"Martin wants to cut back on the saturated and trans fat in his diet. He mentions to you that he is still going to eat hamburgers and fries, but now he will order the burger without cheese and dip his fries in ketchup instead of Ranch dressing."

1. Identify the sources of saturated and trans fats in Martin's diet.

2. Explain whether or not Martin has reduced his dietary intake of saturated and trans fast? \

3. What are several substitutions that Martin could make that would significantly lower his intake of saturated and trans fats?

Assign the correct CPT codes for each case study.

Case Study # 1:

Preoperative Diagnosis: Angina

Postoperative Diagnosis: Patent coronary arteries and grafts, ASHD present

Procedure: Right and left heart cath with coronary angiography

The patient was brought to the cath lab in a fasting state. The right going was prepped and draped in the usual sterile fashion. After local anesthesia was administered, sheaths were placed percutaneously into the right femoral artery and vein. IV heparin 3,000 units were given. Using a thermodilution catheter, right heart pressures were measured, and thermodilution cardiac outputs and AV oxygen differences were obtained. A pigtail catheter was inserted into the left ventricular cavity, and simultaneous left ventricular pressures were measured. A pullback was obtained across the aortic valve.

Using a 7R4 catheter, angiography was performed of the right coronary artery and both vein graft. A 7L4 was used for angiography of the left coronary artery. Additional attempts were made to image the vein graft to the right coronary artery with a right coronary artery bypass catheter. The pigtail catheter was reinserted, and left ventricular angiography and aortic root angiography were performed. The patient tolerated the procedure well and returned to the recovery room.

DX Codes: I25.10, I20.9, Z95.1

CPT Codes:

Case Study # 2

History and Indications: The patient is a 70 year old female who previously underwent a cholecystectomy but presents again with similar pain in the right upper quadrant in the presence of disturbed live function studies.

Procedure: ERCP sphinctereomty and stone extraction. The Olympus Vedeo side-viewing duodenoscoped was atraumatically introduced into the esophagus and advanced with slide-by technique into the stomach. The gastric mucosa was normal. The pyloric channel was normal and easily intubated. The first and second part of duodenum were visualized. The ampulla appeared normal. Initial cannulation was precurved catheter revealed a normal pancreatic duct. A single injection was made into the pancreas. Repositioning was accomplished with the assistance of a straight 0.035 guidewire, and free cannulation and injection of the papilla of Vater was accomplished. Full visualization of the common duct was obtained, revealing a large multifaceted free-floating stone within the proximal duct. The intrahepatic biliary system appeared normal . The extrahepatic biliary system appeared dilated. An exchange was made with the 20-millimiet shpincterotome and sphincterotomy was performed with perfect hemostasis. The duct was then swept with a 15 millimeter stone extraction balloon, and the stone was pulled into the duodenal lumen. The duct was “swept” two more times with negative results. Additional spot and overhead films were obtained to confirm clearance of all stone material. The procedure was terminated with the patient in satisfactory condition, and she was returned to the recovery area.

Assessment: Choledochlithiasis associated with obstruction

DX Codes: K80.51

CPT Codes:

Case Study # 3

The patient is a 77 year old female who has been in generally good health until last month, when she developed a crusty lesion inside the left naris. She initially treated it will Vicks ointment. When it failed to heal, she decided to seek medical attention. Her PCP biopsied this lesion, and the pathologic diagnosis was squamous cell carcinoma of the left internal nasal ala. She is posthysterectomy for endometrial carcinoma 10 years. She has smoked 1 ½ packs of cigarettes each day for the past 40 years.

The patient presented to the outpatient surgery center of the hospital for wide excision of the left internal nasal alar lesion, which is less than .5cm in diameter. This procedure included a full0thickness resection in the middle and posterior thirds of the lateral cartilage, along with vestibular skin and mucous membrane. Nasal reconstruction was required to provide an acceptable cosmetic appearance following excision. A flap graft composite reconstruction was utilized for primary course of the defect that was left following excision, using donor tissue from the right arm and requiring primary closure of a 2-cm graft.

DX Codes:C30.0, Z85.42, F17.210

CPT Codes:

Case Study # 4

Preoperative Diagnosis: Lesion, Right forehead

Postoperative Diagnosis: Basal cell carcinoma, right forehead

Procedure: Excision of 1.0 centimeter lesion involving the right forehead

Technique: The sin and subcutaneous tissue around the forehead lesion were infiltrated with 0.5% Marcaine with 1:100,000 epinephrine. A total of 1.5 cc was used. The patient was then prepped and draped in the usual sterile fashion.

Microscopic excision was carried out. A 2.0 mm margin of resection was planned around the lesion. Long suture was placed on the superior margin and a short suture was placed on the inferior margin. The tissue was excited and sent for frozen section, which returned with a diagnosis of basal cell carcinoma with clear margins. The site was closed with interrupted 5-0 plain gut. The patient was sent to the recovery area in good condition. No complications. Blood loss was 1cc.

DX Codes: C44.319

CPT Codes:

Assignment Details

Bruce Tuckman's stages of team formation outlines four stages, as follows:

1. Forming
2. Storming
3. Norming
4. Performing

Describe a time when you were required to work on a team, either in school or in the workplace. Discuss the strategies the team adopted to manage the teamwork process. Explain the importance of collaboration in solving healthcare problems.

Benjamin, a manager at Mighty Medical Manufacturing, is trying to create indicators of what a job is meant to accomplish, how performance is measured, and expected levels of job performance. What is he attemptingto establish at his company?

1/ Performance standards

2/ Performance criteria

3/ Team-based appraisals

4/ Performance improvement strategies

Case Study: End of Life Decisions

George is a successful attorney in his mid-fifties. He is also a legal scholar, holding a teaching post at the local university law school in Oregon. George is also actively involved in his teenage son’s basketball league, coaching regularly for their team. Recently, George has experienced muscle weakness and unresponsive muscle coordination. He was forced to seek medical attention after he fell and injured his hip. After an examination at the local hospital following his fall, the attending physician suspected that George may be showing early symptoms for amyotrophic lateral sclerosis (ALS), a degenerative disease affecting the nerve cells in the brain and spinal cord. The week following the initial examination, further testing revealed a positive diagnosis of ALS.

ALS is progressive and gradually causes motor neuron deterioration and muscle atrophy to the point of complete muscle control loss. There is currently no cure for ALS, and the median life expectancy is between 3 and 4 years, though it is not uncommon for some to live 10 or more years. The progressive muscle atrophy and deterioration of motor neurons leads to the loss of the ability to speak, move, eat, and breathe. However, sight, touch, hearing, taste, and smell are not affected. Patients will be wheelchair bound and eventually need permanent ventilator support to assist with breathing.

George and his family are devastated by the diagnosis. George knows that treatment options only attempt to slow down the degeneration, but the symptoms will eventually come. He will eventually be wheelchair bound and be unable to move, eat, speak, or even breathe on his own.

In contemplating his future life with ALS, George begins to dread the prospect of losing his mobility and even speech. He imagines his life in complete dependence upon others for basic everyday functions and perceives the possibility of eventually degenerating to the point at which he is a prisoner in his own body. Would he be willing to undergo such torture, such loss of his own dignity and power? George thus begins inquiring about the possibility of voluntary euthanasia.

The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and understanding of a diversity of faith expressions; for the purpose of this course, the focus will be on the Christian worldview.

Based on "Case Study: End of Life Decisions," the Christian worldview, and the worldview questions presented in the required topic study materials you will complete an ethical analysis of George's situation and his decision from the perspective of the Christian worldview.

Provide a 1,500-2,000-word ethical analysis while answering the following questions:

1. How would George interpret his suffering in light of the Christian narrative, with an emphasis on the fallenness of the world?
2. How would George interpret his suffering in light of the Christian narrative, with an emphasis on the hope of resurrection?
3. As George contemplates life with amyotrophic lateral sclerosis (ALS), how would the Christian worldview inform his view about the value of his life as a person?
4. What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?
5. Given the above, what options would be morally justified in the Christian worldview for George and why?
6. Based on your worldview, what decision would you make if you were in George's situation?

Remember to support your responses with the topic study materials.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Read the patient case studies below. List 3 differential diagnosis for each and why you believe these to be solid options that should be considered by the provider. Copy and paste the patient scenarios into a word document and use bullet points below each patient for your differential diagnosis, and then upload the assignment. Below is an example.

Patient X: 7-year-old Hispanic male with a cough and temperature of 99.9F.

• Differential Dx:
  • Allergic rhinitis
  • URI
  • Pneumonia

Patients

Patient 1: 28-year-old woman with opioid use disorder; uses IV heroin; has PTSD; no other medical problems or medications. She currently is single, lives with several roommates, and has a history of legal problems (with some jail time). Sexually active with men and women; inconsistent use of protection.

Patient 2: 70-year-old man with a history of CHF, COPD, and HTN; currently smokes one pack of cigarettes daily; takes Lisinopril, Digoxin, and Symbicort daily. Married to wife of 30 years and is retired (previously an accountant), is supported by adult children, and lives with his wife at home.

Patient 3: 40-year-old woman with a history of breast cancer that was successfully treated with Tamoxifen for several months. Otherwise healthy, with no other issues at this time. She is a successful businesswoman in a high-profile career with much stress. Married to wife of four years; relationship is rocky at times. Denies any substance use; travels frequently.

Symptoms are the same for all 3 patients:

• Shortness of breath
• Chest pain
• Flank pain
• Fever

In one paragraph, describe your own perceptions of health. Then have ask a patient (or family member) for his or her perceptions of health. Compare your personal perceptions with the perceptions of those you interviewed.

A 66-year-old female patient with a past history of diabetes mellitus, hypertension, and vascular disease presented to an internist complaining of a cough and wheezing. The patient had immigrated to the United States from Ecuador several years earlier, and she spoke mainly Spanish. She lived with her son, who had been in the U.S. longer, spoke English fairly well, and worked as a computer technician. The son had sometimes come to medical visits with the patient in the past, but he did not come to this visit. The internist diagnosed sinusitis and attempted to convey to the patient, without using an interpreter, that she should take acetaminophen, rest, and drink fluids.

This physician had a very strong and often-expressed view that people who come to the U.S. should learn to speak English. His grandparents had emigrated from Italy, and the physician liked to point them out as an example of people who had quickly adopted the language of their new country and successfully assimilated to American culture. He had repeatedly said he did not agree with spending his practice’s money on interpreters. If patients wanted interpreters, they could hire their own or use family members, this internist believed. He had expressed this view to the patient and her son at some past visits.

A week after this visit, the patient was significantly worse, and her son took her to the emergency department of the local hospital. Her examination in the emergency department revealed bilateral wheezing. A chest x-ray showed left lower lobe consolidation. Labs taken in the emergency department included elevated blood glucose, slightly elevated white blood cell count and abnormal CPK and troponin levels. The patient was admitted to a general medical floor with a diagnosis of pneumonia, and a nephrology consult was ordered. The patient’s internist was her attending physician. He did not use a language interpreter while she was in the hospital. For the first two days of the hospitalization, the patient’s status seemed to be improving: her respiratory symptoms and kidney function were better. However, the patient then developed shortness of breath and nausea. The internist ordered furosemide and an antiemetic. Repeat labs still showed an elevated CPK level.

The next day the patient had continuing nausea and shortness of breath, and her internist ordered a 100% NRB (non-rebreather) mask and intravenous theophylline. The patient developed respiratory and metabolic acidosis. That evening, at about 11 p.m., the patient had a cardiac arrest. She was resuscitated but remained minimally responsive in the intensive care unit (where she was transferred). Her son withdrew medical care two days later and the patient subsequently expired.

What are the ethical and legal issues in this case?

What event could have been done differently?

What other questions should the nurse ask about the cough?

Develop a problems list from the objective and subjective data.

What nursing diagnoses can be derived from the problems list?

What should be included in the plan of care?

What risk factors are associated with this age group?

Based on the readings, what is the most likely cause of this patient’s cough?

What other questions should the nurse ask about the fatigue?

What other assessments are necessary for this patient?

What are some causes of fatigue?

Develop a problems list from the objective and subjective data.

What should be included in the plan of care?

Based on the readings, what is the most likely cause of fatigue for this patient?

What subjective information should the nurse obtain?

The nurse is assessing the patient’s pulses. Which locations should the nurse check?

The nurse needs to evaluate the adequacy of the collateral circulation before obtaining an arterial blood gas (ABG) sample. How should the nurse proceed?

What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legs?

1. TCRs do not act directly against antigens but trigger a signaling cascade inside the T-cell for further actions.
2. What are the molecules in addition to the TCR that T cells use to initiate their responses to antigens, and what are the functions of these molecules?

. What care should Mrs. M. receive before she is transferred to the recovery room. Why?

Mrs. M. is a 27-y/o gravida 3, para 2, who was admitted at term at 6:30 p.m. She stated that
she had been having contractions at 7 to 10 minutes intervals since 4 p.m. They lasted 30
seconds. She also stated that she had been having "a lot of false labor" and hoped that this
was "the real thing". Her membranes were intact. Mrs. M.'s temperature, pulse and respirations
were normal and her blood pressure was 124/80. The fetal heart tones were 134 and regular.
The nurse examined Mrs. M. and found that the baby's head was at +1 station, and the cervix
was 4 cm. dilated and 80 percent effaced. She reported her findings to the doctor and he
ordered Demerol 50 mg. with Phenergan 25 mg. to be given intravenously when needed.

11. Before planning a response for rescue and recovery all personnel should perform a hazard assessment. True or False.

a) Dmort teams are teams that respond to medical needs of those injured in disasters. True or False.

b) The purpose of triage is to limit the impact that a major disaster will have on hospitals. True or False.

c) Only the SEMO representative can call up the National Guard in New York State. True or False.

d) The only person able to declare a disaster to be a major event is the Governor of the state he must request the presidential declaration. True or False.

e) The American Red Cross has always assisted in major disasters. True or False.

f) The Stafford act assisted all Americans with flood insurance. True or false.

g) The role of public health in a Flu epidemic is to provide surveillance for its county. True or false

h) A NGO’s that always responds to disasters is the World Health Organization. True or False.

i) Emergency Management is most likely to succeed at a disaster because of the effectiveness of its different teams performing their duties as one. True or False