NURS23921 Essay: The Realities Of Practice.

According to the statement given by the erstwhile Registered Nurse, Gita Proudman I think that she did not handle the situation of the dying child appropriately. Gita has been reported to let the child born with various physical deformities, die a peaceful death in her arms (youtube.com, 2017). She held the child for quite a while until he stopped breathing and showed no signs of survival where she defended herself by saying that she merely followed the order of Do Not Resuscitate (DNR) by not resorting to any therapeutic intervention. Hence, under these circumstances I feel she did not complied with the CNO’s Ethics Practice standards. The noble profession of nursing as per the guidelines by the competent authority has identified certain ethical values comprising of client wellbeing, client choice, privacy and confidentiality, respect for life, maintenance of commitments, truthfulness and fairness. The respect for life ethical attribute has been violated in this context by simply letting the child die without even trying for taking measures to restore his life and intervening accordingly. No effort for preservation of the precious human life was made (cno.org, 2017). However, the situation could have been handled differently by means of abiding by the informed decision-making process through collaborative approaches. The RN  could have discussed the matter with her fellow colleagues and should have brought to the notice of the attending physician before acting all by herself. An integrative approach in nursing is crucial to procure optimum benefit out of collaborative practice and judgment making (Hamric et al., 2013).

1. Why did the patient had high blood pressure although medications for hypertension and angina had been provided?
2. Obesity
3. Angina
4. Diabetes
5. Anxiety

The correct answer is anxiety. This is because all the medications that had been administered had correctly addressed his angina and also his hypertension symptoms. However the nurse previously could not apprehend that anxiety may be a reason that also leads to rise of blood pressure. The registered nurse had correctly identified the situation probably due to his experience and had therefore provided him the correct medicine so that he can rest and have a good sleep (Harzheim et al., 2013).

2. What is the most important risk factor that lead to angina in the patient?
   1. Obesity
   2. Angina
   3. Diabetes
   4. Anxiety

Obesity is the correct answer because the condition of obesity is the main factor that results in the formation of hypertension. In obese individuals, there is increase in fatty tissue which thereby increases the vascular resistance and increases the heart’s activity to pump more blood throughout the systems leading to hypertension. This hypertension results in damaging the coronary arteries and also results in blockage of arteries resulting in abnormal blood flow to the heart and hence results in chest pain or angina (Ohman & Alexander, 2014). Again obesity results in diabetes because fat molecules in blood affect the function of insulin. Therefore obesity is the best answer which had resulted in the occurrence of obesity with the later answer that may be correct is hypertension.

3. What type of medication was missed out from planned interventions by the nurse and her RN?
4. Medication for hypertension
5. Medication for angina
6. Medication for diabetes 2
7. All the above

Medication for controlling the type 2 diabetes was not given. Hydrochlorothiazide was given for maintaining hypertension. Ramipril is used for hypertension and congestive heart failure. Metoprolol is also a beta block that helps in treating angina and high blood pressure. Transderm nitro patch is used for treating people with chest pain. It will help the patient by reducing the chances of further such instances as it is preventive medicine. Nitrospray helps in relieving from cheat pain. Hence one can easily understand that no medication was given for uncontrolled diabetes type 2 which should have been provided by them.

1. He had been chopping off his own hair.
2. He had been laughing unnecessarily
3. He had been withdrawn and exhibiting odd behavior
4. He had been crying without a reason

The correct answer to this question is option c, Aaron is an 18 year young man who had been a bright student who had enrolled himself to a journalism program in Australia. However his students recognized his odd behavior and increasing withdrawal from the academics. He had been keeping a low life and stopped social mingling whatsoever, more over he had been telling them that he was son of god and his purpose in life is to fight the devils.

2 . Who else can the nurse collaborate with in this scenario?

1. The clinician
2. The watch man
3. A counselor
4. His friends.

The right answer to this question is option c. Aaron was brought to the psychiatric assessment facility by the city police as he had been running around in the streets at 2 am without any clothes on in the month of February. A contributing factor to may be the fact that his psychological problem has caused him to feel like he is the son of God himself and he feels superior to everybody (Chinman et al. 2014). He has previously been saying his one true purpose in life had been to fight devils and that might be the reason that had him chasing the streets in chill of the night. A counseling help will be beneficial for him to regain his mental balance along with clinical or pharmacological help.

3. what is the ethico-legal dilemma that arose in the case scenario of Aaron Livet?
   a. The patient demands to be treated as God
4. the patient wants to be left out in the cold.
5. the declares he will go running the streets again
6. the patient declares he would not take his medication.

The right answer to this question is the option d. Aaron had declared that being a son of god he would not require any medication to recover from his mental disorder. This provided the ethico legal dilemma in this situation, as per the guidelines of the CNO, the nurse needs to ensure that the patients takes his medication in due time in regular intervals. Where respecting the patient choices and preferences is also a prerequisite of legit care plan as well according to the nursing guidelines (Cno.org. 2017).

Q1. What is the most appropriate reason for the manifestation of the symptoms of sporadic wheezing cough and shortness of breath in Chelsea?

1. Pet hairs
2. Adjacent active steel mill
3. Asthma
4. Smoker parents

The correct answer is d. parent smokers. This is because the kids who are exposed to cigarette smoking environment are at risk for developing long-term respiratory problems like asthma even if they have no episodic of asthma. Third hand smoke is defined as a condition when the residue of the smoke remains in the furniture, clothing, skin and other household things. According to Jara et al., (2015) the risk for developing the respiratory problems in children increases twice if the parents are smokers.

Q2. Why the nurse did a psychosocial assessment in the given Chelsea’s case study?

1. To inform and manage plan of care
2. To find out the reason for the manifestation
3. To assess the family background
4. For psychosocial well-being of the client

The correct answer is a. to inform and manage plan of care. According to College of Nurses of Ontario (CNO) Practice Standards, psychosocial assessment is important as it helps to inform the patient centered care and in managing plan. The ethical values according to the CNO guidelines state that client well-being is an important part of nursing practice and aids in preventing harm. This case study also demonstrates ethical dilemma for the nurse as the parents are the potential reason for the child’s manifesting the above mentioned respiratory problems (Stuart, 2014).

Q3. What is the major ethical dilemma that is faced by the nurse in this case study?

1. Smoker parents
2. Pediatric nursing
3. Nursing assessment
4. Overlapping symptoms

The correct answer is a. smoker parents. In pediatric nursing, the children are unable to take medical decisions on their own and the parents are the sole decision makers. Their personal interests and cultural bias influence the medical decisions made on the child’s behalf. In the given case study, the child is only 6 year old and the parents are the sole decision makers. However, they are smokers and blame themselves for their child’s trouble breathing (James, Nelson & Ashwill, 2014).

Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E. (2014). Peer support services for individuals with serious mental illnesses: assessing the evidence. Psychiatric Services, 65(4), 429-441.

Cno.org. (2017). Retrieved 18 May 2017, from https://www.cno.org/globalassets/docs/prac/41034_ethics.pdf

Druss, B.G., Ji, X., Glick, G. and von Esenwein, S.A., 2014. Randomized trial of an electronic personal health record for patients with serious mental illnesses. American Journal of Psychiatry, 171(3), pp.360-368.

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (2013). Advanced practice nursing: An integrative approach. Elsevier Health Sciences.

Harzheim, D., Klose, H., Pinado, F. P., Ehlken, N., Nagel, C., Fischer, C., ... & Mayer, E. (2013). Anxiety and depression disorders in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Respiratory research, 14(1), 104.

James, S. R., Nelson, K., & Ashwill, J. (2014). Nursing care of children: Principles and practice. Elsevier Health Sciences.

Jara, S. M., Benke, J. R., Lin, S. Y., & Ishman, S. L. (2015). The association between secondhand smoke and sleep?disordered breathing in children: A systematic review. The Laryngoscope, 125(1), 241-247.

Ohman, E. M., & Alexander, K. P. (2014). The challenges with chronic angina. The New England journal of medicine, 371(12), 1152.

Stuart, G. W. (2014). Principles and practice of psychiatric nursing. Elsevier Health Sciences.

Youtube.com. (2017). ONA: The Gita Proudman Story - Pt.1. YouTube. Retrieved 18 May 2017, from https://www.youtube.com/watch?v=15Aco7aJtdM