Case Study On Biomedical Ethics In The Christian Narrative

To Prepare

· Review this week’s media presentation with Dr. Terry Buttaro. Reflect on the importance of developing an in-depth understanding of pathophysiology.

· Select a disorder from the following list:

· Adrenal insufficiency (Addison’s disease)

· Atherosclerosis

· Cholelithiasis (gallstones)

· Colon cancer

· Cystic fibrosis

· Hemophilia

· Nephrolithiasis (kidney stones)

· Osteoporosis

· Parkinson’s disease

· Tuberculosis

· Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how that factor might impact your selected disorder, as well as potential associated alterations and symptoms.

· Identify the pathophysiology of the associated alterations, including the normal and altered cellular function. Consider both intra- and extra-cellular changes that occur.

Post a brief description of a patient scenario involving the disorder and the factor you selected. Explain how the factor might impact your selected disorder, as well as potential associated alterations and symptoms. Finally, explain the pathophysiology of the associated alterations, including changes in cellular function.

Learning Resources

Required Readings

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

· Chapter 1, “Cellular Biology”

This chapter reviews cellular biology to establish a foundation for exploring the pathophysiology of disease. It also covers the structure and function of cellular components, cell-to-cell adhesions, cellular communication, cellular metabolism, membrane transport, the cell cycle, and tissues.

· Chapter 2, “Genes and Genetic Diseases”

This chapter explores genetic disorders and factors that impact genetic disorders. It also examines how mutations and chromosomal abnormalities lead to transmission of genetic disorders.

· Chapter 4, “Altered Cellular and Tissue Biology”

This chapter examines disorders related to cell adaptation, injury, and death. It also explores disorders associated with altered cellular and tissue function as a result of aging.

Hammer, G. G. , & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.

· Chapter 2, “Genetic Disease”

This chapter reviews the clinical manifestations, pathophysiology, and genetic principles of genetic diseases. It also explores different types of genetic diseases and the mechanisms involved.

· Chapter 5, “Neoplasia”

This chapter explores various disorders associated with neoplasia. It also covers causes and effects of common cancers and tumors resulting from neoplasia.

Required Media

Laureate Education, Inc. (Executive Producer). (2012d). Introduction to advanced pathophysiology. Baltimore, MD: Author.

In this media presentation, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pathophysiology for the advanced practice nurse.

Question 1

1. Which of the following groups of chemicals was widely used as insulating fluid in electrical equipment?

[removed]		Dioxins
[removed]		Polybrominated diphenyl ethers (PBDEs)
[removed]		Polychlorinated biphenyls (PCBs)

1 points  

Question 2

1. Occupational asthma is known to be caused by synthetic organic chemicals, dusts, and _______________.

[removed]		alpha radiation
[removed]		certain bacteria
[removed]		certain metals

1 points  

Question 3

1. Which of the following products are made using processes that involve perfluorochemicals (PFCs)?

[removed]		Consumer electronics
[removed]		Flexible plastic containers
[removed]		Non-stick coatings

1 points  

Question 4

1. The effect of _______________ in inducing _______________ appears to have no threshold.

[removed]		lead / neurotoxicity
[removed]		methylmercury / decrement in IQ
[removed]		particulates / fibrosis

1 points  

Question 5

1. In the United States today, young children get most of their exposure to the lead in lead paint by __________.

[removed]		ingesting chips of paint
[removed]		ingesting dust that contains lead
[removed]		inhaling airborne lead

1 points  

Question 6

1. Which of the following is the most common medium for people’s exposures to solvents?

[removed]		Dust
[removed]		Groundwater
[removed]		Meat or fish

1 points  

Question 7

1. _______________ are the major cause of stratospheric ozone depletion.

[removed]		Chlorofluorocarbons (CFCs)
[removed]		Perfluorochemicals (PFCs)
[removed]		Polybrominated diphenyl ethers (PBDEs)

1 points  

Question 8

1. In the human body, carbon monoxide (CO) _______________.

[removed]		binds to hemoglobin, displacing oxygen
[removed]		compromises the body’s defenses against airborne particulates
[removed]		concentrates in the thyroid, causing thyroid cancer

1 points  

Question 9

1. _______________ are widely used to degrease metals—for example, in the manufacture of electronic components.

[removed]		Perfluorochemicals (PFCs)
[removed]		Phthalates
[removed]		Solvents

1 points  

Question 10

1. Hearing loss is associated not only with exposure to noise, but also with exposure to _________.

[removed]		air fresheners
[removed]		household pesticides
[removed]		secondhand smoke

1 points  

Question 11

1. Which of the following pollutants is a key contributor to acid deposition?

[removed]		Carbon dioxide
[removed]		Carbon monoxide
[removed]		Ozone
[removed]		Sulfur dioxide

1 points  

Question 12

1. When automobiles burn gasoline, they:

[removed]		emit ozone, which reacts with volatile organic compounds (VOCs) to form photochemical smog.
[removed]		emit VOCs, which react with NOx and other chemicals to form photochemical smog.
[removed]		increase ozone at ground level, contributing to depletion of ozone in the stratosphere.

1 points  

Question 13

1. Many phthalates affect the _______________.

[removed]		central nervous system
[removed]		endocrine system
[removed]		respiratory system

1 points  

Question 14

1. Sick building syndrome is a set of __________.

[removed]		construction features of a building that make people feel ill
[removed]		indoor air pollutants associated with construction materials
[removed]		symptoms that people experience when they spend time in a building

1 points  

Question 15

1. Some likely human health impacts of polybrominated diphenyl ethers (PBDEs) are suggested by their chemical structure, which is similar to that of _______________.

[removed]		human growth hormone
[removed]		neurotransmitters
[removed]		thyroid hormones

To complete:

Complete Parts 1 and 2 – A, B, and C (D for Part 2) for this assignment. Answer in complete sentences, and be sure to use correct English, spelling and grammar. Sources must be cited in APA format. Each part (A & B) the response should be at least two and one-half (2 ½) double-spaced pages.

Part 1.

A: Sheila Meyer, a medical assistant in Dr. Ryan’s large cardiovascular practice, is taking the medical history of Edna Helm, an obese elderly woman with congestive heart disease. Edna states, “I’m always short of breath, and I perspire all the time. I guess I’m gaining weight, but the funny thing is that only my legs seem heavier. My heart is pounding when I lie down at night; it even seems to stop sometimes. I’ve even started to wear red nail polish to hide the funny blue color of my nails.

Edna gives you a copy of her medical history from an out-of-state physician. The medical history indicates that she has had the following conditions, tests, and procedures:

Conditions	Tests	Surgical Procedures
Positive Babinski signAllergic rhinitisAortic insufficiencyAscitesGastritisOsteoarthritis	Holter monitor testingRadioimmunoassay testProtein bound iodine testGlucose tolerance test	Basal cell carcinoma removed in 1992Sebaceous cyst removed in 1982Meniscectomy in 1978Rhytidectomy in 1970

Using correct medical terms, chart Edna’s presenting symptoms. Define each of the procedures and conditions listed on her medical record. Your response should be one (1) page in length.

B: Victor Krenz is assisting Dr. Connors with the fifth cataract surgery for the day. The patient is Kathy Wall, a diabetic patient, whose condition has been stable enough for her to undergo a surgical procedure. Victor has performed a six-minute surgical scrub on his hands before each of the five procedures. Dr. Connors indicates that he is in a hurry to get back to his office for a heavy afternoon schedule of patients. After both Dr. Connors and Victor are scrubbed, gowned, and ready to begin the operation, Victor feels a slight prick on the tip of his gloved finger as he moves the sterile syringe and needle on the tray. Dr. Connors, who does not notice the accidental needlestick to Victor’s glove, states again that he is in a hurry to finish this procedure. Victor knows that it will delay the surgery if he has to change gloves. He also knows that his hands have had a surgical scrub five times that morning and that they are clean.

Provide detailed answers for each of the following questions. Your response should be one-half (1/2) page in length.

· Can Victor justify not changing into new gloves?

· What could happen to Ms. Wall as a result of Victor’s needlestick?

· How should Victor handle this situation?

C: José Menendez is an elderly patient of Dr. Juárez, a board-certified urologist. José has a history of recurrent UTIs dating back more than 10 years. When he becomes symptomatic, he has been instructed to call Dr. Juárez’s office and schedule a urinalysis. Dr. Juárez’s receptionist has just received a call from Mr. Menendez. He says he knows he is supposed to come in for a urine test but that he just wants a prescription phoned in to his pharmacy instead. The receptionist asks Emilia, Dr. Juárez’s medical assistant, to take the call from Mr. Menendez.

Emilia listens as Mr. Menendez recounts that he is experiencing dysuria—painful, burning urination. She asks him to come in for a urinalysis, explaining that, as per standing orders, a clean-catch midstream specimen needs to be collected. Mr. Menendez repeats to Emilia that he does not want to come in to the office. “Why can’t you call in a prescription for Bactrim? That is what I took last time, and it helped.”

Provide detailed answers for each of the following questions. Your response should be one (1) page in length.

· What is your response?

· Should the responsibility for this call have fallen on Emilia, or should the receptionist have either handled the call herself or passed it on to Dr. Juárez?

· What, if anything, could or should Emilia say to Mr. Menendez to persuade him to come in for the urinalysis?

· Might the cost of the procedure be a factor in the reason why Mr. Menendez does not want to have a urinalysis, and, if so, what, if anything, can Emilia do or say about the cost?

· Is it appropriate in this case, given the patient’s extensive history, to indeed call in a prescription for Bactrim?

· If not, how should Emilia handle Mr. Menendez’s request for his prescription?

· If so, what procedure should Emilia follow to arrange for a prescription?

· How should this telephone call be charted?

· What, if anything, should Dr. Juárez be told about the conversation with Mr. Menendez?

Part 2

A: Marge Riley, an overweight 50-year-old woman with a history of abdominal pain, has been scheduled for a lower GI series on Monday morning. She states she has board meetings every Monday morning at which breakfast is served and that she will come in for her x-rays after the meeting is over. Marge indicates that she does not understand why she needs these procedures.

Provide detailed answers for each of the following questions. Your response should be at least 150 words in length.

· What, if anything, would you tell the patient regarding her need for these procedures?

· How would you describe these procedures to the patient?

· What combination of teaching methods would you use to explain the procedures?

· You are still concerned, after explaining everything to Marge, that she will not follow the instructions. What do you do?

B: Jenny Watmore, a medical assistant working in Dr. Cory’s orthopedic practice, has been asked to assist Mr. Ivy from the wheelchair onto the examination table. Mr. Ivy, who is 70 years old, is weakened on the left side of his body from a cerebrovascular accident (CVA). He weighs 200 pounds and is reluctant to provide much help to Jenny when she has to transfer him from the wheelchair to the examination table.

Provide detailed answers for each of the following questions. Your response should be at least 150 words in length.

· How can Jenny get Mr. Ivy to help her assist him?

· Describe the body mechanics that Jenny should use to assist Mr. Ivy.

· What patient education does Mr. Ivy need?

· What documentation should Jenny provide on Mr. Ivy’s record?

C: Dr. Waring has a solo practice. When she is on vacation, she arranges for Dr. Dumphey to cover her patients. Dr. Dumphey’s medical assistant, Theresa, has just received a call from a patient of Dr. Waring. The patient is an elderly woman, with multiple medical problems, who is possibly having a reaction to a medication that Dr. Waring prescribed two days ago for bronchitis. Her symptoms include nausea, upset stomach, dizziness, headache, rash on her chest, and extreme exhaustion. Theresa senses that the patient may be exhibiting some disorientation to time and place, because it is difficult to elicit consistent responses from her regarding her medications. The patient reports to Theresa that the newest medication she has been taking is Biaxin. The other medications she takes include Prinivil, Cardizem CD, Premarin, Prilosec, Robaxin, Zocor, Ambien, Prozac, Fosamax, Seldane, and aspirin. The patient does not know the dosage of any of these medications but is willing to “open up her bag of medicine” and read each prescription label to Theresa.

Provide detailed answers for each of the following questions. Your response should at least 200 words in length.

· Does Theresa have an obligation, as Dr. Dumphey’s medical assistant, to handle this situation with this patient, or should Dr. Waring simply be notified?

· Is this an emergency situation or potential emergency situation and, if so, what should Theresa do immediately?

· Because the patient seems disoriented, should Theresa even trust what the patient is reporting?

· Should Theresa have the patient read the label of each of her medications?

Today, Stacy is going to interview a potential new employee, Sarah Banks. Sarah is currently finishing a CAAHEP-approved medical-assisting program at a local college and is searching for full-time employment. She has some on-the-job experience dating back to when she was an after-school receptionist for a general practitioner, but that was more than ten years ago.

The clinic tends to hire medical assistants who are certified, experienced, and very capable of dealing with patients from different age groups, races, and cultures. However, Sarah is being considered for the position because, first of all, her father is a personal friend of Dr. Keeler and, second, qualified medical assistants are difficult to find because of the high demand.

Provide detailed answers for each of the following questions. Your response should at least 150 words in length.

· What should Stacy do to prepare for the interview with Sarah?

· Considering that the practice is limited to ophthalmology, would any special requirements be warranted in a medical assistant who was going to work in this area?

· Considering that the clinic’s patient population is mixed by age and race, would any special requirements in a medical assistant be warranted in this case?

· Is it proper procedure for Sarah to be applying for this position given that she has not yet completed her medical assisting program?

· Should Stacy, given the circumstances, invest a lot of time in interviewing Sarah? Why or why not?

· Should Sarah’s ten-year-old job experience be factored into Stacy’s decision to hire Sarah or not?

· If Stacy decides not to hire Sarah, does Stacy need to personally contact the reference and thank him anyway, given that he is a friend of Dr. Keeler?

 The case scenario provided will be used to answer the discussion questions that follow.

Case Scenario

Ms. G., a 23-year-old diabetic, is admitted to the hospital with a cellulitis of her left lower leg. She has been applying heating pads to the leg for the last 48 hours, but the leg has become more painful and she has developed chilling.

Subjective Data

• Complains of pain and heaviness in her leg.
• States she cannot bear weight on her leg and has been in bed for 3 days.
• Lives alone and has not had anyone to help her with meals.

Objective Data

• Round, yellow-red, 2 cm diameter, 1 cm deep, open wound above medial malleolus with moderate amount of thick yellow drainage
• Left leg red from knee to ankle
• Calf measurement on left 3 in > than right
• Temperature: 38.9 degrees C
• Height: 160 cm; Weight: 83.7 kg

Laboratory Results

• WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands
• Wound culture: Staphylococcus aureus

Critical Thinking Questions

1. What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.
2. Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”
3. What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.
4. What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.