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Scenario

Staff Nurse: Thank you for agreeing to talk to me about the discussion we had the other day about assigning patient load. As I started to say in the meeting, but got interrupted, is that I really donât like the new plan that we have. I liked the old one better. I donât understand why we need to change.

Leader: You did get to express one concern about visiting patients in Iron Ridge and that is the communityâs high crime rate. We all recognize this issue, and I do understand. But the new patient assignment scheme is meant to match you with patients who will most benefit from your specialty, and not where you live geographically. There are many patients in Iron Ridge who have diabetes that need your expertise.

Staff Nurse: Wellâ¦ I really do love my patients and I donât hold it against them that they live in a bad part of town. But frankly, Iâm afraid! Every night when I watch the news, there is somebody thatâs been involved in a shooting or a carjacking. I talked to my husband about it and he said that if you insist I go over there, he wants me to quit. Itâs not safe!

Leader: [audible pause] I have an idea I would like to explore with you. What if we sent an escort to accompany you on your visits? Would this help you feel safer in that neighborhood?

Staff nurse: Sure, it would, but do you think thatâs realistic? The last I heard, we didnât have any money to give us nurses raises and bonuses. I mean, do we even have the budget for something like security?

Leader: Itâs realistic as long as I can justify the safety of our nurses. Letâs say the cost is not a barrier to this scheme. What do you think? Staff Nurse: [hesitation] Please let me think about it. I need to talk to my husband, too. I canât decide right now, but youâve given me something to consider.

At times the needs of our families conflict with our work responsibilities. Could this possibly be the underlying issue here?

1)Explain the conflict resolution skills displayed by the leader in the scenario. On a scale of 1-10, how would you rate those of the leader.

2)How might earlier collaboration have been beneficial?

3)Some organizations utilize non Registered Nurses in the Case Manager role. What additional skills, knowledge and attributes would the BSN-prepared Registered Nurse bring to case management in this scenario?

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Jarrod RobelLv2

6 Feb 2019

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Related questions

Please help answer 4 questions:

1. Using the information provided thus far by both Parts I and II, answer the following questions.

What problems both stated and unstated does Phyllis seem to be experiencing? What pieces of background information (patient environment and social/family history) have been provided by the family?

2. Distinguish between the relevant and non relevant symptoms/lab results needed to form a diagnosis. Of the relevant symptoms/lab results, rank them in priority and defend your answer.

3. Given what you know about the role of myelin in action potential propagation and the key information previously identified in questions 1 and 2, explain why multiple sclerosis is the appropriate diagnosis.

4. Consider you are the physician, what would be your strategy to slow progression of the disease and compensate for reduced neuronal function? What is the long-term prognosis with treatment?

The Soccer Mom:

A Case Study on the Nervous System

Jennifer Bolognese, Misti Coronel, Anita Intorre, and

Phil Stephens Biology Department Villanova University

Part IâAt the Soccer Game

Thirty-two-year-old Phyllis Jackson was sitting on the bench at the side of the soccer ?eld, sipping a bottle of

Gatorade. Her husband, Steven, sat next to her with a concerned expression. âIâm really worried about you, honey,â he said.

âIâm just a little dehydrated; Iâll be ?ne.â

âIf this were the ?rst incident, then maybe Iâd agree with you. But your boss has been on your case about your lack of concentration at work, you forgot to pick up the kids from school last week, and quite frankly, you havenât exactly been yourself with me lately. Now youâre having fainting spells during games? Something doesnât seem right.â

âI know things havenât been going well for me lately, but I donât know why. I try so hard at work, at home, with the kids, to be a good wife. So maybe all this stress has made me a little unfocused and disoriented. What do you want me to do about it?â Phyllis said, blinking back tears.

âI think you should see a doctor,â Steven replied, putting his arm around her and drawing her close. âThe kids are getting worried, too.â

Phyllis sighed. âAlright, if it will make you feel better. I really just think I need some time to relax, though.â âWellâ¦ I could drop the kids of at my sisterâs tonight; that would give us a little free timeâ¦â

âThatâs really thoughtful of you. I could de?nitely use a quiet night at home, maybe even go to bed early.â Steven seemed disappointed.

Part IIâThe Doctor Visit

âSo, what seems to be the problem, Mrs. Jackson?â Dr. Warner asked Phyllis.

âMy husband wanted me to come in and see you after I fainted during my soccer game Saturday. Iâve also been having some problems at work, but I think Iâm just stressed.â

âWhat kinds of problems have you been having at work?â

âItâs been hard to concentrate on tasks. Iâve also had some problems typingâIâve been making more errors than usual, and oftentimes my ?ngers will go numb.â

âI see,â said Dr. Warner, taking a few notes on his clipboard. âAccording to my records you are not on any long term medication. Have you noticed any problems outside of work?â

âWell, my husband has been complaining about our personal life lately. And last week, I completely forgot that I was supposed to pick up our two daughters after school. Iâve been feeling really tired lately; even my coordination seems of.â

âHow long has this been going on for?â

âA few weeks, but this isnât the ?rst time. These problems seem to come and go, but itâs getting to the point where I canât just ignore them anymore. I donât know, maybe Iâm just depressed.â

âWhy do you say that?â

âMy mother suffered from depression throughout my childhood.â

âWell, depression certainly could cause some of the symptoms youâre experiencing,â Dr. Warner said thoughtfully. âIs there a history in your family of any neurological disorders?â âI donât think so. I have some vague recollection of my grandfather in a wheelchair when I was really young, but I donât know what was wrong with him.â

âOkay,â said the doctor, nodding. âWell, the few preliminary tests weâve run show that you are not pregnant, and that you are not going through menopause. Iâd like to send you to see Dr. Thrush, a friend and colleague of mine. She is a neurologist at the local hospital and she will run a few tests to explore your symptoms a little further.â

Questions: Analyze

1. Using the information provided thus far by both Parts I and II, answer the following questions.

Part IIIâDiagnostic Tests

Dr. Thrush looked over the results of Phyllisâs Magnetic Resonance Imaging (mri) and evoked potential tests. She was thinking how glad she was that Steven had accompanied Phyllis on this visit as she showed them the MR images of Phyllisâ brain.

âThe machine took pictures of Phyllisâ brain in slices. The dark areas are the brain tissue, Phyllis, and the white areas in the middle and around the outside are the cerebrospinal ?uid.â

âIs that normal? Am I ok?â Phyllis asked. âAnd what are those little white dots in the tissue?â

âThe white dots are what concerned me,â replied the doctor. âSo we did another type of mri, called dark ?uid, so that your cerebrospinal ?uid would not show up white.â

âBut I still see the white dots in my brain tissue. What does that mean?â

The doctor looked down, knowing that this was never an easy thing to tell a patient.

âI am afraid that this indicates that there are plaques or scars in your brain, and that you may have multiple sclerosis.â

Tears began to form in her eyes as Phyllis squeezed her husbandâs hand.

âI am afraid that the evoked potential test and the elevated levels of myelin basic protein in you cerebrospinal ?uid indicate the same thing.â

Questions: Evaluate and Apply

2. Distinguish between the relevant and non relevant symptoms/lab results needed to form a diagnosis. Of the relevant symptoms/lab results, rank them in priority and defend your answer.

Part IVâThe Diagnosis

Dr. Thrush informed Phyllis that she was probably suffering from the relapsing-remitting form of multiple sclerosis (ms), in which relapses of symptoms are separated by periods of remission. ms is a disorder in which the myelination of axons is degraded due to unknown factors. The most commonly accepted explanation is that ms is an autoimmune disorder in which myelin in the central nervous system is attacked by the bodyâs own immune system. There is no known cure for multiple sclerosis. During remission, axons affected by the disorder regain their function. Voltage-gated sodium channels are concentrated in the nodes of Ranvier and the distribution changes at disease onset.

Questions: Create

4. Consider you are the physician, what would be your strategy to slow progression of the disease and compensate for reduced neuronal function? What is the long-term prognosis with treatment?

Thank you for your time with this

greyporcupine565

It was about 50 minutes into another long, boring two-hourlecture by Dr. Foster. The tall, thin, grayhaired biochemistryprofessor was concluding a chapter on enzymes. The final topic wasenzyme inhibition. Sarah, an energetic and outgoing junior, wasdaydreaming about her upcoming weekend at home for a familyreunion. She was not really paying attention, but heard theprofessor going on and on about alcohol dehydrogenase. At last, Dr.Foster turned to the class and asked, âAny questions?â Sarah,hoping to side-track the professor, enthusiastically waved herhand. As soon as she received a nod from Dr. Foster, she began torecount a story that her grandfather had told her. âMy grandfathersaid that when he was a teenager, alcohols were used as antifreezein automobiles. A group of kids was hanging out in a friendâsgarage. One of them found two bottles of liquid that were markedâalcohol.â He talked everyone else into trying the alcohol. All ofthe kids became severely ill, but about half of the teens died frompoisoning. Someone later found out that one of the bottlescontained methanol and the other a mixture of ethanol and methanol.The kids who lived drank the mixture. Grandpa figured since I was achemistry major, Iâd know why half died and half didnât, but Ididnât know. Do you?â Although Sarah had planned to side-track theprofessor, her story played nicely into his lesson plan. After all,the incident was related to the current class topic of enzymes andenzyme inhibition. The clever professor began, âLet me remind allof you that the enzyme, alcohol dehydrogenase, catalyzes the firstoxidation step in the case of both ethanol and methanol. Methanolis a very common solvent that is quite toxic. I recall an articlefrom a few years ago that described the largest mass methanolpoisoning reported to date. It occurred in Nicaragua. Of theapproximately 800 poisonings, about 45 patients died and otherssuffered blindness (SEMP Biot #412, 2006). I seem to recall thatpoisoned patients received either ethanol or a drug calledFomepizole as an antidote. I think I have some homework that willhelp you to understand what happened in your grandfatherâs story.âQuestions 1. What are the products of methanol and ethanol. 2. Comeup with a possible hypothesis for why some of the teenagers in thegrandfatherâs story died and the others did not. 3. Come up with apossible hypothesis for the case that include the role of theenzyme alcohol dehydrogenase.

blackspider603

I will like you do grammar check, and rewrite it in another form. This is to avoid plagirsm. Thank you.

The purpose of this research is to explain some advantages and disadvantages of the implementation of the electronic medical record in a general hospital and specific units such as Neonatal intensive care unit. Also, it will emphasize different challenges that physician face when using the eMR as well as some solutions they offered in order to help them to overcome the challenge of typing. Most importantly, it will focus on the beneficial use of the eMR such as reduced time when charting specially in nursing as they spend a lot of time when documenting, it will reduce the time in half when using electronic medical record. Also, the research will review how the electronic medical record can enhance the quality of care to the patient. The electronic medical record will provide all the information needed by the physicians or any health care provider when giving care especially the critical patient who needs a quick intervention. This reseach will provide some information on how the eMR can improve quality of care. On the other hand, it will be discussed how the use of eMR can affect the relationship between a health care provider and the patient. As we know, health care providers have to keep a professional but close relationship with their patients in order to provide care and give the best intervention. However, when a health care provider uses electronic medical record some information might be lost when typing from a paper-based system into the eMR. The journals discuss multiple solutions to overcome and to reduce the risk of losing important information of our patient when typing or scanning the information into the eMR. Ventura, M.L., Battan, A.M., Zorloni, C., Abbiati, L., Colombo, M. Farina, S., & Tagliabue, P. (2011). The electronic medical record: pros and cons. The journal of maternal- fetal and neonatal medicine, 24(1), 163-166. doi: 10.3109/14767058.2011.607582 In this journal, researchers want to implement an electronic medical record in a neonatal intensive care unit. This system will enhance critical patientâs treatment because it will implement bedside clinical observation with machine monitoring data, and results from the laboratory. The time of charting for nurses was reduced but medical staff complained about the lack of automation in the reports. Through this journal researchers demonstrate that even though electronic medical record is beneficial because it reduces the charting time, it also can increase the risk for system error which can be fatal for the patients. In conclusion, electronic medical record should be reviewed for any complication that can influence patientâs life. Fox, G. S. (2014). The people versus the electronic medical record, last Thursday. Acad Pshychiatry, 38, 368-372. doi: 10.1007/s40596-014-0042-x In this journal, physicians express their concern about the use of electronic medical record. Physicians believe that the use of technology interferes with the face to face discussion between patients and doctors. Physician stated that the essential and precious communication has been diminished for both care givers and patients. Indeed, I believe with the use of electronic medical record, the lack of interaction and eye contact between the care giver and patient is increasing. This journal is really relevant within the nursing profession because it raises awareness of how important it is to keep the essential of communication between patients and health care providers. In brief, health care providers should find other way to obtain and record patient information to support the doctors and patient relationship. Ossoff, R. H., Thomason, C. D., & Appleton, J. (2010). Challenges with the electronic medical record. Journal of Health Care Compliance, 12(6), 51-54. Retrieved from http://search.proquest.com/docview/822639350?accountid=3455 The authors in this article examine the different challenges that doctors are facing with the use of electronic medical record. Firstly, physicians have to take training to learn how to use the system. However, to overcome the challenge of typing, physicians proposed an idea of creating well detailed templates that list all organs systems. Indeed, templates should be used just as a baseline of information, to help the users to remember the key elements while adding the patientâs information. This is a good point in documentation because even though templates are easier to fill out, medical staff should keep in mind that documentation should be well detailed. Although the templates might be well detailed, it is better to write your own finding when assessing a client. As the authors mention, templates should be used only as a baseline information. The population of interest regarding this journal will be health care providers and people that might want to go into the health care profession. Perez, S., & Keijzers, G. (2012). Missing data in the electronic medical record. Emergency medicine Australasia, 24 (4), 465. doi: 10.1111/j.1742-6723.2012.01564.x The authors of this research explain the problems that caused the transition from paper-based system to electronic medical record. With the implementation of the eMR all paper-based data are scanned into the eMR using pdf files and then destroyed. This caused many missing information in the eMR because they were destroyed before being verified in the eMR. Some solutions were addressed in this journal including; depositing the data collection sheets and separating them from the medical charts and placing them in the data collection boxes. This might decrease the loss of a patientâs important information. In brief, this journal addresses a very important topic about the importance of completely transferring the patientâs information into the eMR. Also, it creates an awareness to keep paper documentation even though the eMR is present. Hoffman, M.A., & Williams, M.S. (2011). Electronic medical records and personalized medicine. Hum genet, 130, 33-39. doi: 10.1007/s00439-011-0992-y The authors emphasize two important aspects of a fully functional electronic medical record. Firstly, it is necessary to present patients or clinicians with a high quality context detailed information when providing care. Secondly, the users must combine clinical information from different sources in order to guide the clinician to improve intervention for a given patient. According to this journal, the use of electronic medical record can increase quality of providing care. As health care professionals our main goal is to provide the best intervention to our patient and this journal proved that the use of eMR can improve the intervention given to the patient. This is because it can give doctors a quick access to patientâs information in a critical scenario or even when just proving care.