Week 3 – Ethical Dilemma

Please reply to the following discussion with one reference. 

Many ethical dilemmas are illustrated in the documentary The Invisible Patients.  The documentary follows Jessica, a nurse practitioner, as she confronts the challenges of caring for homebound patients.  One of her patients is Roger, a 30 year-old male with muscular dystrophy who is nearing end of life.

Jessica is faced with navigating the ethical issues pertaining to establishing a “do not resuscitate” order (DNR).  In the beginning of the film Roger is hesitant to sign a DNR.  He states that he is not ready to die and desires all available interventions that might allow him to continue living, even if that means “bringing him back.” 

Jessica feels that resuscitation would be a painful prolongation of the inevitable.  This stirs internal conflict for her.  She is faced with two opposing possible courses of action.  According to Hamric, an ethical dilemma occurs when a person is faced with two or more obligations that cannot be simultaneously met (2014).  This creates tension due to the differing and opposing demands of these obligations (Hamric, Hanson, Tracy, O’Grady, 2014)  Jessica has undoubtedly seen first-hand the violent and painful process of cardiopulmonary resuscitation, and she obviously knows that these efforts are usually futile, only resulting in unnecessary pain and suffering.  On the other hand, she is duty bound to respect the patient’s autonomy and his personal wishes. 

Jessica handles this situation very professionally.  She gently communicates to Roger and his family the reality of the progressive nature of Roger’s disease.  She tries to put aside her own emotions during the discussion.  Jessica asks open ended questions and empathetically listens to his responses, giving him positive, affirming non-verbal feedback.  In doing this, she is gathering information to help her navigate this ethical dilemma.   This end-of-life discussion was carried out subtly, tactfully, and at length over multiple visits to the patient in his own home. 

These home visits are themselves an example of the NP as a disruptive innovator.  Traditional medicine as practiced today takes place in a clinical setting or a tertiary care center (Hamric, Hanson, Tracy, O’Grady, 2014).  Jessica provides a service that is outside of the status quo by delivering superb patient-centered primary care in the patient’s own home.

I feel I would handle this situation in the same manner.  I believe that it is a fundamental right for people facing terminal illness to decide their own fate.  However, I also believe that fear of death and the unknown that follows too often drives these decisions.  I believe my role is to reassure, encourage, and help relieve this fear so the patient can feel at peace with a decision that reflects the reality of their situation.

Hamric, A., Hanson, C., Tracy, M.F., O’Grady, E. (2014). Advanced Practice Nursing:

An Integrative Approach, Fifth Edition. St. Louis, Missouri: Elsevier Sanders.

Gastro instestinal  Case Study

Chief complaint: “I have recurrent H. Pylori infection”. 

HPI: M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. 

PMH: 

H. Pylori infection gastritis

Diabetes Mellitus, type 2

Surgeries: None

Allergies: NKDA

Vaccination History: Up-to-date

Social history:

High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. 

ROS:

Constitutional: Negative for fever. Negative for chills. 

Respiratory: No Shortness of breath. No Orthopnea. 

Cardiovascular: No edema. No palpitations. 

Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal

Assessment:

Primary Diagnosis: Recurrent H. Pylori infection gastritis

Secondary Diagnoses: Dyspepsia

Differential Diagnosis: Peptic Ulcer Disease

Previous medication plan: two months ago and failed.

1. Clarithromycin      500 mg po BID for 2 weeks
2. Omeprazole      40 mg po BID for 2 weeks and then po daily.
3. Cipro      500 mg po BID for 2 weeks

Plan: Tests

Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results. 

Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test. 

Labs: No new labs are needed.  

Referrals: may refer based on effect of medication therapy given for 2 weeks.

Follow up: return to office in 8 weeks to reevaluate symptoms.

As a future nurse practitioner, it is important that you determine the medications used for recurrent H. Pylori infection. 

Please discuss new therapy guidelines for H. Pylori treatment, and provide patient education.

Below is the website for the American Academy of Gastroenterology Clinical Guidelines (ACG) for the updated H. Pylori therapy. Feel free to consult other peer-reviewed articles within 5 years of publication.

http://gi.org/wp-content/uploads/2017/02/ACGManagementofHpyloriGuideline2017.pdf

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Refection Paper 

The IOM published report, “Future of Nursing: Leading Change, Advancing Health,” makes recommendations for lifelong learning and achieving higher levels of education.

In 1,000-1,250 words, examine the importance of nursing education and discuss your overall educational goals.

Include the following:

1. Discuss your options in the job market based on your educational level.
2. Review the IOM Future of Nursing Recommendations for achieving higher levels of education. Describe what professional certification and advanced degrees (MSN, DNP, etc.) you want to pursue and explain your reasons for wanting to attain the education. Discuss your timeline for accomplishing these goals.
3. Discuss how increasing your level of education would affect how your competitiveness in the current job market and your role in the future of nursing.
4. Discuss the relationship of continuing nursing education to competency, attitudes, knowledge, and the ANA Scope and Standards for Practice and Code of Ethics.
5. Discuss whether continuing nursing education should be mandatory. Provide support for your response.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.  

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. 

The Importance of Health Policy for Health Administrators:

Shi discussed why it is important to study health policy.

• In your own words, explain the significance of health policy for health administrators and why it is important to stay up-to-date on policy trends and debates.

Be sure to cite reliable sources for your answer.

Assignment:

In this assignment, you will develop two separate infographics (informative posters) to discuss two separate health issues relevant to the LGBT communities. In each infographic you will discuss:

• What is the health problem
• Which group(s) are most likely to be at risk
• What social/behavioral/health system determinants affect this
• Identify at least two potential interventions/activities the community, community health agency, community health nurse could offer to prevent and or support this health issue
• What resistance might be met in implementing the intervention/activity

View these links on how to create infographics:

• http://blog.hubspot.com/blog/tabid/6307/bid/34223/5-Infographics-to-Teach-You-How-to-Easily-Create-Infographics-in-PowerPoint-TEMPLATES.aspx
• http://blog.hubspot.com/marketing/free-ppt-infographic-templates-designs-ht

You should submit two infographics and one reference list containing at least three scholarly sources. These can be submitted as three separate files.