1. You are a home health care nurse scheduled for a home visit to your patient, a retired account payable clerk who is 7 days postsurgical with a new colostomy. Your patient lives with her husband who is involved in her care; they compile a list of questions between visits to ask upon your arrival at their home. During this visit, the patient has questions regarding her colostomy equipment and stoma care; her husband has questions regarding his current medication regimen. Both of them express concerns over recent changes in their health care coverage. a. What data in the scenario are pertinent? b. Outline your nursing care responsibilities, as the home health care nurse, in this scenario. Compare and contrast these responsibilities with those found in the acute care setting. c. What would be your recommendation for the husband’s medication questions? d. What is the home health care nurse’s role and responsibilities related to the challenges of health care reform? 2. You are a nursing student attending clinical at a large, urban university hospital where you engage in direct patient care with clinical instructor supervision. At the nurses’ station, you overhear various nurses addressing patient care needs, including an RN requesting consults with a physical therapist, a respiratory therapist, a dietitian, and a social worker. Another nurse discusses the potential need for palliative or hospice care consults for a patient. You observe a physician assistant approach the nurse with a list of written orders. a. Outline the roles of the various licensed health care workers mentioned in this scenario. b. Compare and contrast palliative and hospice care. What is the major difference between the two? c. As a nurse, what is your responsibility regarding physician assistant (PA) orders?

1. a. The pertinent data in the scenario include:
– The patient’s recent surgery and new colostomy
– The patient’s and her husband’s questions and concerns about colostomy care, medication regimen, and changes in health care coverage

b. As a home health care nurse, your responsibilities would include:
– Assessing and providing care for the patient’s colostomy and stoma care needs, educating the patient and her husband on proper colostomy care and equipment use
– Assessing and addressing the patient’s and her husband’s concerns about their health care coverage and providing appropriate information and resources
– Collaborating with other health care providers involved in the patient’s care, such as surgeons or primary care physicians, to ensure continuity of care
– Monitoring the patient’s overall health status, including any signs of complications or side effects related to the surgery and colostomy

In comparison to the acute care setting, the responsibilities of a home health care nurse may include a more extensive focus on patient education and self-care management. The nurse may also need to consider the patient’s unique living situation and address any challenges or limitations that may arise in a home environment.

c. For the husband’s medication questions, as a nurse, your recommendation would depend on the specifics of the questions and the patient’s medication regimen. It would be important to gather all relevant information, review the patient’s medical history, and consult with a pharmacist or the patient’s primary care physician if necessary. Based on this assessment, you could provide appropriate guidance and recommendations for the husband’s medication concerns.

d. The role and responsibilities of a home health care nurse related to the challenges of health care reform would include:
– Staying updated on changes in health care policies and regulations to ensure compliance and provide accurate information to patients
– Advocating for patients to help them navigate the complexities of the health care system, especially in relation to their coverage and access to care
– Collaborating with other members of the health care team, such as case managers or social workers, to ensure that patients receive appropriate and timely care within the constraints of the health care system
– Providing patient education and support to promote self-management and empowerment in navigating health care reform changes

2. a. The various licensed health care workers mentioned in this scenario include:
– Registered nurses (RNs): responsible for direct patient care, including assessments, medication administration, and coordinating care with other health care providers
– Physical therapists (PTs): provide rehabilitative services to improve mobility, strength, and functional abilities
– Respiratory therapists (RTs): specialize in the assessment and management of respiratory conditions, providing treatments and interventions to support respiratory health
– Dietitians: experts in nutritional assessment and planning, providing guidance and education on diet and nutrition
– Social workers: focus on the psychosocial aspects of patient care, addressing mental health concerns, support systems, and community resources
– Physician assistants (PAs): work under the supervision of physicians to provide medical care, including diagnosing and treating illnesses, ordering tests and medications, and assisting in surgeries

b. Palliative care and hospice care are both focused on providing comfort and support to patients with serious illnesses, but they differ in their goals and scope. The major difference between the two is their timing and intent. Palliative care can be provided at any stage of a serious illness and is aimed at improving the quality of life for patients and their families by managing symptoms and addressing physical, emotional, and spiritual needs. Hospice care, on the other hand, is typically provided in the final stages of a terminal illness when curative treatment is no longer effective or desirable. Its primary goal is to provide comfort and support to patients and their families as they approach the end of life.

c. As a nurse, your responsibility regarding physician assistant (PA) orders would include:
– Reviewing the orders to ensure they are clear, appropriate, and within your scope of practice
– Seeking clarification from the PA or the physician if you have any questions or concerns about the orders
– Implementing the orders safely and accurately, documenting any actions taken and patient responses
– Collaborating with other members of the health care team, such as pharmacists or other nurses, as needed to ensure the safe and effective delivery of care
– Communicating with the PA or the physician about any observed changes in the patient’s condition or any issues related to the orders.