resources as the disease progresses to shift the plan from pain management to ensure a comfortable transition to death.

References

Ferrell, B., Malloy, P., Virani, R., Economou, D., & Mazanec, P. (2020). Preparing oncology advanced practice rns as generalists in palliative care. Oncology Nursing Forum, 47(2), 222–227. https://doi.org/10.1188/20.onf.222-227

Philip, J., Le Gautier, R., Collins, A., Nowak, A. K., Le, B., Crawford, G. B., Rankin, N., Krishnasamy, M., Mitchell, G., McLachlan, S.-A., IJzerman, M., Hudson, R., Rischin, D., Sousa, T., & Sundararajan, V. (2021). Care plus study: A multi-site implementation of early palliative care in routine practice to improve health outcomes and reduce hospital admissions for people with advanced cancer: A study protocol. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06476-3

Røen, I., Brenne, A.-T., Brunelli, C., Stifoss-Hanssen, H., Grande, G., Solheim, T., Kaasa, S., & Knudsen, A. (2021). Spiritual quality of life in family carers of patients with advanced cancer—a cross-sectional study. Supportive Care in Cancer, 29(9), 5329–5339. https://doi.org/10.1007/s00520-021-06080-5

Sholjakova, M., Durnev, V., Kartalov, A., & Kuzmanovska, B. (2018). Pain relief as an integral part of the palliative care. Open Access Macedonian Journal of Medical Sciences, 6(4), 739–741. https://doi.org/10.3889/oamjms.2018.163