The case study examines the issue of anonymity vs privacy in relation to a breach of the security of an internet patient portal at a Level 3 Tertiary Training General Hospital in the province of Bataan, Philippines. The Hospital Management Online System (HMOS) is the subject of the case study. HMOS is an integrated health delivery system that is employed at the major hospitals in Metro Manila. Patients who are members have access to the portal and can use it to request appointments, request prescriptions, acquire information about healthcare services, and even seek clinical advice from healthcare professionals.

The sister of Kimmy Chiu (nickname is CK) brought her 17-year-old brother to the primary care clinic after he came down with a fever 2 days ago. She said he has shaking chills, a productive cough, and he can’t lie down to sleep because “he can’t stop coughing.” After C.K. is examined, he is diagnosed with community-acquired pneumonia (CAP) and admitted to your floor. The intern is busy and asks you to complete  routine admission assessment and call her with your findings. Your assessment findings are as follows: C.K.’s vital signs are 154/82, 105, 32, 39.4° C, SaO2 84% on room air. You auscultate decreased breath sounds in the left lower lobe anteriorly and posteriorly and hear coarse crackles in the left upper lobe. His nail beds are dusky on fingers and toes. He has cough productive of rust-colored sputum and complains of pain in the left side of his chest when he coughs. C.K. seems to be well nourished and adequately hydrated. He is a lifetime nonsmoker. Past medical history includes coronary artery disease and myocardial infarction (MI) with a stent; he is currently on metoprolol (Lopressor), amlodipine (Norvasc), lisinopril (Zestril), and furosemide (Lasix); for his type 2 diabetes mellitus, he is also taking metformin (Glucophage) and rosiglitazone (Avandia). He has never gotten the flu shot. He does report getting “hives” when he took “an antibiotic pill” a few years ago but doesn’t remember the name of the antibiotic.

QUESTIONS

1. As the Nurse on Duty in the Emergency Room, which of these assessment findings concern you to encode in the hospital information system? Provide at least five findings.
2. You were asked to check the IVF of CK, and you found out some status to encode in the patients’ electronic health record Is the IV fluid of D5 ½ NSS appropriate for C.K.? State your rationale.
3. While browsing patient’s file, you have noticed that Oxygen Saturation has been ordered and requested for monitoring and evaluation. What is the rationale for ordering O2 to maintain SaO2 over 90%? Are you going to change or not the oxygen delivery in the information system?
4. Which of the following assessment findings would best indicate that C.K. is responding to therapy?

a. Complaints of dyspnea; respiratory rate of 26 on 2 L oxygen; clear lung sounds

b. Cough productive of white sputum; temperature of 37.8° C; SaO2 98% on 2 L via NC

c. Coarse crackles in posterior lower lobes; respiratory rate 22; no complaints of chills

d. Cough productive of yellow sputum; lung sounds clear; SaO2 96% on room air.

5. Discuss the reason why you choose the findings as to be encoded in the hospital patients information system (10 points)

6. You were asked to trace the pathophysiologic process of this case and highlight the expected. Said process will be used for a clinical data online algorithm.  What will be your response in five sentence statements.