Analyze the Health Insurance Portability and Accountability Act (HIPAA) violations in the scenario.

Analyze the Health Insurance Portability and Accountability Act (HIPAA) violations in the scenario.

ROLE OF NURSING

Case Study:

As a staff nurse in an intensive care unit, you accompany Dr. K to assess the condition of a patient, Mr. E, currently in the emergency department. The nursing home where Mr. E resides has brought him to the hospital because of lung congestion. The medical notes indicate that Mr. E is a 67-year-old white male with diabetes, high blood pressure, poor vision, and hearing difficulties, and is mildly developmentally delayed.

After assessing Mr. E’s condition, Dr. K determines that Mr. E has pneumonia secondary to aspiration. Mr. E is dyspneic on exertion and is running a fever of 101o F. He has a blood oxygen saturation level (SpO2) of 88% on room air. Dr. K determines that Mr. E will need to be placed on a ventilator and admitted to the intensive care unit. When Dr. K explains the situation Mr. E shakes his head and says, “Go away! No! No! Take me home.” Knowing that Mr. E is developmentally delayed and hypoxic, Dr. K is concerned that Mr. E does not understand the situation.

Dr. K notes that without the ventilator Mr. E will continue to aspirate and likely die. Dr. K asks you to look at Mr. E’s file to determine whether there is anyone else who might have responsibility for Mr. E. The chart indicates that seven years ago Mr. E checked himself into the local nursing home. When he entered the nursing home a patient advocate helped him fill out an advance directive, which stated Mr. E’s medical wishes. Mr. E clearly indicated that he did not want a ventilator or cardiopulmonary resuscitation. No family member signed the advance directive and it is unclear if any family members were involved. Mr. E has also filled out a medical power of attorney, which states Mr. E wants his younger brother, Mr. Y, to make medical decisions for him in the event he is no longer able to do so.


 

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