1. The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality has identified seven Portfolios of Research. The full list can be viewed at http://www.ahrq.gov/cpi/portfolios/index.html

2. Two of the Portfolios of Research that are of key importance to this week's learning are

(1) Health Information Technology and (2) Patient Safety.

Describe how these two Portfolios of Research relate to the ONC's Health Information Technology Patient Safety Action and Surveillance Plan: June 2013 (Washington, DC: Office of the National Coordinator for Health Information Technology, 2013).

please include references

1. What edits would you make to the General Hospital’s disclosure policy, if any, to improve the clarity of the requirements to both the patient and hospital staff?
2. If General Hospital implemented a new online patient portal that allowed patients to request disclosure of their medical information online, what changes would need to be made to their release of information policy?
3. In the scenario in question 8 above, could General Hospital mandate all release of information requests be submitted through the online patient portal to help streamline the process internally and mitigate access and disclosure risks? Why or why not?

Which of the following is/are true about Medicaid?

Group of answer choices

States cover the same categories of people

States are not required to provide Medicaid

Institutional providers contract with the federal government

Authorized by Title I of the Boren Amendment

All of the above are true

None of the above is true

The right of a provider to receive payment from public insurers generally is determined by regulation or statute, rather than contract.

Group of answer choices

True

False

what are the roles and responsibilities involved in system implementation?

Sepsis and MODS

Patient Profile

W.A. is a 70-year-old female who presented to the emergency department with fever, severe nausea, vomiting, and diarrhea. She is admitted to the intensive care unit (ICU) with a diagnosis of kidney failure and septicemia. Her previous medical history includes glaucoma, chronic kidney failure, hypertension, and insulin-dependent diabetes. She had a left above-the-knee amputation 1 year ago.

Subjective Data

• W.A.’s daughter states she was able to do her daily chores at home independently, but for the last few days it was getting difficult for her to get around and that she needed to take frequent breaks because of shortness of breath and no energy. Her daughter also reports that W.A. had been having headaches with nausea and dizziness for the past few days.
• Goes to hemodialysis 3 days a week

Objective Data

Physical Examination

• Blood pressure 172/92, pulse 110, temperature 101.5°F, respirations 28
• Oxygen saturation 86% on 15 LPM via mask
• Oriented to name only
• Crackles in bilateral lower lobes
• 2+ edema bilateral lower extremities and hands
• Abdomen is distended with hypoactive bowel sounds x4 quadrants

Diagnostic Studies

• CBC: Hemoglobin 7 g/dL, hematocrit 23.8%, RBC 2.57 million/mm³, WBC 14.8 mm³
• Chemistry Panel: Serum sodium 132 mEq/L, serum potassium 6.0 mEq/L, calcium 9.3 mg/dL, phosphorus 6.0 mg/dL, glucose 197 mg/dL, albumin 2.4 U/L, serum blood urea nitrogen 77 mg/dL, serum creatinine 7.30 mg/dL, eGFR African American 10, BNP 182 pg/mL
• Urinalysis: Dark yellow and cloudy, protein 28 mg/dL, positive for casts, positive for red blood cells and white blood cells, positive for glucose and ketones
• Blood cultures pending

Discussion Questions

1. What is multiple organ dysfunction syndrome (MODS)? After reviewing W.A.’s presentation, what organ systems do you suspect are involved and why?

2. What do you think is the origin of W.A.’s septicemia?

3. What additional tests would you anticipate for W.A.?

4. What are the interprofessional care goals for W.A.?

- Name and describe the gold standard of research design and what makes it the gold standard.

An otherwise healthy nine-year-old boy developed flu-like symptoms (nausea/vomiting, decreased oral intake, lethargy, and weakness). After three days, the boy’s father called the pediatrician’s office at 8:00PM on a Saturday night. The on-call nurse practitioner returned the call (which was recorded). The father relayed the symptoms and said that Gatorade was making the boy nauseous, but he was still drinking some ginger ale. The father expressed concern about how tired his son was—he’d slept for 24 hours straight (from 8:00 p.m. the previous night). The boy woke up only to be carried downstairs to watch some TV for a little while. He felt a little better than the day before, but he also had some rectal bleeding and some bleeding from his mouth.

The NP acknowledged the boy’s symptoms and said that most of it sounded like a viral illness, but that the rectal bleeding could be something different. She asked the father several questions in order to get a better understanding of the boy’s condition, including:  

• Was he alert? (father’s response: yes but very tired)
• Had he passed any urine? (response: yes)
• Did he have a fever or rash? (response: no)

The NP then asked the father whether he thought the child was “OK” tonight or felt he should be seen right away. The father replied that he didn’t think he needed to be seen right now. The NP agreed and made plans for him to be seen in the office the next morning (Sunday) after 8:00AM, and she told him to call back if anything developed during the night. The father asked, “I don’t need to worry about him not taking any food? He is taking some ginger ale.” The NP responded by telling him to push the ginger ale and make sure he’s urinating periodically. The NP documented the call in the medical record, including that the father was offered an ED visit (although that was not specifically said, per the audio recording).

At about 4:00AM, the father checked his son and noted that his son was sleeping but also noted that his son's respiratory rate had increased significantly. Since his son was sleeping, the father didn't touch him to check for fever because he didn't want to wake his son. But, the father couldn't rest worrying about why his son was breathing so much faster than normal, almost like he had just been exercising even though his son had been asleep. At about 8:30AM, when the father again checked on his son, his son was not breathing at all.   The father called 911 and started CPR. The ambulance and EMTs arrived within minutes and found the child apneic, pulseless, with fixed and dilated pupils, and his corneas cloudy.   At 9:30AM, the child was pronounced dead.

An autopsy found the cause of death to be diabetic ketoacidosis (the child had undiagnosed diabetes mellitus). His blood sugar was 1,165 (nl 50–80); potassium was 7.1 (nl 3.5–5.3); and his HgA1C was 15.3% (nl 4–5.9%).

The parents sued the nurse practitioner, alleging wrongful death of their son due to negligent delay in diagnosis and treatment of diabetic ketoacidosis.

QUESTION: Identify at least 5 questions you would ask the patient's father to elicit more information to make your decision?

what organization is mandatory for practical nurses to belong to and what is the mandate of this organization?

A 68 year-old male patient is in the intensive care unit recovering from a hemorrhagic stroke. The patient has made some progress and is able to move his previously paralyzed left arm and leg in a limited way. His speech is also improving.

The nurse enters the room and greets the patient. The patient opens his mouth to speak, and his eyes immediately roll upward. His back arches, and then his arms and legs begin to jerk rhythmically.

Q1: What is happening to this patient?

Q2: What might have caused this event?

Q3: Which medication should be administered immediately? What medication might be prescribed for the long term?

Q4: By which route would one need to administer the medication given immediately?

Q5: Should the nurse be especially alert for any adverse effects of the medications that were administered (consider the route by which they were given)?

Q6: Are there pharmacokinetic considerations when dosing these medications? How might dosing be altered if this patient's liver function were impaired? Discuss the dosing considerations for the medication that was given for ongoing maintenance.

Q7: The nurse notes that the patient is taking several other medications, including nimodipine to control his blood pressure. Should the nurse be concerned?

What drew African Americans to the cities in the north during the  Great Migration?

Why did so many African Americans migrate to Newark, NJ at the beginning of the 20^th century?

You are assigned to care for three patients. Which patient would you see FIRST after receiving report? Consider which patient has the highest priority. Explain your answer based on Maslow’s Theory (Hierarchy).

• Patient #1 is complaining of incisional knee pain at level 6 out of 10, after a knee surgery.
• Patient #2 is complaining of difficulty catching his breath 4 hours after neck surgery.
• Patient #3 is complaining of being worried about lack of independence due to being confined to bed after a motor vehicle accident.

Should the drinking age be changed back to 18 years or stay at 21 years, and why? Should it be older?? Younger??

  Be sure to cite your references in APA format. Each post should be a minimum of 75 words.

Read the case scenario and apply the FIVE STEPS OF THE NURSING PROCESS.

Identify:

-Three appropriate nursing diagnoses

-For each nursing diagnosis provide one goal/expected outcome (goal should be SMART)

-Three nursing interventions for each diagnosis (independent, dependent, collaborative) and with scientific rationale

-One evaluative statement for each nursing diagnosis (indicate if goal met, goal partially met, or goal not met)

Follow the standard format of a nursing care plan. Thank you.

Levi Yosh is a 36-y/o police officer assigned to a high crime police precinct. One week ago he received a surface bullet wound to his arm. Today he arrives at the outpatient clinic to have the wound redressed. While speaking with the nurse, Mr. Yosh mentions that he has been promoted to the rank of detective and has assumed new responsibilities. He states that since his promotion, he has experienced increasing difficulty falling asleep and sometimes staying asleep. He expresses concern over the danger of his occupation and his desire to do well in his new position. He complains of waking up feeling tired and irritable. During the interview the nurse notes that he is pale, drawn with dark circles under his eyes. Temp: 37.0 C Pulse: 80 bpm, Resp: 18cpm, BP: 140/90mmHg