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Case Study Form (CMCN307 Leadership Communication)
Case Study Form (CMCN307 Leadership Communication)
Your Name: Bobby Lada
Title of this paper: Pandemic Problems
Theory or concept you used for analysis:
Source of information (APA style):
Storyful Rights Management. (2020, October 8). Woman calls 911 After Being Refused Service for Not Wearing a Mask [Video]. Youtube.
https://www.youtube.com/watch?v=tDOzkkjeIVwDeveloping The Leadership Message. Leadership Communication. Retrieved from
https://westsidetoastmasters.com/resources/communication_secrets/ch01.htmlCase description (more than 300 words) – You have to add the number of word count (such as 456 words) at the end of this section to indicate how much words you wrote for this section.
In this case, a woman is trying to go get into a shopping center to get grab a couple of items. She gets to the door and tries to enter the store without a mask on and one of the employees of the store quickly denies her from entering the premises. The employee continues to explain to her that she needs to wear a mask in the store because of the pandemic that the world is in but she feels like it is her right to not want to wear a mask in the store. The lady tries to convince the employee that if she wears a mask it causes her serious anxiety and discomfort. She then continues to complain and decides to call the police. She gets on the phone with the police expecting them to support her ridiculous protest, but they explain to her that the company has the right to refuse service to whomever they want especially if there is a sign in front of the store that says wearing a mask is required. The woman stands in the doorway as she continues the conversation on the phone with 911 calling out specific laws that she says allows her the right to be able to not wear a mask and now adds on the has a religious exemption. When the store employee notices her reasons changed from panic attack to religious, he pointed this out and her response is that it is a mixture of everything. Further more she explains that she should be allowed entry into the store because no one is in the store, and the employee stated that he is someone and is in the store and does not want to be at risk of COVID nor of losing his job for not following protocol.
(Word Count: 301 Words)
Theoretical analysis (more than 300 words) – Why is this case a case of leadership communication? How can the theory or concept you have chosen be applicable for or relevant to the case you selected? Add a word count at the end of this section.
According to westside toast masters, “Leadership communications consists of those messages from a leader that are rooted in the values and culture of an organization and are of significant importance to key stakeholders, e.g. employees, customers, strategic partners, shareholders, and the media”. The employee at the store directly showed his leadership communication by delivering his companies expectations to guest upon entering their place of business. He not only informed the woman of the store policy, he refused her entry, and he also named out stake holders that would be impacted by now following this protocol. He named out himself as an employee, other people that might be entering the store being at risk due to this woman not wanting to wear a mask and also the company policy being fair across the board for all people entering the store. Furthermore, his leadership really showed up as he remained consistent in his message even when the woman tried to use fear to get him to change his answer and calling 911. The gentleman remained calm, talked in respectful manner, and delivered proper reasoning. The reasons aligned with the store’s values and values of the community with the 911 operator reiterated on the phone with faced with the situation This builds trust and shows the company has values, consistency, and morals. Lastly, according to Westside Toastmasters traits of leadership communication are significance, values, consistency, and cadence and the employee displayed each of these characteristics in this video. Hence, he showed a great role of leadership communication and all of the situation is documented on video. The company will know they have a true leader on their hands that not only showed up for this situation but will show up in any situation and is there to follow the rules and will lead their organization with integrity.
(Word Count: 304 Words)
Acute Impaired Tissue Perfusion
Acute Impaired Tissue Perfusion
Introduction
The ability of blood to circulate unimpeded throughout the body is what is known as perfusion, it involves the process of hemoglobin in the blood binding with oxygen through respiration in the lungs, in cases where the process is unable to be complete a perfusion state is said to exist. This deficiency can be identified through the diagnosis of the inadequate tissue perfusion symptoms and signs of organ failure, mainly due to lack or inadequate circulation of oxygenated blood through body organs or system. It is with this above understanding of its importance that this article seeks to address its effects on patients with acute impaired tissue perfusion, characteristic, other related factors, outcomes in both patient and caregiver diagnosis, relevant interventions and rationales and the family and patient teachings.
The perfusion within the ineffective tissues can occur in various body systems like the peripheral, cerebral, renal, gastrointestinal, and cardiopulmonary. It can be described as a condition that exhibits a reduction in the blood flow which results in the capillary tissues failure to nourish, since it causes less nutrition and oxygenation at the cellular level. There are divergent effects on a patient if the condition persists mainly if it is an acute condition can turn tragic and cause tissue or organ damage or even death, if it is a mild condition it will have no or few effects on the patient (Maylor ME, 2005).
The main defining characteristics for diagnosing the condition include peripheral issues such as clammy skin, absent or absent peripheral pulses, edema, numbness or pain, cerebral issues like seizures, lethargy, restlessness, confusion decrease to light reaction, and cardiopulmonary effects such as angina or hypertension. The renal system can also have impacts like hematuria and blood pressure change or problems in the gastrointestinal like abdominal pain, nausea or absent or decreased bowel sounds.
Indicators of tissue perfusion on patient would include symptoms of possible impaired blood clotting capabilities and blood flow, and decreased tissue perfusion. Also by monitoring and comparing the patients pulse to ensure that it is steady. Other indicators could be identified through performing therapeutic interventions that have diagnostic testing characteristics like vasodilator therapy and angiograms indicators like heparinization or embolectomy. It can also be done by performing a possible cardiac output test like by using an anti-embolism device or raising an affected limb as necessary. Other specific interventions would include administration of oxygen, range of motion exercises or often change of body positions (Gardiner SM et, al, 1990).
Other related factors that also lead to perfusion of tissues would include mismatch of blood flow with ventilation, Hypovolemia, venous flow interruption, hypoventilation, altered affinity of hemoglobin for oxygen, interruption of arterial flow, impaired transport of oxygen across capillary membrane or alveolar, enzyme poisoning; hypervolemia, decreased hemoglobin concentration in blood, exchange problems, mechanical reduction of arterial blood or venous flow (Kupper N, et.al, 2011).
The care givers expected outcomes would include improvement in the Urinary Elimination, Circulation Status, Fluid Balance, Cardiac Pump Effectiveness: cardiac and Tissue Perfusion, Tissue Perfusion: Peripheral and Tissue Perfusion: Cerebral. On the other hand the expected client outcome would include them demonstrating an adequate and efficient perfusion in their tissues as demonstrated by them having dry and warm skins, an absence in respiratory distress, palpable peripheral pulses, verbalized treatment regimen knowledge, adequate urinary output, recognize change in lifestyle that would encourage tissue perfusion, include appropriate medication and exercise and their possible actions and side effects.
Patients who exhibit acute cerebral perfusion symptoms would include them showing signs of orthostatic hypertension which causes them to experience dizziness while getting up; the interventions would include teaching them on remedies of addressing the dizziness like rising slowly, while seated they flex their feet upwards, they set for a while before standing, trying to have someone present while trying to stand and sitting immediately they start feeling dizzy. The rational for emphasizing on addressing this condition would be that it leads to a decrease in the cerebral perfusion fusions or stroke which if addressed early can be treated.
It can also be diagnosed by monitoring the neurological status, mainly by performing an examination of the neurological functions, or in cases where symptoms of a (CVA) cerebrovascular accident are present like in hemiplegia, hemiparesis or dysphasia. Feeling the temperature and skin color for signs of mottling, skin pallor, absent of pulse, cold skins or cool temperature could signify obstruction within the arteries, which would signify urgency for immediate intervention (Makhsous, M et.al, 2007).
The main lessons for the family and the client would be them being taught on importance and ways of avoiding getting exposed to cold conditions in any kind of weather condition by stressing on their dressing. They will have a better understanding of proper foot care and the need to inspect and wash their feet daily since they will be aware of its relevance to a diabetic patient and as such implement the recommended special insoles, padded socks and jogging shoes. The diabetic client will be more knowledgeable on the relevance of undertaking a comprehensive foot examination annually that comprises of a Semmes-Weinstein monofilaments sensation assessment where they will be referred to a footwear professional for therapeutic inserts and shoes fitting, in which the incurred costs are covered by the Medicare (Wipke-Tevis D,et.al,2004).
In patients with arterial disease they are taught on the importance of following proper weight loss programs, not smoking, controlling hypertension and hyperlipidemia, careful control of their diabetic conditions and stress reduction. For the patients with venous disease, they are taught on the relevance of maintaining the recommended procedures of elevating their legs at intervals, wearing support hose and watching for skin breakdown on their legs as stipulated by the physician. The client/family are also taught on ways of recognizing symptoms/signs that the physician should be notified about example presence of a new foot lesion, change in skin temperature or abnormal sensation.
Reference
Maylor ME.(2005) Signs and symptoms of hypothetical wound assessment by nurses. Br J Nurs (6):S14-20.
Makhsous, M, Priebe, M, Rowles D, Zeigler M, Chen D, Lin F. (2007)“Measuring Tissue Perfusion During Pressure Relief Maneuvers: Insights into Preventing Pressure Ulcers.” Journal of Spinal Cord Medicine, (5): 63-73.
Kupper N , Mitchell D , et al:(2011) Nursing management: inflam-matory and structural heart disorders . In Lewis S , editor: Medical-surgical nursing: assessment and management of clinical problems, ed 8 , St Louis , Mosby/Elsevier , p
Wipke-Tevis D , Rich K , et al: (2004)Nursing management: vascular disorders . In Lewis S , editor: Medical-surgical nursing: assess-ment and management of clinical problems, ed 8 , St Louis ,Elsevier , pp 866 –
Gardiner SM, Sompton AM, Bennett T, Palmer RMJ, Moncada S (1990) Control of regional blood flow by endothelium-derived nitric oxide. Hypertension 15:486–492
Case Study Example
Case Study Example
Scenario:
Joe is in his 80s and has been receiving outpatient chemotherapy for cancer. He fell in his apartment and broke his hip, so he ended up in the hospital for 2 weeks. Towards the end of his stay, he began experiencing a fever and rapid heart rate. He had stomach pain and terrible watery diarrhea many times throughout the day. He became severely dehydrated. It was hard for him to manage the nausea. His doctor took a stool sample and noticed an anaerobic Gram positive bacteria.
This case is an 80-year-old cancer patient, named Joe, who acquired an in-hospital infection while being treated for a hip fracture secondary to cancer. Joe is currently undergoing cancer treatment with chemotherapeutic drugs. Hospital acquired infections are a serious matter within our healthcare system; so much so that in 2014 the CDC did a study and determined that about 4% of hospitalized patient’s suffered from a hospital acquired infection (Monegro et al., 2020). To put that number into perspective we look at local, nationally ranked Johns Hopkins Hospital. Johns Hopkins has roughly 107,000 inpatient admissions annually, using the 4% number mentioned previously, that equates to 4,280 patients in one hospital system in one year that suffered from a hospital acquired infection (Fast Facts: Johns Hopkins Medicine, 2020).
Based on the information provided in this case study I have determined that Joe is suffering from a common hospital acquired infection, Clostridium difficile. Joe’s compromised immune system, his abdominal pain, fever and watery stool are all classical indicators of a Clostridium difficile infection. Clostridium difficile (C. difficile) is a spore-forming, gram positive anaerobic bacillus (Clinical C. Diff Q & A, 2020). C. difficile is a common cause of antibiotic associated diarrhea and currently accounts for 15-25% of all episodes of antibiotic associated diarrhea (Clinical C. Diff Q & A, 2020). C. difficile is often caused by specific antibiotics that wipe out the “good bacteria” within a patient’s GI tract, other patients at risk are those with compromised immune systems (Clinical C. Diff Q & A, 2020).
C. difficile has some key characteristics that make it easy to spread within a hospital environment; for one, it has a protective outer coating that potentially allows it to live for months if not years on surfaces and in the soil (Prevent the Spread of C. Diff (Deadly Diarrhea)., 2019). Second, C. difficile requires the use of soap and water to prevent the spread of germs, with the increase in usage of alchol based hand sanitizers like Purell in the hospital environment, which is not effective at killing C. difficile, it is easier for hospital staff to unintentionally spread the disease (Prevent the Spread of C. Diff (Deadly Diarrhea)., 2019). Third, C. difficile requires cleaning beyond the traditional norm within the hospital environment, a bleach solution is required in order to kill C. difficile spores, this is a higher level of cleaning than is what is typically used for most room turnovers within a hospital environment (Prevent the Spread of C. Diff (Deadly Diarrhea)., 2019). Finally, it is important to note that various studies have shown that C. difficile has been present in anywhere from 2%-15% of the healthcare workers sampled, while this is a relatively low number, it could provide a substantial source of potential infection to the immunocompromised patient’s that C. difficile infects so readily (Prevalence of Clostridium Difficile Colonization among Healthcare Workers, 2013). C. difficile is shed through GI tract and out of the body through feces and can be transferred with any surface contact of infected materials (Clinical C. Diff Q & A, 2020). In the hospital setting modes of transmission could include any number of items: hospital beds, rectal thermometers, sheets, toilets or hospital employees’ hands just to name a few. While surface contact is the most common mode of transmission, a 2010 study suggests that C. difficile is also transmittible through the air and notes that individual rooms are the safest option for preventing the spread of C. difficile (Adalja, 2019).
Despite its virulence, C. difficile generally responds well to treatments. About 20% of patients who acquire C. difficile will see it resolve with just the discontinuation of the antibiotics they were previously prescribed (Clinical C. Diff Q & A, 2020). The remaining patients will often see improvement with a change to a more appropriate antibiotic, usually Vancomycin for Fidaxomicin (Clinical C. Diff Q & A, 2020). Other treatments will include replacement of fluids to prevent the dehydration that is commonly associated with diarrhea. It is important to treat C. difficile early as it can lead to serious conditions such as dehydration, sepsis, toxic megacolon and in rare cases death (Clostridium Difficile: Epidemiology, Diagnostic and Therapeutic Possibilities—a Systematic Review, 2013).
If left untreated, C. difficile can cause a number of different symptoms, the most common of which are watery diarrhea, fever, loss of appetite, abdominal pain or tenderness and nausea (Clinical C. Diff Q & A, 2020). While those symptoms might sound minor, in totality they can ultimately lead to dehydration, a perforated colon (which is a life threatening condition that will require surgery) or a very serious condition called sepsis which is characterized by high fever, high heart rate and severe low blood pressure which can ultimately be fatal.
According to the Cleveland Clinic, with treatment, the prognosis for C. difficile is usually positive, they state that with proper antibiotics the fever will subside within two days and the diarrhea within two to four days (C. Diff (Clostridioides Difficile) Infection Outlook / Prognosis, n.d.). They do report that 10-20% of patients may see a re-emergence of symptoms within one to two weeks (C. Diff (Clostridioides Difficile) Infection Outlook / Prognosis, n.d.). More serious complications like a perforated colon, dehydration or sepsis could require longer hospital stays to treat appropriately.
In conclusion, our patient Joe, is suffering from a Clostridium difficile infection acquired during his hospital stay for his broken hip. His immunocompromised system, caused by his cancer treatments, places him at an increased risk for hospital acquired infections. With quick identification and rapid treatment with appropriate antibiotics, Joe has a good chance of overcoming his C. difficile infection and getting discharged to rehab to continue healing from his hip fracture.
Works Cited
Adalja, A. A. (2019, January 29). Airborne Spread of Clostridium difficile | 05-14-2010 | CBN article. Clinicians’ Biosecurity News | Johns Hopkins Center for Health Security. https://www.centerforhealthsecurity.org/cbn/2010/cbnreport_05142010.htmlThis source is a world-renowned hospital that is consistently ranked as a “top hospital” within the United States.
C. diff (Clostridioides difficile) Infection Outlook / Prognosis. (n.d.). Cleveland Clinic. Retrieved November 8, 2020, from https://my.clevelandclinic.org/health/diseases/15548-c-diff-clostridioides-difficile-infection/outlook–prognosisThis source is a world-renowned hospital that is consistently ranked as a “top hospital” within the United States.
Clinical C. diff Q & A. (2020, March 27). Centers for Disease Control and Prevention. https://www.cdc.gov/cdiff/clinicians/faq.html#anchor_1529601781962This source is a federal government agency.
Clostridium difficile: epidemiology, diagnostic and therapeutic possibilities—a systematic review. (2013, November 1). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950610/This source is a peer reviewed medical journal.
Fast Facts: Johns Hopkins Medicine. (2020, January 1). [Graph]. Hopkins Medicine. https://www.hopkinsmedicine.org/about/_downloads/JHM-Fast-Facts.pdfThis source is a world-renowned hospital that is consistently ranked as a “top hospital” within the United States.
Monegro, A. F., Muppidi, V., & Regunath, H. (2020, September 3). Hospital Acquired Infections. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/books/NBK441857/This source is a peer reviewed medical journal.
Prevalence of Clostridium difficile colonization among healthcare workers. (2013, October 4). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850636/This source is a peer reviewed medical journal.
Prevent the spread of C. diff (deadly diarrhea). (2019, November 4). Centers for Disease Control and Prevention. https://www.cdc.gov/cdiff/prevent.htmlThis source is a federal government agency.