Legal and ethical nursing
For this assignment, create a PowerPoint presentation based on any three of the following four case studies.
Read the case study You be the Judge presented at the end of Chapter 18 which begins, “The older adult male patient was admitted…” (Guido, p. 363) and answer the following questions:
You be the Judge
The older adult male patient was admitted to the hospital emergency center with major blunt abdominal trauma following a car crash. In the emergency center, the nurse carried out the physician’s order for a dose of morphine for the patient’s pain, which he said was an 8 on a scale from 1 to 10. After being given the morphine, the patient’s blood pressure dropped significantly, and the patient went into cardiac and respiratory arrest after lapsing into unconsciousness.
The nurse alerted the physician, who immediately intubated the patient and sent him to the operating room to be resuscitated and then for exploratory surgery to determine the extent and cause of the abdominal bleeding. The patient was never revived, and he died the next day in the facility’s intensive care unit.
The family has brought a wrongful death lawsuit, alleging that the morphine was the cause of the patient’s demise. In the lawsuit, there were no allegations of excessive dose, improper administration of the medication, or inattentive monitoring by the nurses in the emergency center.
• Was the nurse negligent for not questioning the use of morphine for a patient with blunt abdominal pain before administering the dose of morphine?
• Would knowing that the patient’s blood pressure was 148/94 when the morphine was administered impact the finding of the trial court?
• What evidence would you argue in the nurse’s defense regarding the care of this patient?
• How would you decide this case?
Read the case study You be the Judge presented at the end of Chapter 19 that begins, “An 82-year-old patient…” (Guido, p. 394) and answer the following questions:
An 82-year-old patient who was herself a retired physician was admitted to a rehabilitation facility after surgery to repair a broken hip. During her stay at the rehabilitation facility, she woke one morning feeling nauseous and began vomiting blood. The rehabilitation physician believed that the patient had an upper gastrointestinal bleed for which she needed to be hospitalized.
She was immediately taken to the emergency department at the acute care hospital located on the same campus as the rehabilitation facility. She was evaluated and monitored in the hospital emergency department for two hours and then moved to the hospital’s intensive care area for continuous monitoring and treatment.
Complications caused her death in the early hours of the subsequent morning. Her estate subsequently filed a lawsuit for an EMTALA violation, alleging that the patient was not stabilized as mandated by the Act.
• What initial care should the patient have received in the emergency center?
• Did the emergency department staff meet the standards of care for a patient with these presenting signs and symptoms?
• Was the admission to the intensive care area a violation of the EMTALA law?
• How would you decide this case and what provisions of the EMTALA law would you anticipate the court enumerated in its holding?
Read the case study You be the Judge presented at the end of Chapter 20 (Guido, p. 415) beginning with, “The patient was a detainee,…” and answer the following questions:
The patient was a detainee, not yet proven guilty, who was being held in the county jail pending trial on felony charges of dealing controlled substances and creating a public nuisance. The patient suffers from a blood clotting disorder that causes him chronic pain. He was prescribed OxyContin for this pain by his current physician. The patient was seen and evaluated as part of his booking into the county jail. Instead of prescribing the OxyContin
for him, the jail physician-prescribed Vistaril, clonidine, and Donnatal to manage his narcotic withdrawal, started ibuprofen and Tylenol for his pain management, and continued the metroprolol, Coumadin, and Nexium that he had been taking. The jail nurses administered these medications per the physician’s orders.
The patient continued to suffer chronic and debilitating pain while in the county jail and, on his transfer to the state prison system, he brought a lawsuit against the county jail physician and nurses for violation of his Constitutional rights.
• Should the nurses have followed the physician’s orders and continued the ordered medications, which varied significantly from his pre-jail medications, specifically his medications for pain?
• Was it deliberate indifference to the patient’s medical needs to change his pain medications in the belief that he needed to withdraw from narcotics?
• What more could the nurse have done to prevent a lawsuit from being filed for an Eighth Amendment violation?
• How would you expect the court decided this case?
Read the case study You be the Judge presented at the end of Chapter 21 (Guido, p. 440-441) beginning with, “An elderly woman was admitted to the hospital…” and answer the following questions:
An elderly woman was admitted to the hospital from home, then admitted to a skilled nursing facility for rehabilitation, and then to an assisted living facility. She had chronic
kidney failure that required dialysis. Sometimes her mental status deteriorated into confusion, usually just before her dialysis appointments. At some point, she also suffered a
stroke, which seemed to affect her cognitive status.
Over the course of a few weeks, she spoke with an attorney several times on the phone, discussing with him how to write her last will and testament. She had had a lifelong rift with one of her siblings and chose not to give anything in her will to the now deceased sibling’s children. She also wanted to give substantial amounts to charity rather than to her other two siblings and their children.
The attorney mailed her will to her at the assisted living facility. The social worker and a second individual from the facility’s staff witnessed her signature on the document in her
room at the assisted living facility. When she died, the children of her estranged sibling contested the will and sued in court to have the will vacated.
• What types of questions should be asked of the social worker and the other individual who witnessed her signature on the will?
• What other evidence should be requested of the nursing staff to best ascertain her cognitive ability at the time she dictated how she wanted the will drafted and at the time she signed the document?
• Does the fact that she had been estranged for many years from the sibling whose children are now suing factor into the final decision of the court?
• How would you decide this case?