Under the ACA, health insurance companies cannot refuse coverage to individuals because of a pre-existing medical condition. Define what is a pre-existing medical condition? Also, what are the pros and cons of this provision under the law? 250 word answer

Discuss the role of the Joint Commission in health care. Why is Joint Commission accreditation important for health care facilities? What are the Joint Commission standards? 500 words.

Compose a 3-page research paper addressing the role of the Affordable Care Act (ACA) plays in the US health care system. Support your information through research or credible sources. Address the following topics.

• What are the primary goals of ACA?
• What are the current benefits and issues pertaining to the ACA?
• What is a pre-existing medical condition under the ACA?
• What is the ACA Marketplace?
• What are the Federal government Medicaid Expansion funds?

A 73-year-old female presents to the emergency department with nausea and confusion. The client normally takes digoxin, furosemide, and enalapril.

A. What will the nurse assess when caring for this patient? Include physical assessment and laboratory monitoring.

B. The patient's digoxin level of 2.2 ng/mL. What does the nurse do with this information?

Why are Do Not Resuscitate Orders a legal or ethical issue that is faced in healthcare?

b. The patient asks the student nurse what it means to develop resistance to anti-infectives. When the student nurse is teaching the patient about the anti-infective agent, it is important to include what general points to minimize bacterial resistance?

Marty Miller, age 26, who is training to run her fifth marathon, has gradually increasing dyspnea on exertion, fatigue, and weight gain. She has no children and is not now pregnant. Her nurse practitioner suspects a thyroid hormone disorder.

Instructions: Answer the following questions about Marty’s pathophysiology:

1. What are other symptoms about which you should ask Marty? Why?

2. If Marty has developed hypothyroidism, what might be found on examination?

3. The nurse practitioner drew blood to measure Marty’s TSH levels. What gland secretes TSH?

4. If Marty has hypothyroidism, what do you expect the TSH results to be? Why?

5. Marty is started on thyroid replacement therapy. Why should you teach her the signs and symptoms of hyperthyroidism as well as those of hypothyroidism?

6. What should Marty be taught to ensure adequate absorption of levothyroixine?

7. When her thyroid disorder was undiagnosed, was Marty at risk for thyroid storm? Why, or why not?

Brad Johnson (BJ) is a 54-year-old diagnosed with pituitary adenoma He undergoes a transsphenoidal hypophysectomy to remove the tumor.

1. Before surgery, what conditions might BJ’s pituitary adenoma precipitated?

2. After surgery, he has huge urinary outputs of 500 to 600 ml/hr. What is the most likely cause of his high urine output? What other clinical data would support this diagnosis?

3. BJ receives subcutaneous Desmopressin (DDAVP) to manage his high urine output. What is the rationale for this therapy? How can effectiveness be assessed?

4. It is expected that after his transsphenoidal hypophysectomy, all of BJ’s anterior pituitary hormones will be deficient (panhypopituitarism). What type of hormone replacement will be needed?

John, 78 years old, is a sometimes homeless veteran. He is missing many teeth from years of no dental care. John receives a monthly retirement check but he has great difficulty meeting his monthly bills, let alone buying enough food, and this has caused many evictions. When he can afford them, John has his prescriptions filled for a diuretic (for high blood pressure) and a statin (for high cholesterol). John isn’t sure what his current weight is, but he has had to tighten his belt to the last notch over the past eight months. He has no family with whom he is still in contact, and he eats all of his meals alone. At a neighbor’s insistence, John is visiting the local senior center to eat lunch for the first time. The day he visits, each person is having a free nutrition screen completed by a program staff member.

Questions:

1. Using the “Determine Your Nutritional Health” checklist (p. 459), assess John’s nutritional status. What is his score?

2. Review the “DETERMINE: Warning signs of poor nutritional health” checklist shown in Table 18.5 (p. 458). Prioritize John’s nutrition problems based on this screening tool.

3. What parts of the nutrition education handout created by the University of Florida IFAS Extension (access at http://edis.ifas.ufl.edu/he944) should be used to provide nutrition education to John?

4. What should the local senior center registered dietitian do for John to help address the nutrition problems you identified in #2?

Maleah Brown is a 46-year-old Caucasian who goes to her primary care provider with a chief complaint of weakness. She tells the nurse that she saw a dermatologist a month ago, because her skin tone showed increased pigmentation. The dermatologist told her to stay away from tanning beds, because she has the type of skin that darkens quickly. She recently returned from a vacation in a very sunny, warm location. She states that she is very concerned about her skin and her extreme fatigue and weakness. During the physical examination, her vital signs are measured as BP 90/68, HR 90, RR 18, and T 98.9ºF. Her skin tone is a golden brown, and all her mucous membranes are golden brown. MB denies using a topical instant tanning lotion. She weighs 110 pounds and is 5 feet, 7 inches tall. She reports that she has lost 15 pounds in the past 5 weeks. Blood tests show a blood glucose of 68, Na 110, and K 5.

1. What pathophysiologic processes could explain the serum levels of glucose, sodium and potassium?

2. MB is diagnosed with primary adrenocortical insufficiency, or Addison’s disease. She is prescribed corticosteroid therapy. What are essential teaching points for dosing schedule, indications for increased doses, emergency administration, and identification of her condition to healthcare personnel?

3. MB is started on corticosteroid replacement therapy. One week later, she is admitted to the emergency department with hypotension, dehydration, weakness, lethargy, vomiting, and diarrhea. What is the most probable cause of these signs and symptoms?

4. Which treatment measures are likely to be used to resolve the cause of MB’s signs and symptoms?

Explain what is meant by the visual pathway. Include in your description of the visual pathway the blind spot, and what causes it.