As reproductive technology increases, pregnancies from sperm and egg donations are more common. What information should sperm and egg donors supply to future potential children?

Discuss the pros and cons of genetic testing?

• Make a list of at least three ways you can influence clients to associate positive emotions with health promotion behavior.
• Explain the reasons for choosing these methods.

Discuss in an overview form with not less than 350 words the significance of nutrition in physical and mental wellness as a student

1. a nurse is preparing to administer epoetin to a client who has anemia due to chemotherapy. which of the following actions should the nurse plan to take?

a. review the clients Hgb level prior to administration.

b. use the z-track method when administering the medication.

c. shake the vial for 30 seconds prior to withdrawing the medication.

d. ensure the client is not taking iron supplements while on this medication.

2. a nurse is caring for a client who is postoperative and reports frequent leakage of small amounts of urine. the nurse notes that the client's bladder is palpable upon examination. the nurse should identify these findings as which of the following forms of incontinence?

a. stress.

b. urge.

c. functional.

d. overflow.

3. a nurse is assessing a client who has Guillain-Barrè syndrome. which of the following findings should the nurse report to the provider immediately?

a. decreasing leg strength.

b. decreasing voice volume.

c. decreased deep tendon reflexes.

d. decreased sensation in the arms.

Write a 175- to 265-word response to the following questions:

• What impact does the use of demographic data have on public health initiatives?
• What type of data do you believe is most valuable for this purpose?

A pregnant diabetic female, age 28 years, is expecting for the second time. She has a history of miscarriage, at the time of her miscarriage, she was a volunteer in Haiti and didn't seek out medical assistance. Her OBGYN is concerned that this current pregnancy may result in a similar outcome due to a hemolytic disease due to a Rh incompatibility. Her physician ordered an amniocentesis at 34 weeks gestation as she is considering inducing labor, and results are as follows:

Optical density at 450 nm = increased

Liley graph reading = 0.6

L/S ratio = 2.1

FLM II = 55 mg surfactant/g of albumin

Questions:

1. What do these tests reveal? Why is the FLM II reading important in this case? Explain your answer.

2. Why is the physician considering inducing labor? Explain your answer.

The patient in this case is a 57 year old female that has experienced joint pain for ~ 5 years. Her joints are becoming progressively deformed with swelling. Her physician decides to order a synovial fluid analysis, including a cell count, differential, RF, protein, glucose, LDH, and crystal analysis if indicated. He also orders blood work: Rheumatoid Factor and glucose level. Her results are as follows:

Questions:

1. What do these results suggest that the patient has? Explain your answer, providing evidence to support your answer.

2. If the patient had gout., what would her results be instead?

Compare and contrast primordial, primary, and secondary prevention. If you were to develop a prevention program to combat type II diabetes in Alaska, what would be the best method and why?

Health Care Management Case Study

Case Presentation

Raymond Wiley operates a small business in a rural area. There is a 10-bed hospital in his community that has a 2-bed intensive care unit (ICU). A large hospital with comprehensive services is located in a nearby city 100 miles away.

Mr. Wiley became ill with a fever and cough. Because his regular physician was out of town, he went to the local hospital, where he was diagnosed with pneumonia and admitted. Mr. Wiley received supportive care, but after 3 full days with no apparent improvement, the admitting physician transferred him to the city hospital for a referral with a pulmonologist.

The Wileys wanted to drive to the city hospital in their private vehicle, as opposed to having Mr. Wiley transported by ambulance. Their rationale was based on the fact that Mrs. Wiley could drive, Mr. Wiley was stable, and their insurance did not cover ambulance transport unless it was a medical emergency. Up to this point, Raymond had only received supportive care; his intravenous line had been capped, and he was taking oral antibiotics. Their request to drive him was refused, and he was transported by ambulance; they were charged $1300 for the transport.

When Raymond arrived at the city hospital, it took 2 days for the pulmonologist and thoracic surgeon to see him because the admitting unit got his name mixed up with another patient. A computed tomography scan was completed, which revealed he had a large mass and pleural effusion. Mr. Wiley was then seen by a thoracic surgeon, who scheduled him for a thoracotomy the next day—a Sunday. This required assembling an on-call surgical team at the higher weekend rate.

After surgery, Raymond was in the ICU. He experienced several postoperative complications precipitated by the initial delay in correct diagnosis and treatment. On postoperative day 11, an order was written to transfer Mr. Wiley out of the ICU to the medical unit, but because of a shortage of nursing staff on the medical unit, he remained in the ICU for 2 additional days before being transferred to a medical unit and discharged home later that day.

Mrs. Wiley spent 10 months of her time fighting many of the charges because her husband’s care had been delayed by the medical team, causing his complications and extensive hospitalization. The Wiley’s thought they should not be charged and held responsible for the 3 days in the rural hospital, the 2 days in the city hospital before Mr. Wiley was seen by the specialist, and the 2 additional days spent in the ICU because the hospital was short staffed. The insurance company and hospital finally agreed on how much the insurance company would pay for the $136,000 worth of services billed. The hospital ended up writing off $60,000, and the Wiley’s paid $5000 in co-payments.

Case Analysis

Mr. Wiley’s care was not cost effective because there were many delays that were costly both from a systems viewpoint and from the exacerbations to the seriousness of his illness. The hospital eventually was forced to write off nearly half of the billed charges, which will eventually result in higher charges across the system to compensate for these and other losses. Mr. Wiley’s story highlights how a lack of communication resulting in a lack of effectiveness in timely treatment continue to haunt health care, affecting the quality of patient care and outcomes as well as patient costs. Value was not attained because Mr. Wiley’s care was delayed in both the rural and the tertiary care hospitals.

Questions (Please respond to both questions in your response.)

1. Speculate as to how Mr. Wiley’s care might have been different if a pay-for-performance rather than a fee-for-service plan was in place.

2. What risks are involved with a pay-for-performance plan?