Case Study

Case Study

Mr Henry Wilson is a 54 year old bank manager who presents to the Emergency Department with a sudden onset of shortness of breath and left sided chest pain whilst watching the evening news. The pain has been constant for one (1) hr.

He has no relevant past history and he is taking no regular medications. He is 160 cm tall and weighs 95kg.

You are the Registered Nurse caring for Mr Wilson on arrival.

Mr Wilson states he has left sided chest pain. The pain is not exacerbated by deep breathing, coughing or movement. He is diaphoretic and has a pain score: 8/10. His vital signs are Temp: 37.2, HR: 84, BP: 150/90 mmHg, RR: 18, SaO2: 95% in RA. Glasgow Coma Score (GCS): 15. He is treated in the Emergency Department and a 12 lead ECG is done (results below).

The medical officer has inserted an IV cannula.

The medical officer orders the following to be commenced immediately and then re-review.

• Oxygen Therapy
• Blood pathology to be collected, including FBC, EUC, LFT, BSL and cardiac markers.

• Medications: Morphine 2.5 mg IVI for pain
Aspirin 300mg stat
Clopedigrol 600mg
Anginine

• X-Ray: Mobile chest.

The results of Mr Wilson’s cardiac markers have been processed by pathology and are as listed below:

CK-MB: 1.0mcg/L
Troponin I: 2.0mcg/L

Assessment Task:

As a guide in no more than 1000 words (using your criteria sheet), apply the ABCDE framework and critically analyse the clinical indicators in the case study and their significance. In particular, apply your knowledge in interpreting the attached 12 lead ECG to determine care priorities for Mr Wilson. Then identify and discuss the most important nursing interventions (at least two priority interventions) relevant to Mr Wilson’s needs and the rationales for these as you assess him. Your paper should demonstrate an understanding of the pathophysiology and treatment ordered by the medical officer (i.e oxygen, ECG, medical tests, medications) and your nursing responsibilities associated with this treatment. Discuss 2 of the 4 medications identified. Please remember to write this paper in a formal/analytical style.

case study

CASE STUDY
Mr Black, a 61 year old businessman was watching the 7pm television news when he developed sudden onset of difficulty in speaking and drooping of the right side of his mouth. He was not able to lift his right arm or stand up. His wife immediately called the ambulance. The paramedics, using the FAST protocol assessed Mr Black as having had a stroke and transported him to a hospital with an acute stroke thrombolysis centre. He was admitted to the Emergency Department at 8pm.
History obtained from wife.
Mr Black was diagnosed with hypertension 10 years ago for which he takes Metopropol daily. He smokes about one packet of cigarettes/day and drinks alcohol socially. There is no history of serious illnesses or allergies. His father died of a heart attack at the age of 60.
Vital signs
BP 150/80 mmHg
Pulse 90bpm and regular
Respirations 20 breaths/minute
Temperature 36.5???? C
SaO2 95%
Neurological examination
Pupils equal – 2mm and reactive to light
Right facial droop
Paralysis of right arm and weakness of the right leg
Normal strength in the left arm and leg
Decreased sensation on right side of the body
Right knee and ankle reflexes moderately brisk compared with those on the left
Plantar response is extensor on the right and flexor on the left
Difficulty with speech – repeats yes to all questions
Laboratory tests
Full blood count – all values within normal range
Blood glucose level – 6.5 mmol/L
Electrolytes, urea and creatinine – all values within normal range
ECG – normal sinus rhythm
CT brain scan (2hours from symptom onset)
No intracranial haemorrhage or mass lesions. Suggestion of early ischaemic changes in left hemisphere.
Diagnosis
Mr Black is diagnosed with a left middle cerebral artery distribution stroke. He is assessed as being eligible for thrombolytic therapy.
Management
IV Alteplase (8.1mL bolus over minute; 72.9 mL added to 50mL sodium chloride infused over 60 minutes via a volumetric control pump).
Continue antihypertensive medication
24 hours after completion of alteplase follow-up CT brain scan – if bleeding excluded commence Assasantin???? SR capsule twice a day

PART 1 – Pathophysiology template
Complete a pathophysiology template for an ischaemic stroke that affects the dominant left cerebral hemisphere (400 words).
PART 2- Questions related to the case study
Question 1 (450 words) Explain the pathogenesis that leads to the structural and functional changes resulting from Mr Black’s stroke.
Question 2 (150 words) Explain how two of Mr Black’s clinical manifestations are related to the structural and functional changes caused by the stroke.
Question 3 (250 words) Relating your discussion to the pathogenesis of Mr Black’s condition, explain the mode of action of Alteplase and Assasantin®.

World war one and its Consequences

You MUST read the book before writing the essay.
The book is Worlds of History: A comparative Reader Volume Two: Since 1400 by Kevin Reilly
Read Chapter 24, World war 1 and its consequences: Europe and the world, on pages 918 to pages 953. READ ALL of the materials in that chapter. Discuss what you take to be the editor’s objectives for the chapter. Evaluate the materials he includes, particularly from the standpoint of whether they advance those objectives and illuminate your understanding of history. Did you find any or all of these materials thought-provoking? if so how? Did any of these materials significantly enhance your knowledge and understanding? Did some parts of the chapter work better than others? Would you suggest any changes? Overall, how would you assess the value of the chapter as a learning tool?
Again, you must have the book to write the essay, use the book to support your idea. and remember to cite.

Toward Leadership in a Global Society

Choose 3 theories and analyze your own leadership and that of your 2 exemplars. In doing so, clarify the setting or cultural issue and the positive social change exemplified by your chosen leaders and your own past, present, or future efforts to bring about change. In regard to your own leadership, focus on efforts at changes in specific learning settings.

**Analyze yourself and the 2 leaders in light of situational leadership and leadership ethics

***FYI: The two exemplars (leaders) I have selected for this paper are Martin Luther King Jr. and Frederick Douglass.

Factual Scenario for Authentic Assessment Project: Gumdrop Northern

Factual Scenario for Authentic Assessment Project: Gumdrop Northern

Gumdrop Northern was a long-term military contractor and munitions manufacturer with annual revenues of $500 billion. The company employed 105 workers—highly paid United Auto Workers (UAW) technicians and mechanics. Gumdrop Northern manufactured body armor and armored vehicles for the U.S. military. Contrary to international law and treaties, the company also manufactured landmines, exporting them to Afghanistan and Iran, its best foreign customers. More than half of its profits derived from these clandestine operations.

All of Gumdrop Northern’s products had problems. Although the company was paid handsomely for its body armor and armored vehicles, the materials it used in manufacturing were substandard. The body armor did not protect service members from most antipersonnel ammunition. The simple addition of a standard issue flak jacket would have prevented most injuries, but Gumdrop did not tell the military because it feared that it would lose its contract. In addition, its armored vehicles, although quite strong and sturdy on the sides and top, had only a thin sheet of steel on their undersides, making them especially vulnerable to improvised explosive device (IED) explosions.

The landmines Gumdrop sold to the Taliban in Afghanistan and to the Iranian government were themselves defective. Many who attempted to plant the mines were themselves killed in the process due to faulty switches. Most of the mines’ victims were children and soldiers. When the U.S. military realized that Gumdrop Northern had sold it inferior body armor and armored vehicles, Department of Justice (DOJ) lawyers became involved, and the families of injured or killed U.S. service members consulted attorneys. Gumdrop’s corporate leaders were now looking down the barrels of criminal prosecution, and classes of plaintiffs were forming and growing quickly.

The Gumdrop board knew the company’s days were numbered. Although Gumdrop could afford to pay the class-action plaintiffs and could have replaced its top executives if they were imprisoned, the board came to the conclusion that the company’s fiduciary duties to shareholders would best be fulfilled by its abandoning its production facilities in the United States and establishing a factory in Argentina, a country that does not extradite to the United States; and Colombia, where union organizing is not a problem, as unionists are regularly murdered. But first, Gumdrop had to try to get out from under the potential legal liabilities, both to the families of service members who had been injured or killed as a result of using Gumdrop products and to the workers in its U.S. plant, who were protected by a collective bargaining agreement and by U.S. labor and employment laws. As it had more than 100 employees, under the Worker Adjustment and Retraining Notification (WARN) Act (see http://www.doleta.gov/layoff/pdf/WorkerWARN2003.pdf), the company would have had to have given employees 60 days’ notice of its departure from U.S. operations. Such notice would have had some undesirable consequences. First, it would have given notice to plaintiffs and to the U.S. military that Gumdrop was planning on leaving the country. Second, the exceptionally militant and well-paid UAW workers could have undertaken acts of sabotage or have at least have left on their own terms rather than on those preferred by Gumdrop. Third, under the UAW collective bargaining agreement, workers were entitled to significant amounts of severance pay in the event of a plant shutdown or mass layoff.
Violation of the law, however, would have imposed significant backpay liability on the company, which it wanted to avoid.

Gumdrop formulated a plan. First, it would outright fire five workers for no cause and would offer an early retirement package to five others that they could not refuse. This would bring the number of workers to 95, which would remove the company from the jurisdiction of the WARN Act. Then, Gumdrop would file for bankruptcy, under which it was certain to be able to reject the collective bargaining agreement. (When a company files for bankruptcy protection, the Bankruptcy Court has the power to relieve the bankrupt company of its contractual obligations when necessary. Bankruptcy is often used by companies who feel excessively burdened by union demands.)

These two courses of action were successfully undertaken in remarkably short order. Gumdrop now had neither notice requirements under the WARN Act nor severance liability under the now-rejected collective bargaining agreement. The bankruptcy also short-circuited the class-action suit brought by the families of injured or killed service members. With all remaining assets of Gumdrop in the hands of a court-appointed trustee in bankruptcy, no one would be paid for anything.

In the interim, Gumdrop had established relationships with contractors in Argentina and Colombia and had factories up and running even before the bankruptcy papers were filed in the United States. Company assets had been transferred to banks in Argentina and Switzerland, which assured customers that the money would be safe from creditors, whether foreign governments or other parties. Gumdrop profits and share value were maintained. Argentina and Colombia were ecstatic to have Gumdrop in their countries. Individual lower-level administrators were handsomely rewarded by Gumdrop for enabling the business to function smoothly and not be bothered by the host countries’ environmental laws, labor laws, and other (admittedly minimal) business restrictions. Argentinian and Colombian government leaders believed that the radiation and chemicals leaking into the local groundwater was a small price to pay for the cut-rate military equipment it received in return, enabling it to battle insurgents, union activists, and drug dealers.

Final Scenario Analysis
This course involves analyzing a scenario that I will provide, identifying and discussing the relevant ethical issues, discussing any legal issues or liabilities created by or related to the scenario, and developing solutions to ethical problems.
The scenario analysis culminates in the creation of a paper in the form of a complex memorandum directed to a company executive officer discussing the ethical issues and your recommendations. The memo will show how you have developed, sharpened, and applied critical thinking skills in recognizing, evaluating, and proposing a solution to ethical problems that arise in business management.
You are encouraged to engage in your own reflection, critical analysis, and argumentation, in addition to drawing influence from other sources. Support all viewpoints with arguments intended to justify the position to others.

Required Elements to include in the Final Scenario Analysis:
•Provide the relevant facts of the case
•Provide the basis of each ethical issue, and how legal concerns, managers’ fiduciary duties, and effects on corporate stakeholders define or relate to the issue
•Discuss and proposes a solution to each of three ethical issues raised in the scenario.
•Provide a reasoned argument for the best solutions, for both the short- and the long-term, for the company’s ethical, and any related legal, problems

In Meeting the Required Elements, students will:
•Distinguish the ethical issues from purely management, marketing, finance, etc. issues
•Distinguish legal issues from the ethical issues and explain how these issues are related
•Use and integrate the concept of fiduciary duties in analyzing managers’ ethical responsibilities
•Clearly and succinctly state facts relevant to the statement and resolution of the ethical issues
•Identify fiduciary duties arising in factual circumstances
•Support your recommendations with well-reasoned arguments and justifications.
•Articulate alternative courses of action, evaluating them in terms of implicated stakeholder interests and fiduciary duties.
•Persuasively justify one alternative as the best for the business, considering both ethics and bottom line
•Properly attribute words and ideas from other sources