History and physical examination: Case Study

History and physical examination
History and physical examination
History and physical examination


Name: Mrs. Tiffany Jones

Age: 32

Sex: Female

Referring physician: Self-referred, seems reliable

Chief Complaint: “I have been having severe headaches for the last two days.”

History of Present Illness (HPI)

 For the previous five days, Mrs. Jones has been experiencing frontal headaches.  She describes the pain as bifrontal, throbbing and moderately severe. The pain began after a minor accident when she slid from a ladder and fell and hit her head.  The accident was minor states that she did not see the need for review.  She has been taking Tylenol as painkillers, but it is no longer effective. The headaches are not associated with nausea and vomiting. The pain is aggravated by activity and is relieved by rest and put a damp towel on her forehead. The patient denies associated paresthesias, motor-sensory deficits or visual changes.

Medications: Tylenol 400 mg 1 tablet after 4-6 hours

Allergies: Aspirin causes gastrointestinal discomfort

Tobacco: About five cigarettes per day (Since the age of 18)

Alcohol: Takes wine on rare occasions

Past Medical History (PHM)

Childhood illness: Chickenpox, Mumps, Measles

Adult Illness: None

Surgeries: Tonsillectomy at age 6

Ob/GYN: G200P2, normal vaginal deliveries, two living children. Menarche at the age of 13years and LMP a month ago. Not sexually active, No psychiatric disorders.

Health maintenance:  Not up to date

Family History

Father died at age 46 in an accident. Mother is 67 alive and diagnosed with dementia.  She has one brother 30 years old, alive and healthy. Her two daughters age 6 and four years are alive and healthy. No family history of TB, diabetes, cancer, or cardiovascular disease.

Physical examination: Psychosocial History

She is born and raised in Deltroit, finished college and married her high school boyfriend. She works as a librarian in a nearby college. She lives with her family in their mortgaged house. She gets little exercise but is watchful of her diets. She feeds on homemade foods only. She uses seat belt regularly and sunscreen lotions.

Review of System

 General: Denies fever, night sweats or chills

Skin: Pale and dry. Patient denies bruising rashes or skin discolorations

Eyes: Patient use corrective lenses

 Ears: No ear pain, discharge or any hearing changes

Nose/Mouth/Throat: No sinus complication, no nose bleeds, no dysphagia, or throat pains

Breast: Deferred

 Heme/lymph/ Endo:  No anemia or bleeding issue. No swollen glands. She does not feel excessive thirst or present cold intolerances

Cardiovascular: She denies orthopnea, peripheral edema or chest pains

Respiratory: She denies SOBs, wheezing, dyspnea or hemoptysis. She has no history of TB or pneumonia

Gastrointestinal: Denies NVD, has no abdominal pains, constipation or hemorrhoids. Denies eating disorders

Genitourinary/Gynecological: no hematuria, no night-time urination or changes in urine quantity

Musculoskeletal: Denies muscle pains, has mild back aches, no history of fractures of osteoporosis

Neurological: No seizures or syncope of transient paralysis

Psychiatric: No distress, no depression, psychosocial disorders or suicidal thoughts.

Objective data

Vital signs: Height 5’2”, Wt 143lb, BMI 39.0, Bp 130/70 right arm seated, HR 88, RR 18, t 98.6F

General Appearance: Patient is alert and oriented. Denies acute distress, she is well groomed and generally healthy

Skin: Skin is intact, pale and dry. No bruising, rashes or lesions


Head: Normocephalic and atraumatic

Eyes: Intact EOMs and PERRLA, no sclera infection or lesions

Ear: Positive reflex, no discharge, infection or foreign bodies, visible umbo and short process

Nose: bilateral canals, no rhinitis in both nares, oral pharyngeal mucosa is pink, moist and not erythmatous. No dental prosthesis, nodules or thyromegally.

Cardiovascular: S1 and S2 is heard with normal and regular rate, no peripheral edema, no murmurs or edema

Respiratory: No chest pain, wheezing, or un-labored respirations

Gastrointestinal: abdomen soft and non-tender, No palpable masses, no abdominal pain, normal bowel sounds, no change in elimination frequency or change of color.

Breast/Chest: no lymphadenopthy, nipples with no discharge, chest unremarkable

Genitourinary: Bladder is non-distended, no hematuria or dysuria, no changes in urine color or elimination frequency

Musculoskeletal: Normal gait, good stability, no complaints of foot pain or edema

Neurological: Clear speech, good tone and posture normal and erect. Intact cranial nerves II to XII

Psychiatric: Well groomed, alert and oriented, maintained eye contact and answers questions appropriately.


Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Mosby (ISBN: 978-0-323-11240-6).

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The Parietal Lobe

The Parietal Lobe
The Parietal Lobe

The Parietal Lobe

Question 1

The parietal lobe is located at the top region near the back of the brain. There are two parietal lobes – left and right parietal lobe. This part of the cerebral cortex is involved in vision, speech, sensation and interaction with other regions to connect sensory input from external environment and interpretation of the stimuli. Parietal lobe stroke occurs when the blood vessel supplying blood to this region ruptures or gets blocked.

This interferes with sensation of the entire opposite sides.  This is because motor system of the brain is mainly found in the frontal lobes (Knoefel, 2011). It starts with promoter regions for coordination of complex movements to the primary motor cortex where output is transmitted into the spinal cord leading to contraction and movement of the muscles.

The primary motor cortex located on the left side of the brain is responsible for the movement and muscle contractions in the right side of a person’s body and the primary motor cortex on the right controls movement of the left side. This explains why patient with right parietal stroke gets return of voluntary movement in the left hand (Migliaccio et al., 2014).

Question 2

Fronto parietal stroke affects the frontal and parietal lobes part of the brain. A right fronto-parietal stroke patient with better movement in the left hand side is also likely to may not necessarily have better attention of the side. This is because the frontal lobe is responsible for solving skills, emotions, and selective attention behavior. On the other hand, the parietal lobes control sensations such as touch and pressure.

Therefore, the indication of stroke will depend on the region of the brain involved. Stroke on the right hemisphere cerebrum affects left side whereas stroke in the left hemisphere affects the right side.  In addition, injury in the left lobe disrupts the patient understanding of the written and spoken word (Knoefel, 2011).

Question 3:

Visual motor integration refers to a person’s ability to perceive visual information, process it and move the motor system accordingly.  The idea that the front ends of visual system is responsible for breaking down stimulus for down into their constituent’s parts such as pattern, shape, motion, color and to glue the feature in the parietal lobe neuron.

Therefore, patients with right front parietal stroke make it challenging to grasp coordination. Visual- motor integration involves three processes; a) visual stimulus analysis, b) fine-motor control and c) conceptualization. Deficit in any of the three processes influence the final outcome. For instance, if fine motor control and visual analysis are within the normal range, then the challenge lies in the conceptualization (Johansson, 2012).

Question 4:

It can be challenging to farm with Parkinson’s disease because of tremors and rigidity that makes it difficult to hold hand tools and increases the likelihood of accidental injuries to self and others. In addition, the increased diminishing balance can increase risk for secondary injuries due to fall, slip or trip.

In addition, the medications used to treat the disease are associated with light headedness, confusion, insomnia and dizziness can dramatically reduce the patient’s energy. Therefore, these are the safety risks to consider when supporting the patient engage in his chosen hobby (Santos-García & de la Fuente-Fernández, 2013).

Question 5

Parkinson disease is a neurodegenerative disease described by non motor and motor symptoms that negatively impact the patient’s quality of life.  Most of PD patients are stigmatized because of the visible motor and non motor symptoms. The symptoms of this disease are difficult to hide and are perceived as unscrupulous by the public. This includes observable traits such as gait difficulties, tremor and drooling. These symptoms disrupt the autonomous integration into the society due to their exterior conditions. In addition, the deteriorated self esteem evokes feelings of embarrassment and shame which results into isolation (Santos-García & de la Fuente-Fernández, 2013).

In addition, stigma and seclusion is not only associated with the observable signs and symptoms but also due to progressive loss of functionality. This factor further contributes to bad self image, self efficacy and autonomy. In fact when interviewed about their life history, most of the patients explain symptoms as the key issue for seclusion and low self esteem due to increased physical dependence.

Stigma also arises from awkwardness and inability to do activities that require simple motor actions. This reduction to functionality results into increased social disengagement associated to stigmatization. Stigmatization may also occur due to hindrances to communication.  PD patients may be mislabeled for instance as drunkards. In addition, the delayed thinking and difficulty to convey their opinions easily can make them feel frustrated and isolated. The difficultness to decipher PD patient’s mute expressions makes them feel alienated and disconnected from others (Maffoni et al., 2017).


Johansson, B. B. (2012). Multisensory Stimulation in Stroke Rehabilitation. Frontiers in Human Neuroscience, 6, 60. http://doi.org/10.3389/fnhum.2012.00060

Knoefel, J. E. (2011). Clinical neurology of aging. Oxford University Press.

Maffoni, M.,  Giardini, A.,  Pierobon, A., Ferrazzoli, D., and Frazzitta, G.  (2017). “Stigma Experienced by Parkinson’s Disease Patients: A Descriptive Review of Qualitative Studies,” Parkinson’s Disease, Article ID 7203259, doi:10.1155/2017/7203259

Migliaccio, R., Bouhali, F., Rastelli, F., Ferrieux, S., Arbizu, C., Vincent, S., … & Bartolomeo, P. (2014). Damage to the medial motor system in stroke patients with motor neglect. Frontiers in human neuroscience, 8, 408.

Santos-García, D., & de la Fuente-Fernández, R. (2013). Impact of non-motor symptoms on health-related and perceived quality of life in Parkinson’s disease. Journal of the neurological sciences, 332(1), 136-140.

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End of life care

End of life care
End of life care

End of life care: Are they better off dead?

The most painful event in life is when one loses someone close to them. The people they shared memories with both good and bad. The extent of the hurt often does depend on the situation that they find their loving members. There is a huge difference between a person who dies suddenly and one whom the family members watch while he slowly fades makind end of life care a sentimental factor. The situation also does worsen when the family handles the responsibility of caring for their loved ones as they approach the end of their life. One gets to see the strong personality of their loved one that they cherish fade away replaced by pain (Gillan et al., 2014, p.332).

In the dying father and child image, the children are present, and they get to witness the death of their parent. It is a sad event and something that may end up leaving them traumatized or scarred for life. In the picture, one can see one of the children covering their eyes is inferred to mean that they do not want to see their father pass away or they are crying. Tears are a means of expressing our sadness especially in a dreadful situation like death (Murphy 2016 et al., p.254).

It is globally accepted that we will all die at one point in our lives, but no one is ready to see death approach especially when they are not ready (Rowland et al., 2016). As illustrated in the picture, the father is receiving home care as he nears his death. The aspect of patients being taken care of at home arises from two aspects either the hospital has done all they can and informed the patients who decide to spend their last days at home. The second reason deals with the lack of finances, where the family cannot afford to have their patient admitted in the hospital (Tong et al., 2014, p.915).

The family is better placed to understand what their suffering member requires as they near their death from an emotional and spiritual perspective. The emotional perspective is more important to the passing member as they need to feel that someone cares about them. The care they receive solidifies the concept that their lives were worthy in the long run. This is the reason that most members gravitate to their families as they approach their end days (Davies et al., 2014, p.919).

The care is given to the patient often takes different forms depending on their state of mind and disease.  In the case of members suffering from chronic diseases like cancer, the pain is often reflected in their eyes and weary bodies. The family members need to assist their loved ones with the help of the medical practitioner to aid the person spend their last days being as comfortable as possible. The aspect of treatment and euthanasia does come into play when discussing the end life care (Wilson, 2013, p. 504).

At times the treatment of people with chronic diseases becomes very expensive to the point that they decide to stop the treatment to save their families the burden of incurring a huge debt (Mathers et al., 2013, p.206). Does the family have a role to play in altering the decision made by the suffering member?

According to the Australian medical health system, the family members have a minimal role in altering the decision of the patient in the case they are still capable of making a sound decision. Despite, this they can discuss with the family member and convince them of continuing with the treatment if they have the finances (Visser, Deliens, and Houttekier, 2014, p.604).

Based on Ewing et al., 2014, p.248, the nursing team has the responsibility from the moral and legal perspective of discussing with the patients the decisions they are to undertake. Once the patient has made their decision, their role comes to an end. Some of the responsibilities that they undertake based on this context are; offering the family members and the patient advice on the treatment available, the cost and what they consider the best option.

The second scenario inferred from the picture focuses on elevating the suffering of both the dying father and the children is euthanasia also referred to as assisted dying. According to Quinlan (2016), euthanasia refers to the intentionally ending the life of a person with the aim of relieving them from the pain that they are undergoing. This is often encouraged in situations where the person is suffering from a chronic and painful disease or is in a coma that is irreversible.

From the legal perspective, the states of New South Wales and Victoria are moving towards drafting legislation that permits euthanasia for Australian citizens (Teno et al., 2013, p.470). The condition stimulated to allow euthanasia is when the patient is suffering an incurable disease that will necessitate them to terminate their life. The decision to give the go ahead for euthanasia lies with the family members and the patients as long as they are above the age of 25 years. Also, the family member at the end of their life needs to have a sound mind at the point of deciding (Morton et al., 2017).

In the case of the dying father and child picture, the love and pain are evident in the way they have gathered around the father. The children love their father and are very young to witness the end of his life. Traumatic events like death often inhibit the effective development of people especially children (Berg, 2014).

 Based on the picture the children are very young most of them are below the age of 15 a clear sign that their brain is still developing. I am certain that it is not right but in this case, it is not fair for them to witness such immense suffering of someone they love dearly. Euthanasia would have been a better way to end the pain that they are all experiencing. In this case, the father should have decided to decide to save the elder family member from experiencing any guilt from the incident (Anaf, 2017).


The end of life care is important to the person seeing their life fade away. Most prefer to spend their last days with their families to stay in the hospital. The picture that guides the reflective essay displays this concept. The love and care given by the members enable them to feel comforted as they prepare themselves psychologically for their departure. The end of life care takes different forms as discussed in the essay it can be through euthanasia, hospitalization or home care. One of the common denominators in all the three forms is the advice of the medical practitioner.


Anaf, J. M. (2017). Voluntary euthanasia laws in Australia: are we really better off dead?. The Medical Journal of Australia, 206(8), 369.

Berg, L., Rostila, M., Saarela, J., & Hjern, A. (2014). Parental death during childhood and subsequent school performance. Pediatrics, peds-2013.

Davies, N., Maio, L., Rait, G., & Life, S. (2014). Quality end-of-life cares for dementia: What have family carers told us so far? A narrative synthesis. Palliative medicine, 28(7), 919-930.

Ewing, G., Grande, G., & National Association for Hospice at Home. (2013). Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: a qualitative study. Palliative Medicine, 27(3), 244-256.

Gillan, P. C., van der Riet, P. J., & Jeong, S. (2014). End of life care education, past and present: A review of the literature. Nurse Education Today, 34(3), 331-342.

Mathers, S. (2013). End of Life Care in Progressive Neurological Disease: Australia. In End of Life Care in Neurological Disease (pp. 205-212). Springer London.

Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic approach. Lippincott Williams & Wilkins.

Murphy, B. J. (2016). Voluntary euthanasia laws in Australia: are we really better off dead?. The Medical Journal of Australia, 205(6), 254-255.

Quinlan, M. (2016). “Such is Life”: Euthanasia and capital punishment in Australia: consistency or contradiction?. Solidarity: The Journal of Catholic Social Thought and Secular Ethics, 6(1), 6.

Rowland, C., Hanratty, B., van den Berg, B., Pilling, M., & Grande, G. (2016). Valuing friends’ and family support for end of life cancer care: A national study of the economic costs of informal care giving. Palliative Medicine, 30(6), NP34.

Teno, J. M., Gozalo, P. L., Bynum, J. P., Leland, N. E., Miller, S. C., Morden, N. E., … & Mor, V. (2013). Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. Jama, 309(5), 470-477.

Tong, A., Cheung, K. L., Nair, S. S., Tamura, M. K., Craig, J. C., & Winkelmayer, W. C. (2014). Thematic synthesis of qualitative studies on patient and caregiver perspectives on end-of-life care in CKD. American Journal of Kidney Diseases, 63(6), 913-927.

Visser, M., Deliens, L., & Houttekier, D. (2014). Physician-related barriers to communication and patient-and family-centred decision-making towards the end of life in intensive care: a systematic review. Critical Care, 18(6), 604.

Wilson, D. M., Cohen, J., Deliens, L., Hewitt, J. A., & Houttekier, D. (2013). The preferred place of last days: results of a representative population-based public survey. Journal of Palliative Medicine, 16(5), 502-508.

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Case Study Report: Patient Care Action Plan

Patient Care Action plan
Case Study Report: Patient Care Action Plan

Case Study report: Patient Care Action Plan

Case Study Report



Case Study Report

Patient Care Action Plan for: William

Main Contact: Gladys

Main Contact’s Relation to Client: Wife

Council area where client lives:  London

Client Address: 49 Featherstone Street, London, United Kingdom

Background This patient care action plan is for William. William currently has liver cancer and he is very much worried about his condition and how his wife Gladys will cope with the situation. When William was growing up, he thought that he would live to reach ninety years old, like his parents, without any serious illness. His dream of living longer has just been shattered after he recently discovered the presence of blood in his stool. On visiting the hospital, William has received a confirmation from Dr. Maxwell that he has liver cancer. William’s immediate carer is his wife, Gladys, who provides assistance with daily living activities as well as with social support. Since William’s kids have their own families and they are mostly committed to work, he has limited access to family support. His living setting is the home environment, and he frequently visits the hospital from where he is cared for by Dr. Maxwell and nurse Linda. Dr. Maxwell has involved other physicians in William’s care. The doctor is working together with other highly qualified healthcare professionals to ensure that William receives the support that he needs for the longest period possible. William’s health condition is not that severe, and his recent health care trajectory indicates that he has a positive progress. His positive health progress is mainly attributed to good communication and a positive relationship with his healthcare providers, including the social worker. At the moment, William largely depends on services obtained from only one GP healthcare resource.
Needs Assessment From the PCC4U Needs Assessment, it is evident that some of Williams needs have been met while there are others, which have not been effectively addressed.
Needs that are currently met  The positive progress that is being observed in the patient is attributed to primary health care services that he is now receiving from the doctors and nurse Linda (Llobera, Sanso, and Leiva, 2017). Through support obtained from the doctors, William has learned and can apply various health promotion options that are available to him. Also, William has been informed about the right people he should approach in case his health condition gets worse. Immediate needs that should be met It is important to prioritize patients’ unmet needs to plan effectively on how to help them manage their health conditions (Khosla, Patel, and Sharma, 2012). There are two major immediate needs that William should be assisted to meet. During his interaction with nurse Linda, William explains that he is in a bit of pain and that he still has a lousy appetite. These conditions are common among older people with terminal illnesses (Goodman, Dening, and Zubair, et al., 2016). In this regard, William should be taught how he can solve his appetite problems and how he can effectively manage pain. Potential needs that might arise William’s healthcare providers should be prepared to address potential needs that might arise in the course of care. It is important to identify possible emotional and physical health problems that may arise to formulate strategies that can be used to prevent them early (Clarke, Bourn, Skoufalos, Beck, and Castillo, 2017). To meet William’s physical and emotional needs, the healthcare providers should engage specialists in palliative medicine and palliative nursing, as well as family members, to provide necessary care as early as possible (Llobera, Sanso, and Leiva, 2017).

Local Resources and Services Scan

Service name and brief descriptionAddress/contact details and website URL (if available)Opening hours/contact hoursHow to access (e.g. is a referral required?)What needs can this service help to meet?Healthcare team member responsible for referral/actionAdditional Comments
Companions of London110 Gloucester Ave, London NW1 8HX, +44 020 3519 8001 www.companionsoflondon.com/palliative-careEvery day: 9.00 am to 5.00 pm. Closed on Saturday and SundayNo referral requiredPrimary care, including emotional and social support.Palliative nurses are available even with short notice.This is a useful back up for William’s primary care and emotional and social support needs.
St. Joseph’s HospiceMare St, London E8 4SA, + 44 020 8525 6000 https://www.stjh.org.uk/contact-us8.30 am to 5.00 pm every day
Referrals are necessary. From 8.00 am to 6.00 pm every day by calling 0300 30 30 400.  Provides all primary care services needed by patients with serious illnesses.Sharon Finn offers social services support and can connect patients with palliative care specialists in the facility.This facility provides hospice care that William may need shortly.
Meadow House HospiceUxbridge Road, Middlesex, UB1 3HW +44 020 8967 5179 http://www.meadowhousehospice.org.uk/Open Monday to Friday from 8.30 am to 5.00 pm, Saturday from 12 pm to 2.30 pm, Closed on Sunday.Referrals are required. From Friday 8.30 am – 16.00 pm by calling 020 8967 5758Psychiatric and primary care services.Jane Cowap is the lead clinician who specializes in psychiatric care for geriatric patients.This facility will be appropriate for William in future when he will be in need of psychiatric support.
Pembridge Palliative Care UnitExmoor St, London W10 6DZ, UK +44 20 8102 5000 http://www.cqc.org.uk/location/RYXY2    Open 24 hours dailyNo referral requiredPsychological and physical support.Doctor Louise Ashley specializes in the treatment of psychological problems, especially for patients with physical disabilities.A useful facility for screening and diagnostic procedures.
Marie Curie Hospice, Hampstead11 Lyndhurst Gardens, Hampstead, London NW3 5NS, UK. +44 20 7853 3400 https://www.mariecurie.org.uk/help/hospice-care/hospices/hampsteadOpen Monday to Friday from 8.00 am to 6.00 pm, Saturday 11.00 am to 6.00 pm, and Closed on SundayNo referrals are necessaryOffers emotional and social support for patients with terminal illness and their families.Lead nurse Angel and Marilyn can assist patients with making appointments and follow-up.William can get necessary emotional and social support from this facility.
Hospice UK34-44 Britannia St, Kings Cross, London WC1X 9JG +44 20 7520 8200 http://www.hospiceuk.org/Open Monday to Friday from 9.00 am to 5.00 pm, Closed on Saturday and SundayNo referrals are necessaryProvides all types of home-based care needed by patients with serious illness.Carol Warlford is the Chief Clinical Officer in charge of all forms of palliative care in the facility.This facility is appropriate for meeting William’s physical, social, physiological, and emotional needs both now and in future.
St. Christopher’s Personal CareSydenham, UK +44 20 8768 4500 http://www.stcpersonalcare.org.uk/    Open every day from 9.00 am to 5.00 pm.No referrals are requiredOffers support with all forms of care including medication, nutrition, activities of daily living, social support, and emotional support.Denise, Maxine, Tony, and Sandra are highly trained to offer palliative care to all patients with various needs.The facility is a useful back up for William’s palliative care needs.

Action Plan

Medication: The nurse should plan a visit to the physician to provide the right prescription for William to enable him to manage pain effectively (Ramanayake, Dilanka, and Premasiri, 2016; & Al-Mahrezi, and Al-Mandhari, 2016).  This arrangement should be made as soon as possible.

Nutrition: The nurse should contact a nutritionist to help with the development of a feeding plan for William and his wife. Since appetite is one of William’s problems that should be solved urgently, this action should be started as soon as possible (Forbat, Haraldsdottir, Lewis, and Hepburn, 2016; & Caccaialanza, Pedrazzoli, and Zagonel, et al., 2016).

Physical Activity: William’s wife should contact a trainer to help William with physical exercise (Lowe, Tan, Faily, Watanabe, and Courneya, 2016; & Chandrasekar, Tribett, and Ramchandran, 2016). This arrangement should be made before William’s next meeting with the GP.

Counselling: The nurse should plan a visit to a professional psychologist to plan counselling sessions for William and his family (Pino, Parry, Land, Faull, Feathers, and Seymour, 2016). This plan should be ready before William’s next meeting with the GP.

Referral to Hospice: The nurse should contact a social worker to provide William and his wife with detailed legal information related to the procedures he should follow when he will be required to relocate from home-based care to the hospice (Hui and Bruera, 2016). This arrangement should be made when William will no longer be in a position to make decisions by himself.

Reference List

Al-Mahrezi, A. & Al-Mandhari, Z. (2016). Palliative care: Time for action. Oman Medical Journal, 31(3): 161-163. doi:  10.5001/omj.2016.32

Caccaialanza, R., Pedrazzoli, P…& Zagonel, V. (2016). Nutritional support in cancer patients: A position paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE). Journal of Cancer, 7(2): 131-135. doi:  10.7150/jca.13818

Chandrasekar, D., Tribett, E. & Ramchandran, K. (2016). Integrated palliative care and oncologic care in non-small-cell lung cancer. Current Treatment Options in Oncology, 17: 23. doi:  10.1007/s11864-016-0397-1

Clarke, J., Bourn, S., Skoufalos, A., Beck, E. & Castillo, D. J. (2017). An innovative approach to health care delivery for patients with chronic conditions. Population Health Management, 20(1): 23-30. doi:  10.1089/pop.2016.0076

Forbat, L., Haraldsdottir, E., Lewis, M. & Hepburn, K. (2016). Supporting the provision of palliative care in the home environment: A proof-of-concept single-arm trial of a palliative carers education package (PrECEPt). BMJ Open, 6(10): e012681. doi:  10.1136/bmjopen-2016-012681

Goodman, C., Dening, T…& Zubair, M. (2016). Effective health care for older people living and dying in care homes: A realist review. BMC Health Services Research, 16: 269. doi:  10.1186/s12913-016-1493-4

Hui, D. & Bruera, E. (2016). Integrating palliative care into the trajectory of cancer care. Nature Reviews Clinical Oncology, 13(3): 158-171. doi:  10.1038/nrclinonc.2015.201

Khosla, D., Patel, F. D. & Sharma, S. C. (2012). Palliative care in India: Current progress and future needs. Indian Journal of Palliative Care, 18(3): 149-154. doi:  10.4103/0973-1075.105683

Llobera, J., Sanso, N….& Leiva, A. (2017). Strengthening primary health care teams with palliative care leaders: Protocol for a cluster randomized clinical trial. BMC Palliative Care, 17: 4. doi:  10.1186/s12904-017-0217-9

Lowe, S., Tan, M., Faily, J., Watanabe, S. & Courneya, K. (2016). Physical activity in advanced cancer patients: A systematic review protocol. Systematic Reviews, 5: 43. doi:  10.1186/s13643-016-0220-x

Pino, M., Parry, R., Land, V., Faull, C., Feathers, L., & Seymour, J. (2016). Engaging terminally ill patients in end of life talk: How experienced palliative medicine doctors navigate the dilemma of promoting discussions about dying. PLoS ONE 11(5): e0156174. https://doi.org/10.1371/journal.pone.0156174

Ramanayake, R., Dilanka, G. & Premasiri, L. (2016). Palliative care: Role of family physicians. Journal of Family Medicine and Primary Care, 5(2): 234-237. doi:  10.4103/2249-4863.192356

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Error Management Reflection

Error Management
Error Management

Error Management

Types of prescriptions, roles of intra and interprofessional teams, and medicine storage and disposal

            This error management reflection covers what I have learnt from the hospital placement by considering Borton’s model. Specifically, I have explored the error reporting process in the hospital and how it has helped me to understand the principles of clinical governance. Furthermore, this error management reflection describes the difference in error reporting processes in community pharmacy compared to hospital pharmacy.

During my placement, I have discovered that the main types of prescriptions in the pharmacy are outpatient prescriptions, cleansing preparation prescriptions, and ward order prescriptions. The pharmacy rarely uses hospital charts and it does not use TPN requests at all. Furthermore, I have learnt that the pharmacy team members perform roles, which are complementary to one another.

For instance, the pharmacist checks medicine history, the technician reviews medicine history and dispenses drugs, and ATO checks stock of drugs and delivers medicines to the wards. Again the pharmacy has well documented standard operating procedures related to storage and disposal of medicines. In the pharmacy, drugs are stored in shelves and they are categorized based on their functions. Moreover, medicines must be checked and reviewed before they are disposed.

Error management: How error reporting improves clinical governance

            Error reporting plays a significant role in improving clinical governance. According to Freedman (2006), NHS institutions rely on clinical governance to deliver quality care to patients by allowing parents to get involved in their treatment process. Since the patient is the first priority in clinical governance, there is always great need for hospitals to ensure that their error reporting systems are working well in order to improve clinical governance.

Medication errors are avoidable mistakes that are made by health care practitioners during prescription, dispensation, and administration of drugs. Such errors negatively impact on patient safety and outcomes. As MRA (2014) explains, error reporting is one of the ways through which health care practitioners learn their mistakes and it therefore plays a big role in improving patient safety.

During my placement, I have discovered that the main source of medication errors in the facility is incorrect drug labelling, and that error reporting greatly improves clinical governance. Specifically, I have discovered that the hospital has a stable system for detecting and reporting medication errors. In addition, I have learnt that, since it is possible to detect medication errors, the facility should have a plan of how such errors can be prevented.

According to Polnariev (2016), through error reporting, healthcare organizations can easily identify and mitigate risks early enough. Therefore, the facility should employ appropriate measures to prevent recurrence of medication errors in future in order to improve clinical governance.

Difference in error reporting in community and hospital pharmacies

            Error reporting in community pharmacy differs significantly from that of a hospital. During my placement, I have been able to identify two major differences in error reporting between a community pharmacy and a hospital pharmacy during my placement. First, while delegated authorities are charged with the responsibility of overseeing medication errors in the hospital, the board of directors is directly involved in error reporting process in the community pharmacy (Brunsveld-Reinders, Arbous, Vos, and Jonge, 2016).

Second, community pharmacy mainly relies on voluntary reporting while hospital pharmacy utilizes voluntary, confidential, non-confidential, and mandatory reporting processes. Voluntary reporting process that is mainly used by community pharmacy is not very effective because it leaves some errors unreported. However, mandatory reporting by hospitals ensures maximum error reporting and it helps healthcare practitioners to avoid lawsuit.

In this regard, community pharmacies should use mandatory reporting instead of voluntary reporting in order to improve error reporting (Brunsveld-Reinders et al., 2016).

            In conclusion, the most enjoyable parts of my placement were getting to learn the role played by error reporting in clinical governance, and the difference between error reporting process in a community pharmacy and a hospital pharmacy. Through error reporting, hospitals can greatly maximize patient safety and improve their health outcomes.

Unfortunately, effective identification of errors cannot be achieved because some errors go unreported. In order to prevent recurrence of medication errors in future, health care organizations should introduce strict measures of reporting such incidents. However, the least enjoyable part of my placement was retrieving information related to medication errors and error reporting process from employees at the pharmacy.

In order to facilitate easy interaction between the student and the hospital’s workers in future, learners should be allowed to choose facilities which they feel would be comfortable for them to undertake the placement.

Reference List

Brunsveld-Reinders, A. H., Arbous, M. S., Vos, R. V. & Jonge, E. D. (2016). Incident and error reporting systems in intensive care: a systematic review of the literature. International Journal for Quality in Health Care28(1), 2-13. https://doi.org/10.1093/intqhc/mzv100

Freedman, D. B. (2006). Involvement of patients in clinical governance. Clinical Chemistry and Laboratory Medicine, 44(6): 699-703.

MHRA. (2014). Patient Safety Alert.  Retrieved from https://www.england.nhs.uk/wp-content/uploads/2014/03/psa-sup-info-med-error.pdf

Polnariev, A. (2016). Using the medication error prioritization system to improve patient safety. Pharmacy and Therapeutics, 41(1): 54-59.

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Gonorrhea is a sexually transmitted infection (STI) ,caused by Neisseria gonorrhoeae  a bacteria which infects the mucous membranes. The bacteria is often transmitted from one individual to another during sexual contact, including anal, oral or vaginal intercourse. However, babies can also be infected with this condition during childbirth if the mother is infected. In babies, the disease affects their eyes. Hethcote &Yorke (2014) report that some of the factors that may increase the risk of one getting the infection include age, new sex partner, history of gonorrhea infection, multiple sex partners, and co-infection with other sexually transmitted diseases.

The bacteria cannot survive outside human body for long therefore it cannot be transmitted by sharing baths and towel, cups, toilets and seats, kissing or hugging.

Once infected, one presents with urethral discharge while urinating. The infection is treatable therefore one should seek medical attention early after noticing the symptoms.

Presentation of Gonorrhea

Usually, the infection causes no symptoms. However, when they appear it affects multiple body parts, but it appears commonly in the genital tract. Men who have been diagnosed with gonorrhea pus-like discharge from the tip of the penis, painful urination, and swelling and pain in one testicle. In women, the infection causes increased vaginal discharge, dysuria, dyspanuria, pelvic or abdominal pain, and vaginal bleeding between periods such as after vaginal intercourse.

The infection can also infect other body parts such as the rectum where it causes anal itching, discharge of the pus-like substance from the rectum, strains during bowel movements, and bleeding. When it infects the eyes, it may cause light sensitivity, eye pain, and pus-like discharge from one or both eyes. Patients may also develop a sore throat or swollen lymph nodes in the neck if the infection spreads to the throat. It can also disseminate to the various joints causing septic arthritis whereby the affected joints become red, warm, swollen, and extremely painful during movements.

Treatment of Gonorrhea

Adults who have been diagnosed with gonorrhea are prescribed with antibiotics. The Centers for Disease Control and Prevention (CDC) has recommended that patients with uncomplicated gonorrhea should be given a ceftriaxone injection in combination two oral antibiotics, that is, either doxycycline or azithromycin. This is advisable because the drugs provide a wide range of activity which is required due to the emergence of strains of drug-resistant Neisseria gonorrhoeae(Kerani et al. 2015).

Babies who are infected during childbirth are given two eye drops of erythromycin to prevent the spread of the infection. To avoid reinfection with gonorrhea, the patients are advised to abstain from unprotected sex for seven days after he/she has completed the treatment regimen and the symptoms have resolved.

The infection can cause some complications if it is untreated. For instance, it can cause infertility in women by spreading to the oviduct and the uterus cause Pelvic Inflammatory Disease (PID) which causes scarring of the fallopian tubes, increase in pregnancy complications as well as infertility. Infertility can also occur in men if the infection affects the epididymis. Most importantly, the gonorrhea infection predisposes a person to the risk of being infected with STIs such as the Human Immunodeficiency Virus (HIV).

The following steps should be taken to reduce the risk of gonorrhea infection. First, sexually active women should be encouraged to visit health centers annually for gonorrhea screening (Jackson, McNair & Coleman, 2015). Condoms should also be used if a person is having sex with a new sex partner. For those who have been diagnosed with the disease, they should encourage their partners to also go to a hospital for testing.


Gonorrhea has a good prognosis especially if antibiotic therapy is administered early enough. Usually, the infection clears within 2 to 4 weeks if the Neisseria gonorrhoeaeis susceptible to the antibiotics that have been administered. For individuals who have are immune-compromised such as patients with HIV, the infection may last for months and become more severe.


Hethcote, H. W., & Yorke, J. (2014). Gonorrhea transmission dynamics and control (Vol. 56). Springer.

Jackson, J. A., McNair, T. S., & Coleman, J. S. (2015). Over-screening for chlamydia and gonorrhea among urban women age≥ 25 years. American journal of obstetrics and gynecology, 212(1), 40-e1.

Kerani, R. P., Stenger, M. R., Weinstock, H., Bernstein, K. T., Reed, M., Schumacher, C., … & Golden, M. (2015). Gonorrhea treatment practices in the STD Surveillance Network, 2010–2012. Sexually transmitted diseases, 42(1), 6-12.

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