Case Study, Chapter 21, Health Care Reform:  The Dismantling of the Affordable Care Act

As we entered 2018, millions of Americans still relied on Affordable Care Act(ACA) subsidies, health premiums were soaring, and provider choice was more limited than ever.There was, however, momentum for reform. Health care was identified as the country’s leading priority for Democrats (54%) and the second highest priority for Republicans (42%) at the close of 2017.  A group of registered nurses debate the issue of health care reform

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1.  The nurses debate whether the country feels that health care reform is really necessary.  Discuss reasons why reform is needed and what that reform should address.

2.  What were the 10 essential benefits guaranteed by insurance plans in the ACA Health Care Marketplace?  

3.  What are the successes of the ACA?

4.  What are the failures of the ACA?

 

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 ADMISSION HISTORY AND PHYSICAL

Patient Name: Jonathan Jones                                                                                        MR#: 44579

Attending Physician: Ajay Shah, M.D.                                                                    DOB: 12/24/89

Chief Complaint: 27 yo [year old] male presents with 2 days of worsening right lower quadrant belly pain, nausea, and vomiting.

History of Present Illness (HPI): 2 days prior to admission, the patient began complaining of diffuse belly pain that initially felt like indigestion. Over the course of the day, this pain grew progressively worse, localizing in the right lower quadrant. This pain became constant and dull and radiated to the back. The evening prior to admission the patient was awakened by pain and nausea. He drank some Alka-Seltzer and attempted to return to sleep, shortly after which he began vomiting nonbloody or bilious emesis. Shortly thereafter, the patient decided to come to the ED [Emergency Department].

The patient indicates he did have a fever but did not take his temperature. He denies chills, testicular pain, blood in the stool, or recent weight change. The patient’s last bowel movement was yesterday, with some small amounts of mucus but otherwise normal. He notes a history of irritable bowel syndrome. However, he states that this pain is different than the pain he has had in the past.

Past Medical History (PMH): Irritable bowel syndrome, last exacerbation 6 months ago. The rest of the past medical history is unremarkable.

Past Surgical History (PSH): Tonsillectomy and adenoidectomy in early childhood. Umbilical hernia repair at age 4.

Medications: None.

Allergies: NKDA

Social History: The patient is employed as a computer programmer. He is married and has no children. He has a 10-year pack-history (in this case, 5 years, two packs a day) of smoking. He drinks alcohol rarely.

Family History: Both parents are alive and well. One sister has a history of GERD.

Review of Systems: 12-point review of systems was performed and was negative except for those items noted in the HPI above.

Physical Examination

General: The patient is an alert and oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78. Pulse 68 and regular. Temperature 38.56°C (101.4°F).

HEENT: Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears clear. Throat normal.

Neck: The neck is supple with no carotid bruits.

Lungs: The lungs are clear to auscultation and percussion.

Heart: RRR, no m/g/r.

Abdomen: Nondistended. Bowel sounds are normal. There is rebound tenderness on the left side, with discomfort and guarding upon palpation in the right lower quadrant, and positive psoas sign [pain on extension of right thigh with patient lying on left side].

Extremities: No clubbing, cyanosis, or edema, distal extremities warm and well perfused.

Laboratory Data: Hemoglobin 14.6, hematocrit 43.6, WBC 13,000, sodium 138, potassium 3.8, chloride 105, CO2 24, BUN 10, creatinine 0.9, glucose 102. Urinalysis was negative.

Diagnostic Studies: Flat plate and upright films of the abdomen revealed a diffuse small bowel distension with no evidence of free air in the abdomen. CT of the abdomen indicated a thickened cecal wall and dilated appendix.

Assessment/Impression: 27 yo male with PMH significant for irritable bowel syndrome presents with clinical signs of acute onset appendicitis.

Plan: The patient will be admitted and kept NPO, and a laparoscopic appendectomy will be performed in the morning.

Rogers, M.D.

Admission H and P performed and dictated by Dr. Ajay Shah for Dr. Rogers.

Discussion Questions

1. Why is it important that the admitting doctor record information about the patient’s heart, lungs, and other body systems when the pain is in the patient’s abdomen?
2. How would you find out what the abbreviation HEENT means? What are some of the other abbreviations used in this case study, and what do they mean?
3. Using what you’ve learned about word parts, describe the types of surgeries listed in the patient’s past surgical history.
4. The extremities are described as “No clubbing, cyanosis, or edema.” Edema is explained in this chapter. Look up what the other two terms mean.

Your answers need to be typed as complete sentences and be thorough and detailed for full credit.

 

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1. The assessment tasks requires you to:
   1. Identify and discuss two (2) signs or symptoms of clinical deterioration associated with the presenting problem, from chosen case study. This discussion should consider the potential impact of case study data (e.g. pathology results, past medical history) on the health status of the patient in the chosen case.
   2. Following on from your presented discussion associated with point one (1), develop a clinical plan of care which identifies:
    

One (1) priority of clinical care and; 

Discuss three (3) nursing interventions that directly address the identified clinical priority. The discussion should refer to relevant clinical assessments. Measurable outcome parameters for each intervention will be discussed to justify the intervention and evaluate its efficacy. Discussion is to be supported with contemporary research. 

 

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Case Study: Healing and Autonomy

Mike and Joanne are the parents of James and Samuel, identical twins born eight years ago. James is currently suffering from acute glomerulonephritis, kidney failure. James was originally brought into the hospital for complications associated with a strep throat infection. The spread of the A streptococcus infection led to the subsequent kidney failure. James’ condition was acute enough to warrant immediate treatment. Usually cases of acute glomerulonephritis caused by strep infection tend to improve on their own, or with an antibiotic. However, James also had elevated blood pressure and enough fluid buildup that required temporary dialysis to relieve. 

The attending physician suggested immediate dialysis. After some time of discussion with Joanne, Mike informs the physician that they are going to forego the dialysis and place their faith in God. Mike and Joanne had been moved by a sermon their pastor had given a week ago, and also had witnessed a close friend regain mobility when she was prayed over at a healing service after a serious stroke. They thought it more prudent to take James immediately to a faith healing service instead of putting James through multiple rounds of dialysis. Yet Mike and Joanne agreed to return to the hospital after the faith healing services later in the week, and in hopes that James would be healed by then. 

Two days later the family returned, and was forced to place James on dialysis, as his condition had deteriorated. Mike felt perplexed and tormented by his decision to not treat James earlier. Had he not enough faith? Was God punishing him or James? To make matters worse, James kidneys had deteriorated such that his dialysis was now not a temporary matter, and was in need of a kidney transplant. Crushed and desperate, Mike and Joanne immediately offered to donate one of their own kidneys to James, but they were not compatible donors. Over the next few weeks, amidst daily rounds of dialysis, some of their close friends and church members also offered to donate a kidney to James. However, none of them were tissue matches. 

James’ nephrologist called to schedule a private appointment with Mike and Joanne. James was stable, given the regular dialysis, but would require a kidney transplant within the year. Given the desperate situation, the nephrologist informed Mike and Joanne of a donor that was an ideal tissue match, but as of yet had not been considered—James’ brother Samuel. 

Mike vacillates and struggles to decide whether he should have his other son Samuel lose a kidney, or perhaps wait for God to do a miracle this time around. Perhaps this is where the real testing of his faith will come in? “This time around, it is a matter of life and death, what could require greater faith than that?” Mike reasons.

Write a 1,200-1,500 word analysis of “Case Study: Healing and Autonomy.” In light of the readings, be sure to address the following questions:

1. Under      the Christian narrative and Christian vision, what sorts of issues are      most pressing in this case study?
2. Should      the physician allow Mike to continue making decisions that seem to him to      be irrational and harmful to James?
3. According      to the Christian narrative and the discussion of the issues of treatment      refusal, patient autonomy, and organ donation in the topic readings, how      might one analyze this case?
4. According      to the topic readings and lecture, how ought the Christian think about      sickness and health? What should Mike as a Christian do? How should he      reason about trusting God and treating James?

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. 

 

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