Although treatment will take place in a medical facility, how can non-medical treatments be used as a supplement?"
Non-medical treatments can help to support medical care by attending to other aspects of the patient’s health and functioning that may not be reached by other means. Here are some ways non-medical treatments can be used as a supplement:Here are some ways non-medical treatments can be used as a supplement:
Psychosocial Support:
Counseling and Therapy: Offers counseling and ways of handling stress for patients who have long term diseases or those who have gone through a traumatic event. Psychiatry, CBT and counselling and self-help and support groups can also enhance mental health and treatment compliance.
Social Support Networks: Involvement of family, friends, and other resources in the patient’s life can help with the patient’s emotional and physical health and improve the results of treatment.
Lifestyle Modifications:
Diet and Nutrition: That is, diets can be designed to address such diseases as diabetes, cardiovascular diseases, and obesity among others. Medical treatment can be enhanced by nutritional counseling in view of better health results and facilitating the healing process.
Exercise and Physical Activity: Physical activity has numerous benefits in the society today such as preventing diseases that are related to the heart, controlling weight and boosting the mental health. They can also be tailored for the person’s specific requirements and state of health, in conjunction with other therapies.
Complementary Therapies:
Acupuncture and Acupressure: Some of the benefits include; it can be used to control pain, nausea and other signs that are related to different diseases. They are often employed in combination with other approaches to enhance the comfort of the patient and his/her condition.
Massage Therapy: Reduces stress, pains, and muscle tensions that can be helpful in the recovery process of the body.
Education and Self-Management:
Patient Education: This is due to the fact that when patients are informed on their condition, management, and ways of managing their condition, they are more involved in their care. This can enhance patient compliance to the medical regimes and therefore enhance on health status.
Self-Management Programs: Self- management programmes that help in the management of chronic diseases including diabetes and hypertension can enhance the medical care and the level of patient self reliance.
Mind-Body Techniques:
Mindfulness and Meditation: These practices assist in the prevention of stress, anxiety and pain and therefore improves the general health of an individual as well as the outcome of medical treatments;
Relaxation Techniques: Other interventions like breathing exercises and guided imagery have been found to help in decreasing stress and enhance the patients’ power to handle disease and cure.
Complementary Health Practices:
Herbal and Nutritional Supplements: As a note of caution, they can be quite useful if taken in moderation and under the supervision of a doctor, and can also be taken alongside other medication. This is particularly important so as to avoid adverse reactions between the supplements and other prescription medicines.
How can nurses help both patients and caregivers work through mental blocks and depression associated with an illness or injury?"
Nurses are also handy in helping the patients or the caregivers to overcome the mental barriers and the depressions that come with the illness or the harm. Here are several ways nurses can provide support:
For Patients:
Active Listening and Empathy:
Engage in Conversations: Let the patient have a caring environment in which the patient can elaborate on his or her own situation with no form of ridicule. It also makes the patient to have the feeling that he or she has been heard and therefore Increasing his or her confidence.
Validate Feelings: It is therefore important that the patients are able to be understood and their feelings are to be recognised as real. This is in a bid to minimize on loneliness and frustrations that one may be having.
Education and Information:
Provide Clear Information: Educate patients about their disease including the kind of treatment that is available to them and the prognosis of the disease. _ Perhaps, knowing about it can reduce stress and fear because of the unfamiliar.
Set Realistic Goals: Counsel the patients to have a realistic expectation and make them appreciate the little achievements they make. This can enhance the level of control and motivation of the participants because they can change the environment within which they work.
Psychosocial Support:
Referral to Mental Health Professionals: If necessary then one should suggest that the patients should consult psychologists, counsellors or other support groups.
Encourage Participation in Support Groups: Make sure that the patients are taken through group counseling so that they can share with other patients.
Coping Strategies:
Teach Stress-Reduction Techniques: Recommend to patients methods of relaxation, for instance, deep breathing, mindfulness or meditation in an effort to minimize stress.
Promote Physical Activity: Encourage the physical activity as it can has the ability to improve the mood and in turn the mental health of the patient.
Regular Follow-Up:
Monitor Mental Health: The following should be done often; Review the patient’s mental state and condition more often. Be on the lookout for any signs that depression is worsening, or that the writer is stuck.
Adjust Care Plans: Revise the care plans in conformity with the patient’s mental status as well as the impact of care plans on the patient.
For Caregivers:
Education and Support:
Provide Information: Last but not the least, educate the care giver on the sickness or the accident that the patient has and give them a guideline on how to handle the patient. Knowledge is one of the ways that can assist people to overcome or at least reduce the feelings of powerlessness.
Support Caregiver Well-being: Describe to the caregivers the importance of self-care and tell them that they also need to take a break and seek help from other people.
Emotional Support:
Active Listening: Try to listen to caregivers and their concerns and how exhausted they feel. At times this may be all that the affected person requires, a chance to talk to someone who will not interfere.
Encourage Open Communication: Make sure that the patients and caregivers are in a position to present their concerns in order to reduce on the pressure they undergo.
Referral to Resources:
Suggest Support Services: Suggest that one should get or look for company of other people like joining caregiver support groups, seeking counseling services or using respite care to help with the stress that is associated with the job.
Provide Practical Assistance: Provide a list of references of certain organizations or centers that can assist in the caregiving services.
Stress Management:
Teach Coping Strategies: Some of the ways that people can avoid stress and take care of their mental well-being include the following; engaging in mindfulness activities or planning.
Encourage Self-Care: Especially, the caregivers should be informed that they also have to take care of themselves as well as engage in activities that they love to do.
State steps for a fall assessment on a patient using the Morse Assessment fall Risk tool.
To conduct a fall assessment using the Morse Fall Scale, follow these steps:Here are the guidelines in using the Morse Fall Scale for a fall assessment:
Steps for Morse Fall Scale Assessment:How to perform Morse Fall Scale Assessment as follows;
Gather Patient Information:
Hence, the following details should be gotten from the patient; the medical history, the current medications and the history of falls.
Assess the Patient’s History:
Fall History: Gemmell & Browne: “Has the patient fallen in the last three months?”
Secondary Diagnosis: This may include any other factors that may increase the risk of the client to fall as follows:
Perform the Physical Assessment:
Ambulatory Aids: If the patient has any disability in the activities of daily living, if the patient is using any walking aid such as cane or walker.
IV Therapy: It is also vital to check if the patient is on intravenous line or any other device as this increase the rates of fall.
Gait and Mobility: Observe the patient’s mobility, whether the patient is independent in his/her movement or not, whether the patient can walk or not.
Assign Scores Based on the Morse Fall Scale Criteria:Morse Fall Scale Criteria: Assign Scores as Follows:
Fall History: The outcome measures were, for no fall, the participants will score zero, for one or two falls the participants will score 25 points, and for three or more falls the participants will score 50 points.
Secondary Diagnosis: None (no secondary diagnosis): 0, Secondary diagnosis only: 15 points.
Ambulatory Aids: None, 15 points for (cane or walker), 30 points for (crutches).
IV Therapy: The above will be scored as follows; no administration of IV therapy 0 points, administration of IV therapy 20 points.
Gait and Mobility: 0 points for normal; 10 points for mildly diminished; 20 points for diminished.
Calculate the Total Score:
The total points from each of the criteria to produce the total Morse Fall Scale score is illustrated below:
Interpret the Score:
Low Risk: Thus the maximum total score that a candidate can get is 24.
Moderate Risk: For the age group of 25-44 the total score is:
High Risk: A total score of is > 45
Develop a Care Plan:
Create a care plan that is commensurate with the level of risk and which takes account of the problem of falls. This may include interventions such as:This may includes measures like:
Some of the environmental changes for instance include; having objects such as cords on the floor taken away.
Teaching the patient the actions to be taken to avoid falling.
Assistive devices and Supports: Use of the devices in the right manner
Assessment and screening of the patient’s risk of falling should be done on regular basis
Document the Assessment:
The score of the Morse Fall Scale should be documented in the patient’s chart and the reason why the patient is assigned a particular risk level should also be documented. State the care plan and state all the actions that have been made in the process of the care.
Review and Reassess Regularly:
Perform a fall risk assessment of the patient periodically especially when there is a change in the patient’s status or when there is a change in the patient’s management plan
Discuss how functional patterns help a nurse understand the current and past state of health for a patient.
Discuss how functional patterns help a nurse understand the current and past state of health for a patient. Using a condition or disease associated with an elimination complexity, provide an example.
Please provide references"
Functional Patterns in Nursing Assessment:Functional Patterns in Nursing Assessment:
Functional patterns are useful in nurse assessments because they provide the picture of a patient health status in terms of their ability to perform certain activities in their day to day life. These patterns enable the nurses to have an understanding of the present and the past health status of the patient so as to come up with the right care plans and interventions.
How Functional Patterns Aid in Understanding Health Status:How Functional Patterns Aid in Understanding Health Status:
Holistic Assessment:
The functional patterns are a general way of assessing the patient’s state of health where the various aspects of life are considered including dietary intake, bowel and bladder control, physical mobility, and rest. This approach enables the nurses to notice variations from the normal and the effects of these variations on the general health.
Identification of Changes Over Time:Identification of Changes Over Time:
With the help of the functional patterns it is possible to compare the current status with the previous one and determine the changes in the health. This can help the comparison of one picture with another in terms of deterioration or improvement and finding the reasons for these changes.
Personalized Care Planning:
Knowledge of functional patterns enable the nurses to design a care plan suitable for the patient’s need. It assist in goal establishment, choosing the most imperative interventions, and overseeing the advancement made.
Prediction of Future Health Needs:Prediction of Future Health Needs:
The functional patterns can reveal possible forthcoming health problems. For instance, a gradual shift in the bowel movements’ frequency might be an indication of a new disease that needs to be treated at an early stage.
Example with Elimination Complexity:
Condition: Chronic Kidney Disease (CKD) means the gradual and General loss of kidney function over time.
Functional Patterns Assessment:
Current Elimination Pattern:
Assessment: The US section of the assessment looks at the patient’s current urinary habits, how often the patents urinates, the amount, and the condition of the urine. The nurse also evaluate’s any signs and symptoms like dysuria, hematuria, or change in the colour of the urine.
Observation: Some of these may include reduced urine output, presence of proteins in the urine, or dark coloured urine for the patient with CKD.
Past Elimination Pattern:
Assessment: The nurse assesses the patient’s history of the patient’s previous bowel movements, if he or she ever faced problems with urination or had low urine output. This can be done through medical records or the interviewing of the patients.
Observation: The patient might have had normal urinary system and then develop symptoms over time of deteriorating urinary system.
Implications for Current Health:
Understanding Changes: Some of the consistent changes in elimination include decreased urine output and increased protein levels which is signs of declining kidney function. This assists the nurse to know the stages of the CKD and the effects it has on the patient.
Care Planning: From the current and previous elimination patterns, the nurse can establish an effective care plan that includes relief of symptoms, assessment of kidney’s health, and patient counselling on diet and drug compliance.
References:
Gordon, M. (2016). Functional Health Patterns: Assessment and Diagnosis In: Nursing Diagnosis: An Introductory Guide for Generalist Practice. Nurses’ Desk Reference: The Guide to Planning Patient Care. 11th ed. St. Louis, MO: Elsevier.
Gonzalo, J. & Tamayo, L (2021). Chronic Kidney Disease: Management of the Disease. Journal of Nephrology, Vol 34, No 6, pp 1145–1156. DOI: 10. 1007/s40620-021-01035-6.
Roper, N. , Logan, W. W. & Tierney, A. J. (2013). The Roper-Logan-Tierney Model of Nursing: As suggested by the Activities of Living. 5th ed. Edinburgh: Churchill Livingstone.
Please choose one answer.
When conducting an emergency thoracentesis or inserting a chest tube remember the following :
The needle should always be in inserted on top of the rib to avoid vascular structures.
The needle should always be in inserted underneath the rib to avoid vascular structures.
Anesthesia is not needed for chest tube insertion.
There is no need to secure a tube after insertion."
The needle should always be inserted on top of the rib to avoid vascular structures
Directions: Complete the following calculations
Include the correct unit of measurement in all answers, 1. Order:
Erythromicin 0.5 g via g-tube gid. Available: Erythromicin oral solution 125 mg per 5 mL How many ml will you give? 2.
Your patient is to receive intermittent tube feedings. The NP orders 300 ml of 1/3 strength Ensure by N.
1. Erythromycin Dosage Calculation
Order: Erythromycin 0.5 g via g-tube, three times a day (tid).
Available: Erythromycin oral solution 125 mg per 5 mL.
Steps:
1. Convert 0.5 g to mg:
0.5 g=500 mg0.5 \text{ g} = 500 \text{ mg}0.5 g=500 mg
2. Determine how many mL are needed for 500 mg:
Available concentration=125 mg/5 mL\text{Available concentration} = 125 \text{ mg/5 mL}Available concentration=125 mg/5 mL Volume=Desired DoseAvailable Concentration×Volume of Solution\text{Volume} = \frac{\text{Desired Dose}}{\text{Available Concentration}} \times \text{Volume of Solution}Volume=Available ConcentrationDesired Dose×Volume of Solution Volume=500 mg125 mg×5 mL\text{Volume} = \frac{500 \text{ mg}}{125 \text{ mg}} \times 5 \text{ mL}Volume=125 mg500 mg×5 mL Volume=4×5 mL\text{Volume} = 4 \times 5 \text{ mL}Volume=4×5 mL Volume=20 mL\text{Volume} = 20 \text{ mL}Volume=20 mL
Answer: You will give 20 mL.
2. Tube Feeding Calculation
Order: 300 mL of 1/3 strength Ensure.
Available: (Assumed) Standard Ensure formula, with 1 strength Ensure being the full concentration.
Steps:
1. If 1 strength Ensure requires a certain volume to make 1/3 strength, you need to dilute the formula.
2. For 1/3 strength, you would mix 1 part of the Ensure formula with 2 parts of water.
Total Volume=Volume of Ensure+Volume of Water\text{Total Volume} = \text{Volume of Ensure} + \text{Volume of Water}Total Volume=Volume of Ensure+Volume of Water
To get 300 mL of 1/3 strength Ensure:
Volume of Ensure=300 mL3=100 mL\text{Volume of Ensure} = \frac{300 \text{ mL}}{3} = 100 \text{ mL}Volume of Ensure=3300 mL=100 mL Volume of Water=300 mL−100 mL=200 mL\text{Volume of Water} = 300 \text{ mL} - 100 \text{ mL} = 200 \text{ mL}Volume of Water=300 mL−100 mL=200 mL
Answer: You will use 100 mL of Ensure and 200 mL of water to make 300 mL of 1/3 strength Ensure.
What discharge instructions and education will you give a patient with Pneumonia?
It is very significant to ensure that a patient who has been discharged with pneumonia has detailed and clear instructions to follow to help in the healing process and to prevent complications. Here’s a detailed plan:
Discharge Instructions and Education for Pneumonia:Pneumonia Discharge Instructions as well as Patient Education:
1. Medication Management:
Instructions:
The following tips should be observed in as much as you are taking any of the prescribed antibiotics or antiviral drugs. If the symptoms become less severe before the completion of the course then the patient should complete the full course.
If advised so, the patient should take any of the cough suppressants, bronchodilators or steroids as prescribed by the doctor.
Education:
Explain why it is important to complete all the courses of the medications so that the infection may be eradicated and the occurrence of antibiotic resistance may be prevented.
Enumerate the possible side effects and the appropriate management of the same.
2. Monitoring Symptoms:
Instructions:
Accord to the symptoms like fever, cough, and shortness of breath.
Observed for worsening or alteration in symptoms such as dyspnea, chest pain or fever higher than the normal limit.
Education:
The patient should be advised to contact a clinician in the event that the symptoms worsen, in case of breathing difficulties, chest pain or confusion.
3. Rest and Recovery:
Instructions:
It is important to take enough rest to allow a body to fight the infection that is troubling it.
Avoid any form of strenuous activities and as one is able to, they should start engaging in activities gradually.
Education:
Inform them that since the body has the ability to repair itself when one is asleep, enough sleep assist the body to build its defense system.
4. Hydration and Nutrition:
Instructions:
It is recommended that one should take a lot of water to drink so as to be in a position to at least flush out the system and also to make the mucus to be less thick and heavy.
As a way of improving your health and immune system, make sure you feed on balanced diet.
Education:
Emphasize the importance of taking fluids to help in the loosening of the mucus and the importance of feeding so as to recover.
5. Breathing Exercises and Airway Clearance:Pulmonary Rehabilitation: Breathing Exercises and Airway Clearance:
Instructions:
Use any of the preferred breathing exercises for spirometry or if on nebuliser, use it as directed.
Some of the measures that can be taken in an attempt to get rid of mucus are; Frequent intake of deep breaths and coughing so as to expel mucus from the lungs.
Education:
Demonstrate or evaluate the proper way of doing the breathing exercises and mucus clearance.
6. Avoiding Infection Spread:
Instructions:
Practicing good hygiene should be done more often especially washing of hands with soap and water.
Do not come into contact with people especially in crowded or enclosed locations.
Education:
State the precautions that should be made in order not to transmit the disease to other people and the part played by hygiene.
7. Follow-Up Appointments:
Instructions:
Go for a check-up with your doctor and get the tests that are needed to ascertain that the infection has cleared.
Education:
Ensure you tell the patient that it is advisable to go back for a check on the status of the patient and on whether any other treatment is required.
8. Smoking Cessation:
Instructions:
In case you use the smoking substance, endeavor to find ways on how to stop the habit of smoking.
Education:
Warn them that smoking will minimize the lung capacity and will also slow down the rate at which pneumonia heals.
9. Emergency Care:
Instructions:
Understand when it is right to attend the emergency department because of an increase in the severity of the symptoms.
Education:
Some of the signs of a serious condition are; rapid breathing, blue color of the skin, rapid heartbeats, severe chest pains.
References:
Infectious Diseases of National Center for Emerging and Zoonotic Diseases (Division of Vector-borne Infectious Diseases) at Centers for Disease Control and Prevention (CDC). (2023). Pneumonia. Retrieved from CDC Pneumonia
Mayo Clinic. (2022). Pneumonia: Symptoms and Causes. Available online, from the Mayo clinic: Pneumonia.
National Institute of Health, National Heart Lung and Blood Institute (NHLBI). (2021). Pneumonia. Retrieved from NHLBI Pneumonia
In need of urgent and exact answers to all question!
https://www.Nurs.com/drug-biotechnology-pTugN
Healthcare workers who care for patients in their homes are among those at high risk in pandemics. Previous studies in the United States showed that the number of patients who were being cared for at home during a pandemic was nearly 3 times to the number being hospitalized. During the SARS epidemic in Hong Kong, the fall in hospitalizations for those with pre-existing chronic diseases was complemented with an increase for demand for community nursing services at patients' homes. Studies from the United Kingdom found that community HCWs expressed less willingness to work during a pandemic than their hospital counterparts. A similar study in the United States found that the intention to work with quarantine cases among community home health care services was lower (11%) than the willingness of healthcare workers who worked in the hospital (54%). Another study found that for HCWs working in New York City long-term facilities and outpatient centers, the most important barriers to willingness to work were fear and concern for family and self (31%). To the best of our knowledge, there is no other study exploring the willingness of, and factors associated with community nurses to work during the H1N1 pandemic. Thus, this study was conducted to explore the willingness of community nurses to continue to work during H1N1 influenza pandemic.
As nurses are at the front line of the COVID-19 outbreak response and are exposed to hazards that put them at risk of infection, it is vital that they are supported to protect themselves with specific infection prevention procedures and sufficient provision of protective gear at their practice settings, including ventilators, masks, robes, eye cover, face shields, and gloves.3 Nursing managers and instructors must include guidance to nurses and support personnel on emerging COVID-19 problems and hazards that are unique to their field of work.
1)From molecular biology, _______ attaches to the _______ amino acid deposit for _______.
2) Vigor is a prerequisite for the Ubiquitin-proteasome dilapidation trail. Justify or falsify inference.
3)State whether the following is true or false/.
Children have a smaller thymus compared to adults.
4.Where do the lymphocytes mature in?
5. What substance secreted by the human brain is associated with skin coloration?
Identify the gland that secrets it.
6. What is associated with alterations in the concentration of oxygen, hydrogen ions
and glucose in the blood.
7. where does the sensation of touch, pressure and temperature happens in the?
8. State whether the statement below is true or false.
The spleen is situated in the lower right thoracic cavity, just above the diaphragm.
9. What does white pulp encompass majorly?
10. Provide an precise array for the length of the spleen."
https://www.coursehero.com/tutors-problems/Nursing/30678863-8-Standing-Orders-for-your-patient-are-as-follows-Finger-stick/,"Image transcription text
8. Standing Orders for your patient are as follows: Finger stick Blood sugar (FSBS) ac and hs Humulin R U-100 10
units subcut ac meals Humulin N U-100 24 units daily subcut at 0730 At 0730 your patient's FSBS is 110 mg/dL. Your
client will be eating breakfast at 8:00 am. How many units will you administer at 0730? 9. Order: Napro... Show more"
Standing Orders Calculation
Standing Orders:
Finger Stick Blood Sugar (FSBS): Before meals and at bedtime, that is in the afternoon and at night (ac and hs).
Humulin R U-100: 10 units subcut before meals (ac).
Humulin N U-100: 24 units daily by subcutaneous route at 0730.
Scenario:
At 0730: FSBS is 110 mg/dl.
Breakfast is served at 8:00 a. m.
Calculation:
1. Humulin R U-100 (Short-acting Insulin) Dosage:Humulin R U-100 (Short-acting Insulin) Dosage:
Humulin R U-100 is to be given before meals. Since the patient is to take his breakfast at 8:00 am the Humulin R should be taken before the meal but as for the FSBS there doesn’t seem to be a need to alter it from the normal range which is below 180mg/dL.
2. Humulin N U-100 (Intermediate-acting Insulin) Dosage:Humulin N U-100 (Intermediate-acting Insulin) Dosage:
Humulin N U-100 is given at 0730. By the standing orders, the dosage is 24 units of Humulin N U-100 at this time.
Answer:
At 0730 u will give 24u of Humulin n U-100.
Humulin R U-100 insulin (10 Units) will be given before breakfast at 8 am with a view of following the normal pre-meal protocol.
What have you discovered about the professional practice, personal strengths and weaknesses
What have you discovered about the professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. I have to talk about a little about every single of this topics in class. Reference are highly appreciated.
New practice approaches
Interprofessional collaboration
Health care delivery and clinical systems
Ethical considerations in health care
Practices of culturally sensitive care
Ensuring the integrity of human dignity in the care of all patients"
1. New Practice Approaches
Discovery:
The new practice approaches in nursing encompass the formulation of practice advances and technological advancement to enhance the achievement of the patients’ goals. This includes the changes in care delivery such as patient’s care, the utilization of clinical decision support system and the improvement of quality.
References:
Melnyk, B. M. , & Fineout-Overholt, E. (Eds. ). (2019). Evidence-Based Practice in Nursing & Healthcare: A practical handbook for organisations wishing to improve their practices. Wolters Kluwer.
Institute for Healthcare Improvement. (2024). Improving Healthcare Quality. IHI Website.
2. Interprofessional Collaboration
Discovery:
Interprofessional collaboration is the collaborative work of health care givers in the provision of healthcare services. It enhances co-ordination, decreases adverse incidents and, in all probability, the quality of the patient’s care. Some of the strategies are scheduled team meetings, use of integrated electronic health records and co-ordinated care planning.
References:
Reeves, S. , Pelone, F. , Harrison, R. and Goldman, J. R. (2016). Enhancing multidisciplinary working to develop practice and the delivery of healthcare. The Cochrane Database of Systematic Reviews was used for this review.
World Health Organization. (2010). The Interprofessional Education for Collaboration: Learning / Action Systems FRAMEWORK is the result of a three-year effort. WHO Website.
3. Health Care Delivery and Clinical Systems
Discovery:
The systems that are being used in the provision of health care services include the electronic health records (EHRs), telehealth, and patient management systems. The following are some of the reasons that these systems have been developed: to increase efficiency, to bring about the best in patient care, and to aid in decision making.
References:
Wager, K. A. , Lee, F. W. , & Glaser, J. P. (2017). Health Care Information Systems: A Management Model for Health Care Organizations. Jossey-Bass.
HealthIT. gov. (2024). Heath Information Technology in the Improvement of Health Care Delivery. HealthIT. gov Website.
4. Ethical Issue Discussion in Health Care Promotion
Discovery:
In the area of healthcare there are some ethical principles which are patient’s self-determination, informed consent, confidentiality and justice. Potential problems might be identified in ethics of decision making, ethics of resources, and ethics of death and dying.
References:
Beauchamp T. L. , Childress J. F. (2019). Principles of Biomedical Ethics. Oxford University Press.
American Nurses Association. (2015). American Nurses Association: Code of Ethics for Nurses with Interpretive Statements. ANA Website.
5. Culturally Safe Practices in Care
Discovery:
Culturally competent care refers to the appreciation of the patient’s culture, and incorporating this into the patient’s care plan. This increases the overall satisfaction and results of the patient.
References:
Campinha-Bacote, J. (2019). Cultural Competence Education and Training. As indicated in Cultural Competence in Nursing Practice. Springer Publishing Company.
Purnell, L. D. (2018). The Purnell’s Model of Cultural Competence. Springer Publishing Company.
6. Protecting the Dignity of Every Human Being in the Course of Their Care
Discovery:
People’s dignity has to be respected in the workplace, and patients need to be treated with courtesy, acknowledged for their autonomy, and considered in their entirety. This entails acknowledging others and understanding their situation while also practicing the right thing.
References:
Fins, J. J. (2006). The Human Dignity of Patients: Ethical And Policy Analysis. Cambridge University Press.
Gillon, R. (2003). Medical Ethics: Four Principles Plus Attention to Scope. BMJ.
Legal Case Study
On June 17, 2002, the superior court sustained Ethicon's demurrer to the products liability cause of action without leave to amend, relying upon Norgart, supra, 21 Cal.4th 383, 87 Cal.Rptr.2d 453, 981 P.2d 79, and Bristol-Myers Squibb, supra, 32 Cal.App.4th 959, 38 Cal.Rptr.2d 298, to conclude that the statute of limitations barred the products liability cause of action. The superior court stated that when a plaintiff sues based on knowledge or suspicion of negligence, including medical malpractice as in Fox's case, the statute of limitations begins to run as to all defendants, including manufacturers possibly liable under products liability theories. The superior court also stated that Fox failed to demonstrate that amending the complaint could ""overcome the limitations defense."" Fox timely appealed from the superior court's order sustaining Ethicon's demurrer as to the products liability cause of action.
The Court of Appeal reversed the superior court's order and remanded with directions to grant Fox leave to amend to allege facts explaining why she did not have reason to discover earlier the factual basis of her products liability claim. In so ruling, the Court of Appeal held that Bristol-Myers Squibb's ""bright-line rule of imputed simultaneous discovery of causes of action"" did not apply. Ethicon petitioned this court, and we granted review.
additional questions
Question 1
A 25-year-old woman, pregnant in her second trimester, starts to
experience chorea and bilateral ankle arthralgia but has no past history of
rheumatic chorea. In the first hour, her erythrocyte sedimentation rate is
70. Could this be no more than chorea gravidarum?
Question 2
Is valproate as equally effective as haloperidol in the treatment of chorea,
in particular rheumatic chorea?
Question 3
Does a lesion of Guillain-Mollaret's triangle in the brain stem cause a
type of myoclonus other than symptomatic palatal myoclonus?
Question 4
1. In West's syndrome, after the fits have been suppressed, for how
long should treatment with adrenocorticotrophic hormone (ACTH)
continue?
2. Does complete suppression of resistant infantile myoclonic jerks by
ACTH characterize West's syndrome?
Question 5
Are anticholinergics the first line of treatment for primary torsion
dystonia?
Question 6
Can multiple sclerosis (MS) be associated with lack of vitamin D,
lack of sunlight or low fish/cod-liver oil in the diet? By looking at the
epidemiology (none at the equator; more outside 40� latitude, both north
and south; less on top of Swiss mountains than in the Swiss valleys; more
in fishing coastal towns and in Eskimos) this seems to be very important.
Vitamin D modulates the immune system and active vitamin D given
to rats with experimental MS (acute encephalomyelitis) lowers the
monocyte count in cerebrospinal fluid (CSF) by 90% in 72 hours with
return of power to their limbs. Japanese MS patients who ate plenty of
fish were found to have vitamin-D-receptor pleomorphism. The staple
grains and cereals (wheat, barley, oats) eaten in Scandinavian and
northern European countries contain phytic acid, which blocks vitamin D
absorption, and rice is the only cereal free of phytic acid.
Are there any studies where low vitamin D levels in blood are
associated with MS relapse?
Question 7
What are the diagnostic criteria of 'definitive' multiple sclerosis (MS) - as
taught to a medical student? We have found different information from
different sources.
Question 8
How reliable is a CT-brain scan with contrast in showing MS lesions as
enhancing lesions in the presence of a contraindication to use MRI?
Question 9
Is magnetic resonance (MR) spectroscopy of value in differentiating
multiple sclerosis from cerebral autosomal dominant arteriopathy with
subcortical infarctions (CADASIL)?
Question 10
Does hemiplegia due to multiple sclerosis present with hemiparesis
rather than dense hemiplegia (which is more characteristic of a stroke)?
Other than age, what are the clinical signs that would help differentiate
between the two?130"
Legal Case Context
Case Overview:
The case was before the Superior Court in which Ethicon had a motion to quash a products liability claim arguing that any claim with knowledge or suspicion of negligence was time barred.
The lower court retained this decision; Fox was barred from amending the complaint and thus the Court of Appeal ordered a review of the case.
Medical Questions
A Pregnant Woman with Chorea and Arthralgia
Question: A 25-year-old female in second trimester pregnancy with chorea and bilateral ankle pains and ESR 70. Chorea gravidarum is a form of chorea most especially associated with pregnancy §Is this perhaps chorea gravidarum?
Answer: Even though chorea gravidarum is said to show chorea and raised E. S. R. associated with pregnancy the latter does not appear to be true, because E. S. R. is always high in pregnancy even where chorea is absent. However, if bilateral ankle arthralgia is present along with high ESR level it suggest inflammatory or infective cause. Further evaluation is needed in order to differentiate chorea gravidarum from other diseases affecting women in particular rheumatic diseases.
Thirdly, randomised double blind use of valproate and haloperidol for chorea has clearly shown that both the drugs help to improve the symptoms though there was no dichotomy between the two drugs.
Question: One question to consider: Does valproate work to reduce chorea in the same way that haloperidol does, or even rheumatic chorea?
Answer: Haloperidol has been used in past for chorea particularly rheumatic chorea and it was and is considered to be more effective than valproate. Tremors are commonly observed in a number of conditions and chorea is useful for the treatment of chorea but of course rheumatic chorea is not normally began with valproate.
Guillain-Mollaret's Triangle Lesion
Question: What other sort of myoclonus is there besides symptomatic palatal myoclonus which is brought on by injury to Guillain-Mollaret’s triangle?
Answer: In the present study palatal myoclonia was found to be associated with complex lesions involving the structures of the region referred to by many authors as Guillain-Mollaret’s triangle. But in cases of an extensive lesion, other types of myoclonus may be produced but palatal myoclonus is most common.
West’s Syndrome and the management with Adrenocorticotropic Hormone
I: When should ACTH treatment started in West’s syndrome be repeated to suppress fits?
Answer 1: ACTH treatment in West’s syndrome is undoubtedly long term taking weeks or even months because the treatment is surrounded by the level of response of the patient and the doctor who prescribed it.
Question 2: To what extent does complete absence of Infantile Myoclonic Jerks after ACTH in differentiating west’s syndrome?
Answer 2: Lack of infantile myoclonic jerks is also present in west syndrome, albeit this does not in all circumstances bring about diagnosis.
Primary Torsion Dystonia Treatment
Question: Primary torsion dystonia: to use anticholinergics or not?
Answer: In primary torsion dystonia, anticholinergic medications are not the drugs of first choice but is one of treatments used. For the first-line therapy, possibilities include administration of levodopa or, if so required, botulinum toxin injection therapy.
Vitamin D and Multiple Sclerosis
Question: Can current data link low vitamin D and MS relapse?
Answer: In fact, the published literature has shown that the clinical validity of the hyperhealth biomarkers suggested for MS patients, the vitamin D deficiency, for example, could predict the probabilities of relapse. Vitamin D is thought to be involved or exert some influence on components of immunoregulation.
Structuring the Diagnostic Criteria for ‘Definitive’ MS
Question: What are the diagnostic features in patients with ‘definitive’ MS?
Answer: To make a diagnosis of definitive MS the following points have been recommended: Multiple points of time discriminating neurological abnormality effectively, MRI lesions typical or suggestive of MS and all other possible causes have to be ruled out.
MRI in diagnosing multiple sclerosis lesion of the brain
Question: How good is CT-brain scan with contrast in making out the lesions if MRI is out of the question?
Answer: MRI is less sensitive compared to CT in the representation of MS lesions. They can show some enhancing lesion, however, it is not as reliable as for evaluating MS, for instance, in terms of the global perspective.
MRI and MRS for the detection of MS from CADASIL
Question: Is MRS useful for differential diagnosis of MS from CADASIL?
Answer: MRI is generalised as the modality of choice and MR spectroscopy only add the biochemical content of the lesions that may be helpful in differentiating between MS and CADASIL.
Hemiplegia of MS can be compared to the hemiplegia that is caused by stroke.
Question: Are there distinctions between thematological hemiplegia in MS that may present as hemiparesis, and what some might define as truly dense hemiplegia? What are other clinical signs that may be of value in the differentiation of a stroke?
Answer: Hemiplegia By using MS recreational and sports activities, of structural hemiplegia, the outcome is often hemiparesis not inherent critical hemiplegia. Categorical differences are absent; main clinical differences concern the progression, other neurological signs, the history of relapses and remissions.
