Patient rounds involve various disciplines coming together to discuss the patient’s condition and coordinate care. They are used as an educational tool and also help keep everyone on the same page when it comes to the treatment plan. The following case is found in the textbook (Pharmacotherapy: Principles and Practices. Chisholm-Burns et al, eds.  5th edition.  McGraw-Hill.  New York 2019. ISBN-978-1-260-01944-5; Chapter 34. “Patient encounter”).

After reading the assigned chapters in the textbook, resources identified in Dynamed and Evidence based practice guidelines, please present the case to your peers in the form of a discussion. This will be your initial post. Please be sure to address all parts of the case and ensure your responses are well researched [including supporting, evidence based guidelines such those of the WHO, CDC, APS, etc.]. 

Part 1:

HPI:  A 78-year-old man who is to undergo a left above the knee amputation due to a limb abscess

PMH: Peripheral artery disease for 18 years; cardiomyopathy, benign prostatic hypertrophy for 13 years

FH: Mother had osteoporosis; father had diabetes

SH: Lives with wife; has two grown children

Meds: Aspirin 81mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; pantoprazole 40 mg daily; tamsulosin 0.4 mg daily

Pain Assessment: Patient rates pain as 8 on a scale of 0 to 10.

• Based on the type of injury, what type of pain is this patient likely to experience?
• What type of pain management regimen would you suggest in the postoperative period? Explain your answer

Part 2:

Following surgery he was placed on morphine patient-controlled analgesia (PCA). He has been using 55 mg of morphine/24 hours with adequate pain control; however, he developed redness and itching on his neck that is believed to be due to the morphine.

Current Meds:  Morphine PCA; aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily; heparin 5000 units twice daily until discharged home. He will be discharged to a skilled nursing facility for rehabilitation therapy.

You would like to convert him to a combination preparation of hydrocodone and APAP for as-needed pain relief.

• What dosing regimen would you suggest?
• What would your monitoring plan include for this patient?
• How would you assess pain response?
• The patient is concerned about the redness and itching that he developed while on morphine. Would you document this as an allergic reaction?
• What other interventions or education may be necessary at this time?

Part 3:

The patient was discharged to a skilled nursing facility and is receiving physical therapy and occupational therapy 6 days each week.

Current Meds: Aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily, heparin 5000 units twice daily until discharged home, hydrocodone/acetaminophen 5/325 mg every 6 hours as needed for pain.

Pain Assessment: Patient reports pain of 7 out of 10; worse with movement.

Physical therapy notes indicate the patient is unable to complete therapy goals due to complaints of pain.

• Based on this information, what would you recommend to optimize pain control?
• Prescribers play a critical role in prescription drug misuse and abuse prevention. What steps can be taken to identify signs of dependence and abuse and what education can you provide to the patient regarding the negative effects of medication misuse?

Part 4:

The patient has been at the skilled nursing facility for 4 weeks and is making progress toward rehabilitation goals; however, he complains that his leg is throbbing and feels like pins and needles. As a result, he requests to rest several times during her therapy sessions. During unit rounds, his therapist inquires whether her previous pain medication should be reordered.

Pain Assessment: 4 out of 10

Current Meds: Aspirin 81 mg daily; atorvastatin 80 mg at bedtime; multivitamin 1 daily; gabapentin 100 mg three times daily; pantoprazole 40 mg daily, tamsulosin 0.4 mg daily, heparin 5000 units twice daily until discharged home,

• What additional recommendations would you have at this time regarding pain management?
• Are there any other therapeutic issues that should be addressed?

The answer to this question must center primarily on Laudato Si, but should also include other material from throughout the course relating to reverence for creation, as well as the other Franciscan values.  Be sure to cite specific readings, and in the case of Church documents, such as Laudato Si, specific section numbers as found in the document.  (Relevant passages from Laudato Si should be chosen from throughout the document, especially the assigned sections, and not merely from the first few paragraphs.)  NOTE WELL:  Your answer is to be BASED on — and ONLY on — the course material: the reading assignments, notes, and other items posted in this course on Blackboard.  The use of other sources is not permitted and will cause a deduction in your grade.  You are also expected to explain the material in your own words and use quotations only to support or illustrate your points.  Your score will be based on both quantity and quality, but especially on how well you explain fundamental concepts, how well you make and explain these connections, and on how thoroughly you integrate the various course materials into your discussion.  I value solid thinking, but also vision and informed imagination. (Recommended MINIMUM length:  c. 750 words)

Question:  The question has two main parts:  a) Explain and discuss the meaning of and deep connections between REVERENCE FOR CREATION (aka ECOLOGICAL JUSTICE) and SOCIAL JUSTICE, especially as brought out by Pope Francis and by the other course readings.  (In other words, discuss how Laudato Si and other course readings emphasize the connections between reverence for creation and social justice.)  b) Then expand these connections to include how perspectives from other religious traditions (at least two others) tie into these.  In other words, what insights on ecology and social justice are offered by other religious traditions?  

https://www.vatican.va/archive/hist_councils/ii_vatican_council/documents/vat-ii_cons_19651207_gaudium-et-spes_en.html

https://www.vatican.va/content/francesco/en/encyclicals/documents/papa-francesco_20150524_enciclica-laudato-si.html

Directions: Identify an outcome of nursing practice in your area of practice that can be improved.  For example, if you work in home health, you may identify that throw rug use by fall risk patients is too prevalent.  You may be able to use the problem that inspired the theory concepts that you developed in week two.

Briefly support why it is a problem with evidence from the literature. This is not the major focus of the assignment so do not elaborate.

Create a clinical nursing (not medical) theory in the form Concept A | Proposition | Concept B. Think of the structure like two nouns and a verb. While the term proposition is much more complex in the dictionary, in our use it is the connecting term between the two concepts. Examples include Concept A improves Concept B, Concept A is related to Concept B, when Concept A increases then Concept B also increases, etc. When you get to research, you will explore this further as you develop independent and dependent variables. How to use these statistically will come in research and statistics courses.

This clinical theory is identified as an empirical theory when you get to the C-T-E model later in this course. It is empirical in that they can be measured.

Identify and define your concepts. Identify how they could be measured in a research study. Be careful that you do not use compound concepts. If you find the words “and” or “or” in your theory, you are probably too complex.

If you research your question and seek funding, you will need a theoretical model to guide the research. In our assignment, we are using Watson. You will identify the concepts in Watson’s theories that are represented by the concepts you are using in your clinical theory. Match the proposition in her theory with your proposition. To help, the 10 Caritas Processes are Concept A. Choose the one that matches your concept. To clarify, let’s look at Caritas 1 Embrace and use it in middle-range theory. Sustaining humanistic-altruistic values by the practice of loving-kindness, compassion, and equanimity with self/others (Concept A – Very complex and abstract) improves (Proposition) subjective inner healing (Concept B). 

Conclude with your discoveries made in your readings and the impact on the nursing profession of your discoveries. Explore, briefly, discovered questions that require further research. Summarize t in the conclusion.

Expectations

• Due: Monday, 11:59 pm PT
• Length: 5 to 7 pages including title and reference pages
• References: 3 to 10.  There should be enough to support the links between the concepts of the problem and the concepts of Watson’s Theory of Caring.

Nutrition & Hydration/Persistent Vegetative State (PVS)

After studying the course materials located on Module 7: Lecture Materials & Resources page, answer the following: ON ATTACHMENT

1. Cure / care: compare and contrast.
2. Basic care: Nutrition, hydration, shelter, human interaction.
   • Are we morally obliged to this? Why? Example
3. Swallow test, describe; when is it indicated?
4. When is medically assisted N/H indicated?
   • Briefly describe Enteral Nutrition (EN), including:
     • NJ tube
     • NG tube
     • PEG
   • Briefly describe Parenteral Nutrition (PN), including:
     • a. Total parenteral nutrition
     • b. Partial parenteral nutrition
5. Bioethical analysis of N/H; state the basic principle and briefly describe the two exceptions.
6. Case Study: Terry Schiavo (EXCEL FILE on Module 7: Lecture Materials & Resources page). Provide a bioethical analysis of her case; should we continue with the PEG or not? Why yes or why not?
7. Read and summarize ERD paragraphs #:  32, 33, 34, 56, 57, 58.

• Cioffi, A. (2018, March 17). BIO 603 3 17 18 [Video file]. Retrieved from BIO 603 3 17 18 (Links to an external site.)
• Cioffi, A. (2019, April 6). BIO 603 CONSENT 4 6 19 [Video file]. Retrieved from BIO 603 CONSENT 4 6 19 (Links to an external site.)ATTACHMENT UPLOAD