Health and Illness

Ruth is a 62-year-old woman who was hospitalized after a “mini-stroke”. She has now returned to her pre-event level of functioning and is being prepared for discharge. She states, “I know that I have an increased risk for a major stroke, so I want to do everything possible to stay as active and as healthy as I possibly can.”

Ruth Jacobi

Sara, a college freshman, is encouraged to visit the student health center by her roommate because she rarely visits the dining hall for meals, runs 5 to 8 miles a day, and has recently lost a significant amount of weight. Sara states, “I’m plenty healthy, just a bit ‘nuts’ about being fit!”

Sara Gelbart

Daniel is a 27-year-old man with history of schizophrenia. He comes to the mental health clinic, loudly demanding relief from the voices who are telling him to hurt himself. Mr. Sternman is well known by the clinic staff. His medical record reveals that he has had numerous visits to the clinic and that he has difficulty interacting and dealing with various staff members.

Daniel Sternman

REFLECTIVE PRACTICE

Challenge to Intellectual Skills

My first college roommate, Sara Gelbart, seemed the ideal roommate when I first met her. A good student, she was thoughtful, outgoing, and fun. By October, However. I was really worried about her. I noticed that she rarely wanted to come to the dining hall with our group of friends.

When she did come, she just seemed to pick at her food. She also spent a lot of time at the athletic center, running 5 to 8 miles almost daily. I wasn’t surprised when she started losing significant amounts of weight. what worried me was her lack of willingness to talk about her nutritional habits and health.

She told me that she was plenty healthy, just a bit “nuts” about being fit! She also kidded that I’d be healthier if I worked out more often with her. While she was certainly right about that, I was worried that she had a serious eating disorder and wasn’t sure what I could do to help. She politely told me to “mind my own business” when I asked her if she had ever spoken with anyone about her health and eating.

CHAPTER 21

COMMUNICATOR

Susie is a 3-year-old patient with second-degree burns on both legs who currently is receiving debridement. Every time a healthcare provider enters her room, she begin to cry, turning her body toward the wall and curling up with her knees to her chest. Her family lives approximately 1 ½ hours away and can only visit her about once of twice a week.

Susie Musashi

Irwina, a 75-year-old woman transferred from the emergency department, is diagnosed with pneumonia. Her chart reveals that she is hard of hearing, “pleasantly confused” at times, and speaks “broken English”. A nursing assessment is needed.

Irwina Russellinski

Randolph, a middle-aged man diagnosed with end-stage liver failure, is being cared in the intensive care unit. He has been comatose for several weeks. He has numerous tubes and drainage devices in place and is receiving multiple therapies that require continuous electronic monitoring.

Randolph Gordon

Reflective Practice

Challenge to Interpersonal Skills

Recently, I was accompanying a nurse in the intensive care unit (ICU) when I encountered some behaviors that I found to be unprofessional and lacking in interpersonal skills. We were caring for Mr. Randolph Gordon, a middle-aged patient who was in end-stage liver failure and had been comatose for several weeks.

The extend of drains, tubes and technologies being used to care for Mr. Gordon was overwhelming. It was almost difficult to recognize him as human being. I was taken aback when the nurse and some residents entered the patient’s room and immediately began to assess the technological equipment, without any regard for or recognition of the patient.

They proceeded to have a conversation about the patient’s poor condition, unsightly appearance, and foul smell at the bedside, in the direct presence of the patient. They did not speak to the patient and they made no attempt to interact with the patient, not even the slightest touch of a hand.

TEACHER ANDCOUNSELOR

Marco accompanies his wife, Claudia, to the antepartal clinic for a routine visit. They are expected their first child in 5 months. He reports that they are happy and excited but also scared and very nervous. They are planning for a home birth, asking lots of questions about childbirth and their new responsible as parents: “We’re both wondering if we’ll be good parents.”

Marco Garcia Ramirez

Rachel, age 40, is the second wife of a 57-year-old man who has suffered a serious myocardial infarction. They have been married for only 1 year. She says, “I’m a little embarrassed to talk with the cardiologist, but lots of questions about what my husband will be able to do after he gets home.”I’m also wondering about resuming sexual activity.”

Rachel Blumenthal

Alicia is the young mother of a baby boy; the baby’s physician is recommending that he start long-term aspirin therapy. Ms. Bonet is quite concerned about agreeing to long-term aspirin therapy and asks, “I’ve heard so much about Reye’s syndrome and aspirin. What should I do? What would you recommend?”

Alicia Bonet

REFLECTIVE PRACTICE

Challenge to Intellectual Skills

It was during my senior practicum in pediatrics last spring that I met Alicia Bonet, the young mother of a baby boy for whom I was caring. The baby’s physician was recommending long-term aspirin therapy (unfortunately, I cannot remember what condition the child had for which long-term aspirin therapy was being recommend).

Ms. Bonet was quite concerned about agreeing to aspirin therapy, asking me if I knew much about Reye’s syndrome. Then she asked me what I would recommend about whether or not to agree to long-term aspirin therapy. Not really understanding the risks versus the benefits of aspirin therapy or how it actually ties into Reye’s syndrome.

I did not feel competent to answer Ms. Bonet’s questions. Let alone make an educated recommendation to her.

Rehema Kohls

Rehema is a college sophomore who comes to the health care requesting information about sexually transmitted disease(STDS). During the visit, she says,” So many of my friends are concerned about STDs. They all say we should start a group on campus to discuss this problem, and they want me to set it up and the leader. But wouldn’t know were to start or what to do!”

Stephen WallStephen, a 65-year-old widower who lives alone , is admitted to the intensive care unit after an automobile accident in which he sustained trauma to the head, chest, abdomen, and lower extremities. He is being monitored continuously via numerous invasive devices and requires complex care. His closet family member, a 40-year- old son, lives approximately 75 miles away.

Jack CampJack, a middle age single man with a history of diabetes mellitus, is receiving care for a compound fracture of his left lower extremity being treated with an external fixator. Compliance with his diabetic therapy regimen is questionable; he states, “ I really love sweets!” The patient frequently voices loud complaints about his room,

the food, and the hospital routine. He also uses his call light very frequently, stating, “ I just want to see if it’s working and if the nurses will come check on me.”

Challenge to Ethical SkillsWhile in the clinical rotation my junior year, I was assigned the dreaded Jack Camp(still remember his name). He was a middle aged single man receiving care for a compound fracture of his left lower extremity being treated with an external fixator. He had bad case of diabetes, and an even worse sweet tooth. Before I even meet him,

the nurse on the floor were saying things like “good luck” which complaints about his room, the food, and the hospital routine. He also using his call light very frequently. the nurses called him names and discussed their dislike of him in the nurses station, which was in the center of the unit.

As the day, I found out that all this patient wanted was some attention, because he was used to running things in his business. I actually him entertaining.

Kara GreenwoodKara, a high school junior class representative and peer counselor, comes to the local community health center for a routine examination. During the interview, she says, “ My guidance counselor has asked me and few of my friends to develop talk for

our classmates on the dangers we face as adolescents. I know everybody is worried about terrorism, but I want to make sure that we talk about other safety issues, too.”

Bessie WashingtonBessie, a 77-year-old woman, was recently discharged to her home after suffering a cerebrovascular accident (brain attack). She lives alone in a small one-bedroom apartment and uses a walker to ambulate. She says, “ I have so much stuff crammed into this small apartment! I almost feel this morning going from my bedroom to the kitchen.

Juanita and Inez Flores

Juanita, is a young mother of a 1 year old girl, Inez, who is at the clinic for a well child visit, while sitting on a cot with her daughter , whose legs are dangling at the edge of the cot about a foot above ground level, Juanita turns to get something out of her purse and the child falls to the floor and begins to cry loudly.

Challenge to the Ethical and Legal SkillI first meet Juanita Flores while working in the children hospital two summers ago in a nurse externship program. Juanita was the mother of one-year –old girl diagnosed with failure to thrive who had been on the rehabilitation unit for some time. The child was very small and had a feedings program prescribed. One day while I was in the room,

Juanita was sitting on the cot with her daughter, whose legs were dangling at the edge of the cot, about I foot above ground level. I was taking the child vital signs. As the mother turned her back for a minute to grab something from her bag, I turned away to wash my hands in the sink.

All of a sudden I heard a thud and crying as the child feel to the floor. Juanita tried to comfort here. Picking him up and rocking and singing to her.

Although I knew it was not completely my fault, I felt horrible about turning my back on the child for only the few seconds to wash my hands, the seconds that it took for the child to fall. Although Juanita was in the room, the child had been unsupervised for only few seconds. However, I was not watching her at the moment the child fell.

I wanted to tell my preceptor right away and knew I should in case anything had happened to the child, but I was nervous and afraid that I would get into trouble.

Jackson Ray IversJackson Ray comes to visit his mother , who has been hospitalized for tuberculosis. He notices sign on the door to check at the nurse’s desk before entering . He asks, “ What’s going on? Why do I have to wash my hands and wear a mask?”

Esther Bailey

Esther, a 72-year-old female patient on the unit recovering from abdominal surgery and receiving antibiotic therapy for a wound infection, requires insertion of an indwelling urinary catheter due to the development of post-operative urinary retention and inability to void.

Giselle Turheis

Giselle, a 38-year-old woman undergoing chemotherapy treatment for leukemia states, “ I know that you risk for infection is really high because of my poor immune status. But how to do I respond to my Sunday school class, who are used to greeting me with a big hug. I want to be safe, but I know that I need these hugs too!”

Challenge to Ethical and Legal Skills

This is my last clinical rotation before graduation and it has been a difficult year. My focus has been somewhat off for a while, and I haven’t has been prepared as I should have been my clinical and classroom experiences. My clinical instructor has been on my case for the last few weeks.

I’m also realizing that in no time at all I will be out of school and on my own when it comes to patient care. So all sudden. I’ am eager for as many clinical experiences as I can get. To make along story short, I’m thrilled when offered the opportunity to catheterize Esther Bailey, a 72-year-old female patient on my unit.

I quickly review the procedure and go to the patient’s room, with the catheterization supplies in hand, feeling semi confident. After introducing myself and my clinical instructor and explaining what I’m to do., I open the sterile package, prepare the sterile field, and cleanse the meatus. In one quick moment, as the patient asks a question and diverts my instructor’s gaze.

I realize to my horror that I’ve contaminated the catheter. I’ve got a split second to decide what to do. I can tell my instructor what happened , obtain a new kit, and proceed a new, or pretend nothing happened and continued what to do. I don’t like that I’m even considering not admitting the mistake, after everything that has been drilled into

•us about the importance of sterility and the consequences of nosocomial infections . But I’m also prudent enough to realize that it is the time to leave the unit because the rest of the group is waiting for post conference , plus, after all, there are financial costs to ordering another tray. But what if I do not admit the error and by chance the instructor did see me contaminate the catheter? Then my goose is really cooked!