Case Study

REQUIRED READING

Buppert, C. (2021). Nurse practitioners business practice and legal guide (8th Ed.). Jones & Bartlett Learning LLC.: Burlington MA.

• Ch. 7 Negligence and Malpractice

Please also review the following.

• National Practitioner Data Bank. (2021). Self-Query. Retrieved from

After educating yourself on this weeks topics through the required readings, respond to the following:

Case Study: Failure to Diagnose

The patient was a 48-year-old African American female who was experiencing bleeding during bowel movements. Her husband was an established patient of the insured nurse practitioner and made an appointment for his wife due to his rectal pain and bleeding.

During the first appointment with the nurse practitioner, the patient relayed complaints of bright red rectal bleeding intermittently for two months and on several occasions the toilet would be full of blood. She had a past medical history of depression, anxiety, heavy user of alcohol and hypertension and a family medical history positive for colon cancer and cardiac disease.

The nurse practitioner performed a detailed physical assessment on the patient along with a digital rectal examination. The digital exam was negative for any tumors or tears and she diagnosed the patient with bleeding due to internal hemorrhoids.

The NP advised her to have a colonoscopy to rule out other diseases, but the patient adamantly refused any referral. She was given prescriptions for suppositories and a hemorrhoid cream and was scheduled for a three week follow-up appointment.

During the three week follow-up appointment, the patient reported that the rectal pain and bleeding had stopped and she had not noticed any blood in his stools or bleeding.

Over the next eighteen months, the patient was seen eleven times by both the defendant nurse practitioner and another physician working in the practice for various other complaints, but did not relayed any concerns about continued rectal pain or bleeding to the insured. The nurse practitioner never had any further follow-up discussions with the patient about a colonoscopy.

Approximately twenty months after the patients initial office visit for rectal pain and bleeding, her husband made her an appointment to have a colonoscopy due to the patients continued rectal pain and bleeding.

During the procedure, the gastroenterologist found a 4.5 centimeter tumor in her rectum and the patient was diagnosed with differentiated metastatic colon adenocarcinoma. The patient died one year after her cancer diagnosis.

Risk Management Comments

The nurse practitioner could not fully explain why she failed to document the conversation with the patient about having a colonoscopy and her subsequent refusal. She stated that her medical office uses an electronic medical record and she relies on the systems drop boxes to assist her in her documentation. The discussion about the referral for a colonoscopy would have had to be manually entered into the medical record and she may not have had the time between patients to document that conversation.

She testified during her deposition that the patient seemed very uneasy about having her perform a rectal exam and was reluctant to discuss her findings. Her impression of the patient was that she was self-conscious about her rectal pain and bleeding and did not want to discuss it.

She further testified that she did not want to make the patient uncomfortable and that is why she did not follow-up with her about her rectal pain and bleeding in subsequent appointments.

• What Risk Management recommendations would you make? I.e., what should the Nurse Practitioner have done to avoid this lawsuit? Use your states Scope of Practice laws, textbook, as well as other resources to formulate your answer here.

NSO. (2021). NURSE PRACTITIONER MEDICAL MALPRACTICE. Case Study with Risk Management Strategies. file:///C:/Users/strub/Downloads/AORN-Oct-2021-Nurse-Legal-Case-Q4-2018.pdf

Notes:

• Be sure to use APA format
• Address all elements in order to receive full credit.
• Response must include a minimum of 250 words in the initial post which does not include quoted material and required references.
• Minimum of two scholarly sources are required: a) one in-class source that must be referenced and cited and b) one outside scholarly sourcereferenced and cited.