Case Study 3: The Case of Kristopher Kristopher is a 14-year-old boy who was recently accused by a female classmate of forcing her to have sex with him.

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Case Study 3: The Case of Kristopher Kristopher is a 14-year-old boy who was recently accused by a female classmate of forcing her to have sex with him. He claimed that she agreed to have sex with him and then became angry because he went out with other girls. Kristopher is known as a bully and often fights with other students. He was removed from his biological mother’s home when he was 4-years-old because she was unresponsive when he was repeatedly abused by her boyfriend. Kristopher was adopted by his current parents when he was 7-years-old after he had lived in a series of foster homes. He was a known charmer. Despite his charm, however, he had difficulty controlling his temper and seemed to take pleasure in being cruel to other children and animals. During the next few years, Kristopher’s adoptive parents tried to help him. They worked with the school to help him control his temper and provided him with therapy. However, his behavior became increasingly difficult to manage. He frequently lied and sometimes stole money from his mother. He began to spend time with other adolescents who were known to use drugs. His school performance, which had never been satisfactory, deteriorated even further. Soon after he was accused of the sexual assault, he ran away from home but was caught by police and arrested

A. Identifying Information:

Name:

DOB

Age:

Race:

Other Identifying Information:

B. Chief Complaint/Reason for Referral:

C. History of Present Illness:

D. Psychiatric History:

E. Personal and Social History:

F. Medical History:

G. Mental Status Check:

H. DSM IV Diagnoses:

Axis I:

Rule Out:

Axis II:

Axis III:

Axis IV:

Axis V:

I. Diagnostic Rationale:

J. Differential Diagnosis:

K. TREATMENT PLAN:

A. Treatment Goals:

B. Treatment Recommendations/Interventions

C. Prognosis/Obstacles:

Research the case using public sources and describe the facts of the case (e.g. Who? Where? When? and How?

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Case facts in brief
• James Hardie Industries (JHI) is a pioneer fibre cement technology and developed a wide range of fibre cement building products.
• Medical research has shown that the inhalation of asbestos during the manufacture of fibre cement products can cause asbestosis, a chronic disease of the lungs.
• For many years numerous workers have lodged claims of compensation for attracting asbestosis with JHI denying allegations of negligence.
• Eventually, JHI set up the Medical Research and Compensation Foundation (MRCF) to handle claims and payments of asbestos poisoning from its products.
• The MRCF was grossly underfunded with A$293 million (estimated $2.2b required)
• JHI relied on estimates obtained from the company’s consulting actuary, David Minty of Trowbridge Consulting.
• There were accusations of conflicts of interest between the actuary (Minty) and JHI

Required
1. Research the case using public sources and describe the facts of the case (e.g. Who? Where? When? and How? (approximately 1,000 words).
• You may want to begin your research with Gunz, S. and van der Laan, S, (2011) Conflicts of Interest and Professional Independence: The Case of James Hardie Industries Limited, Journal of Business Ethics, 98, pp. 583-596. You are expected to read widely beyond this article.
2. How would you describe the ethical behaviour of management towards asbestos victims? Explain your answer. What should be the company’s responsibilities in this situation? (approximately 1,000 words).
3. Describe the conflict(s) of interest relating to David Minty and/or Trowbridge (the firm of actuaries) and JHI. How should Towbridge have dealt with these conflicts? (approximately 1,000 words).
4. In your opinion, would a code of conduct that was effectively enforced by the profession make a difference to Minty/Towbrdge behaviour (approximately 1,000 words).

Why did the researcher collect information about the lifestyle of community residents? What about the type of businesses present in each community?

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Scenarios:

A researcher wants to know why individuals in Community A have a higher rate of a rare form of cancer when compared to those living in Community B. To find out the reasons for the differences in cancer rates in these two communities, the investigator surveyed residents about their lifestyle, noted the types of businesses that were present in the community and searched medical records. The researcher found that the headquarters for the Toxico Chemical Plant is located in Community A, there is a higher rate of cigarette smoking in this community and residents tended to delay or skip going to the doctor for an annual checkup. In Community B, the largest employer was a department store and on average, residents did not smoke as much as residents from Community A. However, like individuals from Community A, Community B residents tended to delay or skip their annual checkup with their doctor. Instructions: Read the scenario above. Answer the following questions: What makes this a descriptive study? Why did the researcher collect information about the lifestyle of community residents? What about the type of businesses present in each community? Medical records? Can the investigator establish that the chemical plant and cigarette smoking are the cause for the higher rate of cancer among those in Community A? Can the investigator establish that lower smoking rates and the absence of a chemical factory explains the lower rate of cancer among those in Community B? Your post should be a minimum of 250-300 words. Back up your arguments with reliable evidence.

Select syncope, hand tremors, seizures, right/left-sided weakness or paralysis, abnormalities of gait or posture, changes in mental status, and so on.

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Healthy People Initiative (graded)
As the school nurse working in a college health clinic, you see many opportunities to promote health. Maria is a 40-year-old Hispanic woman who is in her second year of nursing school. She complains of a 14-pound weight gain since starting school and is afraid of what this will do to both her appearance and health if the trend continues. After doing her history, you learn that she is an excellent cook and she and her family love to eat foods that reflect their Hispanic heritage. She is married with two school-age children. She is in class a total of 15 hours per week, plus 12 hours of labs and clinical. She maintains the household essentially by herself and does all the shopping, cooking, cleaning, and chauffeuring of the children.She states that she is lucky to get 6 hours of sleep per night, but that is okay with her. She lives 1hour from campus and commutes each day.Using .healthypeople.gov/”>Healthy People 2020as a guide:
1. What additional information would you like to gather from Maria?
2. What are Maria’s real and potential health risks?
3. Pick one of Maria’s health risks. What would be one reasonable short-term goal for this risk?

Cultural Bias (graded)
Understanding cultural phenomena is essential to the completion of an accurate health assessment. Please choose a cultural group from Table 4.1 from your text and describe the cultural differences pertinent to that group. Remember, the table may not include all cultural groups. Let’s try to include all the groups listed in the discussion, so please do not choose a group that has already been done. To expedite this, please use the group name in the title of your post.

week 2

Pain Assessment (graded)
John, a 46-year-old African-American male presents for admission to your hospital for hemi-colectomy for colon polyps. He is complaining of chronic back pain. Patient is on disability from work related injury. History of two (2) previous back surgeries with relief of numbness in RLE but pain has not been relieved. His current medications include Methadone, Neurontin and Norco. John states he takes Benadryl PM every night in addition to his prescribed medications. John is a smoker and smokes 1 PPD. John confides in you that he is considering a spinal cord stimulator for the chronic pain.
• What risk factors does John have for risk of opioid withdrawal during this hospitalization?
• Is there a stigma connected to being disabled and or methadone?
• Does the nurse need to be concerned about acetaminophen use?
• What are the differences in acute and chronic pain?
•

Nutritional Assessment (graded)
Yulang Lei, an 82-year-old Vietnamese man, was admitted to your floor with dehydration and a urinary tract infection following a fall at home. He is alert and oriented, but weak. He appears frail. His admission history includes the following.
• He lives alone; his wife died 6 months ago.
• He states he ran a traditional Vietnamese family, unlike his children, who are married and have now moved away.
• His wife did all the cooking and he hasn’t had much of an appetite since she died. He eats rice and some vegetables, but rarely “bothers to cook meat for just one person.”
• Usual daily activity is reading the Vietnamese community newspaper with his morning tea for breakfast. He says he usually eats lunch, but can’t remember what he usually eats. He has rice and a few vegetables for dinner.
• You notice that his clothes fit very loosely. He states he weighed 140 pounds at his doctor’s office 5 months ago. When you weigh him, he weighs 123 pounds and is 5’8″ tall.
Look at the list of nursing diagnoses in Appendix A of your text. What nursing diagnoses would you choose for Mr. Lei?
• What additional questions would you ask to confirm your diagnosis?
• What physical examination and laboratory findings would you expect Mr. Lei to have?
• What psychosocial and cultural factors should you consider when assessing Mr. Lei?

General Survey and Health History (graded)
Casey is a 17-year-old high school student admitted to the ER with a compound fracture of the left leg obtained falling at the local skateboard park while practicing for a national competition. He has never been hospitalized before. His mother has been notified and is on her way. The EMTs gave him morphine and he reports his pain level as “okay.”
• What part of the interview and examination can be done prior to his mother’s arrival?
• As you enter the room for the first time, what should you observe as part of the general survey?
• As you complete his history, what areas are especially important?
• What are the important developmental considerations for Casey?

The Older Adult (graded)
Jean is a 68-year-old female admitted for a total hip replacement. In her interview you learn that she has a history of obstructive sleep apnea (OSA) with a neck circumference of 16 inches and snores much of the night. She is 5’7” and weighs 265 pounds. She states she is sleepy throughout the day. Her other medical history includes: hypertension treated with angiotensin II receptor blockers (ARB), Diabetic with an Hgb A1c over 8%. Hypercholesteremia treated with a Statin drug. Coronary Artery Disease (CAD) with a history of a drug eluting cardiac stent placed 14 months ago and currently on Plavix and ASA. History of gastroesophageal reflux disease (GERD) and is on Prilosec. Her husband has a history of cerebral vascular accident (CVA) several years ago.
• What medications should she take pre-op and what should she hold?
• Should Jean be allowed to continue ASA pre-operatively?
• Should cardiology be consulted on this matter?
• What are Jean’s risks for diabetes complications? What concerns do you have about her social support system?
•

week 4

Assessment of the Skin (graded)
Describe a patient with an abnormal skin symptom or group of symptoms such as a rash, an itch, redness, a lesion, or wounds. Do not limit yourself to these examples.
• What questions would you ask as part of your focused assessment?
• What history might be associated with the symptom, if any?
• What are the known risk factors for this condition?
• What physical examination techniques would you use?
• What patient education would you give the patient?
• Find a nursing journal article about these symptoms.

Assessment of the Head and Neck (graded)
Choose one area of the head and neck and then select a common complaint (symptom or group of symptoms) patients may have in that area. For example, you may select headaches, earaches, ringing in the ears (tinnitus), sinus drainage and pain, sore throat and cough, and so on. Do not limit yourself to these examples.
• What questions would you ask as part of your focused assessment?
• What history would be associated with the symptom?
• What are the risk factors for this condition?
• What physical examination techniques would you use?
• What patient education would you give the patient?
• Find a nursing journal article about this symptom or condition.

•
• unit 5

Assessment of the Abdomen (graded)
• Describe a patient with an abdominal symptom or group of symptoms, such as bloating, flatus, and eructation; constipation; nausea and vomiting; diarrhea; or abdominal pain. Do not limit yourself to these examples. Remember that there are different types and locations of abdominal pain.
o What questions would you ask as part of your focused assessment?
o What history might be associated with the symptom, if any?
o What are the known risk factors for this condition?
o What physical examination techniques would you use?
o What patient education would you give the patient?
o Find a nursing journal article about these symptoms.

Assessment of the Genitourinary System (graded)
Describe a patient with a genitourinary symptom or group of symptoms; such as incontinence, burning on urination, irregular menses, pain in the scrotum, erectile dysfunction, and so on. Do not limit yourself to these; for example, there are different types of incontinence.
o What questions would you ask as part of your focused assessment?
o What history might be associated with the symptom, if any?
o What are the known risk factors for this condition?
o What physical examination techniques would you use?
o What patient education would you give to the patient?
o Find a nursing journal article about these symptoms.

unit 6

Assessment of Cardiac Status (graded)
Describe a patient with a cardiac symptom or group of symptoms, such as palpitations, hypertension, hypotension, tachycardia, or bradycardia. Do not limit yourself to these examples.
o What questions would you ask as part of your focused assessment?
o What history might be associated with the symptom, if any?
o What are the known risk factors for this condition?
o What physical examination techniques would you use?
o What patient education would you give to the patient?
o Find a nursing journal article about this symptom or condition.
o

Assessment of Respiratory Status (graded)
Choose one area of the respiratory system and then select a common complaint (symptom or group of symptoms) patients may have in that area. For example, you may select wheezes, pulmonary congestion, absence of breath sounds on one side, productive cough, and so on. Do not limit yourself to these examples.
o What questions would you ask as part of your focused assessment?
o What history would be associated with the symptom?
o What are the risk factors for this condition?
o What physical examination techniques would you use? What patient education would you give the patient?
o Find a nursing journal article about this symptom or condition.

o unit 7

Assessing the Musculoskeletal System (graded)
o Describe a patient with a musculoskeletal symptom or group of symptoms, such as joint pain, back pain, neck pain, and so on. Do not limit yourself to these examples. Remember: There are different types and locations of joint pain.
 What questions would you ask as part of your focused assessment?
 What history might be associated with the symptom, if any?
 What are the known risk factors for this condition?
 What physical examination techniques would you use?
 What patient education would you give the patient?
 Find a nursing journal article about these symptoms.

unit 7

Assessing the Nervous System (graded)
Choose one common complaint (symptom or group of symptoms) related to the neurological system. For example, you may select syncope, hand tremors, seizures, right/left-sided weakness or paralysis, abnormalities of gait or posture, changes in mental status, and so on. Do not limit yourself to these examples.
 What questions would you ask as part of your focused assessment?
 What history would be associated with the symptom?
 What are the risk factors for this condition?
 What physical examination techniques would you use?
 What patient education would you give to the patient?
 Find a nursing journal article about this symptom or condition.