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Case Study evaluation. There are two Case Studies below. Pick….

Case Study evaluation.  There are two Case Studies below.  Pick only ONE of the two and thoroughly answer the corresponding questions.  You MUST answer question 3.  

Case Study 1: Mr. Evans, 40 years old, was admitted to the hospital’s medical-surgical unit from the emergency department with a diagnosis of acute abdomen. He had a 20-year history of Crohn’s disease and was on multiple medications including the new biological agent Etanercept, 50 mg, subcutaneously every week. His last dose was 4 days ago. He was (NPO), receiving total parenteral nutrition was through a triple-lumen central venous catheter line.  His other medications were changed to (IV) push every 6 hours.

Over the next 3 days, his condition worsened. He was in severe pain and needed more analgesics. One evening at 9 p.m., it was discovered that his central venous catheter line was out. The assigned RN notified the physician, who stated that a surgeon would come in the morning to replace it. The nurse failed to ask the physician what to do about the IV steroids, antibiotics, and fluid replacement; the client was still NPO and etanercept. The am nurse noted he had no urine output since the night before. She documented this but forgot to report this information to the nurse assuming care responsibilities on the day shift.

The patient’s physician made rounds at 9 a.m. The nurse for Mr. Evans did not tell him that the patient had not voided since 11 p.m., did not request orders for alternative delivery of the steroids and antibiotics, and did not ask about administering the etanercept. At 5 p.m. that evening, while Mr. Evans was having a computed tomography scan, his blood pressure dropped to 70 mm Hg, and because no one was in the scan room with him, he coded. He was transported to the ICU and intubated. He developed severe sepsis and acute respiratory distress syndrome.

1.    Describe all the problems you can find with the nursing care in this case as it relates to the patient outcome.
2.    Evaluate nursing responsibilities in reporting information.
3.    If you worked in risk management, evaluate how you would analyze this situation with the nurse manager and the staff and the steps you would take to come to a reasonable conclusion of what caused the untoward outcome. Pay particular attention to this question.
4.   What would your corrective actions for all those involved in this case include and why? Include what your plan for prevention of this type of scenario would look like.

Case Study 2: You must answer question 5.  In another part of the hospital, Juan was completing his charting on his three babies in the neonatal intensive care unit. He had just finished orientation, and this was his third day working. He was very tired and looking forward to his time off the next several days.

Usually, the nurse-to-baby ratio in the NICU was 1:2; however, the unit had been running short-staffed and each nurse assumed additional patient responsibilities. Prior to him giving report, Juan’s nurse manager came to him and stated, “Ada called in sick. We do not have anyone else to cover the unit and we are under our nurse-to-patient ratio. I need you to stay and work today.” When Juan protested that he had already worked three 12-hour shifts and one 8-hour shift, the nurse manager told him that if he refused, she could “fire him” and report him for patient abandonment.

1. If you were Juan, how would you respond to the nurse manager?
2. Describe what, if any, options Juan has in this situation.
3. Explain what information Juan should find out regarding “mandatory overtime”.
4. Analyze if Juan makes an error that results in harm to a patient whether he can be held accountable. The Hospital?  The Nurse Manager?
5. Presuming there is an untoward outcome, does Risk Management play any part in this scenario, and if so what? (See question 3 above).  Regardless of the outcome does Risk Management or Legal have a role in this scenario?  Pay particular attention to this question.


References is highly required

1. Analyze the importance of interdisciplinary collaboration and communication in the leadership roles
2. Evaluate how nurses can be empowered, how power influences the leadership role the importance of delegating, and how to delegate appropriately.
3. Describe types of organizations and organizational characteristics, the ideal healthcare system, attributes of a healthy work environment, and how these types of environments can be supported in nursing.