Homework Help for Nursing

The hospital risk management department has reviewed Zelda's care.  The medical record is analyzed.  The incident report is reviewed.  It is revealed that Zelda's protected health information (PHI) was disclosed:  to her mother, to her health insurance company, to the county's Adult Protective Services agency, the State Department of Health and Human Services, the medical staff peer review committee, the marketing department (photos are used in an campaign against abuse in the home), and hospital legal counsel. 

Define PHI.  

And are any of these disclosures legally allowable? 

Why or why not?  

Cite to the law or laws that direct your response. 

Here is our shared scenario:  Zelda is in trouble again.  She is brought to the ED by police after a domestic dispute with her husband.  Zelda has lacerations and suffered a hit to her head and is being brought to the ED for assessment and treatment.    Zelda also has little red spots (rash) all over her arms which she says were due to a recent bout with Chicken Pox.  Pictures of her injuries and rash were taken by the ED nurse as part of the department domestic violence policies.  The pictures were placed in the patient’s medical record. 

While helping Zelda get onto the stretcher, Zelda bites the police officer.  The officer’s skin is broken and the officer is cared for by the ED staff.  The ED Nurse submits an incident report to the hospital’s internal risk management reporting system.  In addition, a hospital social worker comes to talk to Zelda about her safety at home. 

 After the biting incident, both Zelda and the police officer undergo testing for HIV and other blood borne pathogens.  The police don’t pursue charges against Zelda and she is discharged that same day. 

Patient Rights in the American Healthcare System.  Visit a hospital website – you may choose a hospital you are familiar with, that is in your community or a nationally recognized health system like Mayo or Geisinger.  On the hospital website, search for patient and visitor information about Patient Rights and Responsibilities. 

In your discussion post, answer the following questions:  Was the information easy to find?  Was it easy to understand? Was the information provided by the hospital consistent with the rights described in the Torrey article assigned?  Do you think that these lists are adequate or complete? Is there a right or responsibility you believe is missing from the lists you have read? 

Identify and explain at least 5 actions that a health care entity should take to ensure that their organization has an effective compliance program.  Why are these actions important?  Discuss the risks of having a compliance program and not following it.  Limit your research to the sources assigned and  listed above.  Support your discussion with references/citations.  Post your discussion by Wednesday at midnight.  Respond to one other student in Group A and one student in Group B by Saturday at midnight. 

What is the Health Care Quality Improvement Act (HCQIA) and how does this law affect a healthcare entity's peer review processes?  What was "the apprehension [that] prompted the creation of HCQIA's National Practitioner's Data Bank (NPDB)"? (Showalter, p 292) What types of reports are required to be made to the NPDB? Present your thoughts on why peer review, and maintaining confidentiality of this work are important activities. Provide references/citations to support your position.

CASE STUDY:

Jolinda Hobble had a history of her left knee slipping out of joint since 1998.  She went to see Dr.  Ralph J. Verygood, an orthopedic surgeon who recommended corrective surgery after Jolinda had  a major dislocation of the left kneecap in July of 2000.  As a result of this surgery, Jolinda suffers from  palsy of her left foot, a condition evidenced by numbness in her big toe and three adjoining toes, the numbness extending about half way up her foot on both the top and the bottom.  Jolinda was advised that she might still experience postsurgical knee problems, including inability to walk altogether.  She also says that she was not specifically warned about possible postsurgical numbness to either her left leg or foot. Dr.Verygood says that he did indeed warn Jolinda about this possibility.

The surgery was performed July 31, 2000.  Jolinda was placed under general anesthetic and remained unconscious throughout the operation.  Dr. Verygood performed a surgical procedure which has the effect of realigning the entire mechanism controlling the kneecap in order to correct the knee dislocation.  During the operation a pneumatic tourniquet was applied to Jolinda's leg to help the operation procedure by cutting off the blood supply to the leg to create a dry (bloodless) surgical field.  Following surgery Jolinda's leg was wrapped by Nurse Vicky with a padded dressing consisting of expandable bandage extending from the toes to the top of her leg.  Nurse Vicky is an employee of the hospital. 

Dr. Verygood was scheduled to take a few days vacation after the operation, but he nevertheless checked on Jolinda in the recovery room within one hour of the surgery. He also wrote detailed orders to be followed during his absence.

Jolinda says that she first awakened around dinner time on the day surgery was performed, but that she did not regain full consciousness until the following morning.  At that time she became aware of a throbbing pain in her left leg which was concentrated on the knee and foot. Jolinda first complained about the pain to the hospital nurse, Nicky the morning after surgery. Nothing was done about the pain, however, until she was checked by Dr. Greatman, Dr. Verygood's partner, on the second postoperative day.  Following Dr. Greatman's visit, Jolinda's bandages were cut off in the foot area giving her some relief and after which she experienced a tingling sensation throughout the whole foot.

Jolinda received follow up care from Dr. Verygood after  surgery for about one year and during this time period Jolinda's complaints of pain and numbness in her left foot continued.

1. Here is some more information to consider:  You end up hiring for your expert, Dr. Richard Cutgood, a board certified orthopedic surgeon, who had performed literally thousands of knee surgeries in his medical career.  Dr. Cutgood is of the opinion that the risk of the type of injuries Jolida has following this type of surgery was statistically nonexistent.

   Dr. Cutgood  concluded that the most probable cause of plaintiff's injury was external pressure either from the tourniquet used during surgery or from the application of tight bandages after the operation.  He considered the probability of nerve damage during the actual surgical procedure to be small because the surgical knife "isn't long enough to reach over and cut that nerve."   Regarding the tourniquet, from his experience tourniquet pressure ordinarily does not result damage to the nerves unless "it is incorrectly applied or it is applied over a bony prominence or the tourniquet itself is defective."

   Dr. Cutgood stated that while nothing in the record indicated that defendant did anything wrong during the surgery, he was of the opinion defendant was "below the usual and customary standard of care" as such result "does not generally occur without some untoward action of the surgeon."

   Does the doctrine of Res Ipsa Loquitor apply to this case?  What does this legal term mean?  What are the conditions that need to be present for this doctrine to apply?

What do you think our health care system in the USA would look like with new enactments with no surprise act?

Examples of electronic communication mediums include email, text message, and video conferencing, to name just a few.

True or False

1. View the video “Nursing the Mind” available at:

                                                                         The nurse’s role in mental health is described as “facilitating recovery.” What did you observe in the video that illustrates nurses facilitating recovery as they worked with clients? What did the nurses do or say that facilitates recovery? Describe two examples from the video and provide rationale for your responses. 

1. In Week 4 you will complete learning modules on Trauma-informed care by Alberta Health Services. As you work through the modules on trauma and trauma-informed care, consider how you will use this knowledge as part of your nursing care. What does it mean to be trauma-informed? Identify and briefly discuss two examples of what you learned from completing the modules that will inform your nursing practice. 
2. What strengths do you bring as a nurse, to working with those affected by mental health concerns and illnesses?

Think about your own diet. Explain 3 ways you can improve your diet. How will these changes make a specific difference to you and your body?

Does anyone know how to do the template with the lab?

An IV solution contains 0.0175% of Drug Z, how much of this IV solution should we infuse, if the patient needs 100
mg of Drug Z?

If this solution is infusing at 50 ml/hr, how long will it take to complete the infusion? Hint: 1mg = 0.001g or ml.

Directions: Your group will be assigned an athlete to research. Your goal is to figure out who would be in the athlete's circle of care based on their age, level of play, and sport. You will also describe each of the roles that you chose. You must have at least 8 different roles for your athlete. For example, if you choose to have a team doctor, you would describe what that doctor's role is in the athlete's circle of care. Create a way to present the information. This can be digital (presentation, infographic, pictures, etc) or you can use paper and draw it out.

Explain the concept of alcohol for causing hypoglycemia and possible treatment.

Explain the concept of alcohol for causing hypoglycemia and possible treatment.

Which of the following laws of thermodynamics denotes temperature measurement?