What are your thoughts about the debate regarding whether health care is a right or a privilege? How has the changing health care environment impacted your practice?
Submission Instructions:
Week 2: Case Discussion: Pulmonary Part One
Setting: A free medical clinic that provides health care for the under-insured.
Your next patient, Michelle G., age 40, is a regular of the clinic and the last patient of the day. The chart states she is here for recent episodes of shortness of breath.
You enter the room and Michelle G is dressed in work clothes, standing up looking at a health poster on the wall. You introduce yourself and ask her what brings her to the clinic today. “I think I may have a cold. I’ve been having a hard time breathing on and off lately.”
HPI: “I notice I’m short of breath mostly at work but by the time I get home feel fine. No episodes of shortness of breath on the weekends that I can recall. But a few hours back at work and I start to feel like I cannot catch my breath again. A few months ago this happened and it was so bad I left work and went to urgent care where they gave me a breathing treatment of some kind and sent me home on an antibiotic. I would like you to give me another antibiotic. She denies sputum. No new allergy triggers noted. She denies heartburn.
PMHx: Michelle G. reports her overall health as good.
Childhood/previous illnesses: eczema as a child
Chronic illnesses: Has seasonal allergies, spring is her worst season. Was seen by an allergy specialist ten years ago, Took allergy shots for five years with great results, now only takes Zyrtec when needed.
Surgeries: Cholecystectomy
Hospitalizations: childbirth x 3.
Immunizations: up-to-date on all vaccinations.
Allergies: Strawberries-Rash; erythromycin- severe GI upset.
Blood transfusions: none
Drinks alcohol socially, smoked 1 pack per week for 3 years in her 20’s. Denies illicit drug use.
Sleeps 6 to 7 hours a night. Exercises four to five days per week.
Current medications: Multivitamin, Zyrtec
Social History: Married, lives with husband and 3 children. Worked in advertising up until 18 months ago when she got laid off. In order to help with the household finances she took a job as a Baker’s assistant at an Artisan Bread Bakery. She arrives at 4 a.m. every morning to begin baking breads/pastries for the day.
Family History: Children are healthy- daughter currently has a sinus infection. Parents are deceased. Mother at age 80 from congestive heart failure. Father died at age 82 from lung cancer, diagnosed when metastasized to brain. PGM: died from unknown causes, PGF: Stroke at age 82. MGM: died at 83, had HTN, atherosclerosis and many heart attacks. PGF: died at 71 from complications of COPD.
PE: Height 5’10”, Weight 140 pounds
Vital signs : BP 130/70, T 98.0, P 75, R 18 Sao2 98% on RA
General: 40-year-old Caucasian female appears stated age in no apparent distress. Alert, oriented, and cooperative. Able to speak in full sentences and does not appear breathless. Skin: Skin warm, dry, and intact. Skin color is pale pink, no cyanosis or pallor.
HEENT: Head normo-cephalic. Hair thick and distribution even throughout scalp.
Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact.
Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus non-tender
Nose: Nares patent with thin white exudate noted. Mucosa appears boggy and pale. Deviated septum noted. Sinuses non-tender to palpation.
Throat: Oropharynx pink, moist, no lesions or exudate. Tonsils 1+ bilaterally. Teeth in good repair, no cavities noted. Tongue smooth, pink, no lesions, protrudes in midline. Neck supple. No cervical lymphadenopathy or tenderness noted. Thyroid midline, small and firm without palpable masses.
Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. Slight wheezing noted inspiration and on forced expiration. Wheezing does not clear with forced cough.
CV: Heart S1 and S2 noted, RRR, no murmurs noted, no displaced PMI. Peripheral pulses equal bilaterally, no peripheral edema
Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organo-megaly noted.
Diagnostic Testing:
Review of the patient’s EMR reveals an old CXR from last winter when she had Bronchitis.
CXR Report: 11/7/2016
This is a PA and lateral chest radiograph on Ms. Michelle X, performed on 11/7/16. Clinical information: low grade fever, productive cough, malaise.
Findings: Cardio-mediastinal silhouette is normal. B/L lung fields are clear. There are no effusions. The bony thorax appears normal. No opacities or fluid. Diaphragm normal.
Impression: Normal chest radiograph without pathology.
Click here to view CXR (Links to an external site.) (Links to an external site.)
You suspect an obstructive/restrictive process and order Pulmonary Function Testing
Pre-Bronchodilator Challenge- FEV1/FVC 60%, FVC decreased
Post Bronchodilator Challenge- FEV1/FVC 75%
**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.
DISCUSSION CONTENT
Description
Application of Course Knowledge
Post contributes clinically accurate perspectives/insights applicable to the results from the physical exam and 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. 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.
Interactive Dialogue
Presents case study findings and responds substantively to at least one peer including evidence from appropriate sources, and all direct faculty questions posted. Substantive posts contribute new, novel perspectives to the discussion using original dialogue (not quotes from sources)
DISCUSSION FORMAT
Organization
Discussion post presented in a logical, meaningful, and understandable sequence. Headings reflect 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.
Based on your performance and the expert feedback in your HISTORY collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain.
Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings in correct assessment of this client.
Based on your performance on the PHYSICAL EXAM collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text.
Based on your performance and the expert feedback in your ASSESSMENT identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client.
Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client.
attached is the case scenario
Critique the 3 presentations attached and follow the rubric.
total of 3 pages, one per powerpointapa format
references from the last 5 years
1- What is Policy?
2- Explain each of them: Public policy—
Private policy—
Health policy—
Social policy—
Organizational policy?
3- Who was F
lorence Nightingale, and what was her contribution to the Nursing Field?
4- Who was Lillian Wald?
5- Who was Margaret Sanger, and in what way she helped to the developments of Nursing Field?
6_ what is (ICN), and what they do?
7- What is s (NLCA) and they do?
Jeanne Blum, RN, is a nurse on a LDRP unit. Recently, the policy and
procedures manual for Jeanne’s unit included the premature rupturing of membranes of a laboring patient
as a practice acceptable for nurses to perform. Jeanne
and some of her coworkers shared their concern over
lunch about this new responsibility.They felt uncomfortable with the possibility of cord prolapse and
other potential medical complications resulting from
this practice. Jeanne gathered data from her state and
many others states and noted that her hospital was
not in compliance with her professional organization
practice standards. Jeanne shared this information with her coworkers. She volunteered to contact the
state board of nursing on their behalf to request a
declaratory statement on the nurse’s role in the initiation of premature rupturing of uterine membranes.
Her state board’s clinical practice committee
reviewed her request for a declaratory statement and
gathered information from other states. A formal
declaratory statement was drafted by the board and
made it available on its Web site. A letter from the
board was sent to Jeanne’s institution, informing it of
the declaratory statement, which stated that the task
nurses were requested to perform was beyond their
scope of practice based on the Nurse Practice Act.
8-Which stage of the policy model does this scenario
represent?
250 words
3 references APA
Review and discuss the goals identified by Healthy People 2020 that are related to reducing violence.
https://www.healthypeople.gov/2020/
Identify potential hazards of hospitalization for all older adult patients (including immobility, delirium, medication side effects, malnutrition, pressure ulcers, procedures, peri- and postoperative periods, and hospital-acquired infections) and identify potential prevention strategies.
at least 400 words in length and utilize at least one scholarly source other than the textbook.
HCA320 Assignment Mod 6:
Assignment:
Accountability in Healthcare
This assignment will be at least 1500 words. Address each bulleted item (topic) in detail including the questions that follow each bullet. There should be three (3) sections in your paper; one for each bullet below. Separate each section in your paper with a clear brief heading that allows your professor to know which bullet you are addressing in that section of your paper. Include a “Conclusion” section that summarizes all topics.
This week you will reflect upon accountability in healthcare and address the following questions:
· Briefly define an Accountability Care Organization (ACO) and how it impacts health care providers:
How do ACOs differ from the health maintenance organizations (HMOs) of earlier years
What role does health information technology (HIT) play in the newer models of care?
· What is the benefit of hospitals partnering with primary care providers?
How does bundling payments contain healthcare costs?
How does pay for performance (P4P) improve quality care?
· Briefly discuss the value-based purchasing program?
How do value-based purchasing (VBP) programs affect reimbursement to hospitals?
Who benefits the most from value-based reimbursement and why?
How does the VBP program measure hospital performance?
Assignment Expectations
Length: 1500-2000 words in length
Structure: Include a title page and reference page in APA format. These do not count towards the minimal word amount for this assignment. Your essay must include an introduction and a conclusion.
References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.
Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and
diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is
currently taking the following prescription drugs:
Please make sure to follow the instructions listed in your Week 4 Module:
Write a 1-page paper that addresses the following:
In 500 or more words share a synopsis of your Website Comparison Paper. Dsicuss the approach you utilized in site selection and detail the positive and negative characteristics of the two sites you compared.
