Mr. Jacobs is a 55-year-old college-educated male recently diagnosed with colon cancer. He is scheduled for surgery with formation of a colostomy. Prior to meeting the patient, the nurse reviews the health record and notes that Mr. Jacobs is able to read English, has family support, and is currently not working. Mr. Jacobs’ wife works in retail. Mr. Jacobs is very health conscious, and his goals are to go back to “normal” life. The nurse notes a comment made by Mr. Jacobs that “a colostomy is the one thing I said I would never live with.” Based on the information gathered, the nurse develops a teaching plan for Mr. Jacobs. The plan includes the provision of written material about colon cancer, anatomy and physiology of the gastrointestinal tract, and alterations presented by having a stoma. Options for care of the stoma are also provided in writing. A second visit to demonstrate how the ostomy appliance is fitted, emptied, and changed is planned. A manikin abdomen will be used to demonstrate and practice stoma care with the patient. Mr. Jacobs is in the developmental stage of generativity versus stagnation. When planning for his learning needs, the nurse also uses multiple sources of information to teach Mr. Jacobs according to his level of education but also attends to the fact that psychomotor learning is required. To evaluate the outcome of the educational intervention conducted, the nurse follows up with Mr. Jacobs to determine his competency (both actual and perceived) in performing the necessary skills of care and Mr. Jacobs’ emotional and attitudinal changes related to the ostomy and his illness. Plans are changed and adjusted according to Mr. Jacobs’ progress toward his goals, incorporating family members while Mr. Jacobs becomes ready for this step. Case Analysis In this case, the nurse attended carefully to assessment before beginning the educational process. Because the patient was well educated, the nurse could rely on multiple forms of education, including written materials. The nurse used hands-on practice to incorporate psychomotor skill. By asking about goals and listening to Mr. Jacobs’ feelings about living with an ostomy before initiating the educational plan, the nurse gathers valuable information about perceptions and attitudes. With this information, the nurse is able to incorporate strategies for addressing the affective domain that will be most effective. Including the family members before the patient is ready may hamper education efforts by limiting trust in the nurse–patient relationship. The patient’s desire to return to his normal life tells the nurse that this patient, in Erickson’s stage of generativity versus stagnation, wants to resume a productive life as soon as possible, lending to motivation to learn. This could have been further enhanced by incorporating frank discussions about the impact on Mr. Jacobs’ sexuality into the teaching plan. Failing to attend to the patient during assessment would have resulted in failure of the patient’s educational experience. For example, if the nurse assumed that the patient would want his wife included from the beginning and arranged the educational sessions with Mrs. Jacobs rather than the patient alone, the nurse would have limited the patient’s ability to express his own needs in the educational encounter.

Question 1: How would the nurse best plan to educate Mr Jacobs regarding care of his colostomy bag after surgery?

Question 2: What is another way in which Mr. Jacobs could be assisted in learning to care for his colostomy?

Question:

There are two items to cover. First, define the term internal audit. In many cases the physician states they did not commit fraud, rather it was their staff that coded and billed inappropriately. For the second part of the discussion, discuss how an internal audit would help the practice avoid prosecution.

Note: Minimum word count for parts I and II is 150 words each. And a reference as well.

Patient Introduction

Location: Orthopedic unit 0800

SBAR report from a night nurse:

Situation: Jared Griffin is a 63-year-old African American male who had a right total knee arthroplasty (TKA) yesterday morning.

Background: Mr. Griffin has a history of MRSA, which was diagnosed 3 years ago when he had surgery for a hammertoe. A nasal swab was done in the office during his recent preoperative check that came back positive for MRSA. Decolonization protocol was initiated prior to the admission for the total knee procedure and he is currently under contact precautions per hospital policy. He has a history of osteoarthritis and mild hypertension.

Assessment: Mr. Griffin is afebrile with a temp of 37.2 °C (99.8 °F), and vital signs have been stable during the night. Pain level has been at a 2-3. He has dangled his feet off the side of the bed and will have physical therapy in his room at 1000. He has been able to bend his knee to a 75-degree angle and the goal is 90 degrees. The surgeon changed Mr. Griffin’s dressing, and discontinued the drain and IV fluids, at 0700 on his morning round. His labs just came up, but I haven't had a chance to look at them yet.

Recommendation: You'll need to go in and do your morning assessment. Continue with contact precautions and observe for signs and symptoms of infection.

Fundamentals of Nursing Care

Taylor, C., Lynn, P., Bartlett, J. (2019). Fundamentals of Nursing: The Art and Science of Person-Centered Care, 9th Edition. Medical-Surgical Nursing Care Asepsis and Infection Control, Chapter 24, pp. 594-637Medical-Surgical Nursing Care Components of a Neurovascular Assessment, Chapter 26, p. 721, Box 26-7Medical-Surgical Nursing Care Postoperative Nursing Care, Chapter 30, pp. 958-966

Diseases and Conditions

Expert Clinical Content from Lippincott Advisor

Methicillin-resistant Staphylococcus aureus

Pharmacology

Expert Clinical Content from Lippincott Advisor Pharmacology

Clindamycin hydrochloride Pharmacology

Oxycodone hydrochloride-acetaminophen Pharmacology

Enoxaparin sodium

Diagnostics

Expert Clinical Content from Lippincott Advisor

White blood cell count and differential Pharmacology

Red blood cell count Pharmacology

Hematocrit test Pharmacology

Hemoglobin level test Pharmacology

Red blood cell indices Pharmacology

Platelet count Pharmacology

Blood urea nitrogen level test

Procedures

Expert Clinical Content from Lippincott Procedures Pharmacology

Isolation garb, donning Pharmacology

Isolation garb, removal Pharmacology

Hand hygiene

1. Document your finding related to Mr. Griffin's preoperative and postoperative assessment findings regarding the presence of an infection.

2. Identify and document key nursing diagnoses for Mr. Griffin regarding current condition.

3. Referring to your feedback log, document all nursing care provided as well as Mr. Griffin's response to this care, including responses related to infection control and the use of personal protective equipment (PPE).

4. Document your handoff report in the SBAR format to communicate Mr. Griffin's future needs.

Watch the TED Talk, What Your Doctor Won't Disclose.

Discuss what the ethical issues are that are disclosed in this talk. How does the relationship between doctors and pharmaceutical companies affect the cost of healthcare for the patient?

What evidence-based resources can one use to facilitate health-illness transitions, the adult patients? What comfort level can you use in finding these resources?

In 2 paragraphs please share any experience you have in working with individuals from backgrounds different from yours. How would this experience translate to working within a health care environment and with patients? What are some of the challenges you have encountered in working with patients from diverse populations? Do you have any challenges related to the field? Please include your references.

ethical implications of using theory to predict and control behavior.  

1) Is the compliance decreased or increased on the above problem?

2) What is the naturally occurring substance that helps keep the alveoli from collapsing?

3) Name the diseases where surfactant may be inactivated in adults?

1) Why would hear bronchial breath sounds in the periphery of the lungs?

2) Name the 3 types of gas flow.

Distinguish between hunger and appetite, including the role of physicological and environmental cues, in explaining why we feel the urge to eat.

Question: How can I counter-argue this viewpoint? (general summary or thoughts of this post for a debate)

                The Nurse Practitioners not being independently contracted makes getting their reimbursement more difficult (Does Contact with Managed Care Organizations Remain A barrier for Nurse Practitioners? 2017). This isn’t the ideal way for their reimbursement as they would probably just be on a salary, and not get compensated for all their visits. Such a high percentage of Managed Care Organizations not contracting with Nurse Practitioners as primary care providers has a negative implication for the Affordable Care Act’s goals of increasing access, lowering cost, and enhancing quality (Does Contact with Managed Care Organizations Remain A barrier for Nurse Practitioners? 2017). The demand for physicians continues to increase. I have worked in many facilities, and from my experience Nurse Practitioners are so helpful to have in a facility to help with volume and overflow of visits. This is something that should be granted more. Nurse Practitioners are extremely qualified and deserve recognition as well.

Not having professionally contracted nurse professionals makes it more difficult to seek compensation(Does Contacting with Managed Care Organizations Remain A barrier for Nurse Practitioners?, 2017). This is not the best way to pay their money, because they possibly will not be charged all their trips. This will not be rewarded. This high degree of Managed Care Agency non-contracting as primary health care providers has a significant effect on the targets of the Affordable Care Act to expand coverage, cut costs and increase quality (Does Contact with Managed Care Organizations Remain A barrier for Nurse Practitioners?, 2017). The need for doctors is also rising. I have served in several hospitals and I will support nurses in a facility with the frequency and overflow of patients due to my training. This is much else to be offered. Practitioners are exceptionally trained and should be remembered.

reference:

Does Contacting with Managed Care Organizations Remain A barrier for Nurse Practitioners? (2017). Nursing Economics, 7.

1. The sternum belongs to which skeletal region?
2. The ilium belongs to which skeletal region?
3. What is another name for patella?
4. Which is the largest bone in the body?
5. What is the flexible, connective tissue called?
6. Ethmoid, frontal, occipital, parietal, sphenoid, and temporal are all part of what?
7. This plate exists at the ends of long bones where lengthwise growth takes in the immature skeleton.
8. What is the soft spot between the skull bones of an infant?
9. Opening of the occipital bone through which the spinal cord passes is called?
10. What is the upper portion of the sternum called?
11. What is the round projection on the temporal bone behind the ear called?
12. What is the flared portion of a long bone, between the diaphysis and the epiphyseal plate?
13. What is the name of a medical doctor who specializes in bone, joint, and muscle conditions?
14. What is the process of bone formation?
15. Name the bone cells that helps form bony tissue.
16. Name the medical doctor who specializes in rehabilitation?
17. Name the twelve pairs of curved bones that form the chest wall.
18. What is the pole-like process extending from the temporal bone on each side of the skull?
19. What is the immovable joint between bones?
20. Name the Lower, narrow portion of sternum.
21. What is the knuckle-like process at the end of a bone near the joint.
22. Name the upper arm bone.
23. What is the lower jaw bone called?
24. What is the upper jaw bone called?
25. What are free, movable joints such as ball and socket or hinge type of joints called?
26. What is a crescent-shaped fibrocartilaginous structure that partly divides a join cavity?
27. Closed sacks of synovial fluid with a synovial membrane located near, but not within a joint.
28. What is loss of articular cartilage and formation of bone spurs at articular surfaces?
29. The disease that causes inflammation due to excessive uric acid in body.
30. What is the compression of median nerve as it passes between transverse ligament and bones and tendons of the wrist?
31. What is a fluid-filled cyst arising from the joint capsule or a tendon in the wrist?
32. What disease is often marked by a “bull’s eye” rash at the site of the tick bite?
33. What chronic inflammatory disease involves joints, skin, kidneys, nervous system, heart and lungs affecting collagen in tendons, ligaments, bones, and cartilage all over the body?
34. Name 3 types of muscles.
35. What type of muscles are under voluntary control?
36. Which type of muscle is not consciously controlled and found exclusively in the heart?
37. Which type of movement is away from the midline of the body?
38. Which type of movement is toward the midline of the body?
39. Which type of movement is circular movement around a central point?
40. Name a group of inherited diseases with progressive muscle weakness and degeneration?
41. What is a uric acid test used to diagnose?
42. What is the acronym for nonsteroidal anti-inflammatory drug?
43. For what conditions might an ESR be requested?
44. Which type of movement is bending the sole of the foot downward toward the

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How do patient portals play a role in a patient’s ownership of their own health.