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Ethical Approaches

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CASE 1

Incidental Finding

Janet Lewis was a registered nurse at Hillside Community Hospital. She had been working numerous extra shifts to cover hours from vacant positions. On top of that, she was a single mother of a child with developmental disabilities, which frequently left her exhausted. Janet had no family to assist her, and she was new in town. Her work schedule did not allow time for socializing, so she had not yet established any close friends to help in times of need. Saturday afternoon, Janet was looking forward to going home after working 72 hours that week; she had just three more hours until she could go to bed. Next thing she knew, two of the second shift nurses called sick, and Janet agreed to cover for one of them. The shift was relatively quiet and uneventful until one of Janet's patients was found unresponsive in his room: a code blue at the end of her shift. Janet normally reacted very well in these situations, but she was barely coherent from lack of sleep. The patient had developed severe bradycardia. The physician attending the call requested atropine. Janet was having trouble focusing, so she asked the physician to clarify; again, atropine was requested. She grabbed a vial from the crash cart, inadvertently reading the label from the vial next to the one she grabbed: lidocaine. She drew up the ordered amount and handed it off to the doctor. The patient's condition worsened. The physician demanded more atropine. Janet was still holding the lidocaine vial and proceeded to dispense the ordered amount. Janet replaced the vial on the crash cart, when the physician ordered additional atropine. She grabbed the vial labeled as atropine and dispensed to the physician. It was at this point that Janet realized she possibly had the wrong medication previously. However, in the hectic moment of the code, she hesitated to inform the physician....

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