Nursing CASE STUDY

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The Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, has dramatically improved the quality of care in the nursing home over the last twenty years by setting forth federal standards of how care should be provided to residents.

This Act is interpreted with the U.S. Code of Federal Regulations (42 CFR Part 483). Such improvements include less use of antipsychotic drugs, a reduction in chemical and physical restraint use, and a reduction in inappropriate use of indwelling urinary catheters.

Mandates

The quality of care mandates contained within OBRA, and the regulations, require that a nursing home must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care.

In order to participate in Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for nursing homes.

The mandates of OBRA are regarded in the nursing home setting to represent minimum accepted standards of care. The failure of a nursing home to comply with the OBRA quality of care mandates in caring for a resident represents a failure to exercise the degree of reasonable care and skill that should be expected.

Penalties

The Indiana State Department of Health is responsible for ensuring that nursing homes follow these mandates through the state survey process. The Department of Health and Human Services (DHHS) and the states may apply penalties against nursing homes for failure to meet the minimum standard of care as defined in the OBRA regulations.

Such penalties may include fines, appointment of administrative consultants to run the nursing home while deficiencies are remedied, and even closure of a nursing home.

• Residents must be assessed to identify their medical problems and their abilities to perform basic self-care activities. The DHHS established a uniform data set, referred to as the minimum data set (MDS), to document this assessment.
• The nursing home is responsible for the safety of each resident. This includes being responsible for orders written by the resident’s primary physician or other medical provider. If the physician writes an order that does not comply with the federal regulations, the nursing home is responsible for making sure the physician changes such order. The mere presence of a physician’s inappropriately written order does not absolve the nursing home of responsibility in providing safe care.
• Provide services that will enhance each resident’s quality of life to its fullest (42 CFR §483.15).
• Maintain the dignity and respect of each resident (42 CFR §483.15).
• Develop a comprehensive care plan for each resident (42 CFR §483.20).
• Conduct a comprehensive and accurate assessment of each resident’s overall health upon admission and at each required interval (42 CFR §483.20).
• Prevent a decline in activity of daily living (ADL) activities, including the ability to eat, toilet, bathe and walk. Staff must provide for ADL care when necessary (42 CFR §483.25).
• Prevent the development of pressure sores, and if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing (42 CFR §483.25).
• Provide appropriate care to those who have urinary incontinence and restore bladder function if possible. This also includes only using urinary catheters when appropriate as outlined in the regulations to prevent adverse consequences related to such use (42 CFR §483.25).
• Prevent accidents, including falls, accidental poisonings and other incidents that could cause injuries (42 CFR §483.25).
• Maintain adequate nutrition to prevent unnecessary weight loss (42 CFR §483.25).
• Provide each resident with sufficient fluid intake to prevent dehydration (42 CFR §483.25).
• Ensure that residents are free from significant medication errors (42 CFR §483.25).
• Have sufficient nursing staff (42 CFR §483.30).
• Ensure that each resident’s rights to choose activities, schedules, and health care are maintained (42 CFR §483.40).
• Provide pharmaceutical (medication) services to appropriately meet the physical and psychological needs of each resident (42 CFR §483.60).
• Maintain accurate, complete, and easily accessible clinical records for each resident (42 CFR §483.75).

Please read the OBRA guidelines and do the paper base on this question .APA style .Thank you

CASE STUDY: Mrs. J is repeatedly asking for a nurse; other patients are complaining, and you simply cannot be available to Mrs. J for long periods.  Considering the setting and the OBRA guidelines, what would you do to manage the situation?

Nursing Case Study

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Required Resources
Read/review the following resources for this activity:

• Textbook: Chapter 9, 10 (section 10.4), 11 (section 11.5), 13
• Lesson
• 1 primary source that corresponds with your selected topic (noted in the topic instructions)
• Minimum of 2 scholarly sources (in addition to the textbook)

Optional Resources to Explore
Feel free to review the library guide for scholarly sources and videos at the following link:

• Link (website): History Library Guide https://library.chamberlain.edu/history

Introduction
The purposes of each case study assignment include the following:

• To hone your abilities to research using scholarly sources
• To advance critical thinking and writing skills
• To compile a response to the prompts provided
• To explore a historical topic and make connections to change over time

Instructions
Pick one (1) of the following topics. Then, address the corresponding questions/prompts for your selected topic. Use at least one (1) documented example of the corresponding primary source in your writing.

Option 1: The American System, Transportation, and Communication
Read the following primary source:

• Link (website): Of Debates in Congress (Clay’s Debate of the American System in 1832) ( https://memory.loc.gov/cgi-bin/ampage?collId=llrd&fileName=011/llrd011.db&recNum=132 Click on “Next Image” to see all pages of the debate: pp.258-262.)

Then, address the following:

• Describe the idea of Henry Clay’s “American System.”
• Based on Clay’s economic vision of America, analyze how the American System would build the American market and economy?
• Analyze the role of mechanization and communication in the American System.

Option 2: The Indian Removal Act of 1830
Read the following primary source:

• Link (website): Transcript of President Andrew Jackson’s Message to Congress ‘On Indian Removal’ (1830) Transcript of President Andrew Jackson’s Message to Congress ‘On Indian Removal’ (1830)

Then, address the following:

• Evaluate the rationale that President Jackson used in the removal of the Native Americans from east of the Mississippi River. Did the removal have the intended impact?
• Identify the responsibilities given to the President under the Indian Removal Act of 1830.
• Compare Jackson’s actions toward Native Americans in the context of his First Inaugural Address with the path of events during the Trail of Tears.
• Determine if the removal of the Native Americans from east of the Mississippi River violate the principles found in the Declaration of Independence?

Option 3: The Abolitionist Movement
Read the following primary source:

• Link (website): Declaration of Sentiments of American Anti-Slavery Society (1833) https://www.loc.gov/resource/rbpe.11801100/?st=gallery (Click on arrows to view all images of the document. Click on plus and minus signs to enlarge or reduce size of images.)

Then, address the following:

• Assess if abolitionists were responsible reformers or irresponsible agitators?
• Explain how abolitionists upheld the Declaration of Independence as the foundation of antislavery and abolitionist thought.
• Assess the effect of the Gag Rule on the Abolitionist Movement.
• Analyze how the women’s rights movement would gain momentum from the antislavery movement.

Writing Requirements (APA format)

• Length: 2-3 pages (not including title page or references page)
• 1-inch margins
• Double spaced
• 12-point Times New Roman font
• Title page
• References page
• In-text citations that correspond with your end references

References

Library of Congress. (n.d.-a). Declaration of sentiments of the American anti-slavery society. Adopted at the formation of said society, in Philadelphia, on the 4th day of December, 1833. New York. Published by the American anti-slavery society, 142 Nassau Street. William S. Retrieved from

https://www.loc.gov/resource/rbpe.11801100/?st=gallery

Library of Congress. (n.d.-b). Of debates in Congress (Clay’s debate of the American system in 1832). Retrieved from https://memory.loc.gov/cgi-bin/ampage?collId=llrd&fileName=011/llrd011.db&recNum=132

Our Documents. (n.d.). Transcript of President Andrew Jackson’s message to Congress ‘On Indian removal’ (1830). Retrieved from https://www.ourdocuments.gov/doc.php?flash=false&doc=25&page=transcript

Nursing Case Study

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1. You are a nurse working in a labor and delivery unit in a small town near a Native American reservation. Charity, your patient, is about to give birth to her sixth child. Her family does not have health insurance. Normally she would give birth at home; however, her blood pressure is high. Her family is doing a dance to scare away the evil spirits that brought about this medical condition. She is in a lot of pain but refuses an epidural. She believes that pain is something that should be tolerated. There are also about 20 family members present to watch the birth, including all of her children. After the baby is born, she hand-expresses colostrum from her breasts and disposes of it. Additional family members arrive with all sorts of food to celebrate the birth of the baby. (Learning Objectives 5 and 6)
A. What are the cultural traits with Charity and her baby that are specific to her Native American culture?
B. How would you provide culturally sensitive nursing care to Charity and her baby?

Nursing Case Study

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Hematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.

Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

Case Study Questions

1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
   In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.

Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.

Case Study Questions

1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.

Submission Instructions:

Include both case studies in your post.

• Your initial post should be at least 500 words in total, (250 words per case study), formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
• All replies must be constructive and use literature such as one intext citation from one scholarly source.
• Please post your initial response by 11:59 PM ET Thursday,and comment on the posts of two classmates  on separate days, starting on Friday to Sunday  11:59 PM ET.
• You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.