Texas has a law that prohibits the removal of mechanical life-support such as a ventilator from a pregnant patient.

In November 2013, when Marlise Munoz was 14 weeks pregnant she was found unconscious in her Texas home.  With her husband and family in deep distress, they rushed her to a hospital where she was placed on a machine to keep her alive.  Soon thereafter, doctors at the hospital pronounced her brain dead.  Her husband and family eventually asked that she be removed from life support but Texas law prohibits removing a pregnant woman from life support if it threatens the life of the fetus.  A Texas Judge has now ordered that the 22 week pregnant woman removed from life support, as requested by the family.  For background, click here: LINK (Links to an external site.). https://www.cnn.com/2014/01/24/health/pregnant-brain-dead-woman-texas/

For our week 4 discussion, answer the two following questions:

[1] From a utilitarian moral perspective of the greatest good of the greatest number and also the utilitarian evaluative criteria of happiness versus suffering, explain the rightness or wrongness of a law that prohibits the removal of a pregnant woman from life support.  Also discuss the sad case of Marlise Munoz with someone else for how that person feels about it and what moral concerns s/he has about this particular case.  Do you think that the husband of Marlise Munoz should only be granted his request to remove his wife because he has concerns about indications of severe abnormalities in the developing fetus but not if the fetus were perfectly normal?  Explain.

[2] In terms utilitarian ethics, discuss the moral issues at stake in the famous so-called Trolley Problem as related in the eText and also Michael Sandel’s Harvard lecture (LINK (Links to an external 

site.)),  https://www.cnn.com/2014/01/24/health/pregnant-brain-dead-woman-texas/

where “you are beside a train track with a train headed down the track. However, on the track ahead are five people who will all be killed if the train continues. But you also have access to a switch, and if you pull it the train will be diverted onto another track where there is only one person” (eText p.36).  Do you think that this type of moral choice between the lesser of evils as in this Trolley Problem is realistic to what we might face in our everyday lives or places of employment?  Do you think there is such a thing as a moral duty to choose between the lesser of evils?  Why or why not?  Can you give an example to support your point?

1. Try taking a different route to class the next time it meets. Before you do this, think about how many changes, large and small, you will have to make to do this.

a-Will you have to leave earlier to be in class on time? 

b-Will you meet different people on your way to class?

c-See different sights?

d-Would you change your route to class on the day of the final exam? 

e-Why or why not? Summarize the positives and negatives of this small change. Relate your responses to this change to the way staff nurses feel when an administrator makes what he or she thinks is a “minor” change. 

2. Think about a change that has occurred in your life. Some examples may be a change of role, a move, a marriage, a birth, a divorce, or a death. 

a-How did you react to the change? 

b-Would you have reacted differently if you had had more information?

c-Using Lewin’s model, describe the basic elements in the situation and how you eventually achieved a comfortable outcome. 

Evaluate and provide examples of how hypothesis testing and confidence intervals are used together in health care research. Provide a workplace example that illustrates your ideas.

Urinary Obstruction

Case Studies

The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary stream for several months. Both had progressively become worse. His physical examination was essentially negative except for an enlarged prostate, which was bulky and soft.

Studies

Results

Routine laboratory studies

Within normal limits (WNL)

Intravenous pyelogram (IVP)

Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate

Uroflowmetry with total voided flow of 225 mL

8 mL/sec (normal: >12 mL/sec)

Cystometry

Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O)

Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O)

Electromyography of the pelvic sphincter muscle

Normal resting bladder with a positive tonus limb

Cystoscopy

Benign prostatic hypertrophy (BPH)

Prostatic acid phosphatase (PAP)

0.5 units/L (normal: 0.11-0.60 units/L)

Prostate specific antigen (PSA)

1.0 ng/mL (normal: <4 ng/mL)

Prostate ultrasound

Diffusely enlarged prostate; no localized tumor

Diagnostic Analysis

Because of the patient’s symptoms, bladder outlet obstruction was highly suspected. Physical examination indicated an enlarged prostate. IVP studies corroborated that finding. The reduced urine flow rate indicated an obstruction distal to the urinary bladder. Because the patient was found to have a normal total voided volume, one could not say that the reduced flow rate was the result of an inadequately distended bladder. Rather, the bladder was appropriately distended, yet the flow rate was decreased. This indicated outlet obstruction. The cystogram indicated that the bladder was capable of mounting an effective pressure and was not an atonic bladder compatible with neurologic disease. The tonus limb again indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was normal, again indicating appropriate muscular function of the bladder. Based on these studies, the patient was diagnosed with a urinary outlet obstruction. The PAP and PSA indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis. Cystoscopy documented that finding, and the patient was appropriately treated by transurethral resection of the prostate (TURP). This patient did well postoperatively and had no major problems.

Critical Thinking Questions

1. Does BPH predispose this patient to cancer?

2. Why are patients with BPH at increased risk for urinary tract infections?

3. What would you expect the patient’s PSA level to be after surgery?

4. What is the recommended screening guidelines and treatment for BPH?

5. What are some alternative treatments / natural homeopathic options for treatment?

Discussion #6

Discuss the use of Evidence-based Guidelines in Practice by Patient Provider, Healthcare Agency.

· 250-word minimum

· At least 1 outside scholarly reference is required besides the course textbook.

· Must answer the discussion question and address the topic in the reply

post.

Must respond to 1 other discussion question. Reply must be a minimum of 100 w

Turnit it similarity maximum 20%