Civil law Case study# 1. Case Study: Post-Operative Care of a Patient Following Esophagoscopy and BronchoscopyJesus PerezSeptember 2, 2023 Welcome to your Civil law Case study# 1. Case Study: Post-Operative Care of a Patient Following Esophagoscopy and Bronchoscopy 1. Nurses' notesHealth historyVital signsLab resultsDuring her three-hour post-operative stay at the hospital, The patient received 30 mg of morphine, 25 mg of Diazepam, 4 mg of Ondansetron2 mg of Hydromorphone5 mg of midazolam50 mg of Fentanyl, and, just prior to discharge, 12.5 mg of promethazine.Question# 1 of 6. Civil law CS1The patient underwent a day-surgery procedure involving esophagoscopy and bronchoscopy during which the physician removed mucus from her lungs. At the time of her discharge, several of the nursing staff voiced that the patient was drowsy, unable to understand discharge instructions, and was acting “drunk and incoherent.”The next day the patient was discovered dead in her bed at 4:00 A.M. The family filed a wrongful death lawsuit, naming the nurses as failing to meet the standard of care in allowing a pharmaceutically inebriated same-day surgery patient to be discharged rather than seeing that she was admitted for overnight observation. The family’s medical toxicologist testified that patients in general have a better chance of survival in the hospital as opposed to being discharged home. He could not, though, testify that this patient would have survived had she been hospitalized as opposed to being discharged a few hours after surgery.Given the medications administered and the post-operative state of the patient, was there a legal duty to ensure that this patient be admitted for an overnight stay for observations? Yes, due to the amount of medication given. No, the drugs administered are standard post-operative drugs. Yes, the nursing staff observed her incoherent state. No, because she was scheduled for day-surgery only. Yes, because she could not understand discharge instructions. No, if a doctor approved her discharge. Yes, based on the combination of her state and medication list. No, unless there's a standard protocol for such observations post-surgery. 2. Question# 2 of 6. Civil law CS1The patient underwent a day-surgery procedure involving esophagoscopy and bronchoscopy during which the physician removed mucus from her lungs. At the time of her discharge, several of the nursing staff voiced that the patient was drowsy, unable to understand discharge instructions, and was acting “drunk and incoherent.”The next day the patient was discovered dead in her bed at 4:00 A.M. The family filed a wrongful death lawsuit, naming the nurses as failing to meet the standard of care in allowing a pharmaceutically inebriated same-day surgery patient to be discharged rather than seeing that she was admitted for overnight observation. The family’s medical toxicologist testified that patients in general have a better chance of survival in the hospital as opposed to being discharged home. He could not, though, testify that this patient would have survived had she been hospitalized as opposed to being discharged a few hours after surgery.Did the nurses, in this case, act as patient advocates? Was there an ethical duty to act as an advocate for this patient? Yes, they acted as patient advocates because they voiced concerns about her state. No, they did not act as patient advocates since they allowed her discharge. Yes, there is always an ethical duty to act as an advocate for patients. No, their role is to follow doctor's orders. Yes, especially given the high doses of medication and her observed state. No, because the patient's advocacy depends on hospital policy. Ethical duty is subjective and varies nurse to nurse. Yes, because patient safety and well-being are the primary concerns. 3. Nurses' notesDuring her three-hour post-operative stay at the hospital, The patient received 30 mg of morphine, 25 mg of Diazepam, 4 mg of Ondansetron2 mg of Hydromorphone5 mg of midazolam50 mg of Fentanyl, and, just prior to discharge, 12.5 mg of promethazine.Question# 3 of 6. Civil law CS1The patient underwent a day-surgery procedure involving esophagoscopy and bronchoscopy during which the physician removed mucus from her lungs. At the time of her discharge, several of the nursing staff voiced that the patient was drowsy, unable to understand discharge instructions, and was acting “drunk and incoherent.”The next day the patient was discovered dead in her bed at 4:00 A.M. The family filed a wrongful death lawsuit, naming the nurses as failing to meet the standard of care in allowing a pharmaceutically inebriated same-day surgery patient to be discharged rather than seeing that she was admitted for overnight observation. The family’s medical toxicologist testified that patients in general have a better chance of survival in the hospital as opposed to being discharged home. He could not, though, testify that this patient would have survived had she been hospitalized as opposed to being discharged a few hours after surgery.Which of the models of patient advocacy should the nurse have considered in this case and why? Please select your answerRights protection model - This focuses on ensuring patients' rights are safeguarded.Values-based decision model - This emphasizes decisions made based on values and beliefs.Holistic care model - Focuses on addressing the comprehensive needs of the patient.Informed Decision model - Prioritizes ensuring that patients make decisions with full information. 4. Question# 4 of 6. Civil law CS1The patient underwent a day-surgery procedure involving esophagoscopy and bronchoscopy during which the physician removed mucus from her lungs. At the time of her discharge, several of the nursing staff voiced that the patient was drowsy, unable to understand discharge instructions, and was acting “drunk and incoherent.”The next day the patient was discovered dead in her bed at 4:00 A.M. The family filed a wrongful death lawsuit, naming the nurses as failing to meet the standard of care in allowing a pharmaceutically inebriated same-day surgery patient to be discharged rather than seeing that she was admitted for overnight observation. The family’s medical toxicologist testified that patients in general have a better chance of survival in the hospital as opposed to being discharged home. He could not, though, testify that this patient would have survived had she been hospitalized as opposed to being discharged a few hours after surgery.Who should be found to have liability in this case? The nurses alone, for not advocating strongly enough. The physician for approving the discharge. Both the nurses and the physician. The hospital, for not having clear post-operative protocols. The patient, for not communicating her state. The family, for not noticing her condition post-discharge. The pharmaceutical companies for producing potent drugs. No one, as complications can arise post-surgery. 5. Question# 5 of 6. Civil law CS1The patient underwent a day-surgery procedure involving esophagoscopy and bronchoscopy during which the physician removed mucus from her lungs. At the time of her discharge, several of the nursing staff voiced that the patient was drowsy, unable to understand discharge instructions, and was acting “drunk and incoherent.”The next day the patient was discovered dead in her bed at 4:00 A.M. The family filed a wrongful death lawsuit, naming the nurses as failing to meet the standard of care in allowing a pharmaceutically inebriated same-day surgery patient to be discharged rather than seeing that she was admitted for overnight observation. The family’s medical toxicologist testified that patients in general have a better chance of survival in the hospital as opposed to being discharged home. He could not, though, testify that this patient would have survived had she been hospitalized as opposed to being discharged a few hours after surgery.From the following potential measures, which could have been implemented by the hospital to better ensure patient safety following procedures that involve heavy sedation or administration of multiple medications? Regular monitoring post-operation until complete recovery from sedation. Mandatory overnight observation for certain procedures or after certain medication combinations. Family or caregiver briefing about potential medication effects post-operation. Clear protocol for the administration and post-operative care of multiple medications. Encouraging the patient to walk immediately after the procedure to expedite drug metabolism. Administering a stimulant to counteract the sedative effects. Allowing the patient to self-administer any further required medications. 6. Question# 6 of 6. Civil law CS1The patient underwent a day-surgery procedure involving esophagoscopy and bronchoscopy during which the physician removed mucus from her lungs. At the time of her discharge, several of the nursing staff voiced that the patient was drowsy, unable to understand discharge instructions, and was acting “drunk and incoherent.”The next day the patient was discovered dead in her bed at 4:00 A.M. The family filed a wrongful death lawsuit, naming the nurses as failing to meet the standard of care in allowing a pharmaceutically inebriated same-day surgery patient to be discharged rather than seeing that she was admitted for overnight observation. The family’s medical toxicologist testified that patients in general have a better chance of survival in the hospital as opposed to being discharged home. He could not, though, testify that this patient would have survived had she been hospitalized as opposed to being discharged a few hours after surgery.Given the unfortunate outcome following the patient's surgery and discharge, which of the following situations or conditions is the nurse most likely required to report by law? The patient's initial verbal reluctance about undergoing the procedure. The patient's family's concerns about the overall hospital environment. Suspected medical negligence due to the combination of medications and subsequent discharge. The patient's previous comments about past positive experiences at the hospital. The patient's prior history of unrelated minor surgeries. The general discontent of the patient's family with medical bills. A nurse's unrelated personal concerns about the hospital staffing. The patient's appreciation for a particular nurse's care during her stay.
