MacMurray Medical Center

Jacksonville, IL

 

Patient: Say, Doris R. Hosp. #356782 Age/Sex/DOB: 81 yrs. F 06 July 1930

Room: ICU #6

Ordering Provider: Samuel Good, MD

 

History & Physical

 

History: This is an 81 year old white female admitted through the ED three days ago after falling at her daughter’s home. Paramedics initiated CPR on their arrival to the daughter’s home. Patient was unresponsive and intubated prior to transport to ED. While in ED, labs, CAT scan, and evaluation by Dr. Perfect supported that pt. had suffered a severe deep intracranial bleed suffering a massive CVA. Dr. Perfect decided against Vlla (rFVlla) after discussing the case with me. Based on recent clinical trial data that suggests that treatment with recombinant factor VIIa (rFVIIa) within 4 hours after the onset of intracerebral hemorrhage limits the growth of the hematoma, reduces mortality, and improves functional outcomes at 90 days, further study of this medication in a broader cohort did not result in improved clinical outcomes and often caused other problems for the patient. Based on the CAT scan, the pt.’s bleeding was due to a ruptured blood vessel and caused by a clot. I concurred with Dr. Perfect on this assessment. Patient was transferred to ICU for further evaluation. Pt. remains unresponsive.

 

History obtained from daughter: Pt. has a hx of hypertension, hypothyroidism, and GERD. Pt. lives 9 months in Florida where her primary physician and nurse practitioner monitor her health. Pt. has lived independently and was active in her community. She flew unaccompanied and without assistance from Sarasota to O’Hare and was at her daughter’s home visiting. Daughter is unsure if pt. took prescribed medications, but she stated that “she c/o a headache and feeling tired earlier in the evening. I gave her two aspirins, and she went to take a nap. I woke her up for supper, and when she came to the kitchen, I asked her how she felt.” The incident occurred immediately after pt. began to respond to daughter’s query.

Current medications: metoprolol tartrate (Lopressor) 50 mg. BID; lisinopril (Zestril) 10 mg. at bedtime; levothyroxine sodium (Synthroid) 25 mcq. Q AM; omeprazole (Prilosec) 20 mg. Q AM and at bedtime.

Daughter denies pt. has history of sexually transmitted diseases, physical/emotional abuse, substance abuse, or mental illness.

Physical: This is an elderly white woman who is 5’4” and weighs 132 pounds. She is in remarkably good shape with no abnormalities to the eye. Skin color is WNLs, turgor is supple, tan, and warm to touch, nails are manicured, hair distribution is normal for age. Neurological exam reveals both pupils are fixed and unreactive to light; the left pupil is dilated, pt. does not response to verbal or pain stimuli. Musculoskeletal exam reveals good range of motion and tone. Cardiovascular: B/P 128/72(L) 122/70 (R); P: 62, reg. bilateral; + pulses in extremities; heart: NSR. Respiratory: Pt. remains intubated on controlled mechanical ventilation (CMV) with 12 breaths/minute; lungs present with some crackles/rales in left lower lobe. Gastrointestinal: No scars; abnormalities in abdominal contour; bowel sounds minimal to absent; liver WNS. Genitourinary: Pt. has an indwelling catheter draining clear amber urine.

Current Treatment: Continue with CMV, indwelling catheter,

· Anticonvulsants to control seizures

· Corticosteroids or diuretics to reduce swelling

· Painkillers

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Brief assessment of the Results of Work Environment Assessment

 

1. Based on the results, how civil is your workplace?

Based on the results, my score was 60, workplace is mildly Healthy. This indicates that my workplace is not a very civil environment.

2. Explain why your workplace is or is not civil?

My workplace is not civil because of lack of proper and respectful communications among employees and employers. Most of the leadership are disrespectful towards each other and this really affects the workplace environment, and therefore interferes with employee’s morale, which in turn affects patient care. Very poor communications are also seen between the employers and their employees. (Smith et al.,1994)

Another reason that makes me feel that my workplace is not civil is heavy workload on the employees. The employees are assigned a lot of tasks to do which they can’t really be manage in a timely manner and hence more nurses should be employed to reduce the workload to provide more efficient patient care. (Forstater et al., 2004)

3. Describe a situation you have experienced incivility in the workplace.

A situation where I experienced incivility in my workplace was being denied a chance of being promoted after advancement. I went for my advancement studies and pursued a bachelor’s degree. Before leaving for my studies, I was promised to be promoted to a leadership role which I was denied after completing my bachelor’s Degree, not due to merit, or my work ethic. I was overlooked because of the friendship between the director of nursing and perspective assistant director of nursing, and therefore the job was given to the friend. (Lawn et al., 2004)

 

 

4. How was this addressed?

This incivility was addressed by leadership being transferred to another organization after a series of disagreements with the employers.

References

Forstater, M. (2004). Green jobs: addressing the critical issues surrounding the environment, workplace, and employment. International Journal Of Environment, Workplace And Employment, 1(1), 53. doi: 10.1504/ijewe.2004.005603

Lawn, P. (2004). Environment, workplace, and employment: an introduction. International Journal Of Environment, Workplace And Employment, 1(1), 4. doi: 10.1504/ijewe.2004.005601

Smith, E. (1994). WORKPLACE ASSESSMENT. The Annals Of Occupational Hygiene. doi: 10.1093/annhyg/38.1.1

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