Cancer is one of the leading causes of death in both men and women. Caring for the cancer patient and family requires a multidimensional approach.

What does it mean to provide a multidimensional approach? What are some examples of how the care team can meet the patient and the family’s needs? Who are the members of the care team and how are they involved in providing multidimensional care?

Sarah is a 69-year old female that presented to the emergency department with shortness of breath. Her past medical history includes heart failure and COPD. Her pulse oximetry on room air is 82%. You notify the provider, and he orders oxygen at 4 L via nasal canula NC. Sarah’s chest x-ray reveals bilateral pneumonia. Her arterial blood gas result are below:

Sarah is admitted to a general medical floor. You are the nurse assigned to Sarah.

1. What potential problems can occur based on the above findings?
2. How would you provide multidimensional care for Sarah?
3. Describe the roles of other departments in Sarah’s treatment plan.

1. The Institute of Medicine has found the quality of healthcare in the United States to be fairly uniform, the same in all settings.

   1. True
   2. False
2. Question 2

   5 Points

   The major focus for CQI decision making is the collection of data.

   1. True
   2. False
3. Question 3

   5 Points

   Optimizing the delivery of health care and improving outcomes are reasons for using CQI in the US health system.

   1. True
   2. False
4. Question 4

   5 Points

   Hospitals using CQI adopt methods first pioneered by Deming's business model.

   1. True
   2. False
5. Question 5

   5 Points

   The Triple Aim became the Quadruple Aim which was a focus on improving the lives of vendors of healthcare equipment.

   1. True
   2. False
6. Question 6

   5 Points

   One goal of successful CQI is to empower employees so that are motivated to assist in the process.

   1. True
   2. False
7. Question 7

   5 Points

   Recent increased use of CQI in US health care results, in part, from the Affordable Care Act.

   1. True
   2. False
8. Question 8

   5 Points

   PDSA and PDCA are the only acceptable tools to use in the CQI process.

   1. True
   2. False
9. Question 9

   5 Points

   CQI is simultaneously two things: a management philosophy and a management method.

   1. True
   2. False
10. Question 10

    5 Points

    Healthcare Element of CQI includes use of epidemiological and clinical studies (evidence based medicine).

    1. True
    2. False
11. Question 11

    10 Points

    The PDSA cycle is continuous and involves the following steps Blank 1.

    • Blank 1
12. Question 12

    5 Points

    If you want to innovate in the hospital which you manage, you should

    1. A) lead by dictate.

    2. B) increase staff pay.

    3. C) institute extensive patient surveys.

    4. D) lead by example.

13. Question 13

    5 Points

    The culture of excellence which CQI aims to foster resembles a

    1. A) culture of achievement.

    2. B) safety culture.

    3. C) culture of enrichment.

    4. D) quality culture.

14. Question 14

    5 Points

    The _______________ definition of quality of care is “the extent to which health care services provided to individuals and patient populations improve desired health outcomes.

    1. WHO

    2. IHI

    3. AHRQ

    4. IOM

15. Question 15

    5 Points

    The Structural Elements of CQI include

    1. a. Use of process improvement teams

    2. b. Use of CQI tools

    3. c.Creation of parallel organization (Quality Council) to monitor CQI

    4. d.Gain commitment from top management

    5. all of the above

    6. only a and b

16. Question 16

    5 Points

    Philosophical Elements of CQI include

    1. Involves a Strategic Focus

    2. Customer Focus

    3. Systems View

    4. Data-driven

       (evidence-based) Analysis

    5. all of the above

    6. none of the above

17. Question 17

    5 Points

    _________________________focuses on conformance quality, which is defined as “conforming to specifications; having a product or service that meets predefined standards”

    1. Total Quality Management

    2. Quality Assurance(QA)

    3. Continuous Quality Improvement

    4. None of above

18. Question 18

    5 Points

    _______________is defined as a structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations.

    1. CQI(Continuous Quality Improvement)

    2. Total Quality Management

    3. Quality Assurance(QA)

    4. Non of above

19. Question 19

    5 Points

    Poor quality care has an impact on

    1. a. patients

    2. b. services which provide care

    3. c. society at large

    4. d. all of above

    5. e. only a

Case Presentation:

            Mr. J, a 65-year-old married man, presented at the emergency room in acute respiratory distress. He was anxious, alert, and gasping for air. His shortness of breath made talking with him difficult. He was accompanied by his wife and nephew.

            Mr. J was fairly well known at this hospital because he had been treated there for almost a decade for his chronic pulmonary disease. His illness progressed over the years to the point where he required assistance dressing and eating, and this assistance was provided by his wife, who cared for him at home. Mr. J had been admitted to the hospital ten months before, at which time he was intubated and placed on a respirator. Later, there was great difficulty weaning the patient from the machine, but the pulmonologist managed to do so after two weeks. According to the family, Mr. J expressed strong feelings at that time that he should never be placed on a ventilator again.

            During the current presentation, Mrs. J and her nephew spoke with the attending physician in the Emergency Department while Mr. J was taken to the treatment room. They explained what they believed to be the patient’s wishes. That is, they asked that Mr. J be given any helpful medications but not be intubated. They also asked that his code status be “do not resuscitate.” The family said the Mr. J should be made “comfortable” and that necessary medications could be given to him.

            The family did not enter the treatment room with the physician. The physician examined the patient, and in the presence of the nursing staff and respiratory therapists, the physician explained the need for intubation to Mr. J, who agreed to this by nodding his head “yes.” This process took place quickly due to the emergency conditions. Mr. J was intubated and placed on a ventilator within ten minutes of admission. Upon learning of the intubation, the family became very upset.

1. Case Question: In one or two sentences, what is the problem and what is the decision to be made?

2. Parties involved and positions: List the parties to the conflict/discussion/consultation and describe their positions in the discussion. (What do they want or not want to be done?)
   1. Patient:
   2. Family members:
   3. Medical team members:

3. Ethical issues: What are the ethical issues involved in the case and what are the positions of the various parties? List ethical principles in conflict or theories of interest.

4. Options available: What are the options available to the parties and what are the potential outcomes of each option?

5. Principle priority: Given all of the facts of the case, the principles/theories involved and the potential outcomes for the parties, which principle and/or theory should take precedence in this case? Why?

6. Case analysis: Although it is virtually never the job of the ethics consultant to decide what to do, for these case analyses, you are asked to state what you see as the preferred option for the parties in this case. What do you think should be done and why?

Briefly describe a method you would use to identify your personal performance in the workplace in terms of feedback from others (in 30-50 words each).

Briefly describe a method you would use to identify your personal performance in the workplace in terms of self-assessment (in 30-50 words each).

Identify the four (4) factors that may affect the achievement of your work objectives.

Discuss the disease process of nephrotic syndrome, acute kidney disease, and chronic kidney disease. What nutrients should the patient include and exclude in their diet plan to avoid further kidney damage? Use evidence from one scholarly source other than your textbook or ATI book to support your answer. Use APA Style to cite your source. PLEASE TYPE.

When and why should residual volumes be checked when patients are receiving enteral feedings?

Discuss 2 (two) factors that may have impacted on the identified physical condition/s.

Discuss at least 3 evidence-based strategies the nurse can incorporate into the patient care plan to improve the nutritional status for HIV/Cancer patients. Use evidence from one scholarly source other than your textbook or ATI book to support your answer. Use APA Style to cite your source. TYPE Please

Identify which study design is applicable for studying the following health outcomes and why?
1. Number of new cases of obesity among college students in Saudi Arabia in 2019.
2. The number of students with obesity who are physically active and the number of students with obesity who are physically inactive.
3. Give two difference between descriptive and analytic cross-sectional study.

Sandy Beeches, a 35-year-old accountant, presents to the office with complaints of nervousness, weakness and palpitations for the past 6 months. Recently Sandy has noticed excessive sweating and wants to sleep with fewer blankets than her husband. Her weight has remained stable at 120 pounds but states “I have been eating twice as much as I did a year ago.” Sandy reports that her menstrual periods are irregular.

Physical assessment:   P=108 bpm, BP 132/64. Appears anxious; smooth, warm, moist skin and has a fine tremor.

1. What do you suspect is Sandy’s diagnosis?   List the manifestations that helped you reach your conclusion.

2. What laboratory tests do you anticipate may be ordered for Sandy? What results might you expect? (Be specific…)

The physician prescribes propylthiouracil (PTU) 100 mg orally 3 times daily.

3. What labs are important to monitor prior to and during therapy with PTU?

4. Explain the mechanism of action of propylthiouracil (PTU).

5. Complete the first half of the medication template using propylthioruacil (PTU) as your prototype medication. BE SURE TO INCLUDE INSTRUCTIONS REGARDING HOW TO TAKE THIS MEDICATION AND LIST POTENTIAL ADVERSE EFFECTS THAT SANDY SHOULD REPORT TO THE PROVIDER IMMEDIATELY WHILE TAKING PTU. (use the back if you need additional room!)

After several months of therapy on PTU, Sandy’s condition doesn’t improve, and she has a total thyroidectomy. Sandy begins thyroid replacement therapy with levothyroxine (Synthroid) 88 mcg orally daily.

6. How will you monitor for the therapeutic effects (of levothyroxine)?

7. Complete the second half of the medication template using levothyroxine (Synthroid) as your prototype medication. BE SURE TO INCLUDE INSTRUCTIONS REGARDING HOW SANDY SHOULD TAKE THIS MEDICATION AND LIST THE POTENTIAL ADVERSE EFFECTS OF LEVOTHYROXINE.

Complete the System Disorder Active Learning Template on HYPOTHYROIDSM. In your paragraph, be sure to explain why Sandy was prescribed each type of thyroid medication, and why she had surgery.

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