1)_Discuss why documentation is important in nursing.                                             2)_Discuss the techniques and assessment of a pregnant adult female abdomen: Leopold’s maneuver.                                                3)_Discuss the techniques and assessment of depression in the older adult.

An 80-year-old man comes to the emergency department reporting acute upper to mid abdominal, sporadic pain and cramping. Upon assessment, the nurse observes abdominal distention and high-pitched bowel sounds. The physician has ordered flat plate and upright abdominal x-rays that show distention of loops of intestine, with fluid and gas in the small intestine in conjunction with absence of gas in the colon. The physician has diagnosed a bowel obstruction.

1. What could be the problem?
2. What do you assess? Name minimum of five assessments and the reason to do it.
3. What would you implement? Name minimum of five implementations and the reason to do it.
4. What would you teach the patient?
5. What is your primary and secondary nursing diagnosis for this patient? Utilize the PES format (problem, etiology, S&S) NANDA FORMAT
6. What is your goal for this patient? Goal must be S.M.A.R.T (Specific, Measurable, Attainable, Realistic, and Timely)

name for the nursing research during the crimean war is

Identify and explain the roles of committees within medical management. How are they integrated to ensure optimal system performance and quality health care? Your assignment should be 2-3 pages in length with a minimum of four resources that support your findings.

Please answer all discussion questions and answer the case study questions.

Discussion Topic: Are the cognitive skills of a child affected by their nutrition?
Discussion Topic: What is the primary cause of fatal ingestions in children younger than 5 years of age? Discuss button battery ingestion.
Case Study: Sally is a 3-year-old girl in the primary care physician’s office. Sally’s mother states that she is having “temper tantrums.”

Subjective Data

The mother states Sally eats well.
Sally sleeps 11 to 12 hours a day.
Sally speaks in four- to five-word sentences.
Objective Data
Birth weight: 3 kg
Today’s weight: 13 kg
Height: 90 cm

Sally speaks in three- to four-word sentences with a 300-word vocabulary.
Questions: Please only provide short answers for the case study section. No more than 2 sentence response for the case study section. Follow the guidelines below for the discussion section.
Is Sally’s vocabulary appropriate for her age?
Are Sally’s height and weight appropriate for her age?
What information can Sally’s nurse give about her temper tantrums?
What is the goal of discipline for a preschooler?

Enter each word element into one cell, with no slashes or spaces. Use as many cells as necessary – you may not need all cells provided. If no entry is required, leave the cell empty. For example, abdominoplasty = abdomin | o | plasty

4. Relating to the abdominal cavity

Medicare Regulations Medicare is a federally regulated program that mandates compliance to its standards through state and federal oversight. One of the primary purposes of Medicare regulations is the protection of its recipients. Medicare Advantage is part of the Medicare Modernization Act, which was passed in 2003. Search the Internet by using the following keywords:

•Medicare regulations

•Centers for Medicare

•Medicaid services On the basis of your research, answer the following questions:

•What are the purposes of Medicare regulations other than the one mentioned above?

•How will the federal government enforce compliance in the Medicare Advantage program? Which two other Medicare regulations do you think are the most important for managed care organizations and why?

•Do you think Medicare and Medicaid programs face challenges from the perspectives of providers, the government, and consumers (recipients of Medicare or Medicaid)? Why or why not?

•What are the different services provided by the Medicare and Medicaid programs? Do you feel there is a need to have two different programs? Why or why not?

•Discuss the advantages and disadvantages of Medicare programs such as Medicare Advantage and Medicare Part D. Do you think Medicare Advantage programs ensure the survivability of Medicare? Why or why not? Additionally, respond to the questions given below after reading the following information in regard to control of managed care organizations at the state level. States have a broad range of control of managed health care organizations. The main interests of the states are to protect the interest of the consumer and regulate the structure of MCOs. •Discuss the regulatory structure used to regulate MCOs and health insurers at the state level.

•Discuss how states came to be the primary regulators of insurance.

•Evaluate the most critical components of state oversight of HMO operations.

•Review the licensing requirements for MCOs in your state and describe the specific requirements to obtain a Certificate of Authority (COA). Compare to the requirements discussed in the course textbook.

•What are the protections available to consumers under the law in your state? Compare these protections to what is discussed in the textbook. •In your opinion, are the state regulations designed for the consumers, or are they designed for the MCOs? .

Besides contracting with HMO’s, explain in 2 pages what are some of the managed care steps that employers can take to constrain health care costs and promote wellness? Identify at least 2 areas and provide a resource for your answer

1. What are four types of wound dressings? Describe the purpose of each.

2. What six factors affect selection of wound-dressing materials?

An 87-year female, with a 3-day history of intermittent abdominal pain, abdominal bloating, and nausea and vomiting, came to the emergency department. She moved from Puerto Rico to join her grandson and his family only 2 months ago and speaks very little English. All information was obtained through her grandson. PMH includes an abdominal hysterectomy 12 years ago and an inguinal hernia repair 2- years ago. She has nod history of coronary artery disease, diabetes or pulmonary disease. She takes only ibuprofen occasionally for mild arthritis. She has no known drug allergies (NKDA). Vital signs are: Blood Pressure 134/84, Pulse 84 beats/minute and regular, Respirations 20/minute and Temperature 97.2º F (36.2 ºC). An IV of D5 ½ NS with 20 mEq KCl at 100 mL/hour is started Nasal O2 at 2 L is also ordered. With some difficulty a nasogastric tube (NGT) is inserted and connected to intermittent low wall suction. The NGT suddenly drains 575 mL and then slows to about 190 mL every hour. After 3-days of NGT suctioning the client’s symptoms are unrelieved. She reports continued nausea, cramping, and sometimes very strong abdominal pain. She seems increasingly lethargic. You look up her latest laboratory test values and compare them to the admission data. Na from 136 to 132 mEq/L, K has changed from 3,7 to 2.8 mEq/L, Cl from 108 to 97 mEq/L, G from 126 to 79, CO2 from 25 to 31 mEq/L, BUN form 19 to 31 mg/dL and Cr from 1 to 1.6 mg/dL. What are some appropriate nursing diagnoses for this client?

An 87-year female, with a 3-day history of intermittent abdominal pain, abdominal bloating, and nausea and vomiting, came to the emergency department. She moved from Puerto Rico to join her grandson and his family only 2 months ago and speaks very little English. All information was obtained through her grandson. PMH includes an abdominal hysterectomy 12 years ago and an inguinal hernia repair 2- years ago. She has nod history of coronary artery disease, diabetes or pulmonary disease. She takes only ibuprofen occasionally for mild arthritis. She has no known drug allergies (NKDA). Vital signs are: Blood Pressure 134/84, Pulse 84 beats/minute and regular, Respirations 20/minute and Temperature 97.2º F (36.2 ºC). An IV of D5 ½ NS with 20 mEq KCl at 100 mL/hour is started Nasal O2 at 2 L is also ordered. With some difficulty a nasogastric tube (NGT) is inserted and connected to intermittent low wall suction. The NGT suddenly drains 575 mL and then slows to about 190 mL every hour.

What are some nursing interventions that you would provide based on the above lab values?

INDICATIONS FOR SURGERY: A 34-year-old female presents with severe abdominal pain. After examination was completed and ultrasound results were reviewed, it was determined that patient had an ectopic pregnancy and surgical intervention was needed. PROCEDURE: Patient was taken to the operating room, and after general anesthesia was induced, she was prepped and draped in the usual sterile fashion. Examination was performed after anesthesia, which showed a normal-sized, nontender uterus, a left adnexal mass, and a fullness in the vagina, all consistent with hyperperitoneum. A 10-mm trocar was inserted directly into the abdomen through a small incision in the umbilicus. Using 3.5 liters of carbon dioxide, a pneumoperitoneum was created. The hemoperitoneum was noticed, and another 10-mm trocar was placed in a small suprapubic incision. Two 5-mm ports were also placed under direct visualization in both the right and left lower quadrants. With an irrigator and aspirator, the hemoperitoneum was reduced. The left fallopian tube was noted to be almost to the point of rupture due to a mass in the tube. The fallopian tube was distended beyond repair; so this needed to be removed. The tube was tied off and removed with its contents through an Endo Catch bag through the 10-mm port. Inspection of the abdomen noted no other problems; adequate hemostasis was noted, and ports were removed. Defects were closed with 0 Vicryl, and the skin was closed with 4-0 Dexon. She was sent to the recovery room in stable condition.

ICD-10-PCS Code Assignment is: ___________ and ____________