Essay

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In each case, answer the questions at the end of the case and give researched references to support your assertions; also, explain what would be the ethical course of action and the legal requirements for action in the case.

 

Case One

 

Mrs. Lewis was head nurse on a medical surgical floor in a community hospital with 250 beds. Over the course of 6 months, she noticed that all patients admitted from the Shady Rest Nursing Home had signs of severe injuries other than those connected with the admitting diagnosis. There appeared to be patient abuse in the nursing home. Mrs. Lewis investigated discreetly and found no explanation possible except abuse. In accord with the obligations of the law in her state, she reported the matter to the Department of Welfare Bureau of Inspection.

 

The Welfare Department investigated immediately, found proof of abuse, and threatened to close down Shady Rest if there were any more recurrences. Mrs. Lewis was overjoyed until her hospital administrator, bypassing the director of nursing, called her in and warned her that she would be fired if she reported any other instances of abuse. Shady Rest sent the hospital a lot of business, and good relations had to be maintained.

 

Mrs. Lewis was even more shocked when she discovered that the administrator was a golf partner of the owner of Shady Rest and was doing an old buddy a favor. Despite fears of retaliation, Mrs. Lewis consulted a lawyer, who threatened the hospital with exposure and with penalties that would follow if one of its employees failed to follow the reporting provisions of the law on abuse in nursing homes.

 

Did Mrs. Lewis act correctly? What should she have done if she could not have afforded to consult with a lawyer? In what ways can whistle-blowers protect themselves? Must the art of intimidation be part of the toolbox of healthcare professionals in order to protect their patients? Is power an appropriate consideration in healthcare ethics?

 

Case Two

 

On a July weekend, Mrs. Allesfertig, nursing supervisor of the whole hospital, discovered that the intensive care unit was seriously understaffed. She pulled two nurses with previous ICU experience off other floors to bring the unit up to strength in view of the extreme level of acute care needed. On the following Monday, Dr. Bestknabe, who has overall responsibility for the ICU unit, closed the unit for further admissions until the staffing had been worked out on a permanent basis.

Should the new staffing policy give the nurses authority to refuse to admit patients when the staff is not sufficient to handle them? (In some hospitals, nurses have this authority.) Can any policy take precedence over the professional judgment of trained ICU nurses?

Analyze the external environment

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Select a health care provider organization in the local community (or nationally), preferably a hospital, a physician group practice, or even a nursing home chain. Conduct an external environmental assessment for the organization along the lines described in chapter 5 of your textbook.  You can get this information from the company’s Web site, other Web sites, journal articles, and other sources. Be sure to cover all the basic categories of environmental factors. Draw a diagram showing the environmental forces you have identified and the interrelationships among them and with the organization.
For this assignment, your report should be at least four pages in length, in current APA edition format and should include the following information:

  • The steps to externally evaluate the firm
  • Description of two environmental forces that may have some impact – positive or negative – on the organization or business.
  • Create a strategic group map showing the interrelationship between the environmental forces and the organization
  • Description of two critical issues specific to the organization, its industry and its customers.

Briefly describe two key features of the Hippocratic Oath that are relevant to modern doctors

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Outline the feedback mechanism that regulates blood glucose homeostasis. (Don’t include the intracellular components.)
Give an example of a hydrolysis reaction discussed in class. What happens to the water molecule in the reaction? (4 pts)
What is the role of positive feedback in labor (childbirth)? (4 pts)
Briefly describe two key features of the Hippocratic Oath that are relevant to modern doctors. (4 pts)
The genetic code is a “triplet code.” Explain. (4 pts)

Amino acids are linked together via covalent bonds called

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Enzymes lower the _______________ _________________ of a reaction.
A fever is an example of an altered _____________________.
Oxygen and carbon dioxide cross cell membranes by ___________ _____________.
Cystic fibrosis is caused by a defect in the ___________________ transport of __________________ ions in the cells of the lungs. The lack transport of the ions
across the lung membranes results in _____________________________ and thickened mucus..
A competitive inhibitor binds to the _________________ __________________ of an enzyme. The Km of glucose permease is 1.5 mM for glucose, but is 50 mM for galactose. This
indicates that the permease’s ___________________ for glucose is higher/lower (circle one!) than that for galactose.
One definition of ___________________ Law is: “The net diffusion rate of a solute across a membrane is proportional to the difference in the concentrations, proportional to the area of the membrane and inversely proportional to the thickness of the membrane.”
Na+/K+ ATPase belongs to the ______- class of ATPases, which means that
V-class ATPases carry out the ________________ transport of _______________ across membranes.
LDL and growth factors typically enter cells using _____________________________ .
The rate of passive transport is dependent upon the ____________________ of the solute and
_________________________.
A(n) ____________________________ is a collection of organs that work together to perform a major body function.
The sodium-potassium pump carries out the _______________________ transport of
_______(#) sodium ions into/out of (circle 1) the cell and __________(#) potassium ions into/out of (circle 1) the cell.
1 glycerol + 3 fatty acids = ____________________________________
The three phases of protein translation are ________________________________________
_________________________________________.
A sensor (receptor), ______________ _________________, and _______________________ are the key components of any feedback system.
The ______________ _______________ of an enzyme is where the substrate binds.
Osmosis is the movement of _______________ across a/an _____________________
membrane from an area of _______________ ________________concentration to an area
of _________________ ________________ concentration.
CH2O is the general formula for a/an ________________________________.
Amino acids are linked together via covalent bonds called ______________________ bonds.
Low-density lipoprotein (LDL) particles are transported into cells by ___________________
________________________ ________________________.
In “Anatomical Position” the legs and feet are ____________________________, the arms are
_________________________ and the palms are_____________________________________
Intermediate filaments, __________________________ and __________________________ are the key structures that make up the cytoskeleton.
The opposite of “ipsilateral” is ____________________________________.
The ability to maintain a stable internal environment even though the external environment changes is called ______________________________.
Globular and fibrous are classes of ____________________________.
Enzymes are organic catalysts that _______________________ the _________________ ________________________ (or energy barrier) of a reaction.
Physiology is the study of _________________________.
An organic catalyst of a reaction usually is a(n) ______________________.
A(n) ____________________________ is a collection of organs that work together to perform a major body function.
The ___________________________ separates the thoracic cavity from the abdominal cavity.
“K” is the chemical symbol for _______________________________.
The sodium-potassium pump carries out the _______________________ transport of
_______(#) sodium ions into/out of (circle 1) the cell and __________(#) potassium ions into/out of (circle 1) the cell.
1 glycerol + 3 fatty acids = ____________________________________
The ______________ _______________ of an enzyme is where the substrate binds.
Osmosis is the movement of _______________ across a/an _____________________
membrane from an area of ____________ _____________concentration to an area
of _________________ ________________ concentration.
A chromosome is the condensed form of _________________________.
Carbon dioxide gets through the cell membrane by ____________ ______________.
The folds of the inner membrane of mitochondria are called _______________.
In prophase, the ___________________ and ______________________ disappear and
_________________ migrate to opposite poles of the cell. These structures reform
during _______________________
CH2O is the general formula for a/an ________________________________.
Amino acids are linked together via covalent bonds called ______________________ bonds.
______________________ is the non-selective uptake of material, like water, from the extracellular environment.