PREPARE A POWER POINT FOR THE CASE STUDY   

6): Brandon and Marilyn Case Study

Justin Tyme – a registered nurse joins the unit after successfully completing new employee and unit orientation. He had worked for 10 years in a similar unit at St Elsewhere but grew tired of the 2 hour daily commute. He is thrilled to be working closer to home. The staff is ecstatic as the unit has been shorthanded and the census is high. The staff likes working with Justin. He is friendly fellow and frequently brings hot donuts and a huge thermos of Peets coffee for the staff. He is always willing to help with lifting and turning patients and often in the first one to respond to patients lights. Justin does not always follow through on his observations and physician orders; he often misses giving routine meds. The staff has taken to routinely double checking Justin’s orders and the following shift often dispenses the missed meds. One morning, Dr. Tauk comes in to review the speech consult he ordered the day before on his patient, Mrs. Dee Phagia, prior to ordering her a diet. Dr Tauk cannot find the consult and asks Charity N. Able RN to locate it and call him. Charity discovers that the order had never been placed. 

On follow up, Charity discovers not to her surprise- that Justin was the nurse who noted the order. Charity does not talk to the manager but does point out the error to Justin who feels terrible about it. Over the next month, Justin continues to make intermittent “small” mistakes which cause no harm to patients and the staff continues to cover. Today, Dr. L. Ovin comes in and notices that her patient, Mr. hart is in atria fibrillation. She orders stat IV digoxin and cancels the scheduled diagnostic procedures. Mr Hart remains in atria fib and as you review his chart, you discover that Justin missed the last two routine digoxin doses.

Base on Health History Guidelines, Health History FormActive, and Health History Worksheet, using RUA Sample Documentation to gather and organize information when conducting the health history of this patient (everything in red is important). 

I also attached a complete Example 2 as reference. 

Remember to include this reference into the work-cited page (add more references as required)

Jarvis, Carolyn. Physical Examination and Health Assessment, 7th Edition. Saunders, 022015. VitalBook file.

Comment 1

“Medication reconciliation is a critical piece of care coordination for all individuals who use prescription medications. 82% of all adults in the U.S. take at least one medication (prescription or nonprescription, vitamin/mineral, herbal/natural supplement); 29% take five or more” (Kantor, et al, 2015). It is easy to imagine with more than 75% of adults taking medication in the United States, that the risk of interactions among prescription and over the counter drugs, along with herbbal supplements, is greatly increased. Pharmacies are getting better about cross-referencing all drugs when new prescriptions come in, but that is only as good as the information provided to them. For example, if a patient uses more than one pharmacy to get their meds filled, and the systems do not “talk to each other” electronically, or the patient takes supplements and herbs and does not notify the physician or pharmacist, there is no way the database will have the information in it. 

Fortunately, there are tools available to patients and families to help with this process in case they omitted certain medications or supplements on their lists that the doctor has. There is virtual tool called “Drug Interaction Checker”, which is a system that cross references the medications the patient is on with any potential dangerous interactions. The patient can enter the names of all medications and supplements into the database for review. If any interactions appeat, they can call the pharmacist or their prescribing doctor to clarify if the medication should be stopped, changed, or continued. 

Comment 2

I agree.  Spiritual care would definitely be an asset in this situation.  Unfortunately, spiritual care is not front in center, at least in the organizations that I have been a part of.  Also, when I worked inpatient and would ask patients if they would like to speak with a chaplain, they used to think something was seriously wrong with them. Some of the cited reasons for lack of spiritual care in hospitals were not having an agreed definition on what spirituality is, what the nurses’ role is in addressing spirituality, the lack of time to meet a patient’s spiritual need, and a lack of training nurses have in spirituality (Rushton, 2014). 

Comment 3

I think this patient is definetly in need of teaching concerning her C-PAP machine for sleep apnea.  Most patients seem to rebel at wearing the mask. So in the first few days especially the nurse could assess whether she is having trouble wearing all through the night. Non-compliant patients need the continued encouragement until they realize how important it is for the progress of their health.  Myown husband for example had to be closely monitored for a year. He would rip it off in the middle of the night and unless I gentle put it back on him he didn’t wear it. and then I didn’t sleep.   Make sure your mask is a good fit. The most common problems with CPAP occur when the mask does not fit properly. So education about the C-PAP is a must for her.

A. Read the three articles below before answering the discussion questions.

•  “It’s Only Natural — Mother’s Love. Mother’s Milk.” BF barriers in the African American communityhttp://www.womenshealth.gov/blog/its-only-natural-mothers-love-mothers-milk.html (链接到外部网站。)链接到外部网站。
• Using a Wellness Program to Promote a Culture of Breastfeeding in the Workplace: Oregon Health & Science University’s Experience, Antoinette Magner; Carrie Anne Phillipi , Journal of Human Lactation (链接到外部网站。)链接到外部网站。, Vol. 31, Iss. 1, February 2015, pp. 40-4
• Factors influencing breastfeeding exclusivity during the first 6 months of life in developing countries: a quantitative and qualitative systematic review,
• Olukunmi Omobolanle Balogun, 2015 John Wiley & Sons Ltd Maternal and Child Nutrition (2015), , pp. 433–451 11

B.  Complete the discussion questions:

1. List the barriers to breastfeeding mentioned and others you recognize based on the review study, “Factors influencing breastfeeding exclusivity during  the first six months” (Olukunmi), and the video link, “It’s only Natural.”

Which of these barriers are surmountable?

2. Explain how you would you set up a community program to encourage breastfeeding. Choose a platform for this program.

Refer to the article above, Üsing a Wellness Program to Promote a Culture of Breastfeeding in the Workplace: Oregon Health & Science University’s Experience”for additional ideas.  

Oregon Program analysis

Do you have suggestions to improve their breastfeeding implementation program?

How well did they address the cultural/ethnic challenges?

Your program objectives

What group will you target (ethnic, socioeconomic, health status) ?

 How will you incorporate nutrition intervention?

 What will your goals be considering some of the barriers mentioned in the articles?

What are some challenges of promoting breastfeeding in another cultural or ethnic group?

3. Submit your comments, then respond to two other student submissions. 

Comprehensive exams in women’s health need to

As with any assessment, the chief complain is often what drives what our questions are and what clinical pathways we explore.  With women’s health that approach is not any different, as we need to explore the “what was”, “what is” and “what will be” for the patient.  The comprehensive assessment is one that is longer in nature and normally saved for the first visit, as if this patient will be a returning patient a more focused examine comes during their following appointments.  The follow is a “blanket” comprehensive assessment that can be tweaked for any patient (Elson, 2008);

1. Chief complaint (is this a focused complaint or a first meeting or annual meeting)
2. History of present illness
3.  Menstrual History
   1.  Age at menarche
   2. Last menstrual period
   3. Menstrual characteristics
      1. Length
      2. How long is flow
      3. Amount of flow
4. Other symptoms? (breast tenderness, pelvic pain, etc)5
5. Pain?
6. Intermenstrual bleeding
7. Perimenopause/menopause
   1. Bleeding pattern
   2. Vasomotor symptoms
8.  Contraception
   1. Current method; is it working?
   2. Previous method; any complications and reason for change
9. Cervical and vaginal cytology
   1. Results and date of most recent pap
   2. Hx of abnormal paps? Why? Treatment?
10.  Infections
    1. Hx of STD?
    2. Hx of vaginitis (types, frequency and treatment)
    3. Hx of PID
11.  Fertility/infertility
    1. Any desire for future?
    2. Difficulty conceiving? Treatments in past?
12. Sexual hx
    1. Type
    2. Concerns about libido, orgasm, dyspareunia
    3. Any hx of abuse? Assault?
13. Obstetric hx
    1. Describe each pregnancy and outcome
    2. Any maternal, fetal or neonatal complications?
14. Past medical history
    1. Current and past illnesses
    2. Hospital admissions
    3. Surgical hx
       1. GYN and Non-gyn
    4.  Medications/allergies
       1. OTC, prescribed, herbal
       2. Allergies to meds, food, environment and reactions?
15. Family hx
    1. Significant illnesses of family
    2. Hereditary concerns
16. Social hx
    1. Relationship status
    2. Level of education
    3. Occupation
17. R.O.S.
18. Abdomino-pelvic
    1. GYN
    2. GI
    3. GU
19. Breast
20. Others

18.Health Maintenance

1. Smoking, alcohol use, drug use
2. Diet
3. Supplement intake
4. Exercise
5. Regular screenings (mammo, pap, colonoscopy)
6. Immunizations and dates

Health maintenance is very important for all ages when related to women’s health.  The following are some ideas of health maintenance for each age group (Well-Woman Recommendations, 2018);

1. Adolescents
   1. If sexually active the patient should have discussion with provider on sexually transmitted diseases and contraceptive use
   2. Drugs and alcohol use
   3. Peer pressure with sexual situations
2. Childbearing
   1. Annual blood work to identify challenges in anemia, TSH, Cholesterol and minerals.
   2. Breast self-awareness
   3. Reproductive health plan
   4. Imitate partner violence

• Peri-menopausal
  1. Hormone therapy
  2. Mammograms
  3. Advance directives
  4. Problems with sexual encounters (pain, dry, etc)

1. Menopausal
   1. Sleep patterns
   2. Changes of the body (hair growth, hormonal changes, sexual changes)
   3. Breast self-awareness
2. Geriatric Women
   1. Sexual function
   2. Injury prevention
   3. Neglect/abuse

Elson, N. B. (2008, July). The Gynecologic History and Examination. Retrieved from The Global Library of Womens Health: https://www.glowm.com/section_view/heading/TheGynecologicHistoryandExamination/item/3#3521

Well-Woman Recommendations. (2018, January 5). Retrieved from The American College of Obstetricians and Gynecologists: https://www.acog.org/About-ACOG/ACOG-Departments/Annual-Womens-Health-Care/Well-Woman-Recommendations?IsMobileSet=false