Case Discussion Pulmonary – Part 2 Follow up Visit

Purpose

The purpose of this assignment is for students to:

1. Improve their ability to formulate diagnoses based on the clinical presentation of patients
2. Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of Pulmonary disorders
3. Design a relevant treatment plan

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1. Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)
2. Develop management plans based on current scientific evidence and national guidelines. (PO 5)
3. Educate patients on treatment decisions (WO1)
4. Select an evidence-based article to support the plan of care for the case study patient. (WO2)
5. Analyze national guidelines and apply them to specific case study situations. (WO3)
6. Review appropriate antibiotic prescribing guidelines. (WO4)

Requirements: (IMPORTANT INFORMATION HERE)

Michelle continues to work in the bakery and her asthma has been well controlled on a low-dose inhaled corticosteroid inhaler, Singular 10mg daily, and Albuterol prn which she uses 1-2 times per week. Michelle presents to the clinic with an acute illness that developed 2 days ago and has a respiratory rate of 24, mild SOB with exertion, O2 saturation of 94%, and complaint of inspiratory and expiratory wheezing. She is able to speak and states her temperature over the last 2 days has been 101 to 102 F. Cough is productive of white sputum. Influenza A is going around the bakery. Exam findings show a woman who appears her stated age and is alert and oriented and though calm, is having mild work of breathing. AR 110 BPM, BP is 150/85, RR: 24, Temp 101.4. She has a nonproductive, dry cough, is mildly short of breath, fair chest expansion, + inspiratory/expiratory wheezes, no rales, no rhonchi. Auscultation reveals no thrills, gallops or extra heart sounds. Apical rate is elevated at 110. Physical exam is otherwise unremarkable. The MA has swabbed her for Influenza A- test is positive.

Discussion Questions Part Two:

1. Determine an appropriate treatment plan for Michelle. Discuss medications, doses, Durable Medical Equipment, and any testing, and apply these directly to her case. Provide your rationale with evidence.
2. Decide whether she is safe to return home, include any prescriptions, or if a referral to a higher level of care is required. Discuss the criteria used to make your decision, how a referral is made, and defend your position.
3. Discuss relevant education and follow up plan.

DISCUSSION CONTENT 

Application of Course Knowledge  

Post contributes clinically accurate perspectives/insights applicable to the results from the physical exam and new diagnoses. Initial post includes the most likely diagnosis/specific treatment plan given case study information supported by rationale and answers all questions presented in the case. Demonstrates course knowledge/assigned readings by: linking tests/interventions accurately to diagnoses, applies learned knowledge specifically to the symptoms and patient information using original dialogue i.e., little to no direct quotes.  

Evidence Based resources  

Discussion post supported by evidence from appropriate sources published within the last five years. The focus of journal articles represents a logical link between the article content and the case study information.  In-text citations and full references are provided. 

DISCUSSION FORMAT 

Category 

Organization  

Discussion post presented in a logical, meaningful, and understandable sequence. Headings reflect the separation of criterion outlined in assignment guidelines.  

**Direct quote should not exceed 15 words & must add substantively to the discussion 

APA/Grammar/Spelling 

Discussion post has minimal grammar, spelling, syntax, punctuation and APA* errors. Direct quotes (if used) is limited to 1 short statement** which adds substantively to the post.  

* APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included. 

On one page, describe your philosophy of nursing.

The definition of philosophy is having a personal and specific outlook and approach you can use to make decisions and take action. Your philosophy of nursing should include your beliefs and attitudes about nursing, being a nurse, your approach to caring for others. It can also include your attitudes about working in healthcare facilities, working as part of a team, or even how you feel about people in general.

Save a copy of your philosophy as you will want to refer to it during your Program.

Assignment as been attached.

1. Prepare examples of various coding and billing issues that you have experienced in the clinical setting (Peds and women’s health).

2. Provide a brief description about the NPI numbers for nurse practitioners.

Answer: 

According to the American Academy of Pediatricians. (2020), current Procedural Terminology (CPT) has specific guidelines for using time as a key factor in determining the level of evaluation and management (E/M) service. First, it is paramount to remember the key factors in determining the level of CPT code which include history, physical examination, and medical decision making for the service. The level of selecting most E/M codes would be determined by these three key factors. In the pediatric practice, pediatricians’ needs to take into consideration the additional time they spent with patients, because it might change the level of coding that is used. On the other hand, time is the key factor when the counseling, coordination of care, or both account for more than fifty percent of the face-to-face time with the patient and/or family. When this situation occurs, it is necessary to enter the total duration of counseling and/or coordination of care into the clinical notes, as well as a description of the counseling and/or coordination of care that took place.

 For example, this future practitioner has performed a detailed history and examination, with the decision making as low complexity, and sixty minutes are spent with the patient; forty minutes of which are spent counseling the patient, the visit is coded 99205 which CPT guidelines indicate has a typical time of 60 minutes rather than 99203, which CPT guidelines indicate has a typical time of 30 minutes, for a new patient. (AAP, 2020). Besides, other issue in the office and other outpatient visits is that face-to-face time is defined as the amount of time the practitioner spends in the room with the patient. It does not include any other nurse time preparing the patient or giving injections. Coding to a general level or under coding could lead to a rejected or denied claim.

The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). The numbers do not carry other information about healthcare providers. As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that might need it for billing purposes

References

American Academy of Pediatricians. (2020). Coding Tips for Pediatricians: Evaluation and

Management Coding Strategies. Retrieved from https://www.aap.org/en-us/professional-resources/practice-transformation/getting-paid/Coding-at-the-AAP/Pages/Coding-Tips-for-Pediatricians-Evaluation-and-Management-Coding-Strategies.aspx

American Academy of Pediatricians. (2020). 2020 Coding and Reimbursement Tip Sheet for

Transition from Pediatric to Adult Health Care. Retrieved from https://www.gottransition.org/resource/? 2020-coding-tip-sheet

CMS. 2019. National Provider Identifier Standard (NPI). Retrieved from

https://www.cms.gov/Regulations-and-Guidance/Administrative-  Simplification/NationalProvIdentStand

View the two videos linked below then answer the discussion question provided.

From the timeline, you are aware that in the 1960’s it was decided that the mentally ill should be provided care/ treat in their communities. This video will explain this process in greater detail.

Deinstitutionalization Movement

This is another segment of the same movie, explaining how communities in the different states were unable to meet client needs. As a result, many became homeless at that time, and many with a mental health disorder are homeless today.

The Homeless Mentally Ill

Initial Post

Do you think the mental health system in our country today functions well, or is it broken? Why or why not?

A  17 year old male client in an inpatient psychiatric unit is being  uncooperative. The client is standing in front of the nursing station,  where the nurse answers incoming phone calls and discusses patient care  with the treatment team. The nurse kindly asks the client to return to  the dayroom and join the rest of patients for group. However the client  says, “No, I am perfectly fine where I am.” A staff member observes the  situation and steps in and states, “you need to go to group now, or we  will have to escort you to the quietroom.” The client looks at the staff  member and says in a calm tone, “you can’t make me move, I am not doing  anything wrong.” The nurse realizes this situation is escalating and is  stuck between a rock and a hard place. Please consider all the details  provided above and answer the following questions:

1. What does the principle of the least restrictive environment have to do with this situation?
2. What role does HIPAA play in this scenario and why does it make the situation more complicated?
3.  Which nurse would be more likely to initiate a restrictive intervention  for this client, a nurse with a utilitarianism view of ethics or a  deontological view of ethics? And why?
4. Finally, how would you resolve this situation?

Assignment: Applying Current Literature to Clinical Practice

Psychiatric mental health nursing practice is one of the newest disciplines to be licensed to provide psychotherapy As such, the majority of psychotherapy research is centered on other disciplines such as psychology, social work, marriage/family therapy, art therapy, psychiatry, and mental health counseling. This makes it essential for you to be able to translate current literature from other disciplines into your own clinical practice. For this Assignment, you practice this skill by examining the literature on group work and group therapy and considering its applicability to your own clients.

Learning Objectives

Students will:

• Evaluate the application of current literature to clinical practice

To prepare:

• Review this week’s Learning Resources and reflect on the insights they provide on group work and group therapy.
• Select one of the articles from the Learning Resources to evaluate for this Assignment.

Note: In nursing practice, it is not uncommon to review current literature and share findings with your colleagues. Approach this Assignment as though you were presenting the information to your colleagues.

The Assignment

In a 5- to the 10-slide PowerPoint presentation, address the following:

• Provide an overview of the article you selected, including answers to the following questions:
  • What type of group was discussed?
  • Who were the participants in the group? Why were they selected?
  • What was the setting of the group?
  • How often did the group meet?
  • What was the duration of group therapy?
  • What curative factors might be important for this group and why?
  • What “exclusion criteria” did the authors mention?
• Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own client groups. If so, how? If not, why?
• Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article.

Note: The presentation should be 5–10 slides, not including the title and reference slides. Include presenter notes (no more than a half page per slide) and use tables and/or diagrams where appropriate. Be sure to support your work with specific citations from the article you selected. Support your presentation with evidence-based literature.

‘THIS JOB IS A REPLY TO THE BELOW INFORMATION DONE BY STUDENT -(discussion)

The proposed health policy chosen is titled Health and Economic Recovery Omnibus Emergency Solutions Act” or simply the HEROES Act. The policy was introduced in the house on 05/12/2020 with the main objective of responding to the Covid-19 disease outbreak by factoring in its impacts on the economy, public health, local and state governments, Americans as well as various businesses. The bill also has other provisions and these include providing emergency supplemental materials to the federal agencies during the FY 2020. What’s more, the bill also ensures that the state, local and territorial governments have the assistance required to fight emergencies such as the global pandemic (Congress.gov, 2020). In addition, the HEROES Act expands paid sick days, as well as ensuring that the family and medical leaves are long enough and addresses the issues of unemployment, nutrition and other health concerns. With regard to fighting the global pandemic, the bill pushes for funding and ensuring that the Covid-19 requirements including testing and contact tracing are properly done, as well as the elimination of cost sharing specifically for Covid-19 treatments (Congress.gov, 2020). Most significantly, the bill also proposes that all employers should develop and engage in the implementation of infectious disease exposure control plans as well as ensuring that employees are well trained and can easily access the PPEs with reference to the global pandemic.

            The Corona Virus pandemic has caused several losses of lives in addition to numerous hospitalizations in the US. Being a highly infectious disease, it is of utmost significance to understand the prevalence of the disease and for the highly susceptible populations, necessary measures should be undertaken to reduce the spread. One of the measures proposed by WHO include containment measures, contact tracing, keeping distance and washing hands among others. Since WHO has proved that these measures may help in the prevention of Covid-19 and other infectious diseases, it is evident that the HEROES bill, if passed, may help in reducing the number of Covid-19 cases, especially by ensuring that the WHO guidelines on containing the pandemic are adhered to, as well as ensuring that employers comply to the containment measures as well as ensuring that their employers are safe. Moreover, another significant component of the bill is that it addresses the impacts of Covid-19 on the US economy, together with ensuring that the disease does not affect individuals, as well as their businesses. All these support the benefits of this bill and how it will aid in opening the economy, honoring heroes as well as sending money to the Americans as asserted by the National Law Review (2020).

Topic 4 DQ 2 

Research a health concern that impacts a population with which you are familiar. How do biostatistics affect the research focus? How do you define the population as your patient? Make sure to include the population and health concern.Give 2 references & 2 responses.

A nursing theory is a body of knowledge providing the foundation that supports excellence in nursing practice and research. In essence, a nursing theory provides the theoretical foundation for nurses to think about their nursing practice; what they do and why they do it.  

You will find that many nursing theories have been developed in the past.  Even today, nurse scholars continue to propose new theories and/ or models.

The purpose of this assignment is to develop a professional PowerPoint presentation in response to the following:

Assignment Criteria:

• Review “Exhibit 2-2: Overview of Major Nursing Theories and Models” on pp. 56 – 59 in Finkelman (4th)
• Select the theory or model that most closely represents your view of nursing.
• Prepare a PowerPoint presentation that includes the following:
  • A brief overview of the theory or model;
  • Why you believe the theory or model most closely represents your view of nursing.
  • The relationship among the concepts of person, environment, health, and nursing as explained by the theory; and
  • How the theory may be applied to planning professional nursing care for individuals and groups of clients. Give two examples for each.
• The PowerPoint presentation should not be more than seven (7) slides excluding the required title slide and reference slide.
• The PowerPoint must include detailed notes in the “Notes Page” section of the PowerPoint. When in PowerPoint, go to View and click on Notes Page.  
• Provide at least four (4) professional references. At least two of the references must be professional peer-reviewed scholarly journal articles.  The other references can be from textbooks and/or reliable websites. 
• Usually for all assignments, references used must be no greater than five (5) years old. However, references found on nursing theories or models are considered “classic sources” and may be used despite their age.
• APA (7th) format must be followed for all citations and references. Attention to grammar and spelling.

I started the template for the PowerPoint and added the book reference.