Determine ethical theories and decision-making models appropriate for healthcare providers to use for providing a safe, quality healthcare experience for the patient  Analyze the role of professional regulation, the standard of care, and codes of ethics in determining healthcare providers’ wide-ranging accountability to self, their profession, their patients, and the public

Prompt In this project, you will analyze a court case involving medical malpractice. Using your analysis of the case, you will address the facts pertaining to the medical standard of care, breach of care, and causation. Further, you will use the facts from the original case to identify an ethics issue, determine an ethical theory that would help provide a safe and quality healthcare experience for the patient, apply a clinician–patient shared decision-making model, and augment or vary the facts of the case to change the outcome.

You will use the following case to analyze for Final Project I:

 Surgery: Iturralde v. Hilo Medical Center USA

Specifically, your case study must address the following critical elements:

I. Introduction: A. Summarize the selected case, including information on the stakeholders involved, the problem, and the time period the incident occurred.

II. Medical Malpractice Component: In this section, you will evaluate the case to address the legal components, the malpractice policies similar to this case, and the standard of care given to the patient and how it was breached. Then, you will draw connections to how this malpractice case impacted stakeholders and healthcare consumers outside of the case. A. Explain the key legal components of the case, including the nature of the issue and the rules that applied. B. Determine relevant malpractice policies in place for addressing the issues within the case. C. Analyze the malpractice case for the standard of care provided to the victim. Be sure to apply what the law states about standard of care to support whether or not it was breached in the case. D. Analyze how the malpractice case would impact healthcare consumers from different cultural backgrounds. For example, would this case have a similar impact on a person from a culture different from the one in the case? How could this incident change the views of these healthcare consumers toward the healthcare system? E. Assess the malpractice case for accountability based on its severity. To what extent was the healthcare provider held accountable?

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III. Ethical Component: In this section, you will evaluate the case to identify the specific ethical issues and determine ethical theories and shared decision- making models that would help resolve the issue and provide a safe, quality healthcare experience. Then, you will propose and defend ethical guidelines for healthcare providers to follow in order to avoid future incidents. A. Describe the ethical issues that led to the malpractice case and explain why the issues are credited with causing the incident. Support your response with research and relevant examples from the case. B. Describe an ethical theory that would help resolve the issue and provide a safe, quality healthcare experience for the patient. Support your response with research and relevant examples from the case. C. Select a physician–patient shared decision-making model and explain how it would provide a safe, quality healthcare experience for the patient D. Propose ethical guidelines that would have helped prevent the incident and would help the organization prevent future incidents. E. Defend how your proposed ethical guidelines will hold healthcare providers accountable to themselves, their profession, their patients, and the public.

II. Recommendations: In this section, you will utilize the knowledge you gained from your malpractice and ethical analyses to recommend and defend strategies that would help improve medical practices and avoid future liability. A. Recommend preventative strategies the healthcare provider could implement to avoid liability in the future. B. Defend how your recommended preventative strategies would assist the healthcare provider in avoiding liability and provide a safe, quality healthcare experience for the patient.

The benchmark assesses the following competency:

Benchmark: 5.1. Understand the human experience across the health-illness continuum.

Research the health-illness continuum and its relevance to patient care. In a 750-1,000 word paper, discuss the relevance of the continuum to patient care and present a perspective of your current state of health in relation to the wellness spectrum. Include the following:

Examine the health-illness continuum and discuss why this perspective is important to consider in relation to health and the human experience when caring for patients.
Reflect on your overall state of health. Discuss what behaviors support or detract from your health and well-being. Explain where you currently fall on the health-illness continuum.
Discuss the options and resources available to you to help you move toward wellness on the health-illness spectrum. Describe how these would assist in moving you toward wellness (managing a chronic disease, recovering from an illness, self-actualization, etc.).
Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract or thesis is required.

Pre-Briefing Simulation And Drug Cards

PATIENT: Keola Akana

THIS ASSIGNMENT HAS TWO PART QUESTIONS

INSTRUCTION

Please keep in mind you will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills.

Therefore, in order to prepare for the simulation, you are required to complete the Pre-Briefing questions & Drug Cards below and submit to the faculty facilitating the simulation prior to the start of pre-briefing. If you do not complete the pre-briefing questions below and submit to faculty facilitating the simulation prior to the start of pre-briefing, you will not be permitted to participate in the simulation.

PART 1 QUESTIONS

SCENARIO OVERVIEW:

Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the medical-surgical unit early on Monday morning for medication adjustment, monitoring, and cardiac rehabilitation. The scenario takes place on Monday at 0900, at which time morning medications are due.

1. What are the nutritional implications, key assessment findings, and nursing interventions for a patient with hypokalemia?

2. What are the signs and symptoms of digoxin toxicity and how would the nurse assess for these symptoms? In your response, be sure to include specific body systems.

3. How would the nurse provide family-centered care?

PLEASE USE REFERENCE LESS THAN 5 YEARS OLD AND APA FORMAT NEEDED.

PART 11 QUESTIONS

SCENARIO OVERVIEW:

Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the medical-surgical unit early on Monday morning for medication adjustment, monitoring and cardiac rehabilitation. During this scenario, students will have the opportunity to assess and manage medication administration for a patient experiencing digoxin toxicity.

FOR EACH OF THE FOLLOWING DRUGS BELOW THAT WAS PRESCRIBED FOR THE ABOVE PATIENT WITH HEART FAILURE, WRITE OUT IN DRUG CARD FORMAT FOLLOWING THE HEADING BELOW

1) THE INDICATION, (2) DOSAGE, (3) CONTRAINDICATION, (4) SIDE EFFECTS, (5) ADVERSE EFFECTS AND (6) NURSING CONSIDERATION

⦁ Patient: Keola Akana Drug Lists

Lasix 40 mg po now and daily

Potassium Chloride CR 10 mEq po daily

Digoxin 0.25 mg po now and daily

Atenolol 50mg po now and daily

Acetaminophen 650 mg po Q 4 hrs PRN mild pain or temp greater than 101.3

IV saline flush Q 8hrs and PRN

N:B: SEE THE ATTACHED SAMPLE OF THE DRUG CARD LIST

Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.

In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:

New practice approaches
Intraprofessional collaboration
Health care delivery and clinical systems
Ethical considerations in health care
Population health concerns
The role of technology in improving health care outcomes
Health policy
Leadership and economic models
Health disparities
Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.

APA style is required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines.

MINIMUM OF 6 REFERENCES, 1500 WORDS, NO PLAGIARISM PLEASE

Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

Example:

PATIENT INFORMATION

Name: Mr. W.S.

Age: 65-year-old

Sex: Male

Source: Patient

Allergies: None

Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.

SUBJECTIVE:

Chief complain: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness.He states that he has been under stress in his workplace for the last month.

Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

ROS:

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.

Respiratory:Patient denies shortness of breath, cough or hemoptysis.

Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

Gastrointestinal:Denies abdominal pain or discomfort.Denies flatulence, nausea, vomiting or

diarrhea.

Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data

CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.

General appearance: The patient is alert and oriented x 3. No acute distress noted.NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT:Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race.

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.

Cardiovascular:S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.

Respiratory:No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.

Gastrointestinal:No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no reboundno distention or organomegaly noted on palpation

Musculoskeletal:No pain to palpation. Active and passive ROM within normal limits, no stiffness.

Integumentary:intact, no lesions or rashes, no cyanosis or jaundice.

Assessment

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed.

Differential diagnosis:

Ø Renal artery stenosis(ICD10 I70.1)

Ø Chronic kidney disease(ICD10 I12.9)

Ø Hyperthyroidism (ICD10 E05.90)

Plan

Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease.

These basic laboratory tests are:

· CMP

· Complete blood count

· Lipid profile

· Thyroid-stimulating hormone

· Urinalysis

· Electrocardiogram

Ø Pharmacological treatment:

The treatment of choice in this case would be:

Thiazide-like diuretic and/or a CCB

· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.

Ø Non-Pharmacologic treatment:

· Weight loss

· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat

· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults

· Enhanced intake of dietary potassium

· Regular physical activity (Aerobic): 90–150 min/wk

· Tobacco cessation

· Measures to release stress and effective coping mechanisms.

Education

· Provide with nutrition/dietary information.

· Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP

· Instruction about medication intake compliance.

· Education of possible complications such as stroke, heart attack, and other problems.

· Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all

Follow-ups/Referrals

· Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn.

· No referrals needed at this time.

References

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series).

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0