Poor Patient Outcome

Relying solely on the classic features of a disease may be misleading. That’s because the clinical presentation of a disease often varies: the symptoms and signs of many conditions are non-specific initially and may require hours, days, or even months to develop.

Generating a differential diagnosis; that is, developing a list of the possible conditions that might produce a patient’s symptoms and signs — is an important part of clinical reasoning. It enables appropriate testing to rule out possibilities and confirm a final diagnosis.

This case portrays a poor patient outcome after a misdiagnosis.

Case scenario

A previously healthy 35-year-old lawyer presents to a primary care office with a chief complaint of chest pain and a non-productive cough. The pain started suddenly 2 hours prior to coming to the office while the patient was sitting at his desk. The patient describes the pain as sharp in nature, constantly present but made worse with inspiration and movement, and with radiation to the base of the neck. His blood pressure in the right arm and other vital signs are normal.

On physical examination the only findings of note are chest wall tenderness and a faint cardiac murmur. The ECG in the office is normal. The patient is observed for an hour in the office and assessed. He is diagnosed with viral pleurisy and sent home on non-steroidal analgesics.

The following day the patient collapses at home and cannot be resuscitated by the paramedic service. An autopsy reveals a Type 1 aortic dissection with pericardial tamponade.

Written Assignment:

Developing a list of possible conditions that might produce a patient’s symptoms and signs is an important part of clinical reasoning.

1. As an NP in primary care what would you have done differently?
2. Discuss the importance of creating a list of differentials for this patient. How could it have changed this outcome?

If a serious diagnosis comes to mind based on a patient’s symptoms:

• Ask yourself; Have you considered the likelihood of it and whether it needs to be ruled out by testing or referral?
• Because many serious disorders are challenging to diagnose, have you considered ruling out the worst case scenario?
• Ask yourself: Do you have sufficient understanding of the clinical presentation to offer an opinion on the diagnosis?
• What other diagnosis could it be? How might the treatment to date have altered the patient outcome?
• What other diagnostic and laboratory or imaging was needed in order to make a complete differential list?  What support tools would you consider using in helping to create a differential diagnosis list?
• Are you familiar with the current clinical practice guidelines for the investigation of a suspected condition such as chest pain?
• 5 pages

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.

In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.

To Prepare:

• Review the Resources and reflect on the evolution of nursing informatics from a science to a nursing specialty. 
• Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization.

Question

Post 1page of a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.

The Case of Mrs. G.
Mrs. G. is a 75 year old Hispanic woman who has been relatively well all of her life. She had been married for 50 years and had five children. Her children are grown with families of their own. All but one of her children live in other states. Mrs. G.’s husband passed away last year, which was devastating for her. She had been very close to him and relied upon him for everything. He was “the life of the party” she always said and was a loving and caring man. Since his passing, Mrs. G. has continued to live in the house they shared for 35 years. In the last month, Mrs. G. has fallen twice sustaining injuries, though minimal. Her home health nurse comes weekly to check in on her. Mrs. G. likes her very much and wishes she could come more often. Mrs. G.’s daughter who lives in the next town over, has been worried and decided with the urging of her siblings and the doctor to start looking for an assisted living facility for her mother. She found one last week and talked with the Director who said she would be happy to help in whatever way was best. The daughter decided to tell her mother that it was time for her to move, so she can be cared for and be safe. When she told her mother, Mrs. G. cried and said, “This will not happen ever. I plan to stay in this house of loving memories for the remainder of my life.”

In 3 – 4 pages answer the following questions:

1. How would you best describe Mrs. G.’s feelings about her life, her family, her traditions, and her future?
2. Did Mrs. G.’s response to her daughter surprise you? Please explain your answer.
3. In what way do you believe her culture might be influencing her decision?
4. If you were Mrs. G.’s daughter what would you say to her that shows you are caring and have compassion for her situation? What nonverbal communication would support that level of communication?
5. Suppose Mrs. G. stands firm about not leaving her house. What resources and collaborations might be available and helpful so the daughter and other healthcare providers can keep her mother safe and make the most effective decision?

As discussed earlier in this course, your personal teaching philosophy is a work in progress. During week 8, you will revisit and revise your teaching philosophy that you submitted during week 1. As part of this assignment, you should evaluate your original philosophy and include a one-page discussion of how your thoughts and ideas about teaching have changed and developed during this course. Guidelines for revising your teaching philosophy and the one-page discussion are below.

Assignment Guidelines

Revised Personal Teaching Philosophy (3–5 pages)

Reflect on the teaching principles and practices discussed during the course.
What did you learn about teaching that you did not know prior to this course?
What stood out as important to you over the past 8 weeks?
Consider how you might expand, adapt, or change your original philosophy to your current perspective on teaching (or you may feel compelled to take it in a completely new direction).
Your revised teaching philosophy should:
Have a clear focus or theme.
Be authentic and personal.
Relay who you are (or aspire to be) as a teacher.
Exhibit genuine enthusiasm for teaching.
Clearly express your current teaching values and beliefs, and discuss why you hold those values and beliefs (whether or not they have changed).
Describe your current teaching goals (whether or not they have changed).
Explain the teaching methods or strategies that you believe are best (whether or not they are different from your original philosophy). Note: make sure the teaching methods you find best are consistent with your goals.
Incorporate any new ideas and/or practices that encourage a rich teaching and learning experience.
Be 3–5 pages, including the evaluation discussion but excluding title and reference pages; length should suit the context. It should be typed in Times New Roman using 12-point font and double-spaced with 1″ margins.
Be well written, using a first person narrative and present tense.
Follow APA (6th edition) format.
Have no any grammatical, typographical, or spelling errors.
Evaluation Discussion of Teaching Philosophy (1 page)

As part of this revised teaching philosophy assignment, you should include a discussion evaluating how your personal thoughts and ideas about teaching have changed during this course.

After you have revised your personal teaching philosophy, carefully review your original teaching philosophy that you submitted during week 1 of this course.
Compare your original philosophy to your revised teaching philosophy and evaluate the following in a one-page written discussion:
Have your teaching goals, methods, or strategies changed, and if so, how and why? Have your teaching priorities and/or perspectives changed or shifted, and if so, how and why?
Do you value different learning experiences, and if so, what are they and why?
Include any additional information that may highlight how your thoughts and ideas have changed or developed during this course.
Include references that you found helpful, insightful, or meaningful in the development of your philosophy of teaching.
In addition to the course texts, include at least two outside sources from peer-reviewed journals to support your ideas.
Your evaluation discussion should:
Be one page excluding title and reference pages, typed in Times New Roman using 12-point font, and double-spaced with 1″ margins.
Be well written, using a first person narrative and present tense.
Follow APA (6th edition) format

this assignment, you will be writing a 1,000-1,250-word essay describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

Select an issue from the following list: nursing shortage and nurse turn-over, nurse staffing ratios, unit closures and restructuring, use of contract employees (i.e., registry and travel nurses), continuous quality improvement and patient satisfaction, and magnet designation.
Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style.
Use at least two references other than your text and those provided in the course.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.