Grand Canyon University Risk

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

  1. Is very anxious and asks whether she is going to die.
  2. Denies pain but says she feels like she cannot get enough air.
  3. Says her heart feels like it is “running away.”
  4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

  1. Height 175 cm; Weight 95.5kg.
  2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
  3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
  4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
  5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

  1. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)
  5. Inhaled short-acting bronchodilator (ProAir HFA)
  6. Inhaled corticosteroid (Flovent HFA)
  7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

  1. Describe the clinical manifestations present in Mrs. J.
  2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
  3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
  4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
  5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
  6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
  7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

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Grand Canyon University Risk

Instructions:

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Use this worksheet to analyze effective strategies for risk management and ethical leadership in the Veterans Health Administration (VHA) Medical Home case.

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Resources:

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Use the following resources to complete this worksheet:

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The Veterans Health Administration: Implementing Patient-Centered Medical Homes in the Nation’s Largest Integrated Delivery System

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Veteran Patient Perspectives and Experiences During Implementation of a Patient-Centered Medical Home Model

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Enterprise Risk Management: Issues and Cases

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Note: This text investigates ERM case studies, both inside the healthcare industry and out. It also explores the key issues for implementing ERM strategies.

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VHA Medical Home Case Questions

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1. Address risks. Consider the risks from the case study concerning the implementation of the patient-aligned care team (PACT) model. How could these risks be addressed as part of an ERM plan?

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2. Identify strategies. What risk management strategies (e.g., ethical, legal, regulatory, leadership, operational, etc.) were used? At what level and how was leadership engaged in implementing those strategies?

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3. Evaluate risks for implementation. What risks were involved in implementing those strategies?

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4. Assess leadership measures in the VHA Medical Home case. In contrast to the PVAHCS case, what leadership oversight and accountability measures are present in the team-based models in the VHA Medical Home case? How appropriate would the identical measures be for monitoring performance in the PVAHCS case?

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5. Increase visibility to patient concerns. In what ways has the enterprise-wide, team-based approach to care management in the VHA Medical Home case helped give greater visibility to patient concerns about care?

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6. Examine patient safety issues in the VHA Medical Home case. What patient safety issues are inherent or explicitly identified in the VHA Medical Home case? Describe the possible implications of these safety concerns from an ERM, ethical, or legal perspective.

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7. Assess the impact of the transition to team-based operations. Using the Impact Assessment Framework, perform an assessment of all impact dimensions and the transition toward a team-based operational model (e.g., PACT) within the VHA Medical Home cases.

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8. Apply risk management principles to the PVAHCS. According to the OIG report, up to 40 deaths may be linked to ongoing practices at the PVAHCS. What practices implemented in the VHA Medical Home case would be appropriate to address leadership accountability and other risks (e.g., ethical, operational) specific to the PVAHCS case?

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9. Contrast potential risks. Describe and then contrast potential risk effects on the VHA clinical staff based on events in the VHA Medical Home case, the PVAHCS system case, and the rest of the VHA system.

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10. Describe PACT model impact on reputational risk. Based on the VHA Medical Home case study, discuss the following topics:

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● the impact the PACT model had on the reputation of the VHA clinics
● the significance of reputation risk within an ERM program
● a recommended measure of effectiveness of the PACT model in relation to reputation

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References:

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