Would you consider these hospitals' work to use alternative medicine a result of a QI intervention? Why or why not? Explain your answer.

A 29-year-old G4P2 Hispanic woman, with a history of gestational diabetes mellitus (GDM), presents to her OB/GYN office for a routine prenatal visit at 24 weeks’ gestation. Her physical examination is unremarkable, and her fetal well-being is reassuring. Because of her previous history of GDM, she is at high risk of developing GDM during this pregnancy and the doctor recommends a glucose challenge test, which is the most common method of screening for GDM. Test results reveal that her 1-hour glucose loading test (GLT) is 179 mg/dL (normal value <140 mg/dL). Because her GLT value is high, she then undergoes a 3-hour glucose tolerance test (GTT), which is used for a definitive diagnosis of GDM. The patient is positive for GDM when all of her plasma glucose values are elevated. Treatment recommenda- tions include beginning a diabetic diet, participating in moderate exercise sessions three times a week, daily home glucose monitoring, and weekly antepartum visits to monitor glycemic control. The doctor explained to the mother that GDM poses little risk to her at this time; however, it is associated with an increase in infant birth trauma and perinatal morbidity and mortality with the risk to her fetus directly related to its size. The goal of antepartum treatment of GDM is to prevent fetal macrosomia, which is defined as an estimated fetal weight of ⩾ 4500 grams, and its resultant complications by maintaining desirable maternal blood glucose levels throughout gestation. It was explained that if diet alone did not maintain blood glucose at desirable levels, then hypoglycemic therapy with insulin injections given several times a day may be required.

1. Why was this patient considered to be at high risk for GDM and tested at 24 weeks’ gestation?

A 29-year-old G4P2 Hispanic woman, with a history of gestational diabetes mellitus (GDM), presents to her OB/GYN office for a routine prenatal visit at 24 weeks’ gestation. Her physical examination is unremarkable, and her fetal well-being is reassuring. Because of her previous history of GDM, she is at high risk of developing GDM during this pregnancy and the doctor recommends a glucose challenge test, which is the most common method of screening for GDM. Test results reveal that her 1-hour glucose loading test (GLT) is 179 mg/dL (normal value <140 mg/dL). Because her GLT value is high, she then undergoes a 3-hour glucose tolerance test (GTT), which is used for a definitive diagnosis of GDM. The patient is positive for GDM when all of her plasma glucose values are elevated. Treatment recommenda- tions include beginning a diabetic diet, participating in moderate exercise sessions three times a week, daily home glucose monitoring, and weekly antepartum visits to monitor glycemic control. The doctor explained to the mother that GDM poses little risk to her at this time; however, it is associated with an increase in infant birth trauma and perinatal morbidity and mortality with the risk to her fetus directly related to its size. The goal of antepartum treatment of GDM is to prevent fetal macrosomia, which is defined as an estimated fetal weight of ⩾ 4500 grams, and its resultant complications by maintaining desirable maternal blood glucose levels throughout gestation. It was explained that if diet alone did not maintain blood glucose at desirable levels, then hypoglycemic therapy with insulin injections given several times a day may be required.

1. Who is at greatest risk when the mother has GDM?

Case Study 1

A 29-year-old G4P2 Hispanic woman, with a history of gestational diabetes mellitus (GDM), presents to her OB/GYN office for a routine prenatal visit at 24 weeks’ gestation. Her physical examination is unremarkable, and her fetal well-being is reassuring. Because of her previous history of GDM, she is at high risk of developing GDM during this pregnancy and the doctor recommends a glucose challenge test, which is the most common method of screening for GDM. Test results reveal that her 1-hour glucose loading test (GLT) is 179 mg/dL (normal value <140 mg/dL). Because her GLT value is high, she then undergoes a 3-hour glucose tolerance test (GTT), which is used for a definitive diagnosis of GDM. The patient is positive for GDM when all of her plasma glucose values are elevated. Treatment recommenda- tions include beginning a diabetic diet, participating in moderate exercise sessions three times a week, daily home glucose monitoring, and weekly antepartum visits to monitor glycemic control. The doctor explained to the mother that GDM poses little risk to her at this time; however, it is associated with an increase in infant birth trauma and perinatal morbidity and mortality with the risk to her fetus directly related to its size. The goal of antepartum treatment of GDM is to prevent fetal macrosomia, which is defined as an estimated fetal weight of ⩾ 4500 grams, and its resultant complications by maintaining desirable maternal blood glucose levels throughout gestation. It was explained that if diet alone did not maintain blood glucose at desirable levels, then hypoglycemic therapy with insulin injections given several times a day may be required.

1. What are two testing methods for GDM?

Case Study 1

A 29-year-old G4P2 Hispanic woman, with a history of gestational diabetes mellitus (GDM), presents to her OB/GYN office for a routine prenatal visit at 24 weeks’ gestation. Her physical examination is unremarkable, and her fetal well-being is reassuring. Because of her previous history of GDM, she is at high risk of developing GDM during this pregnancy and the doctor recommends a glucose challenge test, which is the most common method of screening for GDM. Test results reveal that her 1-hour glucose loading test (GLT) is 179 mg/dL (normal value <140 mg/dL). Because her GLT value is high, she then undergoes a 3-hour glucose tolerance test (GTT), which is used for a definitive diagnosis of GDM. The patient is positive for GDM when all of her plasma glucose values are elevated. Treatment recommenda- tions include beginning a diabetic diet, participating in moderate exercise sessions three times a week, daily home glucose monitoring, and weekly antepartum visits to monitor glycemic control. The doctor explained to the mother that GDM poses little risk to her at this time; however, it is associated with an increase in infant birth trauma and perinatal morbidity and mortality with the risk to her fetus directly related to its size. The goal of antepartum treatment of GDM is to prevent fetal macrosomia, which is defined as an estimated fetal weight of ⩾ 4500 grams, and its resultant complications by maintaining desirable maternal blood glucose levels throughout gestation. It was explained that if diet alone did not maintain blood glucose at desirable levels, then hypoglycemic therapy with insulin injections given several times a day may be required.

1. What is the primary treatment for GDM?

A 35-year-old woman presented to the prenatal clinic after missing her last two menstrual cycles. Her home pregnancy test was positive and an ultrasound confirmed the pregnancy. Gestational age was calculated to be at 10 weeks. An initial assessment of the woman’s medical and obstetric history included the following: She smoked tobacco for 15 years and currently smokes one pack per day; she had recently used cocaine but stated it is not frequent; she denied alcohol use. Her obstetric/gynecologic history included an uncomplicated spontaneous vaginal delivery at 35 weeks’ gestation 4 years ago and 2 years later a cesarean section at 36 weeks’ gestation for nonre- assuring fetal heart tones. Her medical history included chronic hypertension and a history of asthma, for which she had never been intubated or hospitalized. Her vital signs were as follows: temperature 36.7°C, respiratory rate of 20 breaths per minute, heart rate of 86 beats per minute, BP 142/79 mm Hg. Lab results: hemoglobin 13.0 g/dL, hematocrit 37%, white blood cell count 8000, blood type A–, Rh antibody screen positive. She was negative for gonorrhea, chlamydia, and HIV.

1. What fetal complications are associated with this patient’s presentation?

A 35-year-old woman presented to the prenatal clinic after missing her last two menstrual cycles. Her home pregnancy test was positive and an ultrasound confirmed the pregnancy. Gestational age was calculated to be at 10 weeks. An initial assessment of the woman’s medical and obstetric history included the following: She smoked tobacco for 15 years and currently smokes one pack per day; she had recently used cocaine but stated it is not frequent; she denied alcohol use. Her obstetric/gynecologic history included an uncomplicated spontaneous vaginal delivery at 35 weeks’ gestation 4 years ago and 2 years later a cesarean section at 36 weeks’ gestation for nonre- assuring fetal heart tones. Her medical history included chronic hypertension and a history of asthma, for which she had never been intubated or hospitalized. Her vital signs were as follows: temperature 36.7°C, respiratory rate of 20 breaths per minute, heart rate of 86 beats per minute, BP 142/79 mm Hg. Lab results: hemoglobin 13.0 g/dL, hematocrit 37%, white blood cell count 8000, blood type A–, Rh antibody screen positive. She was negative for gonorrhea, chlamydia, and HIV.

1. At this time, what recommendations would you give this patient to improve her health?

DISCUSS NDNQI , WHAT IT IS AND WHY ITIS IMPORTANT

Mr. Miller is a 72-years- Old male with diabetes that comes in for complaints of shortness of breath and weight gain. He states that he frequently becomes exhausted and has extreme shortness of breath climbing the stairs to his bedroom. He has been sleeping on 2 pillows for the past 2 weeks. He also reports a constant, irritating, nonproductive cough lately. Vital signs: T: 98.2; P; 110 BPM; B/P:143/83mm/Hg; RR:30; O2 Sat:90% on RA.

1) Understanding the pathophysiology of heart failure, describe 3 objective findings the nurse should expect when assessing Mr. Miller and provide your rationale for each. Describe 2 priority interventions that should be provided to Mr. Miller.

2) The provider Spironolactone 25mg PO Daily, Carvedilol 6.25mg PO BID, and Digoxin 0.125mg PO daily. For each medication Identify its class and describe its purpose in treating heart failure. Identity priority monitoring for this patient based on these medication orders.

3) Miller receives an EKG on admission and is found to be in atrial fibrillation. He shares that he felt some palpitations over the couple of weeks but denies a previous atrial fibrillation diagnosis. Describe why rhythm is concerning and the treatment nurse the nurse will anticipate.

4) Compare and contrast supraventricular tachycardia and ventricular tachycardia. Discuss EKG findings, manifestations, and treatment for each.

Legislators re-election impact ACA provisions. Adults with coverage of Medicaid under ACA rules affected due to legislators. Re-election for Medicaid expansion that includes the elimination of subsidies, Medicaid funding and loss of consumer protection. Repeal legislation can makeover the gap on congressional effects and government preference. The potential loss of coverage and benefits from repealing financial assistance provisions and Medicaid coverage that opposed the reveal. Public will be affected with repeal efforts.Votes analysis reveals make issues in leaders policy choices. It results in the public to limit their options when the leader's policy was adopted. It affects the Congress decisions that impact the Medicare and Medicaid coverage policy for adults.

Describe the immunological attribute of breast milk.

Week 2: Leadership in Health Care as a Function of Strategic Management

Week 2 Overview

• Evaluate the decision-making process and its relevance in healthcare strategic planning,
• Discuss current trends in the health care field and explain how such trends may impact health care organizations
• Apply evidence-based practices to the decision making process.

Take a look at TED Talk by Simon Sinek on how great leaders inspire action (exploratory).  

Here are some questions to consider during week 2: What does it take to be a great leader? What words describe those who are great leaders? Is there one characteristic that you believe every leader should possess?