1. This case involves a healthcare system consisting of five clinics serving nearly 2 million residents in a large metropolitan area and treating over 500,000 patients annually. In preparation for the implementation of an EHR system for the five clinics, the healthcare system implemented an electronic document/content management (ED/CM) system to handle the imaging, indexing, and storage of selected hard copy documents from active patient paper medical records so that in the future, to support continuity of care needs, key documents would be retrievable through the EHR system. However, the healthcare system lacked the level of internal IT and health information services staff resources required to manage the implementation of hardware/software and to handle the actual paper conversion process, so these aspects of the project were outsourced. The outsourced company installed hardware and software, redesigned workflow in the health information services department, collaborated with the health information management professionals to redesign standardized patient record forms, and worked with IT staff to develop interfaces that would allow for scanned images to be fed into the EHR system. The outsourced company also managed the preparation, scanning, indexing and quality control activities associated with the actual paper conversion process.

Questions

1. As the healthcare system prepares to select an outsource company as its vendor for this project, what types of information should it give to and gather from each vendor under consideration?
2. What are the potential benefits a healthcare system could gain from implementing a document imaging and management project prior to implementing an EHR system?

Trying to form a thesis and outline for a 5-6 research paper. (doing research self)
So far I got the topic of punishment for animals, use, and misuse. Why we shouldn’t use choke chains, electronic collars, or pinch collars to treat animal behavioral problems. What are the adverse effects of using these punishment tools.

The APRN is monitoring a newly intubated patient. He appears to be very anxious and “fighting” the ventilator. What would be the most appropriate action?

What changes in society and/or our environment do you think have occurred since the 1980’s that have contributed to this increase in obesity?

Skilled Nursing Facilities (SNFs) play a vital role in the care of our most vulnerable populations. Maintaining accurate medical records in the SNF setting is important for both quality of patient care, as well as compliance with regulatory bodies. For this week’s assignment, you will demonstrate your knowledge of medical record management in the SNF environment.

A local assisted living facility has decided to expand, with the addition of a skilled nursing facility adjacent to their current residential structure. You have been hired as a consultant to oversee the planning and implementation of medical records compliance. The facility owners and managers have a business background and are not familiar with the rules and restrictions that are applicable to SNFs.

• Liability issues to be aware of, and how to avoid them.
• Include a minimum of three references, in APA format, on a separate page

Describe and evaluate the ethical issues involved in Medicare-funded organ transplants

• Introduce the issue.
• Define the problem.
• Search the literature.
• Analyze the problem.
• Offer possible solutions.
• Propose a single solution.
• Develop an implementation plan.
• Justify why and how if your solution will solve the identified problem.

Write at least 3 paragraphs about 10/20 system. Describe the objective, benefits and the process of this system in sleep study.

Mr. H is a 64 year old male with a history of COPD, HTN, and Type 2 DM. he just arrived this morning from the ED with a diagnosis of uncontrolled HTN (admitting BP 220/110), and chest pain. The symptoms that brought him into the ED were severe morning H/A with occasional vomiting x3 days, SOB, and chest pain. When you examine him you notice a large bruise on his right elbow and hip. He relays history of a fall recently. He complains of dysphasia which he attributes to a sore throat from vomiting. He is slightly disoriented and drowsy, but received a dose of Zofran for vomiting before he was brought up to your unit. His HA has returned but he feels he cannot take anything PO because of his earlier vomiting.

Labs: Na: 145, K: 3.7, Cl: 100, CO2: 28, BUN: 22, Creatinine: 1.5, Blood Glucose: 210, HgB: 12.7, WBC: 10.3, PLTS: 110.
CK enzymes negative
Chest X-ray: no effusions, pneumonia but emysematous changes noted.
Current BP: 156/98 HR: 78 reg. RR: 24 on 4L O2

1) What could be happening to Mr. H? (hint: Is all his symptoms related to HTN?)
2) What symptoms are related to the severe HTN?
3) What symptoms are related to the COPD?
4) what symptoms are related to the Type 2 DM?
5) Based on his history and labs what is probably responsible for the bruising?
6) List all abnormal lab values, possible causes, in a significance of the abnormal lab values in Mr. H plan of care?
7) What does emysematous changes on the CXR mean? What disease process is this related to?
8) What are your top 3 nursing priority concepts (in order of priority) would you use for Mr. H? What nursing interventions would you include for Mr. H?

Case Scenario Jarli, a 50-year old Indigenous client is diagnosed with liver cancer. During a teaching session with him, the nurse makes a connection between his drinking history which began in his early teens and states that “drinking is part of the culture in your community.” While in the hospital, he seems very uncommunicative, sad and, contrary to the nurse’s expectation, receives very few visitors. He travelled from his rural community to undergo chemotherapy as planned but later decided to forego the treatment and return home to be with his family. Two weeks later his wife calls and tells the nurse that he was too scared to continue the procedure, that he is a spiritual leader in the community and this was not taken into account when the nurse did her teachings with him. His wife offers to meet with the nurse to further discuss this so that future Indigenous clients will not have to go for treatment without their culture and spirituality being taken into account.

1. What are some of the reasons Indigenous peoples may be reluctant to access health care services? Discuss how these may have contributed to Jarli’s decision to forego treatment for his liver cancer. What strategies can be utilized to prevent or manage the situation?
2. dentify and discuss some of the alternative healing practices that Indigenous peoples use. Discuss how the healthcare environment incorporates these into its practices today. How would you utilize these in your care for Jarli?

Why do mammography systems use one type of filter, whereas chest x-ray or CT x-ray systems would use another type? What else is different about these x-ray systems?

For a radiograph acquired with automatic exposure control, an increase in which of the following factors will increase patient skin dose the most?

A. Tube current (mA)

B. Tube voltage (kV)

C. Patient thickness

D. patient-to-detector distance

E. Source-to-detector distance

You have just been accepted to nursing school. As a requirement, you have to have a tuberculosis (TB) test as well as a hepatitis B recombinant vaccine. The nurse who administers the TB skin test explains that if significant swelling occurs around the injection site, you will need to have chest x-rays to determine if you are infected with Mycobacterium tuberculosis. On the morning of the second day after the skin test, you awake to find your arm red and swollen in an area about the size of a quarter around the site of the test. It is also tender to the touch. Now you are really worried. Could you have TB?

1. Why does the reaction to the skin test take 36-48 hours to show up? Explain.

2. If you have a tuberculosis infection, why doesn’t the whole body, or at least the respiratory tract, react when the antigen is injected during this diagnostic test? After doing a chest x-ray, your doctor says the results are inconclusive. So, you are put on a six-month course of isoniazid to be safe. About six months later, while sitting in your medical microbiology class during a lecture on tuberculosis, you suddenly realize why you had that positive reaction to the skin test six months earlier. It had nothing to do with being infected, but was because you were born in Norway and your family moved to the United States when you were four years old.

3. What is going on here? Discuss in detail.

4. A while later, you told a friend of yours who is HIV-positive about your TB scare. She said that her doctor doesn't typically use the TB skin test on her, even though people with HIV are more susceptible to TB. Why is the skin test not always a reliable TB test for those with HIV?