What are some of the ethical and

What are some of the ethical and scope-of-practice issues with the shift report below? Rachel: Hey Mike! I hope you had a good day today; I’ll be getting the report on your patient in room 2. Mike: Oh, hi Rachel, sure; here, take a seat Rachel: Shouldn’t we go over to the patient’s room for report? Mike: Nah, the patient’s family is so annoying and they’ll just interrupt; let’s do it here at the nurse’s station really quick. Rachel: Oh, okay. That’s fine! Annoying families are the worst; hopefully they’ll leave soon. Mike: Okay so room 2, Mrs. Brown. She’s a 66-year-old female here for management of her congestive heart failure and diabetes. She is a full code and has no known allergies. Her past medical history includes CHF, hypertension, type 2 diabetes, and obesity. She came into the emergency room yesterday with shortness of breath and was also found to be hypertensive and hyperglycemic, so they admitted her to the floor. Rachel: Ugh, another diabetic who’s noncompliant; what’s new? Mike: Exactly. Anyway, the plan for her is to continue diuresis to fix her fluid overload and continue monitoring her breathing, blood pressure, and blood sugar until we can discharge her home. Rachel: If only these people would eat right, take their meds, and manage their blood sugar, they wouldn’t be here in the first place. Mike: I know . . . it’s not that hard. So, review of systems, neurologically she is intact, A&Ox4, very pleasant, just ready to go home. She has full strength and uses a walker to ambulate. She has no complaints of pain. Physical therapy came by to work with her today, but she was asleep, so I told them to skip her. Her vital signs have been fine all day, heart rate in the 80s, respiratory rate 20s, blood pressures 140s/90s, temperature 36.8 degrees Celsius, and oxygen saturation 98% on 2 liters nasal cannula. She has 3+ pitting edema in her legs that has slowly started to improve with the extra Lasix she is getting. She has a low-sodium diet ordered, but her family keeps bringing her fast food, and I didn’t feel like arguing with them, so I didn’t say anything. Same with her 2-liter fluid restriction. She’s had more than that today, but oh well. She uses the bathroom okay, just a one-person assist, and had a bowel movement this morning. I placed a foley catheter this afternoon, though, because I didn’t want to keep helping her to the bathroom every hour; it was getting annoying. She has no skin issues that I’ve seen. Okay, I think that’s all! Rachel: Okay, thanks. Did you get a doctor’s order for the foley? Mike: No, I just put it in. I’m sure they’d be fine with it. Any other questions? Rachel: I don’t think so. Let’s go say hello to the patient and family together. Mike: I have to give report on my other patients still, but Mrs. Brown knows I’m leaving for the night. I hope you have a good shift. Rachel: Oh okay, thanks. Have a good night

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