Scenario – John is a 32 year old male nurse working in a prison. He is married and has two children at home- one boy at 14 years of age and a girl that just turned ten years of age. A new prisoner to the institution has requested that John be a healthcare surrogate for him because he is 72 years of age and not in good health. John discovers that this prisoner is a pedophile and although no one at work is aware of this, John's son was molested by the father of a friend of his sons while visiting their home. The son has gone through therapy and they continue to have problems with the son, John is hopeful that his son will improve his mental health.

John feels divided because on one hand he feels obligated to serve as an RN professional and on the other hand he feels very hateful of the pedophile lifestyle that seems to encompass the newly admitted prisoner.

Instructions:

1. Read the scenario above, and then answer the following questions:

a. What kinds of issues ethically is John dealing with?

b. How would you counsel John in his dilemma?

c. Finally, what would be a reasonable approach to this problem that John has professionally and personally?

2. Your paper should be:

. One (1) page

  

DISCUSSION RESPONSE 

Search-Based Questions 

1. Read the 

Article – Essentials of Advocacy in Case Management


 Download Article – Essentials of Advocacy in Case Management
, and then, answer the following questions:

a. Case Managers have four duties as described in the article. What are they?

b. What dilemma are Case Managers presented with everyday they practice?

c. What is the relationship between advocacy and provider-driven ?

d. Give four examples of case manager advocacy that are mentioned in the article.

e. Name four Four Basic Perspectives on Advocacy in Case Management Practice.

f. Case management advocacy consists of seven areas of focus. What are they?

2. Your paper should be:

3. One (1) page

. Typed according to 

APA Writing StyleLinks to an external site.
 for margins, formatting and spacing standards.

. Typed your paper in a Microsoft Word document, save the file, and then upload the file.

 

Using the theory of unpleasant symptoms as a guide, what would you look for in an assessment tool for patient symptoms?

 Esophageal Reflux Case Studies A 45-year-old woman complained of heartburn and frequent regurgitation of “sour” material into her mouth. Often while sleeping, she would be awakened by a severe cough. The results of her physical examination were negative. Studies Results Routine laboratory studies Negative Barium swallow (BS), p. 941 Hiatal hernia Esophageal function studies (EFS), p. 624 Lower esophageal sphincter (LES) pressure 4 mm Hg (normal: 10–20 mm Hg) Acid reflux Positive in all positions (normal: negative) Acid clearing Cleared to pH 5 after 20 swallows (normal: <10 swallows) Swallowing waves Normal amplitude and normal progression Bernstein test Positive for pain (normal: negative) Esophagogastroduodenoscopy (EGD), p. 547 Reddened, hyperemic, esophageal mucosa Gastric scan, p. 743 Reflux of gastric contents to the lungs Swallowing function, p. 1014 No aspiration during swallowing Diagnostic Analysis The barium swallow indicated a hiatal hernia. Although many patients with a hiatal hernia have no reflux, this patient’s symptoms of reflux necessitated esophageal function studies. She was found to have a hypotensive LES pressure along with severe acid reflux into her esophagus. The abnormal acid clearing and the positive Bernstein test result indicated esophagitis caused by severe reflux. The esophagitis was directly visualized during esophagoscopy. Her coughing and shortness of breath at night were caused by aspiration of gastric contents while sleeping. This was demonstrated by the gastric nuclear scan. When awake, she did not aspirate, as evident during the swallowing function study. The patient was prescribed esomeprazole (Nexium). She was told to avoid the use of tobacco and caffeine. Her diet was limited to small, frequent, bland feedings. She was instructed to sleep with the head of her bed elevated at night. Because she had only minimal relief of her symptoms after 6 weeks of medical management, she underwent a laparoscopic surgical antireflux procedure. She had no further symptoms. Critical Thinking Questions 1. Why would the patient be instructed to avoid tobacco and caffeine? 2. Why did the physician recommend 6 weeks of medical management? Case Studies Copyright © 2018 by Elsevier Inc. All rights reserved. 2 3. How do antacid medication work in patients with gastroesophageal reflux? 4. What would you approach the situation, if your patient decided not to take the medication and asked you for an alternative medicine approach?