Described Cultural competence comes from experience and exposure to different cultures as well as education through patient interaction. How Bias and cultural dissonance can be eliminated in the healthcare setting by addressing patients' and family values and cultural beliefs?

7.16. The following documentation is from the health record of a 52-year-old patient.

Discharge Summary

Admission Date: 11/14/XX

Discharge Date: 11/17/XX

Discharge Diagnosis: 1. Diabetic ketoacidosis, type 1 diabetes

2. Dehydration

3. Congestive heart failure

4. Aortic valve stenosis

5. Urinary tract infection due to Pseudomonas aeruginosa

6. Hyperkalemia

7. Peripheral vascular disease

8. Hypertension

9. Hyperlipidemia

10. Chronic renal insufficiency

11. Old myocardial infarction

12. Tobacco dependence

13. Coronary atherosclerosis with native coronaries

Admitting Diagnosis: 1. Diabetic ketoacidosis

2. Diabetes mellitus type 1

3. Dehydration

4. Congestive heart failure

5. Hyperkalemia

6. Hyperlipidemia

7. Hypertension

8. Tobacco dependence

9. Severe peripheral vascular disease

10. Atherosclerotic coronary artery disease

11. Urinary tract infection

12. Renal insufficiency

13. History of CVA

Present Illness: A 52-year-old white female with known diabetes mellitus type 1, CVAs, cellulitis, hypertension, chronic renal insufficiency, hyperlipidemia, poorly compliant diabetic. Most recently in hospital from September 3 to September 8 with cellulitis, congestive heart failure, poorly controlled diabetes with diabetic ketoacidosis. Discharged home. She was supposed to be following up with her primary care physician doing b.i.d. Accu-Cheks. She was nauseated for the previous two weeks. As soon as she got nauseated, she quit checking her blood sugar level. She cancelled her physician’s appointment because she was “too sick to go.” She had decreased appetite and was feeling poorly overall. She came to the emergency department with a blood sugar of 737. She had ketones 200 to 250. Her blood urea nitrogen was 75, creatinine 1.8. Her potassium is 6.1, chloride 5, bicarb at 13. Patient is a poor historian, although she is awake and alert at the time of evaluation, on an insulin drip. Overnight her nausea had resolved. The nausea probably occurred because she was in the beginning stages of diabetic ketoacidosis.

Hospital Course: The patient was put on insulin drip. Blood sugars got down. She was put on q.i.d. Accu-Cheks. Once her blood sugar level came down to the 100s, potassium was lowered. I had a very lengthy discussion with patient about the need for keeping physician’s visits and checking blood sugars. The patient was placed on Cipro. Her electrocardiogram showed a prolonged Q T. The patient went to ultrasound and had sludge and possible small stones in her gallbladder, and it was felt that she was able to be discharged home improved.

Discharge Medications/Instructions: Insulin 70/30, 20 units in the a.m., 20 in the p.m., Rezulin 400 mg q. a.m., Tenormin 50 q.d., Plavix 75 q.d., Monoket 10 mg b.i.d., Lasix 20 mg b.i.d., aspirin 325 q. a.m., Zocor 20 once a day, Oxycotin 20 b.i.d., Prozac 20 q. a.m., Vasotec 5 mg q. a.m., Propulsid 10 mg at Ac and HS, Bactrim DS one tablet every 12 hours. She is to see her primary care physician in one week. She is to call if she has any difficulties.

Disposition: Discharged home

History and Physical

Past Medical History: The patient has history of renal insufficiency with a blood urea nitrogen of 30 to 40 with a creatinine of 1.2 to 1.4. She has had a CVA, severe peripheral arterial disease. Echocardiogram done shows aortic stenosis, mitral leaflet thickening, normal left ventricular size, normal diabetes. Smokes three to four packs of cigarettes a day. She has hypertension. She has hyperlipidemia. She is dehydrated. She has a history of atherosclerotic coronary artery disease.

Medications: At the time of admission included Rezulin 40 mg q.d., Prozac 20 q.d., Propulsid 10 a.c. and h.s., Vasotec 2.5 two every morning, Atenolol 50 q. a.m., Plavix 75 q. a.m., Lasix 20 milligrams b.i.d., Novolin 70/30 20 units every a.m., aspirin 325 q. a day, vitamin E, iron, Oxycotin 20 a.m. and h.s., Zocor 20 mg at dinner. The patient has no known drug allergies.

Social History: She is married but her husband lives out of state and works there. She has one daughter. She does not drink and has smoked about three to four packs of cigarettes a day since a teenager.

Physical Exam: At the present time, the patient is afebrile, vital signs are stable. She is awake and alert, oriented times 3.

HEENT: Pupils equal, round, reactive to light and accommodation, extraocular muscles intact, oropharynx benign.

Neck: Supple without adenopathy or jugular venous distention

Lungs: Clear to auscultation

Heart: Reveals a regular rate and rhythm without murmurs, gallops, or rubs

Abdomen: Soft, nontender, positive bowel sounds, no masses noted

GU: Deferred

Extremities: No edema. She has a baseline edema currently. Pulses are absent, pedal pulses.

Laboratory: At the time of admission, her glucose was 737, blood urea nitrogen 75, creatinine 1.8, acetone greater than 200, less than 250, sodium 136, potassium 6.1, chloride 95, bicarb of 13. Her hemoglobin was 13.9 and hematocrit of 44.1, white blood cell count of 9.2 with a left shift showing 80.2 percent neutrophils, 16.2 percent lymphocytes. Platelets were 241,000. Urinalysis shows positive nitrites, greater than 1,000 glucose, 30 protein, 15 ketones, trace hemoglobin. She had 13 white blood count per high power field. Rare red per high power field, 21 bacteria. Gram stain on her u/a showed no organisms seen.

Impression(s): ___________________________________________ 1. Diabetic ketoacidosis

2. Diabetes mellitus type 1

3. Dehydration

4. Congestive heart failure

5. Hyperkalemia

6. Hyperlipidemia

7. Hypertension

8. Tobacco dependence

9. Severe peripheral vascular disease, arterial in nature

10. Atherosclerotic coronary artery disease

11. Urinary tract infection

12. Renal insufficiency

Plan: Admit, hydrate. She has been on insulin drip, we will d/c this now and change to q. 4 Accu-cheks and continue sliding scale. Hopefully on 16th be able to reinstitute her routine meds. Her potassium has now come down to the mid 4’s secondary to her hydration and her sugar being driven intracellular with the insulin drip. I have impressed upon the patient the need for checking blood sugars and keeping M.D. appointment versus death in the future. The patient is on Cipro for her urinary tract infection. Further workup as indicated during hospital stay.

Code Assignment Including POA Indicators

ICD-10-CM Principal Diagnosis:

ICD-10-CM Additional Diagnoses:

ICD-10-PCS Procedure Code(s): ___________________________________________

While on a skiing vacation, you break your leg and are treated by a local provider. Upon your return home, your PCP removes the cast. Explain why or why not to use a bundled code.

What does the term "Fundamentals of Nursing" mean to you?

What qualities and attributes will you bring to the profession of nursing?

How can your instructor support you to be successful in this course?

Describe one aspect of the critical thinking process and tell why that aspect is important to nursing care of patients.

in 150 words please:

• Discuss the following statement: "Children compensate well, but then they crump hard."
  • (Crump is medical lingo for "decompensate and die very quickly)
• Discuss the physiological differences that should be accounted for in children, in regards to treating life threatening conditions
• Discuss the Pediatric Assessment Triangle (PAT). Why do we have a special assessment algorithm for children?

what are your feelings as you begin this clinical experience? make sure you identify feelings, not thoughts. complete the following statement: "i feel ....." what past experiences, perceptions, and thoughts might be contributing to the above feelings? what personal qualities, strengths, and talents do you bring to this clinical experience? identify one goal for the OB clinical related to your personal growth as a nurse.

How does an individual or group (such as a provider) get an HCPCS code added, changed, or deleted?

In a response to a call light, you enter a room to find a 68 year-old patient on the floor next to the bed. The patient is in his first day post-operative for surgical resection of the colon, he had slept all light without compliant, and the report states that he had not been agitated or confused but doing well. a. What assumptions, if any, can you make about this situation/ b. What are the questions that you need to ask?

Tyler Martin, a third year Tyler Martin, a third-year medical student on a family practice clerkship, was directed to obtain a comprehensive H&P of a new patient: D. A. D. A. recently moved to your city and has never been seen at this practice. She comes in today  to  establish care, and she is complaining of a cough. Followingis the student's documentation of the comprehensive H&P. As you read it, keep in mind the requirements set forth in the 1997 Guidelines of Documentation for Evaluation and Management by CMS for information that should be included in a medical record. Refer to the H&P to answer the questions that follow.

1.  Does this document meet the CMS guidelines for documentation of a comprehensive H&P? Why or why not?

You are caring for an older male patient who has been admitted for pneumonia. The patient requires minimal assistance with ADLs. You have cared for this patient the last few nights, and at around 8 PM, he thinks he is at home, he calls for his dog, his thought processes are disorganized, and he is restless. What disorder is he experiencing, and what nursing interventions would be appropriate for this patient?

Please respond in no less than 250 words.

Research the delivery, finance, management, and sustainability methods of the U.S. health care system. Evaluate the effectiveness of one or more of these areas on quality patient care and health outcomes. Propose a potential health care reform solution to improve effectiveness in the area you evaluated and predict the expected effect. Describe the effect of health care reform on the U.S. health care system and its respective stakeholders. Support your post with a peer-reviewed journal article.

Please make each answer is no fewer than 4 full sentences but no longer than 10 sentences. Be clear and concise.

1. What are some examples of sentinel events?

a. Describe the impact of poor quality care on the individual, family, community, and the United States.

b. Create a core value statement.

1. HYPERVOLEMIA

A patient was admitted in the medical ward with chief complaints of shortness of breath. Further assessment reveals the following findings:

• BP –140/90 mm Hg
• HR –111 bpm
• RR –24 cpm
• +2 bipedal edema
• Bibasilar crackles upon auscultation

The doctor initially ordered furosemide 20 mg ampule TIV every 8 hours and the following laboratory tests: Complete Blood Count (CBC), Serum Sodium, Serum Potassium, Blood Urea Nitrogen, Serum Creatinine, Total Protein, and Chest X-ray.

1. Write down three (3) prioritynursing diagnoses for the patient and create a hypothetical FDAR.
2. What laboratory test may give the hint to the doctor about the oncotic pressure of the patient?
3. Create a drug study for FUROSEMIDE specifying the following:
   1. Drug classification
   2. Mechanism ofaction
   3. Indication (*for the case of the patient mentioned above)
   4. Contraindication
   5. Side effects
   6. Nursing Considerations

2. HYPOVOLEMIA

A teenage patient was rushed to the emergency department due to wrist laceration from a suicide attempt. The patient is lethargic and have the following findings upon assessment:

• BP –80/50 mm Hg
• HR –110 bpm
• RR –25 bpm

The doctor initially ordered fluid resuscitation with PNSS 1L, to fast-drip 200 cc then the remaining fluid to run for 6 hours. Stat blood typing was ordered, and 3 units of whole blood was ordered to be transfused immediately after proper cross-matching. The patient was hooked to oxygen 8 liters per minute via face mask.

1. What parameters will the nurse check while the patient is undergoing rapid fluid resuscitation?
2. For a patient who will undergo blood transfusion, enumerate the steps that the nurse should prudently undertake while performing the procedure.
3. List down three (3) priority nursing diagnoses for the patient and create a hypothetical FDAR.

3.THIRD SPACE EDEMA

A patient with portal hypertension secondary to chronic liver cirrhosis was admitted in the surgical ward. The patient presented with emaciated body build, distended abdomen with prominent veins, and jaundice. The doctor ordered paracentesis and the following laboratory tests prior the procedure: Prothrombin time (PT), Activated Partial Thromboplastin Time (APTT), Total Protein, Albumin-Globulin ratio, AST, ALT.

1. List down two (2) nursing diagnoses and create a hypothetical FDAR for the patient.
2. Why is there a need to check the PT and APTT levels of the patient prior paracentesis?
3. What is the rationale behind the order of checking the Total Protein, Albumin-Globulin ratio?
4. Enumerate the following regarding the nursing role in assisting with paracentesis:

• Position of choice
• Site of insertion
• At least three (3) nursing considerations.