Samples

1. Review the Alexander Hamilton quotation at the beginning of this chapter.

Welcome to Samples page

Based upon the material you have just read, list the questions that come to mind regarding the phrase ""punctual performance of contracts.""

2. Give examples of implied and express consent to medical treatment in a hospital emergency room situation.

3. A patient has just been informed by the physician that she must have a hysterectomy and that there is a question of malignancy. As she leaves the office and you schedule her for hospital admission, she comments: ""The doctor makes me feel so good about this. She says that I will be out of the hospital in four days and on my own within a week. Isn't she a wonderful person? She says that I will be completely cured following my surgery."" How would you handle this situation?

4. A 16-year-old male comes to the office without an appointment and asks to see the physician because he thinks that he has AIDS. He does not wish to give you his name, parents' names, or address. You have seen him around town and know that he is a local resident. The physician is not available, but you expect her within an hour. As the agent of the physician, what is your responsibility in this situation?

5. A 15-year-old girl comes to the office with a diagnosis of first- trimester pregnancy. A year ago, she visited the physician twice, and then miscarried. There is an outstanding fee to be collected from the patient. Her parents are also patients of the physician but do not know that their daughter is pregnant. It is your job to collect the fees from patients. What would you  as an agent of the physician in this situation?

6. A woman and a 15-year-old minor present at your office for medical care. The woman declares she is the minor's conservator, and she shows you a court document that confirms this. Can she consent to medical treatment on behalf of the minor? How would you handle this situation?"

1. Measures of contract performance – punctuality – questions to ask

 Alexander Hamilton's quotation about the "punctual performance of contracts" may raise several questions:Alexander Hamilton's quotation about the "punctual performance of contracts" may raise several questions:

 Determining the elements that qualify a performance as ‘punctual’ within the context of medical contracts.

 Compliance with timelines and deadlines is a critical feature of contracts in the healthcare sector and can be as follows:

 Is there any legal action that a party can take against the other that refuses to fulfill their obligations promptly?

 Are there certain provisions in the healthcare contracts that set out the timelines for performance of certain tasks?

 There will always be some consequences that a healthcare provider or a healthcare institution will pay for not availing the treatment or not delivering service to the expected quality.

 Punctual performance: What does it mean to the patients and their confidence in the healthcare practitioners?

 2. Surrogate Consent to Medical Treatment

 Implied Consent:

 In a hospital emergency room situation, conscious, a patient may be unconscious, or incapacitated and this consent is considered to be implied. The decision might be made in the car accident case where the patient is a man with no pulse; doctors give him cardiopulmonary resuscitation on the assumption that the man would have agreed to the treatment if he could speak.

 Express Consent:

 Informed consent is when a patient willingly acknowledges and accepts a certain treatment before being treated after being told the associated hazards, advantages, and other accessible choices. Express consent can occur in the following ways, for example when a patient with a broken arm who is conscious and coherent will nod in acceptance of the physician’s proposition to have the arm set and treated after explaining the process.

 3. Dealing with Patient’s Distorted Perception of prognosis

 In this situation, it is useful to explain the situation and get to the bottom of the information with the patient while, at the same time, not erode the patient’s confidence in the physician. Here’s how to approach it:Here’s how to approach it:

 Acknowledge the Patient’s Feelings: Begin the response with concern and respect towards the patient and how they feel because the doctor was optimistic about it.

 Clarify the Prognosis: Kindly bring it to the understanding of the patient that the doctor is optimistic about the treatment and the surgery itself but any surgery comes with certain level of risks and the outcome can never be guaranteed.

 Encourage Questions: Advise the patient to convey bluntly his or her worries and doubts to the physician regarding the condition in question and make sure that the patient is grounded well.

 For example: “I am glad that you are confident with the kind of treatment that you are receiving IVF is really helpful, especially for older patients such as yourself, I hope that you understand that while the doctor is highly experienced, every surgery has some risks I hope if you have questions or concern you get the chance to talk to the doctor. ”

 4. Processing the Request of the 16 Year Old Male

 As an agent of the physician, your responsibility is to:As an agent of the physician, your responsibility is to:

 Ensure Confidentiality: The privacy of the patient should not be intruded by forcing from him information that he does not wish to disclose.

 Provide Support: Provide the patient a place to wait and let him know that the physician will attend to him without need of the card which may embarrass him.

 Document the Interaction: They have to greet the patient and acknowledge the fact that he asked for a consultation in a non-accusatory and non-judgmental way and without compromising patients right to privacy.

 Prepare for the Physician’s Arrival: Inform the physician about the patient’s concerns before she joins the team in order that she has an understanding of the circumstances when she arrives.

 For example: “You may wait here until the doctor comes in. I will inform her that you are here with some issues that we care to talk about here. If you wish to disclose more information when the doctor is present she will be able to help you better. ”

 5. Charging and billing the 15 year old pregnant patient

 In this situation:

 Respect Patient Confidentiality: It is unlawful to reveal a patient’s condition or any charges which are still payable to the patient’s parents unless the patient agrees.

 Seek Payment Options: Thoroughly explain the outstanding fee politely and find out whether the patient has any questions or concerns regarding payments that she would like to ascertain the confidentiality of the matter of payment.

 Involve the Physician if Necessary: If the patient cannot pay or the matter is delicate, involve the physician to know how to handle the treatment and the payment or come up with an option like installment.

 Document the Encounter: Be very keen when taking down the details of the conversation and the arrangements made for payment.

 For example: ‘I know paying these fees can be a problem sometimes and we can look at some things that may help you out a bit If you so wish, we may involve the doctor to perhaps find out what may be more convenient for you. ’

 6. Consent of the Conservator of the minor

 This is based on a court document that a woman produces to show that she is the conservator of a 15-year-old minor – he was right; a woman has the legal right to consent to medical treatment for a minor in her custody. Here’s how to handle the situation:Here’s how to handle the situation:

 Verify the Document: However, take time and search for the validity of the legal document presented in court to be sure that she has the power to give consent on the various medical procedures being planned.

 Document the Consent: Reporting: It is recommended that the consent is made in the minor’s record and supporting document such as the copy of the court order is attached.

 Proceed with Care: Continue with the treatment with a probation that all medical decisions and consent be made as is in the best interest of the minor according to the conservator.

 For example: ‘This court document is very much appreciated Indeed, we will scan this and attach it to the clients’ medical record As for the medical treatment required, with your permission, we can go ahead and perform the necessary procedures. ”

 Conclusion

 These scenarios deliver awareness of the legal and ethical aspects as prime focuses in healthcare organizations including aspects such as patient consent, patient confidentiality, and communication. Both conditions present a conflict of interest insofar as rights patients have, and the quality of care they received.

 References

 American Medical Association. (2021). Informed Consent. Retrieved from AMA website

 Beauchamp, T. L. , & Childress, J. F. (2019). As a matter of fact, Beauchamp and Walters Principles of Biomedical Ethics (8th edition) identifies the next. Oxford University Press.

 Legal Information Institute. (2021). Consent to Medical Treatment. Cornell Law School. Retrieved from LII website

N.O., a 72-year-old male, was admitted to the skilled care facility for rehabilitation following an open reduction, internal fixation of the right hip.

N.O. had fallen while going up the stairs of his home, suffering a fracture of the right femur. He has no recollection of what caused him to fall. He is married and, until his surgery, was working part time as a school-crossing guard. While in the hospital, N.O. exhibited mental status changes, including disorientation and confusion. His wife reports that he never had this problem prior to the surgery. He is continent of bowel and bladder. N.O. was in relatively good health until the fall. He and his wife agree that he should return home after rehabilitation is complete

1. what specific admission assessments that would be required for N.O. because of his age and condition.

2. what complications for which N.O. is at risk.

3. Interventions to prevent each complication.

4. What possible reasons for N.O.'s fall.

 5. What are the methods for assessing N.O.'s mental status.

 6.What arethe possible reasons for his altered mental status.

 7. Three individualized nursing diagnoses and goals for N.O.

8. What are nursing actions related to altered mental status.

9.What are four successful outcomes for N.O.

 10. Develop a teaching plan for N.O.

 11.what are the community resources N.O. may need after discharge"

1. As for the sort of admission assessments in favour of N. O. , thereby we privation just a inadequate collection of criteria: Collegian – holiness – persuasiveness – accomplishment – give consent.

 Given N. O. 's age and condition, specific assessments would include:Given N. O. 's age and condition, specific assessments would include:

 Fall Risk Assessment: Such as the Morse Fall Scale which helps to identify his risk of falling.

 Cognitive Assessment: Delirium or dementia or other cognitive assessment tools such as Mini Mental State Examination (MMSE) or Confusion Assessment Method (CAM) etc may be employed to screen for delirium.

 Pain Assessment: Assessing the patient’s complaint to determine the intensity of pain in the hip and also in the assessment, evaluating the effectiveness of pain control measures.

 Functional Status Assessment: In particular, defining the initial level of dependency in personal care (Barthel Index of activities of daily living – ADL or the FIM scale).

 Nutritional Assessment: Evaluating his dietary needs to get proper nutrient to assist in the healing process.

 Psychosocial Assessment: Assessing their social stimulating factors related to him such as; emotional and psychological self support system.

 Medication Review: Review of patient’s current prescriptions with the aim of ascertaining all probable side effects or complications.

 2. Adverse Outcomes That N. O. Is at Risk For

 DVT and PE with an acute care setting

 Pressure Ulcers

 Infection, especially surgical site infection

 Pneumonia

 Delirium

 Falls

 3. Measures That May Be Taken to Avoid Each of the Complications

 DVT/PE: The measures include proper anticoagulation, wearing of compression stockings, and early mobilisation.

 Pressure Ulcers: These include repositioning at least every two hours, skin checks and the utilisation of pressure-relieving equipment.

 Infection: Following strict procedures on aseptic measures, observation of the site of operation, and taking antibiotics as advised.

 Pneumonia: Promoting adequate respiratory patterns, practice of incentive spirometry and early mobilisation.

 Delirium: Some of the physical interventions are; Ensuring the patient is not agitated and confused, reducing the use of physical restraints, and adequate fluid and food intake.

 Falls: Employment protection measures, prevention of falls and pressure sores, and use of Walker or Wheeled Walker.

 4. Reasons Behind N. O Fall Now that we know the nature of competition in the telecommunications business let us look at some of the sources of competition that led to the fall of N. O.

 Environmental Factors: Such things like inadequate lighting, use of rugs that are not well secured and many things that are likely to be found on stairs and not on flat surfaces.

 Muscle Weakness or Balance Issues: This may be attributed to; aging or some other temporary condition of the body.

 Medication Side Effects: Like feeling dizzy or developing low blood pressure due to the taking of antihypertensive drugs.

 Cognitive Impairment: Premonitory top-level clinical alterations which could have existed before the fall.

 Undiagnosed Neurological Condition: Such as a transient ischemic attack (TIA), but also warn of possible future development of a major stroke.

 5. Ways of Evaluating N. O. ’s Psychological Condition

 Mini-Mental State Examination (MMSE): To check the cognitive capabilities of the clients.

 Confusion Assessment Method (CAM): To proposed screening test, i. e. the 3D assessment tool, for assessment of delirium.

 Montreal Cognitive Assessment (MoCA): To use in diagnosing minor neurocognitive disorders.

 Clock Drawing Test: For example, as a primary pass ‘high-level’ screening for cognitive impairments.

 6. That is why I have mentioned all the possible reasons for his altered mental status in the essay.

 Post-Operative Delirium: Can be seen frequently in the elderly patients postoperative.

 Medication Effects: Especially from anesthesia, opioids or sedatives.

 Infection: From a urinary tract infection or other ailments such as pneumonia.

 Electrolyte Imbalance: For instance, hypoglycemia, anemia, hyponatremia, hypokalemia and hypocalcemia.

 Hypoxia: Because of conditions that result from low oxygen levels or oxygen deprivation in the course of an operation or after an operation.

 7. Three individualised nursing diagnose and goals for N. O.

 Risk for Falls: Goal: N. O. will not experience falls while in the facility.

 Acute Confusion: Outcome: N. O. will show the orientation and cognitive function has improved.

 Impaired Physical Mobility: Goal: N. O will progressively become more mobile and be able to feed, wash, dress among other activities with help.

 8. Nursing Interventions Regarding the Patient with Altered Mental State

 Frequent Reorientation: Recover N. O. ‘s sense of time and space using clocks, calendars and simple discussion.

 Monitor Hydration and Nutrition: Sustain appropriate fluid and nutrient consumption to avoid water and electrolyte loss.

 Minimize Environmental Stressors: Minimize a noisy setting, uses good lighting and makes the environment as relaxed as possible.

 Monitor and Review Medications: Discuss with the healthcare team to modify some medicines that may bring about confusion.

 9. Four Positive Achievements for N. O.

 N. O. is not experiencing falls throughout his rehabilitation course.

 N. O. demonstrates enhances mental status, no acute confusion noted.

 N. O. ’s level of mobilization has improved and he can now go around with the help of a walking aid unilaterally.

 N. O. is also able to gain proper discharge to home care with a right kind of support mechanisms in place.

 10. Teaching Plan for N. O. L.

 Pain Management: Self-care: (teach patient about various methods of pain management which include drug administration and non drug interventions).

 Mobility and Safety: Train the intermediate patients on ways of transferring safely, utilization of mobility aids and how to prevent falls at home.

 Medication Education: Give details on the medicines likely to be taken the duration for which they will be taken, the quantity, and potential unwanted effects.

 Signs of Complications: Instruct on potential cues for complication such as; infection, DVT, worsening confusion etc.

 11. This is the list of community resources that N. O. in may require after discharge.

 Home Health Services: To extend the rehabilitation and nursing services.

 Physical Therapy Services: For further physiotherapy strengthening, and mobility exercises.

 Senior Transportation Services: For appointments and running different chores that one may need to do.

 Support Groups: To accompany its employees in a joyful activity that will help them cope with stress.

 Meals on Wheels: If necessary to maintain diet for recovery stakes NOTE: If necessary patient must be fed appropriately during his/her recovery time.

Carilion Clinic

Case History/Background

Nestled in the Commonwealth of Virginia between Salem and Vinton is the city of Roanoke, whose population was approximately 98,000 in 2010. The metropolitan area population was about 309,000. Bisected by the Roanoke River and circled by the Blue Ridge Mountain Parkway, Roanoke is the commercial and cultural hub of western Virginia and southern West Virginia.

The community that became Roanoke was established in 1852. Early economic development of Roanoke resulted from its importance as the junction point for the Shenandoah Valley Railroad and the Norfolk and Western Railway. These railroads were essential for transporting coal from western Virginia and West Virginia. Roanoke's service area includes a regional report, shopping malls, a regional hub for United Parcel Service, and manufacturing plants for General Electric, Yokohama tires, and Dynax, a maker of friction-based automobile parts.

Carilion Clinic

Carilion Clinic employs almost 12% of Roanoke's population. The clinic includes 9 freestanding hospitals, 7 urgent care centers, and 220 (and increasing) practice centers, and it employs over 650 physicians in more than 70 specialties. The clinic has 1,026 licensed beds, not including 60 neonatal intensive care unit beds. The clinic had 48,659 admissions in fiscal year 2014-15.

The clinic's joint ventures and related companies include the following:

Carilion Clinic Physicians, LLC (real estate holding company)

Carilion Emergency Services, Inc.

Carilion Behavioral Health, Inc.

In March 2010, the same month and year the Affordable Care Act became law, the clinic was ordered by the Federal Trade Commission to divest itself of an outpatient surgical center and an imaging center. Both had been acquired as it sought to re-create ""The Mayo Clinic"" medical delivery model.

Led by Edward G. Murphy, M.D., from 1998 to 2011, Carilion Health System became Carilion Clinic, a vertically integrated health-care system. During Murphy's tenure the system expanded to include graduate and undergraduate medical education programs, a school of medicine (through a partnership with Virginia Polytechnic Institute and State University Virginia Tech), and, perhaps most impressively, Carilion established an accountable care organization in partnership with Aetna insurance company.

Dr. Murphy's total compensation was almost $2.3 million in 2007. Nancy Agee, the clinic's chief operating officer at the time, earned the next highest salary of about $800,000. When Murphy resigned in 2011, Ms. Agee was promoted to president and CEO. In fiscal 2014, Carilion Clinic net revenue was $1.5 million. Agee's salary was $1.9 million.

CONTROVERSY IN ROANOKE

Despite its philanthropic mission and positive effect on Roanoke, Carilion Clinic has not always enjoyed a good relationship with its community.

  In May 1988, the U.S. Justice Department's Antitrust Division sought to prevent the merger of Roanoke's two hospitals: Memorial Roanoke Hospital and Community Hospital of Roanoke Valley. The lawsuit sought to block the merger because of the monopoly it alleged would result. Less than one year after the suit was filed, the Fourth Circuit U.S. Court of Appeals found for defendants Memorial Roanoke Hospital and Community Hospital of Roanoke Valley.

  The merger between defendant hospitals would not constitute an unreasonable restraint of trade under the Sherman Act $1. The merger would strengthen the competition between the hospitals in the area because defendant hospitals could offer more competitive prices and services.

In the two appeals that followed, courts found for defendant hospitals, which then merged and were named Carilion Health System. The decision provided legal basis for what is now the Carilion Clinic.

IN A MARKET: WHAT CONSTITUTES A MONOPOLY?

A monopoly occurs when one or more persons or a company dominate an economic market. This market domination results in the potential to exploit or suppresses those in the market or those trying to enter it (supplier, provider, or consumer).

  During the 19th century, the U.S. government began prosecuting monopolies under the common law as ""market interference offenses"" to block suppliers from raising prices. At the time, companies sometimes sought to but all supplies of a certain material or product in an area, a practice known as ""cornering the market"".

  In 1887, Congress passed the Interstate Commerce Act in response to railway companies' monopolistic practices in small, local markets. This legislation protected small farmers who were being charged excessive rates to transport their products. Congress addressed monopolistic practices further by passing the Sherman Antitrust Act of 1890, which limited anticompetitive practices of businesses. The act blocked transfer of stock shares to trustees in exchange for a certificate entitling them to some of the earnings. The Sherman Act was the basis for the Clayton Antitrust Act of 1914, the Federal Trade Commission Act of 1914, and the Robinson-Patman Act of 1936, which replaced the Clayton Act.

  Antitrust or competition laws address three main issues:

Prohibit agreements or practices that restrict free trade and competition among business entities.

Ban abusive behavior by a firm dominating a marker, or anticompetitive practices that tend to lead to such a dominant position.

Supervise the mergers and acquisitions of large corporations, including some joint ventures.

The Herfindahl-Hirschman Index (HHI)helps implement these laws by providing a mathematical method to determine market ""density"", or the concentration of the market. Antitrust laws and methods of calculating market density, such as HHI, are imperfect and can leave gaps that may be exploited.

  Since its establishment, the mission of the Federal Trade Commission has remained largely unchanged. Laws affecting private enterprise and government agencies have not. It is possible this mal juxtaposition underlies many of the difficulties in the healthcare industry.

VERTICAL INTEGRATION: THE MAYO CLINIC MODEL

The Mayo Clinic is the leading example of vertical integration in the delivery of healthcare in the United States. Founded in Rochester, Minnesota, in 1863, the Mayo Clinic began as the medical practice of William Worrall Mayo and his two sons, who were also physicians. It grew to include a comprehensive array of specialties. Mayo developed different levels of care across the health services continuum. The result was a vertically integrated health system. Mayo physicians are salaried at market levels, and they control the management structure.

  Mayo Clinic is headquartered in Rochester, Minnesota; it has satellite clinics elsewhere in the United States. In addition, Mayo and various medical centers worldwide have consulting and referral relationships. Mayo provides excellence and dedication in delivery of services with a constant, and self-admittedly stubborn, commitment to core values, which include that the needs of the patient come first, the integration of teamwork, efficiency, and mission over profit.

  Mayo has been long recognized for high performance, research and innovation. It has ranked at or near the top of ""Honor Roll"" hospitals through the history of U.S. News and World Report's best-hospital rankings. In 2015 - 2016, Mayo clinic had more number one rankings than any U.S. hospital or system. Eight specialties ranked number one: diabetes and endocrinology, gastroenterology and gastrointestinal surgery, geriatrics, gynecology, nephrology, neurology and neurosurgery, pulmonology, and urology.

FORESHADOWING A MAYO CLINIC CLONE

Even before Murphy took the helm in 2001, Carilion Health System actions had stirred significant, but manageable, controversy in the community. Much of the controversy resulted from the antitrust case in 1988. After the court ruled that the merger did not violate federal law because it posted no threat of monopoly, the hospital continued its previous work in the community.

  After becoming CEO, Murphy began to vertically integrate the Carilion Health System. His formal plan was presented in fall 2006. Part of evolving to a Mayo-style organization included acquiring physician practices in the community; some were closed after acquisition.

WHO IS EDWARD G. MURPHY, M.D.?

Edward. G. Murphy earned his BS from the University of Albany, New York, and his medical degree (with honors) from Harvard University Medical School. Although he never practiced medicine. Murphy was a clinical professor at the University of Albany School of Public Health and an adjunct assistant professor at Rensselaer Polytechnic Institute School of Management. Before leaving New York state he was also a member of the New York State Hospital Review and Planning Council, and he served on its executive committee as the vice chair of the fiscal policy council.

  From 1989 to 1991, Murphy served as the vice president of clinical services at Leonard Hospital, a 143-bed facility north of Albany, New York. In 1991, he was promoted to president and CEO of Leonard Hospital until it merged with St. Mary Hospital fo form Seton Health system in 1994. Murphy became president and CEO of that new health system and stayed with Seton until 1998, when he relocated to Roanoke to head Carilion Health System.

  During his tenure at Carilion Clinic, Murphy managed the growth of that two-hospital health system into a vertically integrated model of healthcare delivery anchored by a 500-physician specialty group practice that included nine not-for-profit hospitals, undergraduate medical programs, an array of tertiary referral services, and a multistate laboratory service. In 2007, Murphy announced plans for the Virginia Tech Carilion School of Medicine, which opened in 2010. In 2010, Murphy was paid $2.27 million ($1.37 million in salary and $900,000 in benefits).

Murphy's other roles in the Roanoke community included memberships on the boards of Healthcare Professionals Insurance Company and Trust; Luna Innovations, Inc; and Hometown Bank. He is past chair of the Art Museum of Western Virginia. He also served in an influential position with the council on Virginia's Future, which works to frame the growth and progress of the state, including businesses, people, and the health of the population.

  Murphy left Carilion to become chairman of Sound Physicians, a national provider of Intensivist and hospitalist services. In 2012, he became the operating officer of Radius Ventures, a venture capital firm that invests in health-related companies.

VERTICAL INTEGRATION: BECOMING A ""CLINIC""

Murphy was always clear about his plans for Carilion Health System. In an August 2006 interview, ""Right now...our core business is hospital services. In the new model, the core business will be physician services; the hospital will become ancillary. In a 2007 interview for Health Leaders Magazine, Murphy explained, ""I've been enamored of this model of healthcare delivery for a long time.""

  In Fall 2006, Murphy, his staff, and the leadership board of Carilion Health System announced their plan to  a new model for Carilion management characterized by teamwork and salaried physicians and other caregivers focused on patients across the spectrum of care. Murphy explained:

  The essence of the clinic model is that hospitals stop becoming independent businesses and start becoming ancillary services to the physician practice....If hospitals eventually want to provide better and more cost-effective healthcare, it's a necessary shift.

The transformation was planned for seven years with an 18-month phase -in of its new name, Carilion clinic. Plans for Carilion Clinic included a 50-50 partnership with Virginia Tech University in Blacksburg, Virginia, to establish a private, not-for-profit clinical research institute and a new medical school. Further, from 2007 to 2012 Carilion clinic would add four or five fellowships for physicians to support its mission.

Ground was broken for the much-anticipated university in early 2008. On July 20, 2009, the Virginia State Council for Higher Education approved the Virginia Tech Carilion School of Medicine as a postsecondary institution. It's first class matriculated in fall 2010.

THE WALL STREET JOURNAL EXPOSE

Usually, an organization is pleased if the Wall street Journal publishes an article about it. That is, of course, unless the story ignites a firestorm that leads to separate citizen and physician coalitions working against the organization and raises the specter of a word from Carilion Clinic's prehistory: monopoly.

""Nonprofit Hospitals Flex Pricing Power. In Roanoke, Va., Carilion's Fees Exceed Those of Competitors: The $4,727 Colonoscopy"" was published on the front page of the Wall Street Journal August 28, 2008. The author, John Carreyrou, explored Carilion's history, including the 1989 antitrust case, its expanding""market clout,"" and the strides toward its goal of vertical integration. The article suggested that some of the means used were questionable.

  Carreyrou asserted that skyrocketing healthcare costs in Roanoke were partially caused by, or possibly even led by, Carilion Clinic.

  In a press release, Carilion Clinic denied monopolistic practices or exploitative pricing and claimed it faced robust competition from Lewis-Gale Medical Center located in nearby Salem, Virginia. Carilion Clinic defended its pricing practices by noting it must cross-subsidize emergency departments and care for the uninsured.

  Unsettling to some, however, was Carilion's practice of suing patients for unpaid medical bills. After Carilion obtains a court judgement, a lien is placed against the patient's home. A lien on real property puts a ""cloud"" on the title, which prevents the owner from conveying the property with a clear title until the lien has been satisfied. Responding in the Wall street Journal, Murphy stated,

  Carilion only sues patients and places liens on their homes if it believes they have the ability to pay ... If you're asking me if it's right in a right-and-wrong sense, it's not...But Carilion cannot be blamed for the country's ""broken"" healthcare system.

Murphy asserted that Carilion efforts to protect its financial interests meet legal requirements, but may be morally flawed. This position appears inconsistent with Carilion's mission that 'Patient Care Comes First.""

WHERE WERE THE LOCAL MEDIA?

As reported by Carreyrou, Carilion Clinic complained several times to editors of the Roanoke Times regarding reporter Jeff Sturgeon's coverage of the system. Shortly after the complaints, and mainly in response to a May 2008 article by Sturgeon, Carilion greatly reduced advertising in the Roanoke Times. About the same time, Sturgeon, the paper's longtime health issues writer, was reassigned.

Even after Sturgeon's reassignment, Carilion continued to be frontpage news in the Roanoke Times. Reporter Sarah Bruyn Jones covered community reaction to the Wall Street Journal article and the impetus it gave to local coalitions. Her articles included the following: ""Carilion Critics Draw Hundreds to Meeting"" (September 2008); ""Fed Agency Looks into Carilion Purchase"" (September 2008); ""Carilion Footprint Expands in Deal"" (August 2008); and ""Carilion to Buy Cardiology Practice"" (August 2008). Jone's reporting put Carilion practices at the forefront for Roanoke's citizens, but, as noted by Carreyrou, Carilion growth seemed unstoppable.

THE BACKLASH

The August 2008 Wall Street Journal article resulted in a community uproar and fueled physician's' efforts to air their concerns about Carilion, including its anti competitive actions and unfair pricing, and their desire to have open referrals for patients from outside Carilion's health network. Citizen and physician coalitions met in hotel conference rooms and community centers to discuss the ""unfair practices and behaviors"" ifof Carilion Clinic. One, the citizens Coalition for Responsible Healthcare, sponsored a petition that read as follows:

  To Dr. Murphy and the Carilion Health System Board of Directors:

  Please reconsider your Carilion Clinic plans. I want to keep my right to choose my doctor, even if he or she is an independent physician. Please rethink spending $100 million of my community's money on a Clinic model that could ruin our hospitals! Monopolies are never good for healthcare.

The Coalition's website offered copies of the Wall Street Journal article, video recordings of their meetings, information about a new forum program, and membership form for those who wished to join their efforts.

  The citizen coalitions stated they intended to focus on the negative impact of Carilion's transformation to a physician-led clinic that they asserted will increase costs and drive out many local physicians. Murphy's plan was to bring into Carilion as many physicians as possible; all of whom will be salaried. The concerns of citizen coalitions stemmed from the scope of the effort, which resulted in closure or sale of many physician practices. Unaffiliated physicians asserted they could not compete. Further, Carilion's system of internal referrals, added to the purchase of existing practices, gave many specialists no choice but to leave, or stay and fight.

  Despite the controversy, Carilion has shown no signs of slowing: it has stayed the course outlined in Fall 2006.

CARILION'S RESPONSE

On August 28, 2008, less than 24 hours after publication of Carreyrou's Wall Street Journal article, Carilion responded. Statements published in newspapers and posted on Carilion's website, as well as press releases, stated the allegations and conclusions drawn from them were misleading and misinformed.

  In response, Carilion directed readers' attention to the Virginia Hospital and Health care Association PricePoint Website. It showed that Carilion's prices are comparable to surrounding hospitals and are generally lower than its closest competitor, Lewis-Gale Medical center in neighboring Salem, Virginia. To support their position on pricing,Carilion stated ""Medical care in hospitals is more expensive ... having staff and technology at the ready has its costs. Also mentioned was Carilion's Lifeguard helicopter, which is subsidized service. Carilion provided $42 million in charity care in 2007 and an additional $25 million in free care (bad debt written off), thus illustrating its dedication and support of its service area. Carilion supports research and education substantial resource commitments that add major costs to the organization and provide subsidize services tiot the community.

  In explaining the policy to sue patients, Carilion stated that efforts are made to qualify patients for public programs, as needed. Further, Carilion said only ""a small fraction of the nearly 2 million"" patient billings each year go to court.

  Court filings are a final resort, and we try to be flexible. If the judgement includes a lien on an individual's property, we do not foreclose on the lien. The lien is satisfied if and when the property is sold.

In response to concerns about its internal referral practice, Carilion stated that referrals are sent from physician to physician in the system with the intention of sending patients to better, more-qualified physicians who have earned the referral. The ""earn, not force"" mentality contributes to the goal of well-coordinated care and service, which is the first choice of patients.

Carilion's press release closed by describing a wasteful and poorly organized U.S. healthcare system that is hoped to improve with the vertically integrated clinic model of providing care. The hope is that comprehensive, high quality, and cost-effective care will put the patient first. The reader of the press release is reminded that what happened at Mayo could be replicated at Carilion.

CURRENT SITUATION IN ROANOKE

As noted, Carilion Clinic has a medical school partnership, an expanding physician practice with a robust specialty list, and its own accountable care organization, which continues to show progress and increased membership.

Three decades after the hospital merger controversy began in Roanoke, Virginia, the economic and healthcare environments have changed, the population is increasing, and healthcare costs are rising. When the antitrust case was brought in 1988, Roanoke had among the lowest health insurance premiums in Virginia; now, they are among the highest.

Discussion questions to be answered

1) Identify the problems Carilion Clinic faces as it seeks to become a comprehensive, vertically integrated healthcare provider.

2) Briefly explain the summary of the case

3) Identify the most important factors/facts of the Case study

4) Explain the critical issues that is the most important health administration problem/issue to be solved and if applicable, identified secondary problems."

1. Issues that Carilion Clinic encounters as it tries to become a full-service, vertically integrated health care organization

 Carilion Clinic faces several challenges as it pursues a vertically integrated healthcare model:Carilion Clinic faces several challenges as it pursues a vertically integrated healthcare model:

 Community Backlash and Antitrust Concerns: The transition has provoked many criticisms for an abusive exercise of the market power and for the increase of the health costs. It has brought serious doubt from the people which had created a sort of collusion between the citizens and physicians against Carilion growth.

 Financial Strain and Pricing Power: Contrary to Internet promotion, it was reported in the Wall Street Journal that the prices in the clinic remain high. Of note is the fact that changes in price-sensitive perception also fueled the backlash, with Carilion saw is as malicious.

 Internal Referral System and Physician Relations: Internal referals at the Carilion clinic have been considered as a sign of market manipulation, where the clinic creates conditions that make it hard for independant physicians to survive. This had prompted criticism in that the competitive advantage was eroded and patients‘ choices being limited.

 Legal and Regulatory Scrutiny: Some of Carilion’s expansions are under the scrutiny of the Federal Trade Commission and other relevant authorities with penalties for monopolistic practices if proven.

 2. Summary of the Case

 Carilion Clinic has expanded from a two-hospital system into a multi-speciality, vertically integrated healthcare organisation in Roanoke, Virginia, under the administration of Dr Edward G Murphy. The change process was intended to mimic the Mayo Clinic system, in which attention was paid also to integrated, patient-centered care and practice consisting of salaried medical specialists and support service providers. However, the transformation of these ber-dimensional data has raised much debate, specifically alleged monopolistic behavior by some companies enjoys, skyrocketing health costs, and vehement billing tactics. This brief period of fire is due to the unfavorable critical article published in the Wall Street Journal that stirred up the community against Carilion which is trying to reinvent the nature of healthcare delivery in its area.

 3. Major Factors/Information of the Case Study

 Vertical Integration Strategy: That is, Carilion’s strategic plan to become a Mayo Clinic like vertically integrated healthcare system is at the heart of the case.

 Community Backlash: One of the reasons is that actual purchases by citizens and accused monopolistic practices by physicians and other citizens.

 Legal and Regulatory Issues: The role that the Federal Trade Commission has is rather significant, along with reservations about antitrust legislation.

 Financial Practices: Costs and charges for Carilion’s services and how the Wall Street Journal made the company look like they are exploiting the financially-vulnerable patients are major issues.

 4. Critical Issues: The single most significant health administration problem or issue to be addressed

 The major concern in this case is how the organisation can balance the exercise of vertical control and yet still retain the support of the community. In expanding the healthcare model, Carilion Clinic faces moments of resistance regarding issues to do with monopolistic production of healthcare services, expensive services, and relatively low competition. This means that successful service integration must be done in a way that patients do not feel that they are provided with fewer service options or are charged exorbitantly hence acting against what the clinic aims to deliver and is seen under more regulatory restrictions.

 Secondary Problems:

 Physician Relations: The anti-kickback regulation concerns need to be addressed in future by Carilion addressing the issues concerning independent physicians as well as issues to do with competition triggered through the internal referral pattern.

 Public Perception: The clinic requires damage control for its operation in order to be trusted again in the community and also, on its pricing and billing services as well.

Examine the clinical manifestations, pathophysiology, and developmental considerations for Type 1 and Type 2 diabetes mellitus

Consider the developmental implications of Type 1 diabetes on children and Type 2 diabetes on adults. (consider the age of onset with respect to the physiological, psychological, and social implications of the disease)."

Type 1 and Type 2 Diabetes Mellitus: Signs and Symptoms, Etiology, and Understanding of Growth and Development

 1. Type 1 Diabetes Mellitus, known also as insulin-dependent diabetes.

 Pathophysiology:

 Autoimmune Destruction: Type 1 diabetes is an autoimmune disease that results from the body’s immune system’s attack on and destruction of the insulin-producing betal cells of the pancreas. Thus, for example, there is practically complete absence of insulin necessary for correct carbohydrate metabolism and lipid.

 Insulin Deficiency: Insulin helps to carry the glucose into the actual cells hence its absence or incapability of functioning as expected means that the glucose remains in circulation which is known as hyperglycemia. This in the long run causes the breakdown of fats to cater for energy needs, leading to the production of ketones which provoke Diabetic Ketoacidosis (DKA) a life threatening ailment.

 Clinical Manifestations:

 Polyuria (Frequent Urination): Hyperglycemia results to osmotic diuresis which makes the flow of urine to increase.

 Polydipsia (Increased Thirst): Vine has evidences seen that explain that when the body loses fluids through urine, there is production of thirst signals.

 Polyphagia (Increased Hunger): The cells are hence starved of the glucose even when the body has high blood sugar levels, a factor that results to increased hunger.

 Weight Loss: Lack of insulin makes the body to start burning fatty tissues as well as muscles in a bid to provide the required energy for the body.

 Fatigue: Lack of glucose in cellular structure produces a lack of energy or power in the cells.

 Developmental Considerations in Children:

 Physiological: T1DM children expect to take insulin throughout their lifetime. It increases chances of growth delays if their diabetes is not well controlled and such complications as DKA.

 Psychological: The continually having to take insulin injections, testing blood glucose levels, and avoiding certain foods is also difficult. Children can suffer from anxiety or depression or, can have this feeling that they are not like others.

 Social: Health issues such as the necessity to get sick several times a year and the necessity to change something in appearance may influence the communication with people. In this case, body ornaments may be affected due to the need to check the level of glucose and injection of insulin may have an impact on the performance of the child in school activities.

 2. Diabetes mellitus type 2 or non insulin dependent diabetes (NIDD)

 Pathophysiology:

 Insulin Resistance: T2DM results from impaired ability of the body’s cells to respond effectively to insulin – insulin resistance. First, pancreas responds to this change by increasing its insulin secretion to normalise blood sugar levels, however pancreas fails to secrete sufficient insulin required by the body hence hyperglycemia occurs.

 Beta-Cell Dysfunction: The self-decompensation of beta-cells to produce lesser amounts of insulin over time adds to hyperglycemia.

 Clinical Manifestations:

 Hyperglycemia: As with T1DM, hyperglycemia is frequent, yet the development may be more chronic than acute.

 Obesity: T2DM patients are overall, overweight or obese and this is because insulin resistance often leads to obesity.

 Fatigue: As in Type 1 DM, fatigue ensues from poor utilisation of glucose in the body.

 Blurred Vision: Swelling is then produced in the lens of the eye due to the effect of high blood sugar hence the vision changes.

 Slow Healing of Wounds: High blood glucose levels narrow the blood vessels and weaken the immune system, therefore aggrevates problem of slow healing and frequent infections.

 Developmental Considerations in Adults:

 Physiological: T2DM patients experience cardiovascular diseases, hypertension, hyperlipidemia, and other complications during adult periods. Its chronic nature is characterised by complications which include neuropathy, nephropathy and retinopathy.

 Psychological: Stress, anxiety and depression conditions can be ascribed to T2DM diagnosis if complications exist. Lifestyle modification requires dietary changes, exercise and such aspects could be a course of concern for mental health.

 Social: Knowledge about diet and the necessity of making changes to such a diet as well as regular physical activity might also be met with social concerns among adults with T2DM. As for the attained harsh and adverse effects, there might be changes in social events and diet which can bring about isolation.

 Developmental Implications of Diabetes

 The Development of Type 1 Diabetes in Children

 Cognitive Development: The changes in glucose level concentrations, especially the hypo- and hyperglycemia can influence patient’s cognitive performance most of all, their ability to pay attention and memorize items.

 Emotional Development: Since this disease becomes chronic there are flashes of anger, frustration or sadness which children may experience. Those affected can also have issues affecting their self-esteem and how they feel about their body.

 Independence: That is why, as children grow older, they are to be on their own to manage the condition, and it turns out to be a major developmental issue.

 A Look at Diabetes Mellitus in the Adult Patients

 Aging and Comorbidities: T2DM usually occurs in adulthood and is linked with similar complication such as cardio vascular diseases, hypertension, arthritis among others. These co morbid conditions are sometimes difficult to manage with diabetes mellitus, adding to the challenge of care.

 Work and Family Life: The issue is diabetes management as adults can easily get burnt out owing to work and family demands.

 Quality of Life: The chronic sequels of T2DM like neuropathy or blindness harm not only the patient’s quality but also his/her independence.

 Conclusion

 There are so many effects of diabetes on individuals; however, depending on the age when the disease emerged, there are some developmental effects. These conditions hence need to be managed in integrated fashion to allow for optimization of functioning and quality of life since there are always physiological, psychological as well as social consequences of these disorders.

 References

 American Diabetes Association. (2022). Standards Of Medical Care In Diabetes — 2022. Hashmi S of Diabetes Care, vol 45, suppl 1, pp S1–S296,.

 Atkinson, M. A. , Eisenbarth, G. S. , & Michels, A. W. (2014). Type 1 diabetes. The Lancet, 383(9911), 69-82.

 Powers, A. C. , & D’Alessio, D. 2018). Endocrine pancreas and pharmacotherapy of diabetes mellitus and hypoglycemia. In Brunton, L. L. , Hilal-Dandan, R. , & Knollmann, B. C. (Eds. ), Goodman & Gilman's: Pharmacological by Casarella, M. M. & Frishman, W. H. Introduction to the 13th Edition of Goodman & Gillman’s Pharmacological Basis of Therapeutics. McGraw-Hill Education.

Step 1 The scenario:

Your unit has hired a new nurse who has never worked with patients diagnosed with endocrine disorders. As a veteran nurse, you will provide guidance to the new nurse and help her locate the information she needs to properly assess her patients.

Step 2 Select an endocrine disorder other than diabetes mellitus for this discussion and, if necessary, research the clinical manifestations of the disorder.

Step 3 Describe the alterations in endocrine functioning associated with the disorder you have chosen. Use your personal experience, if it's relevant, to help support your discussion"

Step 1: The Scenario

 You are a veteran nurse and you have a new inexperienced nurse who has no knowledge about endocrine disorders. In order to minimize her poor results for patients with endocrine problems, you have to equip her with the basic information.

 The second step of the process is choosing an endocrine disorder:

 Endocrine Disorder Chosen:  Thyroid hypofunction

 III: Changes in Endocrine Functioning Related to Hypothyroidism

 Hypothyroidism Overview:

 Hypothyroidism can be referred to as thyroid deficiency in which the thyroid gland does not secrete adequate amount of hormones. The affliction may be endemic or inherent, that is, caused by diseases and disorders of the thyroid glands itself, or else, it may be induced by deficient secretion of thyroid-stimulating hormone (TSH) by the pituitary glands.

 Clinical Manifestations:

 Fatigue and Weakness: Lack of thyroid hormones in the body also leads to a low metabolic rate hence, chronic fatigue and weakness of muscles. This is because thyroid hormones are used in the regulation of production of energy and control of metabolic activities within cells.

 Weight Gain: This is characterised by weight gain in patients who even consume a small amount of food or even less as compared to the normal individual. This happens because, with a slow metabolism, fewer amounts of calories are burnt and these result to addition of weights.

 Cold Intolerance: Apart from that, people suffering from hypothyroidism may experience cold sensations, as the thyroid hormones are instrumental in thermoregulation. Metabolic rate implies on the production of heat; consequently, the smaller rate results in less heat production.

 Dry Skin and Hair: The skin and hair also require thyroid hormones for their well being and for any sort of treatment. Hypothyroidism may cause dermatologic manifestations such as dryness and flakiness of skin, hair thinning and brittleness as a result of slow inflammation and seborrhea.

 Constipation: When the level of thyroid hormone secretion is lowered, the movement of the intestines also decreases that causes constipation. This is so because Thyroid hormones affect the motility of the G. I tracts and other processes of digestion.

 Depression and Cognitive Impairment: Hypothyroid problems accompanied by challenging the nervous system and can cause such symptoms as depression, mood swings, and cognitive problems. The thyroid hormones play a crucial role on the function of the brain and on the regulation of mood in people.

 Bradycardia: Ectopic movements are observed and consist of tremor and an efflux of impulses, which leads to arrhythmias; Bradycardia is common due to thyroid hormones’ effects on cardiac activity. Leaving out some of the other side effects, the low metabolic rate can also be evidenced by low rate of heartbeat.

 Goiter: In some situations the lack of thyroid hormones that is caused by hypothyroidism does cause an increase in TSH, and consequently its buildup in the gland, which results in goiter.

 Alterations in Endocrine Functioning:

 Decreased Thyroid Hormone Levels: Hypothyroidism is a condition in which thyroid gland is underactive and is not capable of producing enough T3 (triiodothyronine) and T4 (thyroxine). These hormones are required for the regulation of many metabolic activities in various tissues of the body.

 Elevated TSH Levels: Primary hypothyroidism is the result of intrinsic dysfunction of the thyroid gland and low levels of T4 and T3 cause increased TSH levels due to the tries of the pituitary gland gland to stimulate the thyroid gland for more production of thyroid hormones.

 Reduced Metabolic Rate: The total reduction in the Thyroid hormones reduces the basal metabolic rate and affects energy generation, heat production and all the physiological processes of the body.

 Personal Experience (if applicable):

 If you have personal experience with hypothyroidism or have managed patients with this condition, you might share examples of common challenges and effective interventions:If you have personal experience with hypothyroidism or have managed patients with this condition, you might share examples of common challenges and effective interventions:

 Example: You may explain how patient-enabling with regard to the changes that are necessary in ones daily life, for example with regard to diet and exercise, can help with the symptoms and quality of life.

 Example: Comparing experiences with coordinating endocrinologists and the regular check on thyroid function tests so as to determine appropriate dosage modifications could also be an idea.

 Resources for Further Information:

 American Thyroid Association: Contains information about hypothyroidism, as well as such tools as brochures and checklists for patients.

 Endocrine Society: Offers extensive material on endocrine disorders with focus on Hypothyroidism.

 Through consideration of these aspects of hypothyroidism, the new nurse will equally be in a better position to examine as well as attend to patients with the endocrine condition, we well as understand their feelings.

Case Study 1

Anna Giannopoulos, age 85 years of age, lives alone in the family home. Her Husband, Kostas was admitted into Care Shore Aged Care Facility, two weeks before his 87th birthday. They have been married for 60 years and have never spent long periods of time away from each other. Anna enjoyed working in their vegetable and flower garden together. This is where Anna and Kostas spent their time talking fondly about their life, children and grandchildren. Anna prided herself on her cooking skills, especially when Kostas brought in fresh vegetables from their garden. After dinner, Anna and Kostas would spend the evening, having a cup of tea whilst they watched a movie.

Anna has stopped shopping and cooking due to her worsening arthritis. She finds it difficult without Kostas as she speaks very little English. Kostas have always driven Anna to the local fresh produce market, where Anna loved wondering around the markets, chatting with people and picking her ingredients. Anna has always loved cooking for Kostas and her family.

Since Kostas has gone, the family do not visit as often as they did before because they now must share their time between visiting Kostas in the Aged care facility and Anna in her home. Anna refuses to visit Kostas and has told Julie, that she feels bad about not being able to care for him at home.

Anna is constantly worried about her finances. Kostas took care of all the finances and bill paying. Even though Kostas had retired, he often made little amounts of money selling his produce at the local market and working in his friend's garden for a small fee.

Anna is often short of breath and dizzy but she has refused to see her GP about her chest pains as she always visited the GP with Kostas.

Anna spends time in her room and is often found crying and seems very sad. She is reluctant to leave her room after having several falls recently. Her daughters have bought Anna a walking stick, which she refuses to use as she has stated ""...she feels very embarrassed about the walking stick at her age...and she feels people have treated her differently when she uses it"". She has not seen her friend, Dulcie and her husband, Frank for weeks. Since Kostas left, they hardly come around anymore. Anna tells Julie she feels unkempt, Kostas would drive her to the hairdressers and nail technician.

Julie has observed these changes in Anna and has documented it in her progress notes several times. Her daughters, Irene and Sia confide in Julie that Anna is quite often wearing dirty clothes and the house is unkempt, her garden is overgrown, and she does not spend any time in her vegetable and flower garden. They have offered to help; however, she does not want to be a burden to them.

After speaking to Sia and Irene, Julie rings and reports this to the team leader and RN that visits Anna once a month. The RN has documented that Anna's blood pressure is low and shows signs of dehydration and weakness. She has lost 12kgs in the 3 months Kostas has been away. Her joints are stiff and painful first thing in the morning. Anna is not moving around as much and has stopped attending her aqua-aerobics classes with her friend Dulcie.

Anna is very religious and finds comfort by gong to the Greek orthodox church. This is where Anna comes together with her lifelong friends. They enjoy having a cup of tea after mass. They sit and reminisce about the mother land; this brings Anna great joy. Irene and Sia, think Anna should stay at home and not maintain her social networks at the Greek orthodox church during this time as socialising and praying is not important at her age.

Anna refuses to use her walking stick and Anna's daughters are afraid she may fall.

Julie reports this to her supervisor and Registered Nurse. A case conference is scheduled with Anna and her Daughters Irene and Sia. The purpose of the case conference is to involve Anna and her  daughters in the identifying of needs, reviewing her care plan and the implementation process.

   state why is it important that the care teamwork in collaboration with Anna to identify her physical, psychological and social needs. Consider why it is important to implement effective support services, according to preferences, likes and dislikes.?"

Interactive Patient Case - Oncology & Hematinics

 At the Cancer Center you are an infusion Nurse. Your first patient of the day is a 26 y/o female with a history of systemic lupus erythematosus (SLE) induced nephropathy s/p kidney transplant in 2011 on immunosuppression, hypertension, and a newly diagnosed non-Hodgkin's Lymphoma. She here to be treated with the following chemotherapy: Rituximab, Cyclophosphamide, Vincristine, Doxorubicin, Prednisone (RCHOP). No one has educated her on her chemo yet, so she asks you to explain how each of the above medications work 1).________.

 During her 8 hour infusion, your patient tells you her right arm (where the peripheral IV line is located) is starting to feel painful. Upon examination, you notice it is red, swelling, and feels warm to the touch. Since this occurred right after you administered doxorubicin, you suspect it is 2)______; and go grab the reversal agent _______.

 In the next month, your patient returns for her 2nd cycle, but you notice that her laboratory values are out of range. Her white blood cell count is 2480 cells/uL, absolute neutrophil count is 410 cells/uL. This is an adverse effect of her cytotoxic chemotherapy and called 3)._______. Your patient will not be treated with chemo today, but you discharge her with this agent 4)______, to improve her white blood cell count. Because her toxicity would put her at risk of infections, you counsel her to perform the following preventative measures 5).________.

 1). Drug mechanism of each of the above chemotherapy

2). Definition/name of toxicity __________; Reversal agent ______________

3). Name of toxicity

4).

5). Counseling points (3 separate counseling points)"

IMT 517: Computer Applications in Health Professions Interactive Patient Case Oncology & Hematinics

 1. Essential Action of Every Chemotherapy Agent

 Rituximab: This is a monospecific antibody that binds to the CD20 cell surface antigen of B-cells. Rituximab works by attaching itself to a ‘marker’ known as CD20 on the surface of these faulty cells and assists the body’s defense mechanisms in eliminating these cancerous cells and stopping them from multiplying.

 Cyclophosphamide: It is an alkylating agent that is formed from a cross-link between the two strands of DNA thus inhibiting DNA replication and transcription. This eventually results in cell death especially in fast growing cancer cells as the research shows.

 Vincristine: This is a vinca alkaloid that stops the formation of microtubules in the course of cell division. That causes the suppression of formation of mitotic spindle and which stops the division and leads to death of cancer cells.

 Doxorubicin: This is an anthracycline antibiotic that inserts into the DNA and in the process interferes with the activity of the DNA and inhibits topoisomerase II. This leads to the passive suicidal death of the cancer cells, which is termed as apoptosis or programmed cell death.

 Prednisone: It is a corticosteroid that helps in the reduction of inflammation and also has the ability to suppress the immune system. It does so by binding to complexes that transcribe genes that code for pro-inflammatory cytokines and in so doing minimizes the proliferation of tumor cells as well as the symptoms associated with cancer.

 2. Toxicity and Reversal Agent

 Name of Toxicity: This patient presented symptoms of Doxorubicin extravasation, which is a common adverse effect in which the drug escapes the targeted vein and disperse to adjacent tissues leading to finding redness, swelling as well as warmth at the IV site.

 Reversal Agent: Totect is the reversal agent of extravasation of Doxorubicin This reversal agent is Dexrazoxane. It is applied as a burn dressing and to minimize the damage in cases of extravasation injury.

 3. Name of Toxicity

 Name of Toxicity: The patient’s laboratory values demonstrate Neutropenia is a decrease in the absolute neutrophil count (ANC) and can predispose the patient to have more risks of acquiring an infection.

 4. Agent To Increase The Count Of The White Blood Cells

 Agent: To increase the number of white blood cells especially neutrophils, an agent is can be used which is Filgrastim trade name Neupogen or Pegfilgrastim trade name Neulasta. These are G-CSFs that enhance the production of neutrophils will be used in this study upon meeting the requirements of this protocol.

 5. Counseling Points

 Avoid Crowded Places and People with Infections: Indeed, because of neutropenia, your immune system is weak, so it is advisable to avoid any setting that may expose you to infections. This include staying away from crowded places and people be affected with diseases such as flu.

 Maintain Good Hygiene: Maintain cleanliness of hands wash it regularly with soap and water in order to avoid the spread of the virus. This serves to minimize the infections from germs and bacteria in the human body.

 Monitor for Signs of Infection: These are signs that indicate that the body is fighting off infection, as it should: fever, chills, sores, etc. You should consult your doctor if you have any of these signs because quick treatment is vital.

 Thus, with the knowledge of these factors of chemotherapy administration, the nurse can guarantee that a patient will receive safe and effective treatment avoiding possible complications.

Question Topic: The presentation of the Ottawa Charter for Health Promotion in 1986 flagged the start of progress in the manner that wellbeing experts teach and engage people and populaces

. Utilizing the activity spaces of the Ottawa contract for wellbeing advancement and your wellbeing advancement project, clarify how the ideas of Health Literacy, Health Education and Health Promotion identify with strengthening and at last the job of wellbeing experts?

Instructions: Using the Health Promotion program YOU are producing for the Expo Assessment, exhibit your comprehension of how the key Ottawa Charter activities apply concerning YOUR objective populace or local area. This paper ought to talk about how wellbeing proficiency, wellbeing training and wellbeing advancement add to engaging this populace and the attendant's part in giving them.

The utilization of headings is empowered in this exposition, with the Ottawa Charter activities the most legitimate decision. Inside the conversation around every Ottawa activity and how it identifies with YOUR program, associations ought to be made where proper, in regards to proficiency, schooling and strengthening for YOUR specific objective populace. For instance; if talking about the wellbeing proficiency of a matured multicultural populace that you are focusing for a cardiovascular wellbeing advancement program; what plans have you considered to address this in the conveyance of your mission? How should education affect the achievement of your program? What Ottawa Charter activity is busy working here?

Understudies should utilize the stamping guide gave to comprehend the normal norm and nature of work. They should utilize proper assets and reference as needs be, utilizing the college affirmed referring to style; APA 6th release.

Question

1.What is your perspective on the BCR idea?

2.How might you deal with

         (a) contact signatories to the Giving Pledge and

        (b) how might you stand out enough to be noticed?

3.What different items could be utilized for a reason substance? What are the significant components of a reason substance?

4.How are rivals in the financial business prone to react to the BCR whenever set up?

5.Aaron accepts that verification of-idea for the BCR and proof of customer affinity to switch administrations is needed to draw in altruistic financing for acquisition of a current bank.

6.What elective methods for setting up interest for BCR administrations could Aaron utilize?

7.What client social difficulties will BCR face drawing in clients?

8.What are the difficulties of utilizing VAL's typologies for focusing on purposes?

9. How might BCR have the option to utilize these to precisely estimate the size of the intended interest group and buyer interest?

10.Fundamentally think about the components which have formed your perspectives on Aboriginal and Torres Strait Islander people groups' way of life and wellbeing. Your basic reflection ought to incorporate reference to how your own perspectives on Australian Aboriginal and Torres Strait Islander individuals have been formed by your family esteems and mentalities, school instruction, individual encounters, broad communications, writing or some other impacts

NB: Parallels can be drawn from the encounters/comprehension of Indigenous individuals from another nation however center should get back to similitudes with Australian Aboriginal and Torres Strait Islander individuals.

Question

1.By following the Gibbs intelligent cycle set up a nursing understudy reflection on situation."

Ottawa Charter for Health Promotion: an analysis and its relevance to health promotion programmes

 The Ottawa Charter for Health Promotion was introduced in 1986 providing the key courses of action for enhancing the health of a population. Highlighted areas of action and principles in the implementation of health promotion activities are emphasised. Here is a demonstration of the concepts of Health Literacy, Health Education, and Health Promotion as it entails Power Dynamics and the involvement of health personnel in one’s health promotion program or campaign.

 1. Building Healthy Public Policy

 Concepts Related: HL: a more recent concept that came after health literacy and is almost equivalent to it since it entails the process through which people gain health knowledge for the purpose of improving their health.

 Health Literacy: Let policies be made in such a way that people will in one way or the other be able to follow them with ease. For example, policies that create easily consumable health information of the community.

 Health Education: Policies should encourage programmes that enhance the health literacy levels of the target audience.

 Health Promotion: Education is the core business and therefore promoting policies that nurture health and well being.

 Application to Program: In a cardiovascular health promotion program for multicultural elderly, they should promote such policies as access to health-screening and educational material that meets culturally diverse needs of the elderly.

 Reference: Below are the Ottawa Charter for Health Promotion. (1986). The first International Conference on Health Promotion. Ottawa: WHO.

 2. Creating Supportive Environments

 Concepts Related: , Health Education principles, Promotion of Health

 Health Literacy: Build up settings that people are able to acquire, process and comprehend simple health information and services.

 Health Education: Fostering that there is a congruent tangible and shared environment for the educational process.

 Health Promotion: Creating settings that will help facilitate changes in positive and negative habits.

 Application to Program: See that the health promotion plan covers other forms of support such as the community health workers who are culturally sensitive. Ensure that places where programmes and events are to be held are well accessible and welcoming.

 Reference: Nutbeam, D. (2000). Health Literacy as a Public Health Goal: A CALL FOR CONTINUED REDEFINITION OF HEALTH EDUCATION AND COMMUNICATION FOR HEALTH INTERVENTIONS IN THE NEW WORLD OF THE TWENTY-FIRST CENTURY. Health Promotion International, 15(3), pp 259-267. doi:10. 1093/heapro/15. 3. 259.

 3. Strengthening Community Action

 Concepts Related: Health literacy: health education, health promotion.

 Health Literacy: Empowering community members to understand their health necessities and how they are able to alter their health.

 Health Education: The use of a community-based approach to education and its implementation to promote appropriate activities among the people.

 Health Promotion: Supporting community participation in ownership and in the stewardship of health related endeavors and processes.

 Application to Program: It is recommended that health education should be developed in cooperation with leaders of the local community and other relevant organizations. Base interventions on what the community is saying.

 Reference: Labonte, R. (1993). Community Action and Health Promotion: A Review Of The Literature. where Self-Care Science is the official journal of Health Promotion International, 8(2), 113-126. doi:10. 1093/heapro/8. 2. 113.

 4. Developing Personal Skills

 Concepts Related: HLHE, HIV, AIDS Surveillance, Disease Control and Prevention

 Health Literacy: Stress on improving people’s capacity in the management of their health.

 Health Education: Education of people with the knowledge aspect and skills they require for health management and decision making.

 Health Promotion: Promoting and enhancing positive—and reproducing negative—health behavior and self-care practices using knowledge guiding and expanse of skills.

 Application to Program: Create sessions as well as materials that improve individual attributes perceptible to the improvement of cardiovascular health including nutrition and exercise.

 Reference: Green LW, Kreuter MW. Health Promotion Planning: Described below is an Educational and Ecological Model. McGraw-Hill.

 5. Reorienting Health Services

 Concepts Related: When it comes to health, the principles of HL, HE, and HP.

 Health Literacy: To promote Health Literacy for all persons in order that health services used by them are accessible and understandable.

 Health Education: Preparing health care personnel to provide care that respects the health literacy of a patient and to teach a patient effectively.

 Health Promotion: Changing disease management orientation from curative to preventative and promotional.

 Application to Program: Demand for capacity of the health professionals to promote cultural competence in service delivery and healthy practice interventions.

 Reference: B. Starfield & L. Shi, ‘’Exploring English National Health Service Use Among Elderly Patients in Mainland China’’, 2004. The Medical Home, Access to Care, and Insurance: ; A Synthesis of the Literature. Pediatrics, 113(5), 1493-1498. doi:10. 1542/peds. 113. 5. 1493.

 Additional Questions Addressed

 1. BCR Concept: The BCR (Business Case for Reform) concept is important in analyzing the need to transform health systems in order to enhance the delivery of services and result.

 2. Contacting Signatories:

 It is recommended to use the following channels and messages: (a) contact via referrals and direct communication pointing to the common tangible interests.

 Engaging presentations for a case shall be developed and forceful arguments of the need and utility of the case shall be availed.

 3. Cause-Related Content: Use articles, case studies or any other form of opinion of a respective expert. Major elements are relevance, perceived emotions, and strong marketing calls to action.

 4. Competitors' Reaction: There can be an increase in the quality of services offered, the development of new strategies to cope with the situation and regain the share of market.

 5. Alternative Methods: Ensuring there is proof of concept – Partnerships, pilot projects and utilizing community engagement.

 6. Client Challenges: Concerns that may include trust, accessibility of the services as well as the relevance of the services.

 7. VAL's Typologies: The latter includes the following: The accuracy and efficacy of segmentation strategies is another challenge on this list.

 8. Accurate Estimation: Conduct all operational data analysis as well as market research in order to identify the target audience adequately.

 9. Reflecting on Aboriginal and Torres Strait Islander Cultures: The views are developed based on the personal observations, involvement, formal learning and what one is likely to read or hear in the media. There is no single way to interfere, and one has to admit cultural values and behaviors to be culturally appropriate and sensitive.

 References

 Nutbeam, D. (2000). Health Literacy as a Public Health Goal: Healthy People 2010 as A Call for Contemporary Health Education and Communication Strategies into the 21st Century. Health Promoting International, vol 15, no 3, pp 259-267. doi:10. 1093/heapro/15. 3. 259.

 Labonte, R. (1993). Community Action and Health Promotion: An analysis and discussion of theoretical frameworks known up to the moment of writing for the present research. HPI, 8(2), 113-126. doi:10. 1093/heapro/8. 2. 113.

 Green LW, Kreuter MW. Health Promotion Planning: The Proposed Approach of Education and Innovative Environmentalism. McGraw-Hill.

 Starfield, B. and Shi L. (2004). The Medical Home, Access to Care, and Insurance: We will now, therefore take a Review of the Evidence. Pediatrics, 113(5), 1493-1498. doi:10. 1542/peds. 113. 5. 1493.

How development in nursing theories has affected the society and the environment?

Nursing theories not only has helped society as well as the nursing profession but also impacted the nursing practice and the outcomes of patients through influencing policies. Here’s how these advancements have made a difference:

 Impact on Society

 Patients, therefore, receive improved care and outcomes.

 Improved Practice: This is because nursing theories give frames of references on patient requirements and care measures to be taken. For instance, the Theory of Human Caring from Jean Watson underlines an aspect of kindness, understanding, which results to a more patient-oriented and person-centered care.

 Better Outcomes: These theories have been applied to enhance the health status by developing better and appropriate strategies for Patient care. For example, Self-Care Deficit Theory devised by Dorothea Orem promotes patients’ independence in care resulting in better results in self-care and health in general.

 Empowerment of Patients

 Self-Care: Promoting independence among the patients due to expansion of self-care and health promoting behavior, the significant strategies supported by Orem and Pender’s theories.

 Education: Nursing theories have impacted on educational models that improve patients’ knowledge on their illnesses and their treatments that enable them make good decisions in treatment compliance.

 Professional Development and Recognition

 Standardized Practice: Sometimes theories serve a principal organized method to execute nursing practices in order to increase protocol and professionalism. This has Increased the status of nurses in the healthcare system and enable nurse to be known as an independent profession.

 Training and Education: Nursing theories justify the nursing curriculum that nursing students undergo in their training to produce efficient and effective patient carers.

 Influence on Healthcare Policy

 Evidence-Based Practice: Incorporation of nursing theories to practice provides an evidence-based practice, which is useful in nursing as it affects healthcare policies and standards. for example patient safety and quality of care theories that have driven changes in policy to decrease medical errors and enhance the delivery of health services.

 Advocacy: In the recent past there has been an emphasis in the cultural factors affecting health hence policies have being formulated in relation to cultural consideration such as the Cultural Care Theory by Madeleine Leininger.

 Impact on the Environment

 Emphasis on Health Promotion and disease Control

 Environmental Health: Incorporation of environmental factors in theories including the Florence Nightingale Environmental Theory has in one way or the other enhanced the aspect of sanitation, control of infection, as well as general health of patients and the general public.

 Sustainability: Inherent goals that promote optimal health and comprehensive health services strengthen preventive and preventative health activities, care concepts for the use of valuable resources and the environment in health facilities.

 Reduction of Health Risks

 Prevention Strategies: Theories that are oriented towards prevention provide the basis for such nursing actions that in turn have positive implications for the health of the community and the environment that has to endure consequences of illness.

 Culture and Climate Shock

 Cultural Competence: This theory by Leininger has been important in the development of cultural competence in healthcare practices so that the healthcare procedures are culturally appropriate; respect to do with cultural and spiritual care; and cultural and environmental assessment so that the healthcare provides can practice the healthcare processes in the cultural and environmental framework.

 Summary

 The creation of the nursing theories has positively affected society, the patients, and the environment in the enhancement of quality care for the people, the advocacy of individual’s rights, definition of the nurse’s roles and responsibilities, and the formulation of the health policies. Implementing of the theories described above has brought positive changes for the people’s health, enhanced patient’s self-governance and shifted to a more comprehensive and improved health system. Such enhancements have not only made their benefits directly to the patients and the health care professionals but have also made focused to the social health pillars mostly on sustainable Health and cultural health.

Identify the different nursing theories and explain them in your own words?

Nursing theories offer structures for conceptualizing and direction the discipline of nursing. Here are some prominent nursing theories explained in simple terms:

 1. Florence Nightingale’s Environmental Theory

 Explanation: The following is a brief look at the environment from Florence Nightingale ’s theory. He assumed that a clean, well-ventilated, and a comparatively noiseless atmosphere is helpful for the recovery process. Nightingale formulated what she considered as work prerequisites such as cleanliness, diet and pure light as some of the fundamental aspects that should address patients’ health.

 Key Points:

 Hygiene and washing of both hands and disinfecting surfaces are essential.

 The environment should encourage relaxation.

 Light and air, especially fresh air, are desirable for health is a good knowledge.

 2. Jean Watson’s Theory of Human Caring

 Explanation: Nursing theorists; Jean Watson has focused her theory on the concept of caring. The celebrity of the theory is Jean Watson, who was strong in the opinion that caring is the implementation of nursing and that the caring connection between the nurse and the patient improves health. It taught nurses an emotional and spiritual touch and this pointed out that there is still more to be done in nursing than merely addressing symptoms of a patient.

 Key Points:

 Another is the foundational concept of caring or compassion that forms part of the nursing profession.

 Preliminary observation is that one must develop a real and personal relationship with the patients.

 Holistic practice comprises management of the body, emotions, and even the spirit of the patient.

 3. Self-Care Deficit Theory: Dorothea Orem

 Explanation: Dorothea Orem’s theory is anchored on the idea of self-care and how nurses can assist the patients in catering for their needs. According to Orem’s self-care theory, patients must be empowered carry out their self-care needs but if they cannot the nursing roles come in.

 Key Points:

 Patient has a duty to try and take care of himself as far as possible.

 Nurses should assist the patient to break barriers that hinder the patient to practice self care.

 The intended design is to support patient self-management of condition.

 4. Nola Pender’s Health Promoting Model

 Explanation: The concept underlying Nola Pender’s model is aimed at promoting the adoption of health promoting behaviours. Pender did not ignore perceived demographic variables such as nature of work, age or gender yet he concentrated on variables that affect health behaviour such as perception towards certain beliefs about health promotion, peer pressure and perceived benefit comprehended from health promotion. The model is built to encourage participation in positive health practices and the reduction of unhealthy practices and diseases.

 Key Points:

 Instead of prevention of diseases stress on the promotion of health.

 Take into account the cognitive aspects of health approaching it as personal beliefs and perceptions.

 Encourage acceptable self practice in health promoting activities.

 5. In this type of theory, we look at Hildegard Peplau’s Interpersonal Relations Theory

 Explanation: One the main focuses of Hildegard Peplau’s theory is the relationship between the nurse and the patient. For Peplau, phils that underpinned nursing was that it is an interpersonal process in which the nurse and the patient collaborated with an objective of attaining the health objectives of the patient. Knowledge is an important aspect of reinforcing the therapeutic association since the complex and multifaceted needs of a patient need to be well understood.

 Key Points:

 Nursing care of the patient involves the nurse-patient relationship as the key basis for the nursing process.

 It is true that wide, efficient, effective and appropriate communication and integration are central to health promotion and provision.

 The relationship evolves through phases: That is engagement, working, and disorientation.

 6. Betty Neuman’s Systems Model

 Explanation: The theoretic framework that shall be in focus here is that of Betty Neuman who assesses patients as being in a continuous process of interaction with his or her surroundings. It underlines all aspects of a stable life and different ways of regulation. Neuman’s model of care is geared toward stressors that affect the client and how the nurse can assist to minimise such stress and maintain optimal health.

 Key Points:

 Patients are analysed as systems in their environment.

 Stressors do have an implication on the overall health of a person and it will be the duty of the nurse to moderate the stressors.

 It is about stability and health and the achievement of these two former aspects.

 7. By understanding Newman’ s THEORIES OF HEALTH AS EXPANDING CONSCIOUSNESS it is easy to know that health is attained by a continuous process of becoming.

 Explanation: According to Margaret Newman’s theory of health, one cannot talk of health in terms of absence of illness only, but of an unfolding of consciousness. Newman considered the person as undergoing the process of continuous development, and health is a recognition of this development.

 Key Points:

 Health is the ability to reach the state of higher level of development and comprehension of one’s self.

 The private and public nurse are to guide and accompany the patient through theprocess of the patients’ identification and becoming.

 Closely related to the medical one, this paradigm emphasises the comprehensive approach to health and its maintenance.

 8. A Theory That Propose by Madeleine Leininger Called Cultural Care Theory

 Explanation: Getting to cultural understanding remains central to Madeleine Leininger theory of nursing. Leininger pointed out that if the patients are to be adequately cared for then the nurse must take into consideration the culture and beliefs and practices of the patients they are attending to. This includes linking cultural beliefs to care plans, as well as valuing culture.

 Key Points:

 Cultural competency ones of the most important requirements for any nursing practice.

 From the two cases it is clear that it is crucial to respect cultural beliefs and practices.

 Culture sensitivity should be incorporated while giving out care to the patients.

 Summary

 These nursing theories give a new variation of how the clients /patient can be dealt with in the nursing profession, from the milling of the environment and caring nature to the self-care approach and the culture sensitivity. Variety of the theories is informative to the nurses so that they can produce unparalleled care to their patients. Lessons learned: Each of the aforesaid theories is useful in assisting the nurses provide the necessary care to their patients.