1. Competency
   Describe strategies for safe, effective multidimensional nursing care for clients with acid-base imbalances.

   Scenario
   Tony is a 56-year-old, Hispanic male that presented to the Emergency Room with complaints of shortness of breath, which he has been experiencing for the past two days. He states “I haven’t felt good for about a week, but couldn’t afford to miss work.” He complains of a cough, fever, and feeling exhausted. Past medical history includes asthma, chronic obstructive pulmonary disease and diabetes. Upon physical examination, you notice that Tony is struggling to breathe, his respiratory rate is 36 breaths per minute and labored, heart rate 115 beats per minute, blood pressure 90/40 mm Hg, and his pulse oximetry is 84% on room air. You notify the MD. He orders oxygen at 2 L via NC and an arterial blood gas.

   Tony’s ABG results:
   pH 7.28
   PaCO2 – 55 mm Hg
   PaO2 – 70 mm Hg
   HCO3 – 30 mEq/L

   Instructions
   In a 1-2 page Word document:

   1. Determine Tony’s acid-base imbalance
   2. Describe possible causes of the imbalance
   3. Identify the signs and symptoms that Tony is exhibiting as a result of the acid-base imbalance
   4. List the multidimensional care strategies that are appropriate for the care of Tony
   5. Resources
      For assistance with citations, refer to the APA Guide.
      For assistance with research, refer to the Nursing Research Guide.
      Submit your completed assignment by following the directions below. Please check the Course Calendar for specific due dates.
      Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:
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Purpose 

The purpose of this discussion is to discuss organizational changes and ethical-legal influences in a clinical scenario at an out-patient family practice. Students will explore potential effects on patient outcomes and ethical and legal implications for members of the heath care team as a result of illegal behaviors.  Students will develop strategies that result in prevention of untoward outcomes that result in a positive practice culture. 

Activity Learning Outcomes 

Through this discussion, the student will demonstrate the ability to: 

1. Demonstrate effective leadership styles in the management of organizational change (CO3) 
2. Interpret various forms of ethical theories and application into practice (CO4) 
3. Discuss practice guidelines and malpractice prevention (CO2) 

Requirements: 

You are a family nurse practitioner employed in a busy primary care office. The providers in the group include one physician and three nurse practitioners. The back office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice, and has an excellent rapport with all of the providers. 

Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of amoxicillin with her and asked if she could have a refill. You noted the patient’s name on the label, and the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie nor do the other providers in the practice. 

Case Study Questions: 

1. What are the potential ethical and legal implications for each of the following practice members? 
   • Medical assistant 
   • Nurse Practitioner 
   • Medical Director 
   • Practice 
2. What strategies would you implement to prevent further episodes of potentially illegal behavior? 
3. What leadership qualities would you apply to effect a positive change in the practice?  Be thinking about the culture of the practice.
4. A scholarly resource must be used for EACH discussion question each week.