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Immune thrombocytopenic purpura
NMSU Grants
14 yo
Female
Jill
Hopkins
Walk-in at local clinical for uncontrollable nose bleed
Diagnosed with ITP 4 months ago
Assessment
Vitals signs:
T 98.9
HR 78,
BP 124/76,
RR 18,
SpO2 97% (RA)
Pain 2/10
Na: 138 CO2: 25
K: 4.1 BUN: 18 Bgl: 93
Cl: 101 Cr: 1.0
PT: 13.4
PTT: 28.5
INR: 0.9
Hgb: 13.8
Hct: 43
Platelet: 26.3
WBC: 8.1
Labs
Care and Priorities
Chronic
Acute
Prevent bleeding
Priorities:
Priorities:
Platelets: >30
Patient teaching
Stop bleeding, prevent falls, hemodynamic stability
Treatment:
Transfusions,
Treatment:
Steroids and/or transfusion
TRA, rituximab, splenectomy
IgG
Considerations:
lifestyle changes, adherence
Considerations:
Reoccurrence, hemorrhage, death
Risk for imparied social interaction r/t anergia
Interventions:
Risk for spiritual distress r/t religious affiliation’s refusal of transfusion
Interventions
Altered family process r/t nearest hospital located 45 minutes away
Interventions
Ethical Considerations
Law
Policy
The Affordable Care Act (ACA)
The Affordable Care Act (2010) strengthens prevention and wellness efforts.
§24-7A-6.2 NMSA 1978 … Consent for Certain Minors Fourteen Years or Older (homeless youth or parent of a child)
Beneficence
Nonmalifecence
We must not cause harm to the patient. Potential for ethical dilemma if patient refuses treatment due to religious beliefs.
Fidelity
Being completely truthful with our patient/the pt's family about her condition and the benefits/risks of treatment or refusing treatment.
Those in rural areas such as our patient might not have access to the same healthcare services that are offered in metropolitan
Systems of Care
Small rural clinic acts as primary care clinic for community.
Out of Pocket care model used unless client has insurance or Medicaid/Medicare coverage.
Pro:
Con
Meets most basic primary urgent care needs at fraction of cost without insurance compared to hospital 45 minutes away.
Hospital acts as primary, secondary, and tertiary care for Jill.
Cons:
Pros:
For-profit hospital – increased costs, may run battery of tests to gain profit.
Failed to adequately teach Jill and family about Medicaid/insurance options during visit in May, leading to increased medical debt for family.
Farther from Jill’s home – increased costs to family like gas and meals as well as physical/emotional strain.
Small Rural Clinic
Hospital 45 minutes away
Homeopathic Remedies
Lack of Available Community Resources
Family has working-class finances, was not properly educated on applying for Medicaid or SCHIP, and already incurred possibly avoidable medical debt.
Interventions
Assessing health literacy regarding Medicaid/SCHIP/insurance options
Providing patient education on Medicaid/SCHIP/insurance options based on family income, racial/ethnic group, and state requirements.
Small clinics usually have.....
Difficulty staffing
Lack of funding
Patient teaching can be harder
Patient teaching
Out of date practices and protocols
Populations at risk
Median age >50
Improvements in Patient Care
Consistency in health care availability
Professional boundaries
Cultural considerations in health care delivery and patient education
Considerations for patient populations with increased health care disparities and poverty
Education on how politics plays a role in available health care
Surveys and community outreach
References
Bolin, J. N., Bellamy, G. R., Ferdinand, A. O., Vuong, A. M., Kash, B. A., Schulze, A., & Helduser, J. W. (2015). Rural Healthy People 2020: New Decade, Same Challenges. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/jrh.12116.
Giddens, J. F. (2017). Health care economics. In Concepts for nursing practice. (2nd ed., pp. 519-524). St. Louis, MO: Elsevier.
Nelson, W., Pomerantz, A., Howard, K., & Bushy, A. (2007). A proposed rural healthcare ethics agenda. Journal of medical ethics, 33(3), 136–139.
US Census Bureau. (2016, December 30). New Census Data Show Differences Between Urban and Rural Populations. Retrieved from https://www.census.gov/newsroom/press-releases/2016/cb16-210.html.
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