The prevalence of Hepatitis C virus (HCV) infection is increasing throughout the world. Clinically, acute infections are infrequently recognized because most patients experience minimal symptoms or are often asymptomatic. However, the vast majority of HCV- infected individuals become chronically infected. Advanced Practice Nurses must be able to identify patients at risk for HCV.

a. Explain the pathophysiologic processes involved in this disorder and explain how this infection may go undetected for many years.

b. Describe the laboratory tests (including test results interpretation) used to diagnose and differentiate acute versus chronic infection. Include what tests are needed (and why) to manage a patient receiving treatment. Make sure to include the molecular and genotyping testing.

c. Using current pathophysiological knowledge regarding HCV, explain how the current treatments for this viral infection eliminate the infection. Include cure rates for the various treatment modalities.

An 8-month-old girl who is brought in by her parents because of fever and fussiness. Her appetite is poor and she refuses to eat or take most fluids. On physical examination, she has a bright red right TM, dull without mobility or landmarks. Her left TM is pearly gray and mobile. She has yellow nasal discharge; cervical adenopathy and chest clear to auscultation. Her diagnosis is right otitis media.

a. What will you prescribe, for how long, and what dosage?

b. Discuss pathophysiology of the disease or physiology of the organism that the drug(s) are addressing.

c. Rationales for using the specified drug(s), emphasize the APRN role in the assessment, diagnosis, and pharmacological interventions of clients.

d. Indications, contraindications of the drug(s)

e. List the prices of three drugs to treat the selected problem from two different pharmacies.

f. Describe in detail the instructions the patient should receive for the selected drug(s). Write this at a fifth-grade level.

The patient presents to the ER with recurrent headaches, fatigue, and a blood pressure of 185/102. Patient is a long-time smoker, lead a relatively sedentary lifestyle, and has a BMI of 39. History of acid reflux. Patient is going to be kept for over night observation and administer medications to help control his blood pressure.

Patient Blood pressure taken just before transferring to the Med/Surg. Floor 156/87.

Nursing assistant taking the Vital signs: Temp 98.8, Pulse 101, B/P 178/98 this was just taken when patient arrives to the floor.

The nursing assistant reports to the RN that patient is complaining of chest pain.

1.  What would be the priority nursing intervention for Mr. Davis based on the Electronic Health Record information?

The overuse of antibiotics and CT scanning are not only unnecessary and wasteful, but it may create potential harm for patients. According to Centers for Disease Control and Prevention, of the estimated 154 million prescriptions for antibiotics written in doctor’s offices and emergency departments each year, 30% are unnecessary (CDC, 2016). CDC researchers found that most of these unnecessary antibiotics prescribed are for common colds, viral sore throats, bronchitis, and sinus and ear infections that do not respond to antibiotics. Researchers have estimated the rate of inappropriate antibiotic use in adults and children by age and diagnosis. CDC Director Tom Frieden stated, “Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections” (CDC, 2016). According to the Department of Veterans Affairs health care facilities, studies found Medicare recipients were more than twice as likely to receive potentially inappropriate imaging for headaches as those who reported the same symptoms (Joy, 2016). The National Center for Biotechnology Information, stated that one-third of CT scans are medically unnecessary exposing millions of patients to high doses of radiation (NCBI, 2008). The radiation exposure from three or four CT scans is roughly equivalent to that experienced by atomic bomb survivors in Hiroshima, Japan (Schwartz, 2008). CT scanner radiation dose should be reduced as much as possible and alternative diagnostic strategies should be used whenever possible. Excess imaging is an aspect of over testing, over screening, over diagnosis, and over treatment that adds billions of dollars of wasted costs annually.

DO YOU AGREE OR DISAGREE WITH THE MESSAGE ABOVE? WHY?

Anywhere Hospital’s CFO for the past 20 years, Jim Smith, just retired. He worked for the hospital for 40 years and was greatly respected by his staff. The hospital governing board has hired a new CFO, Todd White.

Jim Smith utilized the silo approach to revenue cycle management during his tenure. He relied on his key management personnel to contact upper management of other departments in the hospital to discuss issues and to resolve problems and vice versa.

Todd White, however, had implemented an integrated revenue cycle team at his former hospital three years ago and strongly believed in the power of teamwork. His previous team had gained numerous efficiencies and improved accounts receivable by millions. So when Todd started at Anywhere Hospital he planned on implementing a similar revenue cycle team.

As with any change, Todd was met with much resistance. But after speaking with many of his managers in patient accounts and finance he realized that the employees did not know how to effectively work in teams. And why should they—the previous CFO had not asked them to do so in several years.

1.      What are some creative ways that Todd can help Anywhere Hospital understand the importance of an integrated revenue cycle team?  

2.   How can a manager improve teamwork amongst his or her employees?

3. Does Todd need assistance from a Changer Management Leader? Please explain your answer.

Workstation security can be an issue in many organizations. What are some of the things a health care organization can do to secure a workstation to ensure no PHI is viewed by someone who is not authorized to view it?

1. Discuss the pathophysiology of type one and type two diabetes. Develop a nutritional education plan for either a type one or type two diabetic. Include in your plan the nutritional considerations for one oral medication and one type of insulin used in the treatment of the disorder.

As medical groups sought capitation payments from health maintenance organizations (HMOs), what was a major problem for these groups?

The Case

In How Doctors Think, author Dr. Jerome Groopman reflects on the reasoning process that doctors use to arrive at a diagnosis. He refers to the problem of physicians becoming “locked in” to a diagnosis so early in the process that they overlook the important clues. The result, very often, is an incorrect diagnosis and inappropriate treatment.

The best example I can recall involved my twin brother, John.

He had developed chronic pain in his right hip and was referred to an orthopedic surgeon for advice. The surgeon obtained a CT scan of the hip. It showed some activity at the head of the femur, suggesting the possibility of a cancerous growth. My brother called me from San Francisco (he was on a business trip) and I advised him to arrange a visit with an oncologist at the university hospital located in his hometown. I flew up to be with him during a day of consultations and examinations.

The oncologist, with knowledge of a possible malignancy involving the head of the femur, ordered a new CT scan of the hip. It showed evidence of increased blood flow, furthering the conclusion that there was a tumor. At that time, I asked whether the pain could be due to aseptic necrosis (bone death caused by poor blood supply) of the hip. The response: “Oh no, the nuclear scan would not light up like this. It would be just the opposite.”

A chest x-ray was obtained as part of the workup for presumed metastatic carcinoma. The radiologist noted numerous tiny densities throughout both lungs. Equipped with the referral note from the oncologist and the interpretation of the CT scan, he said to me, “This has to be metastatic carcinoma.”

Late in the afternoon, the oncologist informed John that all findings indicated cancer that had traveled to his bone and lung. (The three main cancers in men that metastasize to both bone and lung are prostate, lung, and lymphoma.) A biopsy of the hip lesion was arranged, and we returned home where John sat down with his family and shared what the doctors had said. He told everyone that he had enjoyed a good life and was ready to die. Many tears were shed.

But John looked very healthy for a man with a tumor that had metastasized to his lungs and bone. Except for his hip pain, he felt well. Sure enough, when the biopsy was done, there was no cancer found. Evidence of aseptic necrosis was found, however, which was healing spontaneously. This explained the findings on the CT scan. Again, there was much cheering and more tears among the family members—this time, though, it was tears of joy and relief.

(The report of a chest x-ray taken some years earlier in another city was tracked down and found to be identical with that of the current chest x-ray—findings thought to be scarring from old granulomas, small areas of inflammation due to tissue injury.)

Within a matter of weeks, John’s hip pain disappeared!

Please provide an assessment of what the facility can do going forward to create a culture of quality and safety.