Mary is an 80-year-old female who presents to the primary care for her follow-up visit post upper respiratory infection.  Her blood work showed a hemoglobin of 7.2 g/dl which was a drop from her previous hemoglobin of 8.0 g/dl. Mary’s primary care has diagnosed her with anemia.

Questions to Answer:

1. What signs from each body system would you expect Mary might also be exhibiting? Explain each.
2. What other lab values may be affected by anemia?
3. Describe the different types of anemias.
4. What diagnostic test would you expect for Mary to identify the source of the bleed?
5. List nursing interventions and rationale that the provider may order for Mary.

You are the registered nurse on duty at a skilled nursing facility. Judy, a 35-year-old, full-time nurse’s aide on the day shift, has been with the skilled nursing facility for 10 years. You have worked with Judy on numerous occasions and have found her work to be marginal at best. She tries to be extra friendly with the staff and occasionally brings them small treats that she bakes. She also makes a point of telling everyone how much she needs this job to support her family and how she loves working here. She has a disabled daughter who relies on her hospital- provided health insurance to have her health-care needs met. Most of the other staff seem willing to put up with Judy’s poor work habits, but lately, you have felt that her work has shown many serious errors. Things are not reported to you that should have been-intake and output volumes that are in error, strange recordings for vital signs, and so on. She has tried to cover up such errors, with what you suspect are outright lies. She claims to have bathed patients when this does not appear to be the case, and has said some patients have refused to eat when you have found that they were willing to eat for you. Although the chief nursing officer acknowledges that Judy is only a margin- ally adequate employee, she has been unable to observe directly any of the behaviors that would require disciplinary action and has told you that you must have real evidence of her wrongdoing in order to for her to take action. During morning report, you made a specific request to Judy that a confused patient, Mr. Brown, assigned to her, be assisted to the bathroom, and you told her that someone must remain in the room to assist him when he is up, as he fell last evening. You also told Judy that when in bed, Mr. Brown’s side rails were always to be up. Later in the morning, you take Mr. Brown his medication and notice that his side rails are down and after pulling Up and giving him his medicine, you find Judy and talk with her. She denies leaving the them side rails down and insisted someone else must have done it. You caution her again about Mr. Brown’s needs. Thirty minutes later, you go by Mr. Brown’s room and find his bed empty and discover he is in the bathroom unattended. As you are assisting Mr. Brown back to bed, Judy bursts into the room and pales when she sees you with her patient. At first, she denies that she had gotten Mr. Brown up, but when you express your disbelief, she tearfully admits that she left him unattended but stated that this was an isolated incident and asked you to forget it. When you said that it was her lying about the incident that most disturbed you, she promised never to lie about anything again. She begged you not to report her to the chief nursing officer and said she needed herjob. You are torn between wanting to report Judy for her lying because of concerns about patient safety and also not wanting to be responsible for getting her fired. To reduce the emotionalism of the event and to give yourself time to think, you decide to take a break and think over the possible actions you should take.

Evaluate this problem. Is this just a simple leadership-management problem that requires some problem solving and a decision or does the problem have ethical dimensions? Using one of the problem-solving models, solve this problem (Traditional problem solving process, nursing process, MORAL decision-making model)

Case Study #1:

You are a nurse in an acute care hospital. Your new patient JD is in the hospital for fractures. His chart showed he has type 2 diabetes with HbA1c of 8.0%. JD’s sister came in to visit at lunch and brought him a Big Mac (3 slices of bread) with large fries on the side in addition to a bag of potato chips and a bottle of orange juice. You are concerned about the high carbohydrate content of the meal and discussed this with JD and JD’s sister. JD’s sister said, “I know my brother has diabetes, so I didn’t bring him soda or dessert.”  JD said “I really love my carbs, but I know I should avoid all carbs to make my sugar low. Doctor said something about my ‘A1c’. Do you know what that is about?” Both JD and his sister said they would like to learn more about diabetes and diet.

• Q1. Please explain to JD why he needs carbohydrates and describe the 2 functions of carbohydrates mentioned in the lecture
• Q2. Please explain to JD’s sister the different types of carbohydrates. Provide 2 examples of simple carbohydrates and 2 examples of complex carbohydrates.
• Q3. Please explain to JD and his sister what the HbA1c test is and how to use A1c level to categorize normal blood sugar, pre-diabetes, and diabetes according to the ADA. Please also describe the target HbA1c level for people diagnosed with diabetes.
• Q4. Please explain to JD and his sister some of the diabetes treatment options, including diet, exercise, insulin injections, and oral medications.

Who are the stakeholders, and what gains or losses do each have?