Instructions

This assignment gives you an opportunity to consider the facts of a case potentially involving claims of negligence. You will have the opportunity to analyze the possible claims, as well as the potential defenses to any claim presented by the plaintiff. The facts of the case are described below.

Following an automobile accident, a 46-year-old man was brought to the hospital emergency department by an ambulance. The patient seemed to be alert, was able to answer questions, and claimed to be suffering from a great deal of pain. The physician administered 15 milligrams of morphine intravenously. The patient needed blood but refused a transfusion. After being observed in the emergency department for several hours, the patient was placed on a medical-surgical unit for observation. The following morning, he was unresponsive, and he was eventually pronounced dead. It was later discovered that he had a long history of drug and alcohol abuse. The night of the accident, he had injected heroin and drank several shots of tequila and multiple cans of beer. He had not disclosed any of this to the doctors or nurses treating him. Several years later, his estate sued the physician, claiming medical malpractice.

Analyze the possible outcomes of the lawsuit under one of the following scenarios:

• If death was the result of overdose
• If death was the result of failure to administer blood
• If death was the result of subdural hematoma

In your short paper, analyze the potential success of a claim for negligence under one of the three possible scenarios. Include a detailed discussion of each element of the negligence claim and why that element is met or not met. Discuss the possible defenses that could be reasonably asserted by the doctor to each claim, and why that defense might apply. Lastly, include a paragraph describing which, if any, claim you believe might be the most successful against the doctor and why.

Please use link site as reference. 

https://www.ama-assn.org/practice-management/hipaa/hipaa-violations-enforcement

Rubric post below please follow rubric!

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Share a case study from your clinical practice or from the literature on an endocrine disorder. Discuss the pathophysiology of the disorder, including the effects on the endocrine feedback system, and the role of the hypothalamic-pituitary axis. Identify the pharmacologic agent(s) used to treat the disorder and how the pharmacologic agent(s) alters the pathophysiology.

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Case Study for Care Plan  Assignment:

A retired 69-year-old man “Mr. Casey” with a 5-year history of type 2 diabetes. Although he was diagnosed 5 years ago he had symptoms indicating hyperglycemia for 2 years before diagnosis. His fasting blood glucose values of 118–127 mg/dl, which was explained to him as “borderline diabetes.” He also states he has had past episodes of nocturia with large pasta meals and Italian pastries. At the time of diagnosis, he was advised to lose 10 lbs.

Referred by his family physician to the diabetes clinic, Mr. Casey presented with recent weight gain, suboptimal diabetes control, and foot pain. He has been trying to lose weight and increase his exercise for the past 6 months without success. He had been started on glyburide (Diabeta), 2.5 mg every morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon.

Mr. Casey also takes atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia. He has tolerated this medication and adheres to the daily schedule. During the past 6 months, he has also taken OTC medications to try to control his diabetes. He stopped these supplements when he did not see any positive results.

He does not test his blood glucose levels at home and expresses doubt that this procedure would help him improve his diabetes control.

Mr. Casey states that he has “never been sick a day in his life.” He is retired and volunteers locally. He lives with his wife of 48 years and has two married children. Although both his mother and father had type 2 diabetes, Mr. Casey has limited knowledge regarding diabetes self-care management and states that he does not understand why he has diabetes since he never eats sugar. In the past, his wife has encouraged him to treat his diabetes with herbal remedies and weight-loss supplements, and she frequently scans the Internet for the latest diabetes remedies.

During the past year, Mr. Casey has gained 22 lb. Since retiring, he has been more physically active, playing golf once a week and gardening, but he has been unable to lose more than 2–3 lb. He has never seen a dietitian and has not been instructed in self-monitoring of blood glucose.

Mr. Casey’s diet history reveals excessive carbohydrate intake in the form of bread and pasta. His normal dinners consist of 2 cups of cooked pasta with homemade sauce and three to four slices of Italian bread. During the day, he often has “a slice or two” of bread with butter or olive oil. He also eats eight to ten pieces of fresh fruit per day at meals and as snacks. He prefers chicken and fish, but it is usually served with a tomato or cream sauce accompanied by pasta. His wife has offered to make him plain grilled meats, but he finds them “tasteless.” He drinks 8 oz. of red wine with dinner each evening. He stopped smoking more than 10 years ago.

The medical documents that Mr. Casey brings to his appointment indicate that his hemoglobin A1c(A1C) has never been <8%. His blood pressure has been measured at 150/70, 148/92, and 166/88 mmHg on separate occasions during the past year at the local senior center screening clinic. Although he was told that his blood pressure was “up a little,” he was not aware of the need to keep his blood pressure ≤130/80 mmHg for both cardiovascular and renal health.

Mr. Casey has never had a foot exam as part of his primary care exams, nor has he been instructed in preventive foot care. However, his medical records also indicate that he has had no surgeries or hospitalizations, his immunizations are up to date, and, in general, he has been remarkably healthy for many years.

Physical Exam

A physical examination reveals the following:

• Weight: 178 lb; height: 5′2″; body mass index (BMI): 32.6 kg/m2
• Fasting capillary glucose: 166 mg/dl
• Blood pressure: lying, right arm 154/96 mmHg; sitting, right arm 140/90 mmHg
• Pulse: 88 bpm; respirations 20 per minute
• Eyes: corrective lenses, pupils equal and reactive to light and accommodation, Fundi-clear, no arteriolovenous nicking, no retinopathy
• Thyroid: nonpalpable
• Lungs: clear to auscultation
• Heart: Rate and rhythm regular, no murmurs or gallops
• Vascular assessment: no carotid bruits; femoral, popliteal, and dorsalis pedis pulses 2+ bilaterally
• Neurological assessment: diminished vibratory sense to the forefoot, absent ankle reflexes, monofilament (5.07 Semmes-Weinstein) felt only above the ankle

Lab Results

Results of laboratory tests (drawn 5 days before the office visit) are as follows:

• Glucose (fasting): 178 mg/dl (normal range: 65–109 mg/dl)
• Creatinine: 1.0 mg/dl (normal range: 0.5–1.4 mg/dl)
• Blood urea nitrogen: 18 mg/dl (normal range: 7–30 mg/dl)
• Sodium: 141 mg/dl (normal range: 135–146 mg/dl)
• Potassium: 4.3 mg/dl (normal range: 3.5–5.3 mg/dl)
• Lipid panel
  • Total cholesterol: 162 mg/dl (normal: <200 mg/dl)
  • HDL cholesterol: 43 mg/dl (normal: ≥40 mg/dl)
  • LDL cholesterol (calculated): 84 mg/dl (normal: <100 mg/dl)
  • Triglycerides: 177 mg/dl (normal: <150 mg/dl)
  • Cholesterol-to-HDL ratio: 3.8 (normal: <5.0)
• AST: 14 IU/l (normal: 0–40 IU/l)
• ALT: 19 IU/l (normal: 5–40 IU/l)
• Alkaline phosphotase: 56 IU/l (normal: 35–125 IU/l)
• A1C: 8.1% (normal: 4–6%)
• Urine microalbumin: 45 mg (normal: <30 mg)

Please use the attached Care Plan outline for this assignment and post in the “Drop Box” under “Instructional”.

Credit of care study to: Geralyn Spollett, MSN, C-ANP, CDE

Reference: 

American Diabetes Association. (2003, January 1). Case Study: A Patient With Uncontrolled Type 2 Diabetes and Complex Comorbidities Whose Diabetes Care Is Managed by an Advanced Practice Nurse. Retrieved from http://spectrum.diabetesjournals.org/content/16/1/32 

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