Case Study : An Extended Stay

We know that he had sustained an at home fall. We learn that he has a history of pain and a prescription for oxycodone for back pain. We know that his vital signs on admission appear stable; he was not showing any signs of respiratory distress. As we look at the staff that was listed that day we do get the sense the hospital may have been short staffed. Staffing report shows there was one MD, one RN and one LPN managing at least 4 patients including- one patient was a child. Evidence based research has proven that the nurse to patient ratio is directly related to the patient outcomes (Stanton, 2004). It is important that we consider the staffing level that this rural ED as we know short staffing can be blamed for not being able to take the full amount of time needed to do a proper health history. A detailed health history is an imperative part of the care process; it is used by the staff to accurately assess any acute changes that may take place in the patient throughout their stay.

The initial problem with Lewis Blackman's case was that lewis was administered inappropriate medication. First he was given a strong dose of opioid pain medication and on top of that prescribed an adult IV painkiller called Toradol. His medication was being increase even though it was not affecting the patient relieve pain. The nurses fail to diagnose the patient's pain and reevaluate him on his pain status. Followed by that Lewis was having trouble breathing, that is one of the first priorities for a nurse. Yet they assume because he had a history of asthma, him having affected breathing was normal. Therefore, his vital signs, pulse oximeter, were compromised the day after surgery from 90 to 85 which is low. The hospital was not concerned

The plaintiff in Ard v. East Jefferson General Hospital, stated on 20 May, she had rang the nurses station to inform the nursing staff that her husband was experiencing symptoms of nausea, pain, and shortness of breathe. After ringing the call button for several times her spouse received his medication. Mrs. Ard noticed that her husband continued to have difficulty breathing and ringing from side to side, the patient spouse rang the nursing station for approximately an hour and twenty-five minutes until the defendant (Ms. Florscheim) enter the room and initiated a code blue, which Mr. Ard didn’t recover. The expert witness testified that the defendant failed to provide the standard of care concerning the decease and should have read the physician’s progress notes stating patient is high risk upon assessment and observation. The defendant testified she checked on the patient but no documentation was noted. The defendant expert witness disagrees with breech of duty, which upon cross-examination the expert witness agrees with the breech of duty. The district judge, upon judgment, the defendant failed to provide the standard of care (Pozgar, 2012, p. 215-216) and award the plaintiff for damages from $50,000 to $150,000 (Pozgar, 2012, p. 242).

There was additional backup staff present (including a respiratory therapist) that could have been called upon for help, yet they never were. The charge nurse or nurse supervisor could have stepped in at this point to provide additional help. A lack of present nursing staff and support can lead to unfavorable patient outcomes, as is the case with Mr. B. Additionally, the staff on duty could have lacked training regarding protocols or their training could have been out of date.

There are errors and hazards in care that occurred in the Mr. B scenario. One error was the emergency room physician’s failure to recognize the signs and symptoms of deep vein thrombosis (DVT) that Mr. B was presenting. If not treated early, a DVT can become a pulmonary embolism, a fatal condition that Mr. B unfortunately developed. Another error in care that happened in the Mr. B scenario is the nurses’ failure to monitor Mr. B’s ECG and respirations. Early detection of critical ECG and respiratory changes could have initiated medical interventions that would have saved Mr. B’s life. One hazard is the emergency room nurses’ heavy patient load at the time of Mr. B’s sentinel event. Another hazard is having a licensed

Thank you guys for the response. Working as a beside nurse and having that holistic belief, I found myself being upset when every patient upon admission is started on pharmacological DVT prophylaxis in addition to mechanical prophylaxis. The reason for that is that those two orders are a part of EPIC admission order set and I do not agree with it. I strongly believe that an admitting physician or whoever is responsible for the admission process should asses the patient first and based on the assessment prescribe what is needed, instead of just following EPIC. Maybe in years to come we are going to be able to make some changes and educate our physicians about the fact that care really need to be provided based on the current need for that person.

I returned to the recovery ward, my patient was still hypertensive and tachycardic and I felt by assessing her non-verbal signals of communication that she was still in great discomfort. After 15 minutes of no improvement I returned to theatre to see the anaesthetist, I explained that I was not happy with the patient’s level of pain and requested that he come to the recovery ward to assess the patient. He reluctantly came to the recovery ward and after spending a few minutes assessing the patient agreed that she was in an unacceptable level of pain and prescribed a further 5mg of morphine which I duly gave to the patient in 2.5mg increments. After this the patients heart rate and blood pressure decreased to pre operative levels, she seemed to be more relaxed and eventually fell asleep. After a further period of time spent continually reassessing the patient and when I was satisfied she was comfortable and haemodynamically stable I discharged the patient back to the ward.

In a case as sensitive as this one, it is important to prioritize which chronic illness is most dangerous at the time. While his blood pressure was extremely high, being 170/100, it is important to understand

On august 13, 2016 I was assigned to follow one of the ICU Nurse. It was a very calm day. She had two patient one was more critical than the other. Both patients were on the ventilator because they had to be intubated the night before. The lady is obese and had gastric bypass surgery two years ago and suffering from severe sleep apnea, but the patient is non-compliance to the CPAP treatment. That was her second time being intubated. She was admitted for seizure monitoring because she was constantly having seizures the day before while she was at home. Due to the fact that she did not want to wear her CPAP machine while in the hospital, after pain medication was administered she was found unresponsive, that was the reason for her intubation the night before. Patient was on intermittent suctioning, she has sinus tachycardia . I had the opportunity to observe some of her daily care. The patient was on fentanyl but when the Dr. try to wean her out of the ventilator she stop breathing, therefore, the DR. discontinue the fentanyl temporarily in other to retest her later.

The case I will discuss comes from the Journal of General Internal Medicine and is as follows: the patient is an 80-year-old woman who suffers from nonresectable lung cancer and has been diagnosed with lobar pneumonia. Other conditions present are: hypertension, diabetes, chronic renal insufficiency and severe degenerative joint disease. While improvement was seen with initial treatment, the patient suffered worsening hypoxemia, level of consciousness obtunded, and developed acute renal failure. Thus, the only means to prevent death was intubation with

This can be read as a key ethical question to many healthcare case studies because of the errors and situations that occur. One of the explanations for this occurrence may be the overwhelming workload, chaotic environment and lack of individual attention prescribed to each patient. These issues can cause a disruption to the ethical principle of Beneficence. The principle of Beneficence calls to action the act of helping others and having compassion for the patients. This principle can be threatened when a doctor or caretaker is overworked and unable to effectively manage the series of patients and work they are assigned to take on. I believe that the admitting doctor did not initially catch the error of not calling for the specific drug need because he was more focused on getting Mr. Londborg stable and on the medication to treat his initial and present condition before worrying about the preventative medication. In addition, the doctor was so focused on helping everyone all at once that he was blind to the small details and loose ends that needed to be taken care

Every one of us has relied on a medical professional at least a few times in our lives. When we get seriously ill, or suffer a serious injury, we put our health in the hands of doctors, nurses, and pharmacists, fully expecting to be treated with a certain degree of professionalism and safety. Unfortunately, sometimes the expected care is not given, or not given to the extent which the ailment requires. In these situations, we can feel blindsided, confused, even taken advantage of.

Although a definite risk factor for DVT can easily be identify in a patient, but there may be more than one factor that could cause DVT in the same patient. Some of the most common risk factors that the nurse practitioner should look for in any patient includes a history of immobilization, long term hospitalization that may require bed rest, any case of recent surgery such as total hip replacement, total knee replacement and hip fracture surgery (Yong, et al 2016). Others include obesity, history of previous diagnosis of venous thromboembolism, stroke, lower extremity trauma, malignancy. In female patients, the nurse practitioner should look out for the use of oral contraceptives or hormone replacement therapy, pregnancy or postpartum status

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

As of April 2017, the Australia Government abolished the Temporary Work (skilled) visa (subclass 457) and replaced it with the Temporary Skill Shortage (TSS) to be effected on March 2018 (Australian Government, 2017). The TSS visa is deemed to cause an overhaul on temporary employment of overseas workers who fill jobs requiring critical skills. This is because a more stringent criteria that is not in use under the 457 visa will be employed to assess incoming overseas temporary workers. This change will not only affect businesses, but the human resource planning and recruitment practices as well. The HR will be forced to revise its forecast practices so as to align their organisation’s strategic direction with proper planning, while