Case Study 9. Answer the questions. Health, Medicine, Nursing Essay

For this assignment, read the case study and answer the questions. Each section should have at least 500 words. Thanks.
A.
A nurse had been working in a critical care unit for more than 25 years, gaining respect for her competence and dedication, before suspicions began to gather that she was di-verting narcotics for her own use. The acute care hospital used a computerized medicine dispensary for enhanced distribution and better monitoring of narcotics. The dispensary unit recorded the nurse’s personal keypad code and the patient’s data before it could be unlocked, and narcotics dispensed. Though the hospital was slowly moving to an all-electronic charting system, at present the nurses were also required to document the narcotic usage by handwriting the patient’s name, medication, time, route, and dosage on a more traditional paper medication administration re-cord (MAR). Discrepancies were noted between this nurse’s patients’ electronic data for narcotic administration and the handwritten notations made on the paper record. The nurse was first questioned by her supervisors and then she was suspended, as they did not find her explanations credible. Her grievance was upheld by the arbitrator assigned to the case, and the hospital appealed. At trial, other nurses from the same unit testified that
they frequently completed their paper record documentation during their breaks or at the end of the shift, often when they could not remember exactly what medications or dosages they had administered to patients. There was additional information that the nurses would electronically sign for narcotics, prepare IV drip bags in advance of when they were needed, and then discard these same IV bags when they were no longer required or the physicians had changed the medication orders. Additionally, these nurses testified that they often deviated from the physician’s order for an IM injection, electing to give the medication by an IV route. Finally, there was testimony that the hospital had no formal policy for which nurse was to document narcotics in the paper record when two nurses, such as a preceptor and a mentee, both had responsibility for the patient. The nurse who was suspended testified that she, too, frequently entered data into the paper record long after she had administered the medication and, in some rare instances, entered the data on the following day.
QUESTIONS
1. Did the facility have sufficient evidence to suspend the nurse?
2. How should the testimony of the other nurses in the unit affect the outcome of this case?
3. What additional questions should the institution address before the court rules in this case?
4. How would you have ruled in this case?
B.
The patient was seen by the NP in an outpatient clinic for persistent diarrhea, which the patient had been experiencing for a two-week period. The NP, after consulting with the clinic physician, started the patient on Flagyl, an anti-bacterial medication. Nine days later, the patient phoned the clinic, stating that the medication was making him feel worse, not better. He was instructed to continue with the medication. He collapsed at home the next day and was taken by ambulance to the emergency center where he died. The death certificate pointed to a cardiovascular event with hypertension as a contributing factor; no autopsy was per-formed. The patient’s family sued the NP and the clinic for negligence. At the trial level, the medical expert for the family testified that the NP should have ordered a complete metabolic panel, sent a stool sample for analysis, scheduled a follow-up visit within 48 hours, and taken into consideration that Flagyl can enhance diarrhea.
QUESTIONS
1. How should the expert witness for the defense offer testimony that the NP and the consulting physician had met the standards of care for this individual patient?
2. Did not having a full autopsy impact the outcome of the case either for or against the NP and the clinic?
3. Would the care of this patient have been positively impacted by a more thorough examination of the patient’s gastrointestinal problems?
4. How should the court decide on the issue of negligence?
C.
A licensed practical nurse (LPN) who worked for a nursing personnel agency worked one evening shift at the Veterans Administration Hospital in a major city. She cared for a patient who had recently undergone hip replacement surgery. Since his surgery, the patient had consistently spiked significant temperatures, but his temperature generally responded well to oral Tylenol, 500 mg, tabs ii, every four hours as needed. The change nurse explained to the LPN that the patient was to continue on every-four-hour vital signs, including temperatures, and that he was to be medicated if his fever increased, even if only at low-grade levels. During the evening that she worked, the LPN obtained the patient’s temperature at 4 P.M. and again at 8 P.M. He had a low-grade fever at the 4 P.M. hour, and his temperature had risen to 102 degrees orally at 8 P.M. At both intervals, the LPN administered Tylenol as ordered. The charge nurse did not assess the patient during the evening, nor did she inquire about the patient’s condition. The nurse caring for the patient at midnight noted that his temperature was still elevated (102.4°F orally). When notified, the attending physician ordered blood cultures, additional treatment for his ever-increasing fever, and a change in antibiotic therapy. Despite this aggressive therapy, the patient developed a fatal septicemia, and the patient’s family sued for wrongful death. At trial, the court determined that the charge nurse had been derelict in her duty to supervise this patient and assessed partial liability against the LPN and the charge nurse.
QUESTIONS
1. Did the nurse manager have a responsibility to super-vise the care of the patient?
2. Was the care of this patient appropriately assigned to the LPN by the charge nurse or could the charge nurse have more appropriately delegated the care of the patient?
3. If the charge nurse assigned the care of the patient to the LPN, did she retain any supervisory responsibility that would result in her liability in this case?
4. How do the principles associated with delegation and supervision figure into this case? 5. How would you decide this case?