You have been working as a nurse in the adult oncology unit for the past year. You have developed a close relationship with many of your patients, but Mr. Newcomb has a special place in your heart. He has been diagnosed with stage 4 pancreatic cancer and has undergone aggressive chemotherapy. Each day his wife has come to the unit to be with her husband. They have been married for over 40 years and share a deep love.

Mr. and Mrs. Newcomb have made the decision to no longer continue with treatment and have decided that hospice care is needed. Over the past few days, you have watched Mr. Newcomb’s health decline, and you can tell from your experience that he does not have much time left to live. Mr. Newcomb has been very open about discussing his death, and you have had the opportunity to learn about his life and the legacy he will leave behind.

While you are completing your rounds, you stop in Mr. Newcomb’s room to see how he is doing. You ask, “Is there anything else I can do for you?” Mr. Newcomb has rarely asked for anything, but today he has one request. Mr. Newcomb states, “Before I die, I would like to see my mistress one more time. Mrs. Newcomb is always here. Do you think you could tell her that I will be busy for a few hours tomorrow so I can make arrangements to see my mistress one more time?”

Reflect on the following questions before you begin working on this task:

●   What would you do in this scenario?

●   How can your knowledge of ethical principles be utilized to determine your response to Mr. Newcomb?

●   How would this affect you as a nurse and direct provider of care for Mr. Newcomb?
Requirements:

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. Use the Turnitin Originality Report available in Taskstream as a guide for this measure of originality.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A.  Summarize how the principles of beneficence, non-maleficence, autonomy, and justice apply to the scenario by doing the following:

1.  Describe how you would respond to Mr. Newcomb’s request.

2.  Evaluate how you applied the principles of beneficence, non-maleficence, autonomy, and justice to the scenario.

3.  Examine how personal beliefs and values influenced your response to the scenario.

4.  Describe three strategies to promote self-care.
B.  Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

C.  Demonstrate professional communication in the content and presentation of your submission.

Nurse’s Role in Influencing the Legislative Process

For this week’s project, you’ll answer three questions related to your opportunity as a nurse and an advocate. The first two questions relate to influencing a bill is traveling through the legislative process. The third question refers you to the social determinants of health as described in your course textbook reading and asks you to think specifically on your role as a nurse in influencing social determinants of health.( SEE ATTACHED)

In a brief paper (no more than 2 typed pages, 1 inch margins, 12 font Times New Roman or Courier New), answer the questions below. Write each question as a new topic area and then follow with a paragraph or two to answer the question. You may find it necessary to search for answers to the questions outside of the assigned reading. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources.

Answer the following questions:

· What parts of the lawmaking process does a nurse have an opportunity to influence the final bill passage?

· List at least two ways that this influence can take place. In your opinion, would one way be preferable over the other?

· Reviewing the social determinants of health, select one to respond to this question:

o What role can nurses play in promoting health status through policy changes directly affecting this social determinant?

Submission Details:

· Submit your response in a 2-page Microsoft Word document (500 words).

Apply information from the Aquifer Case Study to answer the following discussion questions:

· Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

· Describe the physical exam and diagnostic tools to be used for Mr. Payne. Are there any additional you would have liked to be included that were not?

· Please list 3 differential diagnoses for Mr. Payne and explain why you chose them.  What was your final diagnosis and how did you make the determination?

· What plan of care will Mr. Payne be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.

You and Dr. Lee take a few minutes to review Mr. Payne’s chart:

Vital signs:

· Temperature: 98.6° Fahrenheit

· Heart rate: 80 beats/minute

· Respiratory rate: 12 breaths/minute

· Blood pressure: 130/82 mmHg

· Weight: 170 pounds

· Body Mass Index: 24 kg/m2

Past Medical History: Diabetes, well controlled. Hypertension, fair control. Hyperlipidemia, fair control.

Past Surgical History: None

Social History: Works as a truck driver, which involves lifting 20-35 lbs 4 hours of the day, married with 2 daughters,

Habits: Quit smoking two years ago, drinks 1 to 2 beers occasionally on the weekends, no history of IV drug use.

Medication:

· metformin 500mg 2 twice daily

· glyburide 5mg 2 twice daily

· amlodipine 2.5 mg daily

· lisinopril 40 mg daily

· simavastin 40 mg daily

Allergies: No known drug allergies.

Can you tell me about your back pain?”

“As I told the nurse, the pain started two weeks ago after I lifted a box at work. Right away, I got this sharp pain on the left side of my back. The box wasn’t even that heavy.

“I talked to the nurse at work; she said to ice it and to take ibuprofen. It got better after three days. But, I was playing softball with my daughter last weekend, and the pain came back. This time it was worse than before. This week, the pain is so bad I can hardly get out of bed. I get a sharp pain in my back which goes down my left leg to my ankle.”

“On a scale of 0 to 10, 10 being the worst, how severe is the pain?”

“It’s probably a 7.”

“Have you found anything that improves the pain?”

“Ibuprofen and Naproxen worked at first, but they are not helping much anymore.”

“What about positions that make things better or worse?”

“The pain is worse with any movement of my back or sitting for a long time. It is better when I lie down.”

“Have you had back pain before?”

“Yes, I have back pain from time to time. But I’m usually better after 2 to 3 days. This is the worst pain I have ever had.”

Review of Systems

Mr. Payne does not have numbness or weakness in his legs. The pain is better when he lies down. He denies urinary frequency, dysuria, problems with bowel or bladder control, fever or chills, nausea or vomiting, or weight loss. He denies any specific trauma, except for when he lifted a 10-pound box at work. He denies unrelenting night pain.

Based on your differential, you determine that it is highly likely that Mr. Payne is experiencing a mechanical cause of back pain with nerve involvement such as a disc herniation. It is possible that he has spinal fracture, but a lack of trauma history makes the latter unlikely. It is important to consider cauda equina syndrome, as it calls for immediate surgical investigation, but it is unlikely in the absence of neurological symptoms like loss of bowel or bladder control. Finally, infectious etiology, such as pyelonephritis, is unlikely without fever and chills, urinary frequency and dysuria.

Back Exam – Standing:

Mr. Payne has normal curvature, tenderness on palpation on the left lumbar paraspinous muscle with increase tone. Full range of motion, but has pain with movement. His gait is normal. He can walk on his heels and toes. He can do deep knee bends.

Back Exam – Seated:

Mr. Payne denies feeling pain when checked for CVA tenderness. He has no pain in his right leg with the modified version of SLR. While he does not exhibit a true tripod sign, he does complain of pain when his left leg is raised. Mr. Payne’s reflexes are 2+ and equal at the knees and 1+ at both ankles. The motor exam reveals no weakness of the muscles of the lower extremities. His sensory exam is normal.

Pulmonary Exam: His lungs are clear.

Cardiovascular Exam: His cardiac exam demonstrates a regular rhythm, no murmur or gallop.

Three weeks later, Mr. Payne returns for his follow-up appointment and you discover the following:

Pertinent History

Mr. Payne has had little relief with the treatment prescribed. He is frustrated that he has been in pain for more than a month. His pain has been progressively worse. It radiates down the lateral part of his left leg and side of his left foot. This pain is worse than the back pain. He does not have any problems with bowel or bladder control and there is no weakness of his leg.

Pertinent Exam Findings

Vital signs: stable

Neurologic: Normal gait, but moves slowly due to pain; range of motion is full, with pain on flexion; SLR is positive at 45 degree on the left; motor strength intact; reflexes 2+ bilaterally at the knees, absent at the left ankle, 1+ at the right ankle.

Dr. Lee agrees with your diagnosis of radiculopathy of S1 nerve root with progression. She orders an MRI and sets up an appointment to see Mr. Payne after the MRI.

You and Dr. Lee now return to Mr. Payne’s exam room to talk about treatment options with him. Dr. Lee tells Mr. Payne to avoid strenuous activities but to remain active. Dr. Lee increases the dosage of naproxen to 500 mg BID to take with food. Since his pain is intense (7/10), he is given a prescription for acetaminophen with codeine to take at night, when his pain is severe. Mr. Payne declines a muscle relaxant because they usually make him drowsy. He would like to be referred to physical therapy as it was helpful in the past.

FOLLOW-UP TREATMENT

MANAGEMENT

One week later, Mr. Payne returns for follow-up. You review the results of the MRI report.

MRI report:

1. Moderate-size, herniated disc at L5-S1 with associated marked impingement on the left S1 nerve root and mild to moderate impingement on the right S1 nerve root. There is mild central canal stenosis.

2. Annular tear with a small central disc herniation at L4-5 causing mild central canal stenosis.

You review the findings with Dr. Lee. She agrees with your diagnosis of radiculopathy of S1 nerve root due to a large herniated disc at L5-S1.

You call Mr. Payne two weeks later to see how he is doing. He reports that he is doing quite a bit better. He went to an osteopathic physician who did some manual therapy and started him on a strict walking program. He is very encouraged and plans on losing weight through exercise and diet.

Select a family to complete a family health assessment. (The family cannot be your own.)

Before interviewing the family, develop three open-ended, family-focused questions for each of the following health patterns:

1. Values, Health Perception
2. Nutrition
3. Sleep/Rest
4. Elimination
5. Activity/Exercise
6. Cognitive
7. Sensory-Perception
8. Self-Perception
9. Role Relationship
10. Sexuality
11. Coping

NOTE: Your list of questions must be submitted with your assignment as an attachment.

After interviewing the family, compile the data and analyze the responses.

In 1,000-1,250 words, summarize the findings for each functional health pattern for the family you have selected.

Identify two wellness problems based on your family assessment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.