In this exercise, you will put in to practice what you have learned in the previous modules. Read the THREE scenarios on the next pages and write a ½-1 page description of what could be a solution in each situation. Provide rationales for each solution. Post your responses in the D2L Assignment box. This assignment will count towards your participation grade. Scenario #1: A 72 year-old woman is being cared for at home after a heart attack. She is able to get out of bed and use the bedside commode unaided, but she cannot do much more than that. Her husband and adult children care for her on a daily basis. In general, they do a satisfactory job, except for the fact that they will not empty the bucket on the commode. When the home health aide comes for a visit, the bucket is always full and the room has the stench of feces and urine. The home health nurse has been to the home and discussed this with the family on several occasions. The patient does not seem to object to the stench. The family is adamant that this is the job of the nurses. You are the new home health nurse assigned to the patient. You have decided that this is a problem with a solution. Approach the family with a new and fresh attitude toward the problem. Keep in mind your legal, ethical, and personal responsibilities and limitations. Scenario #2 A home care patient is experiencing pain secondary to surgery for right foot amputation. She takes a liquid narcotic in suspension form. Her doctor ordered 2 teaspoons q. 4 hrs, PRN for pain and gave orders to the home health nurse to titrate the dose to the patient’s pain level. The nurse is to report on the patient’s pain level and response to the analgesics every week. Given the patient’s condition and level of pain and previous response to analgesics, there is no fear of addiction in this patient. The nurse has explained the treatment plan to the patient, and she concurs with the analgesia plan. However, the patient will not measure the amount of medication she takes each time. Every time the nurse visits, the patient reports that she takes a “couple of swigs” and that it relieves the pain. She does not see the need to make a detailed record of her use of medication because the system she is using works. Design a program that will be agreeable to this patient and still meet the nursing need of documenting episodes of pain and how much medication was needed for relief of pain. You must consider your legal and ethical role as a nurse and the ideal of patient autonomy. Scenario #3 With the major emphasis in downsizing and restructuring health care to be financially successful, issues of quality nursing care come up frequently. One common issue related to quality nursing care is medication errors. In a downsized work environment, medication errors may increase due to limited staffing with licensed nursing personnel. Often staffing is just enough to be adequate or slightly below what is necessary for safe and quality patient care. You are a nursing supervisor, and you want to research a medication that was omitted during a change of shift period. What questions are you going to ask? Who will you look to for information? How will I know if a medication error is a result of a nursing colleague’s mistake or a result of an understaffed nursing unit?
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