name one healthcare organization that uses the joint operating agreement partnership
In: Nursing
In: Nursing
Read each of the case studies presented, and explain, What your opinion is and how you arrived at it.
Case Studies
A. Brent underwood, a health insurance professional in the Beach Front Medical Clinic, is convinced by Bertha Parker, a 60-year-old patient of the clinic, that she is a "financial hardship" case. Brent tells Ms. Parker that he will send in a claim to her insurance company and "write off" any balance that they do not pay. Determine if Brent is within this legal rights as a health insurance professional to do this for Bertha. If not, decide if his actions constitute fraud or abuse.
B. Mary Larson visits Dr. Jacob Astor, her obstetrician, for a suspected pregnancy. Dr. Astor performs an examination, determines she is pregnant, and asks you, one of his versatile healthcare professionals, to arrange for an ultrasound. The office is busy, so you inform Mary that you will schedule the procedure later and call her with the appointment date and time. Later that day, you telephone Mary’s residence and her husband answers the telephone. You inform him of the appointment time that has been set up for Mary’s ultrasound. Is this a breach of confidentiality? Why or why not?
C. You are employed as a health insurance professional for Dr. Gail Lorber, a family practice physician. Dr. Ian Sutton telephones from the State University epidemiology laboratory. He informs you that he is doing a clinical study on infectious diseases and is requesting a list of all patients who have been treated for hepatitis A, B, and C in the past 5 years. Do you need to procure a written release from each patient to give this information to Dr. Sutton? Why or why not?
In: Nursing
ICD 10
1. A 70-year-old female presented to the hospital with fever, myalgia, arthralgia, tachycardia, and dehydration and was believed to be septic. This patient has a history of hypertension, CHF, and migraines. Routine medications include Lasix 40 milligrams by mouth each morning, if needed, for significant pedal edema and Isordil 20 milligrams by mouth four times a day.
A variety of studies were obtained to further delineate the source of her problem. Urine cultures were negative. Blood cultures grew Escherichia coli. The blood urea nitrogen level was 22, and a random glucose was 149. An anterior-posterior film of the chest taken at the same time showed acute pulmonary edema.
The patient received intravenous fluids. The patient's routine medications were continued, and she received intravenous antibiotics. On the fourth day of her hospital stay, it was believed that the patient had reached maximal hospital benefit and was therefore switched to oral antibiotics and was discharged. The patient left the hospital in good condition.
DISCHARGE DIAGNOSES:
Septicemia due to Escherichia coli
Dehydration
Hypertensive heart disease
with heart failure
2. A 2-year-old male presented with fever, vomiting, and abdominal pain. The patient was severely dehydrated with a blood urea nitrogen level of 54, indicating acute renal failure. Blood cultures obtained grew Staphylococcus aureus. The patient was treated with a 10-day course of intravenous vancomycin. The patient also received intravenous fluids and had improved renal function. Upon admission, the patient was noted to have a rash on his buttocks and was treated with topical ointment. The patient improved and was discharged.
DISCHARGE DIAGNOSES:
Sepsis due to Staphylococcus aureus
Severe sepsis with septic shock
Acute kidney failure
Dehydration
Diaper rash
3. A 94-year-old male was admitted to the hospital with a chief complaint of abdominal pain and loss of weight. The patient had a history of coronary artery disease and myocardial infarction. There is no history of coronary bypass surgery. The patient had a nebulizer at home and takes metoprolol. These medications were continued during the patient's stay. Physicalrevealed abdomen to be tender to palpation in the left mid and lower quadrants with some rebound. Bowel sounds were present, and there was no guarding. Blood pressure was normal. Pulse, respirations, and temperature were normal.
During hospitalization, EKG showed sinus rhythm with myocardial changes of ischemia. Sputum cytology was suggestive of adenocarcinoma, compatible with bronchoalveolar growth. Chest x-ray showed metastatic lesions and chronic obstructive lung disease in both lung fields. Barium enema showed adenocarcinoma of proximal sigmoid colon. Abdominal series showed no evidence of obstruction, but moderate dilation of his transverse colon was evident. Patient was seen in consultation, and it was decided to do as little as possible at this time due to the patient's age and lung conditions. The patient agreed with this approach and requested discharge to home to receive hospice care.
DISCHARGE DIAGNOSES:
Carcinoma of sigmoid colon
Probable metastatic bronchogenic carcinoma, right lung
and left lung
Chronic obstructive lung disease
Coronary artery disease
Previous myocardial infarction
4.
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This patient is a 43-year-old female with a long history of joint pain. Lately she had been feeling very tired and weak. She also has had intermittent abdominal pain with nausea and vomiting. Her joint showed tenderness of the knees. She denied any problems suggestive of hypothyroidism (myxedema). The patient's hematocrit was 27.6, serum iron was found to be decreased at 27, and thyroid functions were found to be markedly low. Upper GI series showed a 4-millimeter ulcer at the posterior wall of the duodenal bulb. The patient was transfused 2 units of packed red cells. She was started on ferrous sulfate 300 milligrams twice a day. She was also begun on Tagamet for the ulcer. Further questioning revealed that she had indeed been hypothyroid in the past and has been on thyroid medication until stopped by another physician. The patient was restarted on Synthroid 0.2 milligrams per day. She was discharged on the sixth hospital day. DISCHARGE DIAGNOSES: Hypothyroidism Anemia due to myxedema Acute duodenal ulcer 5. This patient is a 14-year-old African American male who was admitted due to sickle cell crisis and acute chest syndrome. His mother has sickle cell anemia, and his father has the sickle cell trait. Because of this, the patient was tested at birth; a blood sample was drawn, and it was sent to the laboratory for hemoglobin electrophoresis to obtain a definitive diagnosis. Unfortunately, the test was positive for sickle cell disease. The patient was given intravenous fluids and was started on Darvocet for pain management. When the Darvocet failed to keep his pain at an acceptable level, he was switched to Vicodin. The patient is to be discharged with follow-up in the pediatrician's office tomorrow. DISCHARGE DIAGNOSES: Sickle cell crisis with acute chest syndrome Family history of sickle cell anemia 6. A 31-year-old white male presented to the emergency room reportedly having taken 8 to 10 naproxen at home in a suicide attempt. He reported that he had been having trouble with his wife, and he is unemployed. He had apparently become despondent over this and attempted to take his own life with his girlfriend's pills. The patient is admitted to the telemetry unit due to paroxysmal ventricular tachycardia. The patient was started on metaraminol for the tachycardia. Fortunately, the patient seemed to sustain no other ill effects from the naproxen. The mental health service was consulted, and an appointment was made for outpatient services. He was given Prozac to treat his depression. At this time, the patient does not appear to be a threat to himself or to others. He appears remorseful and denies any suicidal ideations. He was discharged in good condition. DISCHARGE DIAGNOSES: Suicide attempt with naproxen Paroxysmal ventricular tachycardia Depression Unemployment Marital relationship problems Home (place of occurrence) |
In: Nursing
In: Nursing
In: Nursing
In: Nursing
In: Nursing
In: Nursing
A middle age gentleman arrived at the ER with persistent diarrhea for the previous 3 days. Upon gathering the patient's history, recent foreign travel was noted. The attending physician noted increased respiration and decided to order an ABG. Results are reported as:
| ABG Analyte (reference range at 37oC) | Patient's result |
| pH (7.35-7.45) | 7.21 |
| pCO2 (35-45 mmHg) | 19 mmHg |
| pO2 (85-105 mmHg) | 96 mmHg |
| HCO3 (22-29 mmHG) | 7 mmHg |
| SO2 (>95%) | 96% |
1. What is this patient's acid-base status?
2. Why is the bicarbonate result so low?
3. Why does the patient have rapid respiration?
In: Nursing
One employee is confused by the term “determinants” and asks for clarification. You give a general definition, differentiating between downstream and upstream determinants, and provide the examples below. You ask them to identify which of the determinants below is the upstream determinant of not wearing sunscreen—the health behavior—for skin cancer prevention. They correctly select
Having a family history of skin cancer
Thinking there is no way you could get skin cancer
Hating how sunscreen makes your skin feel
Sunscreen not being available in local stores
In: Nursing
Since hypertension can often be asymptomatic,
(1) what are some effective methods that can be utilized to help us identify it early, and
(2) what are the risk factors that we need to look for, and (3) what are some of the main barriers to patient compliance with pharmacological therapy? What can we do to help improve compliance?
In: Nursing
The staff members seem to understand the ecological perspective behind public health program design, so you're ready to move on. “Many interventions are focused specifically on prevention,” you tell them, and explain that there are various levels of prevention that programs can focus on. “For example, a Health Department Policy requiring all new county employees to get tested for Tuberculosis is a _________ prevention intervention.”
In: Nursing
Velteri vs flolan – how set up and how they work. Amount of drug used. Types of diseases used on.
In: Nursing
What reasons do you think are the largest causes as to why electronic health information standards are important and difficult to implement? What is being done to facilitate interoperability? Include 1 reference
In: Nursing