Delaware Courts

Review the links to the resources below and then explain the court system in Delaware.
Many states elect their judges which has created a great deal of debate. Much of it has to do with campaign donations. Since 2000 the Judges up for re-election have raised over 18 million in Ohio. For more detail see http://www.judicialselection.us/judicial_selection/campaigns_and_elections/campaign_financing.cfm?state=OH which explains the basics. One of the issues our Chief Justice has is that voters knew nothing about the candidates.This page was created to help – http://www.courtnewsohio.gov/happening/2015/JVCWebsite_090115.asp#.VqI9LVMrLBI. Three things that she wants to address are the influence of politics, lack of knowledge of the candidates, and better information to the public on the process in general. You can find more detail on http://ohiojudicialreform.org/ . Take a few minutes to view the survey results! That still assumes (as she does) that Judges should be elected (which is not the case in some states). The states also differ on whether the party is listed on the ticket. See the map at http://www.pbs.org/wgbh/pages/frontline/shows/justice/que/map.html
PBS Frontline did a segment on this you may find interesting. See http://www.pbs.org/wgbh/pages/frontline/shows/justice/etc/synopsis.html .
Once you have reviewed these resources, tell us about the state of Delware , how are the courts set up? What are the rules for placing a person on the court? Does it vary by level? Are they elected? Is the party included? Are there debates around fundraising or other issues? Do you have any specialty courts (like drug, Veterans courts)? In essence, explain the court system in Delaware to us!

Sample Solution

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Redaction is necessary to anonymize an electronic health record

Discuss in 500 words, how much redaction is necessary to anonymize an electronic health record. Is it enough to redact the name? The name and address? Is a medical record like a finger print?

Sample Solution

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: The purpose of this assignment is to encourage you to analyze pathophysiological processes and mechanisms of human disease, identify clinical signs and symptoms and diagnostic data consistent with the pathology of common health problems and determine appropriate medical treatment and nursing care based on best practices found in the literature.

Case Study Assignment for Unit III

 

Purpose: The purpose of this assignment is to encourage you to analyze pathophysiological processes and mechanisms of human disease, identify clinical signs and symptoms and diagnostic data consistent with the pathology of common health problems and determine appropriate medical treatment and nursing care based on best practices found in the literature. This assignment emphasizes critical thinking and problem-solving through the correlation of cellular and multi-system pathology with related assessment and diagnostic data, medical treatment and nursing management.

The answers to the questions should be complete and include professional literature to support each answer. You should include at least 3 current references (< 5 years old) of which 2 must be journal articles. References should include current nursing journals and other professional health related literature. The assignment should be uploaded electronically into blackboard under the appropriate assignment link.

The paper should be typed using APA format. APA format requires that you use correct grammar and spelling and double-space your entire paper. Use the questions as your headers. Please include the following rubric at the end of your paper.

The assignment will be graded using the following criteria:

Patient Case Analysis Assignment

Grading Criteria

Possible Score Earned Score
Answers to Questions

1. Demonstrates comprehensive critical analysis of pathology, assessment and diagnostic data, medical and nursing management (points accrued in case study)

30

 

 
Format

1. Answers are supported by references

 

1. Follows APA format

5

3

2

 
Total Score 35  

 

 

 

 

 

Necrotizing Fasciitis Case Study

Teri Billings, William Claytor, Krista Gagnon

Introduction

C. S. is a 33-year-old, married, African American male who presented to the ED for progressively worsening body aches, abdominal pain, and swelling and draining in the peri-rectal and perineal area. Patient stated he “developed a pimple on his buttocks a week ago and it broke open today”. Patient also stated his “weakness and pain have been worsening over the past week”.

The only medical history consisted of hypertension and insulin dependent diabetes diagnosed four years ago, but patient reports he has not been taking insulin for at least one week. Patient is employed full-time and denies any family medical history, allergies, or alcohol, tobacco, or drug use. Patient was diagnosed with diabetic ketoacidosis (DKA) and peri-rectal abscess. Upon medical workup, patient was found to have necrotizing fasciitis / Fournier’s gangrene, so both infectious diseases and general surgeon were consulted.

Question 1: Explain the pathophysiology of necrotizing fasciitis? Give details about the cells involved and the process of inflammation. (4 points)

 

Question 2: Why is diabetes in the patient’s history a risk factor for necrotizing fasciitis, and how does diabetes compound the problem? (3 points)

 

Question 3: What is the probable cause of the chief complaint of abdominal pain? Think about edema and the mediators released during inflammation and incorporate into your answer. (3 points)

 

Physical Assessment and Diagnostics

Review of Systems

C. S. complains of fever and chills. He denies sore throat, nasal drainage or visual changes. He denies chest pain or palpitations. He denies any cough, wheezing or shortness of breath. C. S. does complain of abdominal pain, but denies any nausea, vomiting, diarrhea, black or bloody stools. He denies hematuria or dysuria. He also denies any rashes or easy bruising. C.S. does complain of swelling, pain, and redness in the perineal area. He denies any headache, syncope, near syncope or focal weakness. He denies any psychiatric or musculoskeletal problems. The remainder of a complete and careful review of systems is entirely negative and within normal limits.

Physical Exam

C. S. vital signs upon admission were: temperature 101.8, pulse 117, respirations 16, blood pressure 125/67, and oxygen saturation is 99% on room air. The patient’s general appearance is a well-developed, well-nourished African American male in no apparent distress. His head is normocephalic, atraumatic. Pupils are equal, round, and reactive to light. Extraocular motion is intact. There is no sclera icterus. Oropharynx is clear without lesion or exudates. Mucous membranes are moist. His neck is supple without mass, lymphadenopathy or JVD. His lungs are clear to auscultation bilaterally, without wheezes or crackles. His heart is regular, with tachycardia. No murmurs, gallops or rubs are noted. His abdomen is soft, nontender, with positive bowel sounds. His rectal/GU area revealed the presence of a left-sided peri-rectal wound with purulent drainage and confluent tenderness to palpation along the perineal area. His extremities are without clubbing, cyanosis, or edema. His skin is warm and dry, without rash or bruising. No neurological deficits are present. Patient moves all extremities. His speech is intact. Patient is awake and alert, somewhat flat affect, pleasant and cooperative.

Question 4: What is causing the fever and what are the systemic physiological effects of fever on the body? (3 points)

 

Lab Results

Table 1

C. S.’s Abnormal Lab Results

Test Result
WBC H 20.18
Hgb L 11.7
Hct L 35
Neutrophils % H 95
Lymphocytes % L 3
Neutrophil-Absol H 19.15
Lymphocytes- Absolute L 0.55
Sodium L 128
Carbon Dioxide L 21
Glucose H 485
FiO2 arterial 21 (room air)
pH arterial H 7.46
PCO2 arterial L 29
PO2 arterial L 76
HCO2 arterial L 21
O2 saturation 96%
Creatinine H 2.02
eGFR L 46
Hgb A1C H 12.2
CRP H 8.6

 

Clinical Course

Upon receiving the CT results, C. S. was taken for emergent surgery for debridement of peri-anal abscess and multiple intravenous antibiotics were administered. Two days later the patient was taken back to surgery for another debridement and creation of transverse, loop colostomy since the abscess had spread into the rectal tissues. He was then treated with hyperbaric oxygen therapy. During his third treatment of hyperbaric oxygen, within the first 24 hours, he experienced a rapid increase in heart rate, but no shortness of breath or physical complaints. An EKG was performed after the treatment and he was found to be in supraventricular tachycardia. After cardiac consult and echocardiogram, patient was found to have a patent foramen ovale. Furthermore, after returning to his room on the unit the patient’s wife reported the patient having mental status changes. A CT of the head was performed and discovered a left thalamic lacunar infarct. A patent foramen ovale is the number one cause of stroke in patients under the age of 55. On the third day of admission C. S. did go into renal failure from acute tubular necrosis possibly from sepsis, hypotension, and/or antibiotics. Patient therefore was placed on hemodialysis.

 

Question 5: What is your analysis of these abnormal lab results in relation to the pathophysiology of the patient’s disease process? What findings confirm necrotizing fasciitis? (3 points)

 

Question 6: Based on lab findings, what other complications need to be monitored? Why? (3 points)

 

Question 7: What is the standard treatment for necrotizing fasciitis? (3 points)

 

Question 8: Why is hyperbaric therapy used for the treatment of necrotizing fasciitis? Explain the physiology and potential side effects of treatment. (3 points)

 

Patient Response to Medical Intervention

The wound responded well to treatments. The wound bed was pink and granulating without signs of infection after debridements. Initial wound measurements per the surgeon were 20cm by 15cm. Upon discharge to the patient’s home, the wound measured 12cm by 5cm by 0.2cm. The patients WBC was 20.18 on admission and 11.55 at discharge. Neutrophil percentage dropped from a high of 95% to 79% at discharge. These findings indicate the patient is responding well to antibiotic therapy. His glucose went from a high of 485 mg/dl to a 143 mg/dl at discharge. BUN is stable at 18 and creatinine remains high at 5.22 mg/dl, however is down from 9.78 mg/dl from hemodialysis. The patient will remain on dialysis for an indeterminate amount of time.

Question 9: What wound care orders would be expected for home care? Incorporate knowledge from your lectures/readings on wounds to answer this question. (3 points)

 

Question 10: What discharge instructions should be given to facilitate a positive outcome? (2 points)

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Health care policy can facilitate or impede the delivery of services. For the past several weeks, you have been engaging in an authentic activity by critically analyzing a specific health care policy and various aspects of the impact associated with its implementation

 Policy Analysis Summary

Health care policy can facilitate or impede the delivery of services. For the past several weeks, you have been engaging in an authentic activity by critically analyzing a specific health care policy and various aspects of the impact associated with its implementation. A critical step in the policy process is communicating your findings with others. This week, you will share information from your policy analysis and its implications.

To prepare:

  • Briefly      summarize your policy analysis, focusing on the implications for clinical      practice that may be most relevant or interesting for your colleagues.      Include how evidence-based practice influenced the policy, policy options,      or solutions.

By tomorrow 05/08/2018 10 pm, write a minimum of 250 words in APA format with at least 3 scholarly references from the list of required readings below. Include the level one headings as numbered below”

Post a 2-paragraph succinct summary of your policy analysis paper. Include at least two of the options or solutions for addressing the policy and the resulting implications for nursing practice and health care consumers.

Required Readings

Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York, NY: McGraw-Hill Medical.

  • Chapter      17, “Conclusion: Tensions and Challenges”

    This chapter concludes with final thoughts on the challenge of providing      quality health care and controlling health care costs. The solution is      likely to be resolved only by a collaborative approach, involving all      health care stakeholders, and by health professionals taking the lead.

Howard, J., Levy, F., Mareiniss, D. P., Craven, C. K., McCarthy, M., Epstein-Peterson, Z. D., & et al. (2010). New legal protections for reporting patient errors under the Patient Safety and Quality Improvement Act: A review of the medical literature and analysis. Journal of Patient Safety, 6(3), 147-152.

The authors studied the dissemination of information on the Patient Safety and Quality Improvement Act (PSQIA), a federal act that affords protection to those reporting medical errors. They found medical literature to be inadequate in this regard, and as a result, medical personnel were uninformed on their legal protections. This lack of information has become a barrier to policy implementation.

Jacobson, N., Butterill, D., & Goering, P. (2003). Development of a framework for knowledge translation: Understanding user context. Journal of Health Services Research & Policy, 8(2), 94–99.

Lau, B., San Miguel, S., & Chow, J. (2010). Policy and clinical practice: Audit tools to measure adherence. Renal Society of Australasia Journal, 6(1), 36–40.

The authors study the compliance to renal-care policies by health care professionals. They conclude with the necessity for nurses to support evidence-based protocols as well as to obtain continuing education on new protocols.

McCracken, A. (2010). Advocacy: It is time to be the change. Journal of Gerontological Nursing, 36(3), 15-17.

The author proposes that nurses, as patient advocates, need to be more involved in the making of health care policy instead of reacting to policies that are constantly changing. The article provides a guide to help organize initial policy efforts.

Nannini, A., & Houde, S. C. (2010). Translating evidence from systematic reviews for policy makers. Journal of Gerontological Nursing, 36(6), 22–26.

The article cites geronotological nurses as examples of those who are able to translate research into policy briefs that can be clearly understood by policy makers. Geronotological nurses are in this unique position because of their clinical experience and educational background.

Paterson, B. L., Duffet-Leger, L., & Cuttenden, K. (2009). Contextual factors influencing the evolution of nurses’ roles in a primary health care clinic. Public Health Nursing, 26(5), 421-429.

This article provides details on a study conducted in a nurse-managed clinic related to the changing roles of nurses. The authors found that nurses, in response to social, political, and economic forces, became involved in advocacy for the clinic through political action, government funding issues, and media relations roles.

Sistrom, M. (2010). Oregon’s Senate bill 560: Practical policy lessons for nurse advocates. Policy, Politics, & Nursing Practice, 11(1), 29-35. doi: 10.1177/1527154410370786

The author uses the efforts by a nurse advocate in lobbying for an Oregon bill related to healthy food in public schools to illustrate nurse advocacy and policy making. The bill, developed in response to childhood obesity, did not immediately become law. The author concludes with the importance of considering the political environment when creating successful policy.

Spenceley, S. M., Reutter, L., & Allen, M. N. (2006). The road less traveled: Nursing advocacy at the policy level. Policy, Politics, & Nursing Practice, 7(3), 180-194. doi: 10.1177/1527154410370786

Nurses have always been advocates at the patient-level of care, but the authors of this article promote the need for all nurses to become advocates at the policy level as well. They discuss factors that have kept nurses from getting involved with policy making and they provide strategies to resolve these challenges.

Wyatt, E. (2009). Health policy advocacy: Oncology nurses make a difference. ONS Connect, 24(10), 12-15.

The author presents information on two nurses who have become health care policy advocates—one as a policy maker and one as an elected legislator. Both have been able to use their perspectives from their nursing careers to affect health policy.

Zomorodi, M., & Foley, B. J. (2009). The nature of advocacy vs. paternalism in nursing: Clarifying the ‘thin line.’ Journal of Advanced Nursing, 65(8), 1746-1752.

The authors attempt to distinguish the concepts of advocating for a patient and paternalism, or overriding a patient’s wishes. They provide clinical examples to illustrate the differences between these concepts, and they conclude with strategies to use in practice.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy: Advocating through policy. Baltimore: Author. 

Note: The approximate length of this media piece is 7 minutes.

In this media presentation, Dr. Joan Stanley and Dr. Kathleen White discuss how nurses can influence practice and engage in advocacy through the policy process.

Optional Resources

Birnbaum, D. (2009). North American perspectives: POA, HAC and never events. Clinical Governance: An International Journal, 14(3), 242–244.

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