Clinician Case Scenarios

How would Ed’s blood help protect him from a foreign invader such as the one now in his system?

Case Scenario 1: It has become necessary to ration a vaccine for a contagious disease. There is only enough vaccine available to cover 75% of the U.S. population. It is necessary to determine an appropriate method for doing this. Analyze this case by applying each of the theories of Utilitarianism, Rights-based, Justice-based and Virtue-based ethics as discussed in Module 2. (20 points)

The situation is the decision to breach the confidentiality between a client and his patient. The therapist has to decide if the client will pose a threat to himself or any other 3rd party, or society as a whole. If the therapist feels in any way that the client could be a threat, he has the right to notify the person or the correct officials to insure that no harm comes to anyone involved.

On Tuesday 06/27/2017, veteran Mr. Saenz walked very angrily in my office with his wife about 11:00 AM. I greeted them and offered to sit down; Mr. Saenz and Mrs. Saenz were very upset and asked me where they need to go as they have VA examination, they both said “nobody tells them anything; they have been sitting in waiting room”. They told me that the lady on the desk told them to come to me.

On 7/27/2015, HOH and client attended to ILP meeting with their daughter Emily. Child was observed well dressed for the weather. Client explaining to cm that her floating hospital was cancel and she doesn’t know the reason.

DOI: 7/1/2015. Patient is a 63-year-old female nursing assistant who sustained injury to her left shoulder while helping to move a patient. Per OMNI entry, she was initially diagnosed with adhesive capsulitis of the left shoulder, in the setting of a bursal-sided partial rotator cuff tear. IW underwent a left shoulder arthroscopic capsular release, bursal release, and subacromial decompression on 11/16/16.

As seen in this case study, TM was listed as a full code and no GOC conversation was had between the physicians and the patient until the day of his discharge to home. This led to an unnecessary swallowing study in which the patient needed to be uncomfortably scoped. Due to the lack of GOC conversation the patient also chose to go home with general nursing services instead of end-of-life (EOL) hospice support. In the inpatient medical oncology floors of a large teaching hospital like this one, most patients are covered by rotating interns and residents that are not comfortable having GOC conversations with patients and leave it up to the primary physician to come and discuss.

Al has been diagnosed with a mild to profound sensorineural hearing loss. As a result, he is seriously limited in functioning in the area of Communication.

Jose Diaz D) Client met with his counselor for his 1x1 session to discuss his treatment plan and any other issues that he may have that is of concern. There is three issues that client is concern with 1) his reported that he wants to work on his self-esteem

In the Case Presentation, Cora is a 45-year-old adult who is alert and oriented. She is aware of her COPD disease and has been educated on the consequences of smoking. It is her right to continue smoking and to return to the free clinic as she deems necessary or as permitted. Burkhardt & Nathaniel (2014) states, “refusal to participate in a plan of care, regardless of the outcome, is the prerogative of the patient and must not affect the care given by the nurse. Ultimately, choices about health care practices belong to patients” (p.69). As a healthcare provider, it is our responsibility to educate the patient on the disease process, signs and symptoms, and treatments. It is up to the patient to follow the recommended plan of care.

Pt states that he was seen in the clinic yesterday and was treated for sore throat and postnasal drip. Pt states later that he went to the ER becase he started feeling fatigue, increased postal drip, nausea/ vomitting unable to eat and drink.Pt states the he was treated with Zofran and IV fluids. Pt states that he was informed to pick up his quarter slip her at the clinic. At this, time pt states he is feeling somewhat better but he feels fatigue and he has not attempted anything. Pt pt with 48 hours quarters. Brat diet instruction provided. Informed the pt take Zofran as directed. Pt instructed to return to the ER if has fever greater than 101, abdomen pain/cramping, unable to take liquids or bland diet. Pt agrees and verbalized understanding.

The personal issues with this vignette is that I do not want for anyone to die or be hurt and the professional issue regarding this vignette is determining whether or not a client’s confidentiality needs to be broken. I would determine whether to break confidentiality or not by using the same strategy used to evaluate if a client is suicidal or not. I would start by finding out how serious my client was about committing murder by: discovering if he has a gun, finding out how much thought he has put into this, finding out if he has a plan for committing the crime. I would then discuss the repercussions of committing murder and try to reason with my client. I would then inform my supervisor if the threat seemed legitimate and inform the appropriate legal authorities. Additional actions to support growth would be studying warning signs and red flags that could easily be overlooked when a client is not as verbal as this one about their ideas to commit

Some of the most important issues that should be addressed before deciding where should Jack reside are the following:

The duty to warn is imposed by the clinician by what they know or should know about the client that they assumed responsibility for. This awareness, or lack thereof, can be found in the notes they take, by the patience history or even by the patience own admittance. Once the clinician is aware that the client is a potential harm to himself or others he must move in good faith to try to defuse the situation. It could mean notifying police, hospitalization for the client, continued counseling or medication and finally notifying those in potential danger. (Estates of Morgan v. Fairfield, Family Counseling Center, 77 Ohio St. 3d 284, 1997.) These steps can save the counselor from potential lawsuits and more importantly lives if done in a timely manner.

Mrs. J. arrives at the emergency department with her 6 year old son, PJ, who has a history of Cystic Fibrosis (CF). He is febrile (101.7° F orally), BP 98/66, HR 122, RR 32 with the use of accessory muscles. Mother states PJ has, for the last five days, exhibited signs and symptoms of upper respiratory infection, runny nose, low grade fever, cough, and fatigue. He has lost 2 pounds over the past 5 days due to anorexia though he has not had vomiting. He weighs 36 pounds and height is 3’2”. Today, PJ became more lethargic and his fever was difficult to control with pyretics.