Care of a Patient with Colon Cancer – 2 pages
Care of a Patient with Colon Cancer
Case Study
Juan Martinez, a 52-year-old male, had a routine screening colonoscopy last week. He was asked to come into office for the results this morning. Mr. Martinez was diagnosed with colon cancer and is scheduled for surgery to remove the tumor in 2 days. Care of a Patient with Colon Cancer
1. What psychosocial concerns should the nurse anticipate in caring for Mr. Martinez and his family? With whom should the nurse collaborate in the provision of Interprofessional care?
Mr. Martinez has the surgery and is recovering without complications. His oncologist has discussed radiation therapy with Mr. Rodriquez and his wife. When the nurse comes into his room, Mr. Martinez says, “I thought all the cancer was gone when they took the tumor out! Now the doctor says I need radiation therapy. Care of a Patient with Colon Cancer. My friend had radiation therapy and he had burns! I don’t want burns!” Care of a Patient with Colon Cancer
2. What actions should the nurse take to address Mr. Martinez’s concerns?
Four years later, Mr. Martinez is back in the hospital with a bowel obstruction. He has been cancer-free since the surgery and radiation therapies were completed. Mr. Martinez states “The doctor said this bowel obstruction was caused by the surgery or the radiation. How can that be?”
3. How should the nurse respond to Mr. Martinez?
Esophageal problem – 2 pages
Mr. Williams is a 60-year-old man who has been diagnosed with gastroesophageal reflux disease (GERD).
1. What patient teaching about health promotion and lifestyle changes should the interprofessional team members provide to Mr. Williams?
2. What is the appropriate nursing response?
3. What postoperative instructions should the nurse provide? Care of a Patient with Colon Cancer
Care of a Patient with Breast Cancer – 2 pages
Care of a Patient with Breast Cancer
Ms. Williams is a 35-year-old African-American patient. Earlier this week while performing a monthly BSE, she found a small lump in her left breast. She tells the nurse that she has never noticed abnormalities in either breast before. She states that she is very worried about having breast cancer, because she is a single mother who has a 3-year-old daughter. Care of a Patient with Colon Cancer. Her past medical history includes seasonal allergies to grass and pollen, and her family history includes a maternal aunt who had breast cancer at the age of 68. She is currently taking birth control pills and an over-the-counter antihistamine. Care of a Patient with Colon Cancer
What risk factors does Ms. Williams have for developing breast cancer?
What physical assessment data should the nurse collect?
What health care team members may become involved with Ms. Williams case at this point?
How should the nurse respond to Ms. Williams’ statement?
Lab Assignment: Ethical Concerns – 1 page
Write a detailed one-page narrative explaining the health assessment information required for a diagnosis of your selected patient. Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. What necessary information would need to be obtained about the patient through health assessments and diagnostic tests? Justify your response using at least three different references from current evidence-based literature.
Selected case study: A 27-year-old man with Crohn’s disease has been admitted to the emergency room with an extreme flare-up of his condition. He explains that he has not been able to afford his medications for the last few months and is concerned about the costs he may incur for treatment.
Root Cause Analysis Draft
Root cause analysis (RCA) is a structured method used to analyze serious adverse events. Initially developed to analyze industrial accidents, RCA is now widely deployed as an error analysis tool in healthcare. A central tenet of RCA is to identify underlying problems that increase the likelihood of errors while avoiding the trap of focusing on mistakes by individuals. RCA thus uses the systems approach to identify both active errors (errors occurring at the point of interface between humans and a complex system) and latent errors (the hidden problems within healthcare systems that contribute to adverse events) Care of a Patient with Colon Cancer.
Questions :
1. Student will identify a current problem or issue occurring on a nursing unit or within a healthcare organization.
2. Student will identify at least two (2) stakeholders and interview them to determine the root causes of the problem. (Student may present only 1 stakeholder for draft submission)
Root-Cause Analysis and Safety Improvement Plan
The safety of patients is a priority of every health organization. Medication errors jeopardize patient safety and can occur during prescription, dispensation, administration, and monitoring. Some medication errors cause actual patient harm, while others threaten patient safety. Nevertheless, medication errors are preventable. The purpose of this paper is threefold: to present a sentinel event that involved a medication error in my health organization, apply a root cause analysis to investigate the event, and draft an evidence-based improvement plan to prevent errors in the future.
Analysis of the Root Cause
Mr. D is a 54-year-old black male who has been in the surgical inpatient unit for the past two days for planned surgery to repair an inguinal hernia. Mr. D has been on Pradaxa (dabigatran) for his atrial fibrillation for the past two months. In the evening before the day of surgery, a student nurse administered Mr. D’s dabigatran and documented it. Mr. D was kept nil by mouth overnight before going to the operating room in the morning. On the morning of surgery, Mr. D was draped and cleaned for the surgical procedure.
The surgeon made the first incision after the patient was put on general anesthesia. He then remembered that the patient was an ‘a-fib’ patient and asked the anesthesia team to remind him of the patient’s regimen for atrial fibrillation. He then requested that the patient’s medication history be reviewed before proceeding with the operation. It was found that the nurse had documented giving Mr. D his dabigatran about 9 hours before. The surgeon requested that the patient be weaned out from the anesthesia machine and the operation be stopped due to the high risk of bleeding. He stated that during the previous rounding, he had recommended that the patient’s dabigatran be stopped one day before surgery.
The patient, the nursing, anesthesia, and surgical team were impacted by this event. Stopping the surgery meant that the procedure had to be postponed and rescheduled for another day with clear instructions. The nurse in charge of the patient questioned why the event occurred. The patient then sustained one incisional scar due to this event and could have bled uncontrollably due to the anticoagulation from the medication error.
In my health organization, the preparation process of a patient for major elective surgery involves the anesthesiologists, nurses, surgeons, and the patient’s family members if present. The care professionals ensure that the patient is fit for the surgery. The anesthesiology and surgery department ensures that the patient is eligible for the surgery.
Informed consent is administered and signed by the patient or capable family member and doctor or another family member as the witness the day before surgery. The surgeons also ensure that the patient is physiologically optimized for this surgery. The anesthesiologists and nurses ensure that the procedure is ethical and safe for the patient by providing the required nursing care – both clinical and administrative.
Ideally, the student nurse, upon administration, ought to inform the surgeons and the anesthesiologist about the medications administered. Even though she documented this activity, the medication was administered when the surgical team reviewed the patient and cleared him for surgery the day before. Therefore, this miss in effective communication contributed to this medication error.
Effective communication was initiated by the surgeon’s inquiry intraoperatively. The student nurse assumed that the medication was one of the regular patient medications and thus failed to account for possible outcomes of the medication administration. The surgeon also recommended stopping dabigatran but did not document this plan; thus, the nurse failed to execute it. Therefore, ineffective communication played a vital role in the occurrence of this medication error.
Environmental and human factors played a part in this incident. My health organization is also a teaching hospital. Understaffing has been an issue, especially in the nursing department. The pandemic led to the transfer of some nurses to other acute care units, thus leaving the inpatient wards understaffed. Lack of supervision from the senior nurse and inexperience from the student nurse worked in tandem to contribute to this error. Environmentally, the location of the nurses’ station and the doctors’ units only makes electronic communication the only efficient means.
The existing healthcare technology for the organization that has been implemented to prevent medication errors is the electronic health record (EHR), computerized physician order entry (CPOE), and barcode medication administration (BMCA) technology. However, these technologies were unhelpful because the patient’s medication record was not incorporated into the system. This medication was from a previous prescription from the last visit to a physician and thus was not included in the patient records during his brief stay in the unit.
Application of Evidence-Based Strategies
Many healthcare organizations have implemented various technologies to reduce, if not prevent, medication errors. Technologies such as automated dispensing cabinets, computerized physician order entry, BMCA, and closed-loop electronic medication management systems have been used to manage medication supply, administration, and monitoring (Zheng et al., 2021).
The best practices have aimed at streamlining the prescription, dispensation, administration, monitoring, communication, and documentation of medications and patient care. Ineffective communication during care transitions has been associated with medication errors. Therefore, best practices promote standardized end-of-shift reporting with clear communication and medication review to prevent errors. Bedside shift reporting and medication reconciliation are some of the strategies used to prevent medication errors.
Improvement Plan with Evidence-Based and Best-Practice Strategies
In this health organization, policy and technological change are critical safety improvement plans that should be undertaken to prevent future errors. This improvement plan will aim at promoting interdisciplinary collaboration and nurse handovers. The two critical interventions will be policy change to ensure all nurse handovers are carried out at the patient’s bedside using standardized medication reconciliation and awareness about the need for interdisciplinary communication through standardized documentation. Promoting common rounding that brings together the surgical and nursing teams to ensure that all care stakeholders are on the same page will be an effective safety improvement change strategy.
Nurse handover improvement is a safety change strategy that will reduce medication errors through communication, planning, and documentation. According to Boersma & Freeman (2022), bedside shift handover using standardized communication by effective tools such as SBAR and NU-PASS can prevent medication errors and patient harm. One of the two specific goals of this plan is that after two weeks, nurses will be able to conduct medication reconciliation at the bedside and involve the patient to prevent the administration of medication from the previous patient’s prescription. The other goal is for nurses, surgeons, and anesthesiologists to be able to communicate their plans for medication treatment for every patient through common documentation.
Existing Organizational Resources
Technology is a critical resource that will affect this plan. My health organization has three key technologies that can help in the implementation of this plan. The electronic health record (EPIC), CPOE, and barcode medication administration. According to Sloss & Jones (2019) and Williams et al. (2021), BCMA requires the collaboration of designers and users to ensure usability so that all stakeholders in medication error prevention achieve seamless care delivery. This preexisting resource will require that all nurses master its use to ensure maximal error prevention. The EHR will ensure common communication and standardization of documentation among all care professionals. The policy change to ensure that all stakeholders adopt EHR in their documentation will thus be feasible. Other resources that can influence this plan’s success are the institution’s library and the internet to promote evidence-based practice and reference for care.
Conclusion
Medication errors are multifactorial in causality and multidimensional in outcomes. The provided scenario happened more than a year ago in a teaching institution. The medication error resulted from ineffective communication, staff shortage, and lack of interdisciplinary collaboration. The error could potentially cause fatal outcomes for the patient but was detected in time by the surgeon.
Current best evidence-based practices recommend the use of technology to prevent these errors. However, technology alone is not enough. Policy change, interdisciplinary collaboration, and communication are other key strategies that are essential to error prevention. In this sentinel event, the safety improvement plan aims to prevent future events through mandatory bedside nursing shift reporting and policy change to ensure all care professionals document care notes and plans in the EHR. This would standardize communication and make collaboration efficient.
Care of a Patient with Colon Cancer References
Boersma, K., & Freeman, M. (2022). Effective nurse handoffs: Key considerations for design and implementation. Nursing, 52(4), 51–54. https://doi.org/10.1097/01.nurse.0000823256.78368.d7
Sloss, E. A., & Jones, T. L. (2019). Alert types and frequencies during bar code-assisted medication administration: A systematic review. Journal of Nursing Care Quality, 35(3). https://doi.org/10.1097/NCQ.0000000000000446
Williams, R., Aldakhil, R., Blandford, A., & Jani, Y. (2021). Interdisciplinary systematic review: does alignment between system and design shape adoption and use of barcode medication administration technology? BMJ Open, 11(7), e044419. https://doi.org/10.1136/bmjopen-2020-044419
Zheng, W. Y., Lichtner, V., Van Dort, B. A., & Baysari, M. T. (2021). The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: A systematic review. Research in Social & Administrative Pharmacy: RSAP, 17(5), 832–841. https://doi.org/10.1016/j.sapharm.2020.08.001
Application of Statistics in Health Care – 4 Pages
Statistical application and the interpretation of data is important in health care. Review the statistical concepts covered in this topic. In a 750-1,000 word paper, discuss the significance of statistical application in health care. Include the following:
- Describe the application of statistics in health care. Specifically discuss its significance to quality, safety, health promotion, and leadership.
- Consider your organization or specialty area and how you utilize statistical knowledge. Discuss how you obtain statistical data, how statistical knowledge is used in day-to-day operations and how you apply it or use it in decision making.
Also read: Quality Improvement Proposal Discussion