Referring to Case 10H, (Health Care Ethics, Theological foundations, contemporary issues, and controversial cases) apply the normative basis explained in this chapter to the patient’s medical treatments and request.

Case 10H:

Josephine Stewart, a 78-year-old Caucasian wornan with no family support, has lived for more than ten years with diabetes and, what she has called, “pretty painful” arthritis. In addition to these medical problems, Josephine had a pacemaker inserted nearly six years ago because of her severe arrhythmia.

Yet despite all this, she remained very active: she was a regular volunteer at her parish, attended bingo with friends religiously, and even worked more than thirty hours a week at the Walmart near her home. About a year ago, Josephine noticed significant swelling in her face and neck as well as a “tightness in her chest” that had never been there before.

Initially, she brushed these off as possible side effects from the new medication she was taking for her arthritis. Soon after, though, she began coughing up blood, which prompted her to visit her primary care physician. After extensive testing, it was determined that Josephine had non-small cell lung cancer (NSCLC) with lymph node metasta-
ses (N3), which made her ineligible for surgical resection.

The consulting oncologist suggested, nonetheless, that she undergo chemotherapy to combat the spread of the disease and possibly induce a remission. After considerable reflection and talking with her pastor, Josephine consented to the chemotherapy. Nine months of on-again, off-again chemotherapy did little to deter the NSCLC and after talking with her physicians, Josephine
decided hospice was the best option for her. She told her oncologist “her time had come” and it “made no sense to keep fighting when God was calling.” The hospice nurse was notified and the next day came to visit Josephine to discuss plans for leaving the hospital and being enrolled in hospice. During the visit the hospice nurse made it clear that all curative treatments would be forgone and that this included artificial nutrition and hydration.

Josephine informed the nurse that she understood and made it clear she did not want a feeding tube if and when the time came. To the astonishment of the hospice nurse, though, Josephine asked if she could also have her pacemaker turned off. Her reason was she did not want to have her life prolonged “any more than it needed to be.”

The hospice nurse consulted with Josephines primary care physician, who did not like the idea of turning off the pacemaker. She thought this was “tantamount to euthanasia” and called for an ethics consult to help her work through the conflict.

A 65-year-old Portuguese female, Mrs. M, with a 3-year history of squamous cell cancer of the cervix presents with severe pain in the perineum. The patient lives alone. Her husband died two years ago. She has 6 grown children. She takes care of her 5 grandchildren, ages 3 to 13 while their parents work and she is very close to them. She speaks little English.

1. How might the nurse obtain a thorough pain assessment? What aspects of the pain assessment should be included?

2. The patient describes her pain as an 8 on the 0-10 scale, occurring constantly in the perineum, but is worsened when she voids. She is currently taking hydrocodone/acetaminophen, 2 tablets every 4 hours (12 tablets – 60 mg hydrocodone ≈ 60 mg morphine). She frequently awakens and takes the medications during the night. She states (with help of the translator) that the medicines relieve the pain by approximately 25%. What can be done to ease Mrs. M’s suffering?

3. Examination of the perineum reveals inflamed excoriated tissue from the labia to the rectum. Additionally, stool appears to extrude from the vagina. As Mrs. M’s nurse, what can you do?

4. You are working night shift and observe the following: The excoriation is cleared, and the pain is under control with 10 mg of morphine q 4 hours (or 6 doses/day). She uses approximately 3 additional doses of 10 mg of morphine for breakthrough pain per day. Thus, she is using approximately 9 doses/24 hours. Unfortunately she awakens at night in pain. What might be the best analgesic regimen for this patient? She describes no adverse effects to the medications.

5. The patient is being prepared for discharge to hospice at home when she expresses some concern regarding her son, who has a history of substance abuse. She is afraid he might use her medications. How will you react to this information?

Explain how inter-professional collaboration will help reduce errors, provide higher-quality care, and increase safety. Provide an example of a current or emerging trend that will require more, or change the nature of, interprofessional collaboration. Please use at least 2 references so I am able to expand

Understanding how policy affects patients’ and health care consumers’ overall health will bolster an already well-established understanding of the importance of nurses’ advocacy for their patients.

Consider the health outcomes of patients who are either uninsured or underinsured. Provide details about how health policy can positively and negatively have an impact on the rate of uninsured and underinsured people.

Review The Uninsured and the ACA: A Primer – Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act from the Kaiser Family Foundation.

Part 1 

Address the following questions:

• Who are the underinsured and uninsured?
• Why are they underinsured or uninsured?
• What impact do they have on health care cost?
• What impact do they have on access to care?
• What are the affected resources within hospitals?
• What threats to public health do they pose?

Part 2

Answers the following questions:

Include Introduction and Conclusion

Number and write out the question

1. How has policy affected the rate of underinsured and uninsured individuals?
2. What impact has underinsured and uninsured individuals had on insured individuals in terms of cost, access to care, and resources?

A 35-year-old man with no PMH presents to a clinic with symptoms of fever nausea/vomiting, and a progressive rash. He claims that he was hiking in Colorado with his family and a week later, developed a rash that he states “has a lot of red dots.” The rash is itchy and painful. It started from his wrist and has now progressed to his chest and trunk. The patient’s temperature = 99.3 degrees F, HR = 80, RR = 18, and BP = 110/70. Physical exam reveals a petechial rash that started on his hands (shown below) and has now spread all overe his body. Our patient denies any allergies. What is the treatment for this disease?

a. Penicillin

b. doxycycline

c. Penicillin g and ceftriaxone

d. acyclovir