Alan, age 75 is a white man admitted to the hospital following a cerebrovascular accident. He has a history of Type 2 Diabetes Mellitus, Hypertension, moderate obesity, and consumes 4 alcoholic drinks per day. Medication on admission are Lasix, Inderal, Hydrochlorothiazide, and Diabanese 500 mg orally twice a day. Alan comes to the clinic regularly, and at his last visit, he complained of blurred vision, polydipsia, polyuria, and a weight loss of 8 pounds in the past two weeks. He was admitted to the hospital with a diagnosis of a urinary tract infection and hyperglycemia. Physical examination revealed the following: • Height 5’11” • Weight 215 lbs. • Cholesterol 380 mg/dl • Triglycerides 300 mg/dl • Blood Pressure 160/82 mmHg • Blood Sugar 315 • Family History: Sister has had Type 2 Diabetes Mellitus for 10 years.

1. What are Alan’s blood glucose and lipid goals?

2. Identify the times of day Alan should check his blood glucose levels?

3. List the symptoms and clinical data that support treating Alan for hyperglycemia. What are the appropriate treatment strategies?

4. What effect does Alan’s daily alcohol consumption have on his blood glucose levels?

5. What long term complications would you expect if Alan’s blood glucose levels are not properly controlled?

1. What can effective communication do for the patient or coworker?
2. What are some things to remember when trying to build trust through communication?
3. What barriers can create miscommunication?
4. What are some ways you can offer criticism in a professional manner?

CASE STUDY TEMPLATE

Case study: Carol, a 50 yr old female patient presents to the office with a month-long history of intermittent headache. Headaches occur 1-2 times weekly, and last approximately 2-3 hours, and improve with over the counter treatment. Pain is described as sharp, and bilateral. Denies systemic symptoms. She has no history of headaches. The patient reports she recently lost her husband in an accident.

PMH includes Diabetes Mellitus Type 2

Social history: Current every-day smoker, ½ PPD, denies ETOH.

Family History: Mother deceased 89 years old with breast cancer

                             Father deceased 72 years old congestive heart failure

Medications: Hormone replacement therapy,

          bupropion XL (Wellbutrin) 150mg by mouth every day.

Vitals: Temp 100F, BP 150/90, HR 70, RR 18

working diagnosis to answer the following questions:

1: Are there any risk factors that predisposed this patient to the working diagnosis?

2: Consider Past Medical history, Social and/or Family history- does any of this influence or support your working diagnosis? if so, explain.

2: What is the classic subjective presentation for a client who has your working diagnosis? (HPI-OLD CART-PQRST)

4: List the body systems will you need to examine based on your working diagnosis, and include the findings that would be expected in that condition.

5: What procedures, labs or diagnostic studies will you need to order to support your working diagnosis, and indicate what results would support your diagnosis.

6: Using approved guidelines from your guideline texts (Fenstermacher or Cash & Glass), establish the treatment plan for this patient. Be specific and include medications you would order, strength, frequency, length of treatment and any referrals for interprofessional care.

7: What type of education will the patient require about the diagnosis and management plan?

8: What is your follow up plan for the patient?

What priority nursing actions apply to the case study (Saunders document along with page number)

John Duncan, 56yr-old male, Dx- Gastroenteritis, returned yesterday from Cancun, c/o intractable diarrhea, weak, pale, and refusing to eat. No known allergies (NKA). Non-significant past medical Hx. Vital signs Temp 99.4, BP 106/72, P 96, RR 20, SaO2 91%. Neuro WNL's, alert and cooperative. IV maintenance fluids with D5 1/2 NS at 125ml per hour in left forearm. c/o headache- medicated with Lortab 5mg PO at 0900, takes Lomotil 10ml PRN q 4 hours last dose at 0834. Stools are decreasing but patient remains very weak. Wife at bedside. Diet as tolerated. Dr. Jones.

Discuss at least three ways that you can incorporate clean eating/healthy eating habits into your lifestyle.

The MOST meaningful pieces of Healthcare legislation in the last 20 years have been?

When a Doctor’s office or Hospital files false claims to Medicaid/Medicare what are the consequences?

Which one of these does the patient usually have access to through a patient-portal?

Regional health information organizations (RHIOs) and health information exchange (HIE) initiatives have emerged that bring multiple stakeholders such as provider organizations (hospitals, physicians, community health clinics, local public health departments, and emergency departments, for example), health plans, payers, and consumer groups into formal partnerships to exchange health data electronically.

Healthcare information is the component of Healthcare Databases which needs to be protected. But in order to do that, we need to know what defines Health Info. According to the HIPPA Act Health Information is which one of these? Select BEST answer:

Health care providers and others must obtain written authorization from a patient prior to disclosure of health information for routine uses of treatment, payment, and health care operations.

A Patient Centered Medical Home (PCMH) is an approach to providing patient care that is facilitated through what TYPE of health care organization?

The MOST IMPORTANT purpose of HIE (Health Information Exchange) is for Health Organizations to:

The notion of Preventive Medicine which is still in use today was the foundation on which the concept of managed care was built on. Under this role the ‘gatekeeper’ or primary care provider was supposed to:

The difference between Medicare and Medicaid is that Medicare is made to help adults over 65 and Medicaid is made to help adults who are in financial difficulties and cannot afford health insurance.

HCI112

Dr. Buthainah is a family physician who refuses the use of EHR in her clinic because she believes that her patients' health information is not secure in the EHR. As a health informatics specialist, write a 150-200 words letter explaining to her actions that have been taken by governments and professional bodies to safeguard EHR data.

Scavenger Hunt
Think about the three domains of development: biosocial or physical, cognitive and psychosocial and how they propel growth throughout our lives.
Choose only ONE stage of development: Infancy/Toddler (birth to 2 years); Early Childhood (3 to 6 years) or School Age (6 to 12 years).
Hunt for 2 items that promote the growth and development in each of the three domains: Biosocial, Cognitive and Psychosocial.
Justify/explain why you chose each item. Specify how it fosters development in the domain you have identified it is compatible to. Use small cards and type at least 3 skills that each item help to develop.
It is important that each chosen item it is age appropriate for the stage of development you identified and it is also appropriate for the domain of development.
Materials

• 6 safe, age and domain appropriate items.
• 6 index cards . Write at least 3 skills for each item that it will help to develop.
• 3 zip lock bags (optional) to keep items organized for each domain.
• 1 grocery bag (optional) to keep all items organized for this assignment.  
  
  Once you have identified your items, think critically about why they complement that stage of development and how they further development in the domain you have chosen.
  Write at least 3 skills that they promote for each domain: for example markers help development of the fine motor skills and eye and hand coordination, as well as writing.

Choose items in good repair and in a working condition. The standard is:" what would you like to receive as a gift on your birthday ?"

Write clear skills appropriate for each item. Identify the age group and the 2 items for each domain.

write out how proteins are synthesized. (Hint: Transcription + Translation). write the process of transporting exogenous and endogenous lipids in the blood.

How is FEMA (Federal Emergency Management Agency) an integral part of healthcare administration?

Read the article that you will find entitled “The experience of nurses working with nursing students in a hospital: a phenomenological investigation.” Give a brief summary about the research study. Select one of the mid-range nursing theorists that can be used as the theoretical framework of the study and justify your answer. You must include at least two paragraphs in your analysis.

Objective:
This article explores the experiences of nurses working with Spanish nursing students in a hospital.
Methods:
a qualitative phenomenological approach and a convenience sample were used. Twenty-two nurses belonging to a public hospital in Spain were included in the study. The data were collected through unstructured and semi-structured interviews, and analyzed using Giorgi's proposal. The Consolidated Criteria for Qualitative Research Reports were followed.
Results:
Three main themes describe the experience of nurses: "The relationship of the nurse with the nursing students" Most nurses emphasize the importance of the first contact with the students and consider that the attitude of the students is essential. "The definition of the role of the student in clinical practice"; it is necessary to unify the role and interventions of the nurse to avoid misguiding the students and to establish priorities in clinical practice. "Build bridges between clinical environments and the University"; the need to establish common ground and connections between the university and the hospital's clinical services was emphasized. Nurses think that the educational program should also be designed by the clinical services.
Conclusions:
Understanding the meanings of female nursing students with nurses can provide a deeper insight into their expectations.
Descriptors: Nursing Education; Hospitals; Students in Nursing; Qualitative research

Mrs. C., an independent, 96-year-old woman, has a history of rehospitalization because of atrial fibrillation resulting from CHF and hypertension.

After her most recent hospitalization, Mrs. C. was treated and released into home care at an agency in Washington. A home telemonitoring system that tracks and transmits patients’ vital signs was placed in her home. The primary goal of placing this patient on the telemonitor was to provide daily monitoring of her condition, thereby avoiding unnecessary rehospitalizations.

One morning, Mrs. C.’s telenurse detected an alarmingly low oxygen saturation level in the patient’s transmitted data. In response, the nurse telephoned Mrs. C. and asked her to retake her oxygen reading. The reading was confirmed and the telenurse contacted the patient’s physician, who requested immediate transportation of the patient to the hospital emergency room. Medics were called and Mrs. C. was taken to the hospital, where she was diagnosed with a pulmonary embolism.

The prompt response resulted from early detection and timely intervention enabled by the home telehealth equipment and a home health nurse’s oversight. One notable fact in this case is that although the primary goal of monitoring patients is to avoid unnecessary hospitalization, in this case the hospitalization was necessary for the patient as a result of her elevated blood pressure and compromised oxygen saturation levels. The patient was still asymptomatic at the time of detection. However, the telehealth intervention and subsequent hospitalization allowed for the embolism to be treated before any serious damage occurred.

Under the traditional home care model, this patient might have been seen by a nurse only two to three times per week, and the clinician does not have knowledge of the patient’s condition in between visits. However, having vital patient data tracked and transmitted daily allowed for rapid response that resulted in a positive outcome, perhaps a life-saving intervention for this patient.

• What assessment information in the patient situation is the most important and of immediate concern for the nurse?
• What patient condition(s) are consistent with the most relevant information?
• Which possibilities or explanations are most likely to be present in the patient situation? Which are the most serious or a priority?
• What actions would most likely achieve the desired outcome for this patient?
• Which actions are the most appropriate and how should they be implemented?
• What patient assessment would indicate your actions were effective?

what are environmental causes for phenykeytonuria (PKU) during pregnancy

2. postal causes for PKU?

please there are two separate questions