Health and

Illness

Ruth Jacobi
Ruth is a 62-year-old woman who
was hospitalized after a mini-stroke.
She has now returned to her preevent level of functioning and is being
prepared for discharge. She states, I
know that I have an increased risk for
a major stroke, so I want to do
everything possible to stay as active
and as healthy as I possibly can.

Sara Gelbart
Sara, a college freshman, is
encouraged to visit the student
health center by her roommate
because she rarely visits the dining
hall for meals, runs 5 to 8 miles a
day, and has recently lost a
significant amount of weight. Sara
states, Im plenty healthy, just a bit
nuts about being fit!

Daniel Sternman
Daniel is a 27-year-old man with history
of schizophrenia. He comes to the
mental health clinic, loudly demanding
relief from the voices who are telling him
to hurt himself. Mr. Sternman is well
known by the clinic staff. His medical
record reveals that he has had
numerous visits to the clinic and that he
has difficulty interacting and dealing with
various staff members.

REFLECTIVE
PRACTICE

Challenge to Intellectual
Skills
My first college roommate, Sara
Gelbart, seemed the ideal roommate
when I first met her. A good student,
she was thoughtful, outgoing, and
fun. By October, However. I was
really worried about her. I noticed
that she rarely wanted to come to the
dining hall with our group of friends.

When she did come, she just

seemed to pick at her food. She
also spent a lot of time at the
athletic center, running 5 to 8 miles
almost daily. I wasnt surprised
when she started losing significant
amounts of weight. what worried me
was her lack of willingness to talk
about her nutritional habits and
health.

She told me that she was plenty

healthy, just a bit nuts about being fit!
She also kidded that Id be healthier if I
worked out more often with her. While
she was certainly right about that, I was
worried that she had a serious eating
disorder and wasnt sure what I could
do to help. She politely told me to mind
my own business when I asked her if
she had ever spoken with anyone
about her health and eating.

CHAPTER 21

COMMUNICATOR

Susie Musashi
Susie is a 3-year-old patient with
second-degree burns on both legs
who currently is receiving
debridement. Every time a healthcare
provider enters her room, she begin to
cry, turning her body toward the wall
and curling up with her knees to her
chest. Her family lives approximately 1
hours away and can only visit her
about once of twice a week.

Irwina Russellinski
Irwina, a 75-year-old woman
transferred from the emergency
department, is diagnosed with
pneumonia. Her chart reveals that
she is hard of hearing, pleasantly
confused at times, and speaks
broken English. A nursing
assessment is needed.

Randolph Gordon
Randolph, a middle-aged man
diagnosed with end-stage liver
failure, is being cared in the
intensive care unit. He has been
comatose for several weeks. He
has numerous tubes and drainage
devices in place and is receiving
multiple therapies that require
continuous electronic monitoring.

Reflective Practice

Challenge to Interpersonal
Skills
Recently, I was accompanying a
nurse in the intensive care unit (ICU)
when I encountered some behaviors
that I found to be unprofessional and
lacking in interpersonal skills. We
were caring for Mr. Randolph Gordon,
a middle-aged patient who was in
end-stage liver failure and had been
comatose for several weeks.

The extend of drains, tubes and

technologies being used to care for
Mr. Gordon was overwhelming. It was
almost difficult to recognize him as
human being. I was taken aback when
the nurse and some residents entered
the patients room and immediately
began to assess the technological
equipment, without any regard for or
recognition of the patient.

They proceeded to have a

conversation about the patients
poor condition, unsightly
appearance, and foul smell at the
bedside, in the direct presence of
the patient. They did not speak to
the patient and they made no
attempt to interact with the patient,
not even the slightest touch of a
hand.

TEACHER AND
COUNSELOR

Marco Garcia Ramirez

Marco accompanies his wife, Claudia,
to the antepartal clinic for a routine
visit. They are expected their first child
in 5 months. He reports that they are
happy and excited but also scared and
very nervous. They are planning for a
home birth, asking lots of questions
about childbirth and their new
responsible as parents: Were both
wondering if well be good parents.

Rachel Blumenthal

Rachel, age 40, is the second wife of a

57-year-old man who has suffered a
serious myocardial infarction. They
have been married for only 1 year.
She says, Im a little embarrassed to
talk with the cardiologist, but lots of
questions about what my husband will
be able to do after he gets home.Im
also wondering about resuming sexual
activity.

Alicia Bonet
Alicia is the young mother of a baby
boy; the babys physician is
recommending that he start long-term
aspirin therapy. Ms. Bonet is quite
concerned about agreeing to longterm aspirin therapy and asks, Ive
heard so much about Reyes
syndrome and aspirin. What should I
do? What would you recommend?

REFLECTIVE
PRACTICE

Challenge to Intellectual
Skills
It was during my senior practicum in
pediatrics last spring that I met Alicia
Bonet, the young mother of a baby
boy for whom I was caring. The babys
physician was recommending longterm aspirin therapy (unfortunately, I
cannot remember what condition the
child had for which long-term aspirin
therapy was being recommend).

Ms. Bonet was quite concerned about

agreeing to aspirin therapy, asking me
if I knew much about Reyes
syndrome. Then she asked me what I
would recommend about whether or
not to agree to long-term aspirin
therapy. Not really understanding the
risks versus the benefits of aspirin
therapy or how it actually ties into
Reyes syndrome.

I did not feel competent to answer

Ms. Bonets questions. Let alone
make an educated
recommendation to her.

Rehema Kohls

Rehema is a college sophomore who

comes to the health care requesting
information about sexually transmitted
disease(STDS). During the visit, she
says, So many of my friends are
concerned about STDs. They all say we
should start a group on campus to
discuss this problem, and they want me
to set it up and the leader. But wouldnt
know were to start or what to do!

Stephen Wall
Stephen, a 65-year-old widower who lives
alone , is admitted to the intensive care
unit after an automobile accident in which
he sustained trauma to the head, chest,
abdomen, and lower extremities. He is
being monitored continuously via
numerous invasive devices and requires
complex care. His closet family member,
a 40-year- old son, lives approximately 75
miles away.

Jack Camp
Jack, a middle age single man with a
history of diabetes mellitus, is receiving
care for a compound fracture of his left
lower extremity being treated with an
external fixator. Compliance with his
diabetic therapy regimen is
questionable; he states, I really love
sweets! The patient frequently voices
loud complaints about his room,

the food, and the hospital routine.

He also uses his call light very
frequently, stating, I just want to
see if its working and if the nurses
will come check on me.

Challenge to Ethical
Skills

While in the clinical rotation my

junior year, I was assigned the
dreaded Jack Camp(still remember
his name). He was a middle aged
single man receiving care for a
compound fracture of his left lower
extremity being treated with an
external fixator. He had bad case of
diabetes, and an even worse sweet
tooth. Before I even meet him,

the nurse on the floor were saying

things like good luck which
complaints about his room, the food,
and the hospital routine. He also
using his call light very frequently.
the nurses called him names and
discussed their dislike of him in the
nurses station, which was in the
center of the unit.

As the day, I found out that all this

patient wanted was some
attention, because he was used to
running things in his business. I
actually him entertaining.

Kara Greenwood
Kara, a high school junior class
representative and peer counselor,
comes to the local community
health center for a routine
examination. During the interview,
she says, My guidance counselor
has asked me and few of my
friends to develop talk for

our classmates on the dangers we

face as adolescents. I know
everybody is worried about
terrorism, but I want to make sure
that we talk about other safety
issues, too.

Bessie Washington
Bessie, a 77-year-old woman, was
recently discharged to her home after
suffering a cerebrovascular accident
(brain attack). She lives alone in a
small one-bedroom apartment and
uses a walker to ambulate. She says,
I have so much stuff crammed into this
small apartment! I almost feel this
morning going from my bedroom to the
kitchen.

Juanita and Inez Flores

Juanita, is a young mother of a 1
year old girl, Inez, who is at the clinic
for a well child visit, while sitting on a
cot with her daughter , whose legs
are dangling at the edge of the cot
about a foot above ground level,
Juanita turns to get something out of
her purse and the child falls to the
floor and begins to cry loudly.

Challenge to the Ethical and

Legal Skill

I first meet Juanita Flores while working

in the children hospital two summers
ago in a nurse externship program.
Juanita was the mother of one-year
old girl diagnosed with failure to thrive
who had been on the rehabilitation unit
for some time. The child was very small
and had a feedings program
prescribed. One day while I was in the
room,

Juanita was sitting on the cot with her

daughter, whose legs were dangling
at the edge of the cot, about I foot
above ground level. I was taking the
child vital signs. As the mother turned
her back for a minute to grab
something from her bag, I turned
away to wash my hands in the sink.

All of a sudden I heard a thud and

crying as the child feel to the floor.
Juanita tried to comfort here.
Picking him up and rocking and
singing to her.

Although I knew it was not

completely my fault, I felt horrible
about turning my back on the child
for only the few seconds to wash my
hands, the seconds that it took for
the child to fall. Although Juanita was
in the room, the child had been
unsupervised for only few seconds.
However, I was not watching her at
the moment the child fell.

I wanted to tell my preceptor right

away and knew I should in case
anything had happened to the
child, but I was nervous and afraid
that I would get into trouble.

Jackson Ray Ivers

Jackson Ray comes to visit his
mother , who has been hospitalized
for tuberculosis. He notices sign on
the door to check at the nurses
desk before entering . He asks,
Whats going on? Why do I have to
wash my hands and wear a mask?

Esther Bailey
Esther, a 72-year-old female patient
on the unit recovering from
abdominal surgery and receiving
antibiotic therapy for a wound
infection, requires insertion of an
indwelling urinary catheter due to the
development of post-operative
urinary retention and inability to void.

Giselle Turheis
Giselle, a 38-year-old woman
undergoing chemotherapy treatment
for leukemia states, I know that you
risk for infection is really high because
of my poor immune status. But how to
do I respond to my Sunday school
class, who are used to greeting me
with a big hug. I want to be safe, but I
know that I need these hugs too!

Challenge to Ethical and Legal

Skills

This is my last clinical rotation before

graduation and it has been a difficult
year. My focus has been somewhat
off for a while, and I havent has been
prepared as I should have been my
clinical and classroom experiences.
My clinical instructor has been on my
case for the last few weeks.

Im also realizing that in no time at all

I will be out of school and on my own
when it comes to patient care. So all
sudden. I am eager for as many
clinical experiences as I can get. To
make along story short, Im thrilled
when offered the opportunity to
catheterize Esther Bailey, a 72-yearold female patient on my unit.

I quickly review the procedure and go to

the patients room, with the
catheterization supplies in hand, feeling
semi confident. After introducing myself
and my clinical instructor and explaining
what Im to do., I open the sterile
package, prepare the sterile field, and
cleanse the meatus. In one quick
moment, as the patient asks a question
and diverts my instructors gaze.

I realize to my horror that Ive

contaminated the catheter. Ive got a
split second to decide what to do. I
can tell my instructor what
happened , obtain a new kit, and
proceed a new, or pretend nothing
happened and continued what to do. I
dont like that Im even considering
not admitting the mistake, after
everything that has been drilled into

us about the importance of sterility and

the consequences of nosocomial
infections . But Im also prudent enough
to realize that it is the time to leave the
unit because the rest of the group is
waiting for post conference , plus, after
all, there are financial costs to ordering
another tray. But what if I do not admit
the error and by chance the instructor
did see me contaminate the catheter?
Then my goose is really cooked!