Critical thinking exercise 7.6

How do personal health record systems benefit health insurance carriers?

Critical thinking exercise 7.7

One might argue that any patient who takes the initiative to create a PHR and spends at least several hours populating it probably has a good grasp of what information is important to include and what may safely be excluded. Do you agree with this line of reasoning? Why or why not?

A 50 year-old Hispanic female came into your 24-hr Emergency care clinic complaining of purpuric lesions on her left and right ankles. She stated that she was being treated for rheumatoid arthritis with leflunomide and steroids.

1.What is your initial differential diagnosis? Give at least three.

You begin to take a patient history and review of symptoms. She is originally from Venezuela but moved to the United States before Hugo Chavez and Nicolas Maduro came to power, and she has not returned in over nine years. She has lived in Corpus Christi for eight years with her husband and two children. She is not on blood thinners such as warfarin (Coumadin). She denies use of alcohol, tobacco, or illicit drugs. She lives in Flour Bluff but states she has not gone to the beach or been on the water for over five weeks. She has not eaten raw seafood in the last four weeks. She denies any known drug allergies.

2a. What conditions might you now exclude?

b. Why can you exclude these?

The patient had rhinorrhea and myalgia. She stated she had no sore throat, shortness of breath but a sporadic cough, felt no fever or chills, no nausea, vomiting or diarrhea, no abdominal pain, no leg swelling or pain in the extremities. Examination revealed temperature of 38.1°C, heart rate 106 beats per min, BP 126/68 mm Hg, respiratory rate 16 breaths per min, and oxygen saturation of 98%. Lungs were clear on auscultation. Her White blood cell count was 4600/microliter (normal 4500-11,000) lymphocyte count was 700/microliter (normal 1000-4800). Her electrolytes, kidney and liver function tests were within normal range.

3a. Do these findings allow exclusion of some of the differential diagnosis possibilities, and suggest some other possibilities?

3b. What other tests would you perform?

The patient was given nucleic acid amplification tests for COVID-19, influenza A, and respiratory syncytial virus—all were negative. She was sent home with fluticasone nasal spray, with the diagnosis of sinusitis. She returned two days later, complaining of shortness of breath. Her oxygen saturation had decreased to 94% .

4. What possibilities must now be considered? List at least four.

Radiography of the chest revealed a 5 cm mass in the left lower lobe. A CT scan revealed ground-glass opacity, and some left hilar lymphadenopathy.

5. What conditions from question 4 should be included?

Patient now had a temperature of 39oC, complained of a productive cough with green sputum, weakness, nausea and vomiting. The heart rate now increased to 115 beats per minute, BP was 138/85 mm Hg. Auscultation revealed crackles in the left lower lobe. Oxygen saturation dropped to 92% within the two hour wait in the emergency room.

6.a. What are the most likely conditions the patient could have?

b. What should your next steps be with this patient?

c. What is your diagnosis?

Enumerate the challenges of living with chronic conditions.(elective 2)

asap.

Students, you will create a Disease Diary. The Disease Diary will contain 3 entries.One entry for each of the following systems: Cardiovascular System Lymphatic System Respiratory SystemInstructions and requirements for each entry (system): Name of disease & description a graphic (picture/illustration) of some aspect of the disease  causes & risk factors signs & symptoms diagnosis prevention prognosis treatment  How the disease affects the system? What was the most interesting part of the disease? What was something new you learned about the disease? Which aspect of the disease would you like to learn more about? Was there anything about the disease that confused you? If so, explain. You must use at least 10 bold terms from the chapter that pertains to your disease. Make sure those terms are in bold and underlined in each entry. For instance, if you are doing cellulitis, you would probably include the following bold terms from chapter 5 (integumentary system): epidermis, dermis, subcutaneous tissue, true skin, corium, integumentary, skin signs, anti-inflammatory agents. Please cite resources (at least 3) for each entry h

Our medical systems are broken. Doctors are capable of extraordinary (and expensive) treatments, but they are losing their core focus: actually treating people. Doctor and writer Atul Gawande suggests we take a step back and look at new ways to do medicine—with fewer cowboys and more pit crews. Explore the following. What can you learn from them? Search the web for a similar resource. give a few paragraphs explanation of how it fits into the chapter 10 content Health Institutions (Public Health 101)

What can a medical center learn from an auto manufacture? What if waiting rooms were a place to improve daily health care? What if doctors could prescribe food, housing, and heat in the winter? Explore the following. What can you learn from them? Search the web for a similar resource. give a few paragraphs explanation of how it fits into the chapter 10 content Health Institutions (Public Health 101)

1. Which condition cannot be treated over the counter (OTC)?

A. Tinea pedis
B. Onychomycosis
C. Vulvovaginal candidiasis
D. Jock itch

2. Which of the following is not a mechanism of action of antifungal agents?

A. Inhibiting antimetabolite activity
B. Inhibiting fungal cell wall synthesis
C. Fungal cell membrane destruction
D. Interfering with nucleic acid synthesis

3. Select the drug that should not be taken concurrently with posaconazole.
A. sertraline
B. nitroglycerin SL
C. cimetidine
D. sucralfate

4. Which of the following is false about pressure

injuries?
A. Pressure injuries are "bedsores."
B. To prevent these injuries, you should reposition an immobilized patient every 2 hours.
C. The scale for assessing a patient's risk for developing pressure injuries runs from 1 to 4, with 4 representing the highest risk.
D. Pressure injuries tend to form near bones close to the skin

5.Which answer correctly characterizes wound
severity staging?

A. Stage 1: wounds extend through skin involving
underlying muscle, tendons, and bone.
B. Stage 2: wounds have blisters and an exposed dermis.
C. Stage 3: Infection is not a concern
D. Stage 4: Skin is unbroken from a superficial wound

6. Debridement of dead tissue is accomplished by applying all of the following except

A. collagenase
B. hydrocortisone
C. papain and urea
D. Granulex

7. Which is a potential burn complication?

A. Scarring
B. Bone and joint problems
C. Pneumonia
D. Infection
E. All of the above

8. The most common adverse effect of mafenide is
A. itchiness
B. burning
C. coldness
D. dry skin
11.

Explain why the nurse should know how to calculate his or her own medications, even if the pharmacy has already calculated the medication

Scenario: You are the Chief Executive Officer [CEO] of a health services organization. This organization has inpatient and outpatient facilities, home healthcare services, and other services that meet your patient population’s needs. It also has a world-renowned AIDS treatment center. The organization has always enjoyed an excellent reputation and its quality of care is known to be excellent. Unfortunately, your organization has recently been featured in every media vehicle known to man. The reason: Someone downloaded the names of 4,000 HIV+ patients seen in your HIV clinic and posted the list on the Internet. The Board of Trustees is furious and wants to fire you. You have been able to convince them that they need to keep you as CEO to fix this major crisis. You hire a computer security consultant who comes into your organization, disguised as a nurse manager. After three days, she comes to you with the following report.

• Nurses log in to the computer system with their passwords and then walk away, leaving the system open and running.

• Dr. Jones leaves his password taped to his PC on a piece of paper.

• Fax machines and printers are in open rooms without locks.

• One password can access the entire database in the hospital including human resources.

• There are no programs reminding staff to change their passwords on a regular basis.

• She pretended to forget her password and other nurses gave her their password.

• She requested sensitive patient files and staff provided her with the files without question

You must address the following:

• A brief assessment of the problems that your organization faces from a ‘big picture’ health care management point of view. This should be a high-level overview of the category/categories of problems that your organization currently faces. (1-page maximum)

• An overview of key laws, regulations, and guidelines that are relevant to the scenario. Be sure to support your assessment with examples of why you believe each law, regulation, and/or guideline is relevant. (1-page maximum)

• The identification of 2 similar situations that have occurred within the health care industry in recent years. A brief explanation of how the identified organizations handled the crisis and an assessment of whether this approach would work for your organization. (1-page maximum)

• An explanation of how your organization could best handle this crisis. (1-page maximum)

RUBRIC: Sources, Management issues, Legal issues, Two situations, Recommended actions.

You are working in a senior center. The primary population served in this center are those who have suffered a stroke in the past and required some sort of rehabilitation during recovery. The clients may or may not still have some sort of neurological deficits (think eating, fine motor skills or mobility).   You have determined that this ADA risk test would be useful to use in your clinic. You will need to develop educational materials to be included in this risk reduction program. Describe two types of educational materials you will develop and why the materials are needed for this population.

What are community assets and needs? How were these determined? What different forms of sets and needs are present?

To Be Or Not To Be A Person
Think critically about your definition of a person.

• What does it mean to be a person?
  In other words, what are the essential characteristics or traits necessary for human personhood?
• There is a variety of scientific, philosophical, and religious assumptions about when a person starts.
  Select at least TWO of the following assumptions about the start of personhood and describe them in your initial post.
  Note: All assumptions and positions are welcomed and encouraged. However, DO NOT answer this question without drawing from one or more of the assigned readings or other reliable sources in support of your ideas.
  • Conception?
  • Gastrulation?
  • Implantation (around the 14th day?)
  • Fetal heartbeat (around 3-4 weeks)?
  • Viability (around the 23rd week)?
  • Birth?
  • The end of infancy?
• When does a person end? How do you know?
  

Quality of Life What do we mean by quality of life? Who should be able to define the quality of life when making an ethical decision? What is your personal definition of quality of life and how might that affect your decision-making on behalf of patients?