D-The patient arrived on time for his session. Upon meeting with the patient, he immediately reports he is stable on his dose and then informed the patient about the need to reschedule appt. due to an appt. with CT works with his job coach. This writer asked the patient for any proof of documentation and his response was no. This writer strongly advised the patient that in the near future, if he has to end the session for any reason due to another appointment to either call this writer the day before to reschedule during the same week and also, provide proof of documentation. The patient reports that he wasn't asked for any documents before with his prior counselor and how he is good with appointments. This writer addressed with the patient
Mrs. Hylton is a 45 year old female who presented to the ED via LEO under IVC by her therapist, Melanie, from ADS. Per documentation Mrs. Hylton denies suicidal ideation and homicidal ideation to nursing staff and MCM before the evaluation. She also contracted for safety with MCM. Dr. Horton requested a mental health assessment on Mrs. Hylton. Before the assessment Ms. Melanie and her supervisor Melissa were contacted. Ms. Melissa reports Mrs. Hylton verbally contracted for safety, however left before ADS could type up terms of verbal agreement. Melissa reports afterwards she was not aware of Mrs. Hylton symptoms of psychosis when speaking with her until being informed by Melanie of findings after conversation with Mrs. Hylton. Melanie upon
The Board received a complaint on 04/02/2014 regarding patient Gloria Kinder from Dena Andrews who has a POA for health care matters on the patient. The complaint was regarding Dr. Negron taking over care of the patient after her primary care doctor retired. The complainant states that the doctor would not refill her potassium, did not do follow up labs, and would not care for the patient.
I cared for a 76-year-old end-staged chronic obstructive pulmonary disorder patient who was admitted for respiratory distress. The doctor requested that my nurse and I get the family together for a family meeting. During the meeting, the doctor communicated to the patient and his family members that the patient will be palliative and no longer be in the ICU. The family members were concerned about the transfer of care to the medicine unit, what to expect from palliative care and other options for care. This scenario did not go well because the patient and family would have benefited from a palliative nurse with expertise, respiratory therapist to discuss other options, pharmacist about medication change if needed, social worker to help guide the family through end of life care for their father. In addition, there was no collaboration with interprofessionals prior to the family
Anthony is a 40-year-old Asian American male who presents on the unit from RRC-W. He is SMI designated and on COT. He is ACOT for non-compliance. Per clinical team, client has been ignoring his diabetic condition due to increase psychosis and delusions. His team believes once he is stabilized on medication, he will begin to recognize his diabetic condition. Upon arrival, client refused intake assessment and vital signs. He will benefit from meeting with provider to discuss medication
The staff believed the patient’s altered behavior was due to the possible drug withdrawals. While the symptoms are similar, there are distinct differences between hypovolemic shock- secondary to blood loss, and acute opiate withdrawals. With a thorough exam, the staff should have been able to recognize this difference. The Clinical Opiate Withdrawal Scale, (Wesson, D. R., & Ling, W., 2003) would have been the proper objective measurement tool to be able accurately, assess the patient. Another breach of duty was not getting the CT scan down in an appropriate amount of time. The physician had a high index of suspicion that the patient was bleeding internally, yet the CT was not completed until the following morning. Lastly, the patient admitted to a substance abuse problem, yet a drug screen was not ordered. If it had been, they would have seen there were no opiates in his system and he was positive for alcohol and benzodiazepines.
LPA asked C1 was he being given his medication? C1 said yes. LPA asked C1 how often did he have to take his medication? C1 said he has to take medication every day; he takes Focalin in the morning and evening, then at bedtime he takes Clonidine. LPA asked C1 had any of the staff given him too much medication or had anyone made him take medication when he was not supposed to? C1 said no, the staff have been giving him his medications around the same time each day and he has been taking his medications. LPA asked C1 had any of
This week we had an officer working whose S11 had expired in LMS. The officer reported to medical and complete his S11 examination prior to his expiration date. The officer was told by the medical staff that before they could complete his approval he needed to follow up with his primary care physician to confirm a pre-existing condition was being treated and controlled by the doctor. The officer was asked to have his primary care physician forward the documentation to TVA’s medical and once this was done they would sign off on the TVA documents completing the officers annual S11 evaluation. The officers asked the medical staff to send him an email with her request for the additional documentation for which she did. However the nurse never
R: The member started the application with her name and date of birth. The member did the same thing with her Medicaid application. She fills out her name and date of birth and expects the MHS ro complete the rest of the application. MHS informed the member that she would assist with the application, but MHS will not do it for help. The member aptitude changes, the member is now upset the MHS will not complete the application. The member went to the restroom and got lost. The member said she forgot which room I was in. The member said “You could have been done by now.” The MHS
Patient has a history of abusing other substances and was very med seeking for benzos and opiates in the ED ("I don't want yall to give me nothing if it ain't IV Ativan and Morphine"). He reports drinking a 1 gallon of wine daily. He denies other drug use and this was confirmed by his most recent drug screen which was negative for substances with a BAC of .42. Upon arrival patient was put on detox protocol with Ativan scheduled every 6 hours. Upon assessment this morning patient denies any withdrawal symptoms. After TACT confronted him about malingering and patient admitting this, TACT then began to discuss discharge options. When TACT asked Mr. Farley about withdrawal symptoms he only expressed
She reports pain in her left thigh which she describes as constant burning, shooting pain that radiates down her leg. The pain is 10/10 in severity. She states that her pain is so bad she has not slept in 4 days; the pain is preventing her from sleeping, eating and standing to perform her ADLS. “When I am in this much pain, I cannot eat” she has a poor appetite, has been taking small sips of boost nutrition supplement. The patient appointment with Dr Delo is schedule for Thursday 2:30 pm. I call Dr Delo’s office to request a sooner appointment for the patient. I spoke with Donna who informed me that, they did not have an earlier appointment available. The patient is getting lymphedema therapy and massage at home from home health agency, but it is not effective. I called Dr Conidi office with intent to discuss the patient’s unrelieved pain, I was informed by the office staff, to call back office and leave a message. The patient has tried different classed of pain reliever (Opiates, NSAID, Neuropathic pain agent) with not relive or reduction in her pain. After collaborating with the Palliative medical director and discussing the patient unrelieved pain, the different medication that has been tried with no palliation of her pain,
• The patient must provide a written request to their physician, signed with two witnesses present.
On my first day of week three clinical at 0830, client W and I were on our way to the dinning room and client B asked me to put his jacket on, so I told client W that I would meet him in the dinning room. After I helped Client B, I was on my way to the dinning room and nurse A told me that client W was experiencing difficulty breathing and we needed to give him his 0900 inhalers earlier. He was having audible wheezing and rapid respiratory rate. Therefore, we had to give client W his inhalers, SalbutaMOL Sulfate, which is a bronchodilator to allow the alveoli in the lung to open so th...
I introduced myself to the patient stating that I was a student nurse and gained verbal consent to carry on with the assessment, as a student nurse you must respect patients wishes at all times, if t...
The nurse confirmed patient identification, asked subjective questions focusing on chief complaints, performed a focused assessment, obtained medication list, baseline vitals, and assessed the patient’s past medical history. She asked the patient questions such as previous hospitalization/surgery, metal implants, allergies, health history, sleep apnea, and alcohol/tobacco use. The nurse told the patient the doctor would be with her shortly. The nurse reported to the doctor regarding the patient and obtained orders for treatment from the doctor. The nurse then started an IV line and hung an IV solution bag of normal saline because the patient was experiencing abdominal pain. The nurse also administered pain medications and the patient was ready to be discharged. The nurse gave discharge instructions and made sure that the patient had a ride
Clinical Orientation was the concept of the week. Knowing what’s the importance of Hand washing or hang hygiene and knowing how to execute it well was the topic during the simulation day. It is about preventing to chain of infection from nurses to patients, family, friends and to the public. So nurses having a knowledge on how to execute hand washing properly makes the nurse to be aware of their own hygiene and the nurse would be able to provide individualised hygiene care. (Crisp et all, 2013) Knowing your way around to the hospital and knowing hand hygiene was the main focus of the clinical orientation.