Samples

How could a nurse assist the following clients to become more comfortable?

a. A sixty-five-year-old woman with terminal cancer of the pancreas.

b. A seventy-five-year-old man whose wife died one year ago and is now recovering from the flu."

A. A 65 year female presenting in the emergency with end stage pancreatic cancer

 1. Pain Management

 Assessment: The nurse should then use the necessity appropriate pain scales to assess the patient and in addition observe for other signs which the patient cannot tell which indicate that they are in pain.

 Medication Administration: Finger aspiration or any kind of ecchymosis which will scale it, use opioids or any standing medications to control the client’s pain and alter with the dosage as per the report of the said client.

 Non-Pharmacological Techniques: Administrative methods using natural ways for instance use of a drug allied to relaxation procedures, visualization or even massage for managing pain.

 2. Symptom Management

 Nausea and Vomiting: Administer the antiemetics after consultation with the doctor and advise the patient some of the recommendations to take regarding their diets which includes taking food in small portions and strictly avoiding cloudy water.

 Dyspnea: If the patient requires additional oxygen, provide it to him and assist the man in positioning his body so as not to suffer or get an ache, this can be done when one gives the man an upright position that leans forward.

 3. Emotional and Psychological Support

 Active Listening: Support patient’s familiar and affection to give comfort to the patient through reducing the patient’s stress about the disease.

 Counseling: Includes a referral for a Counselling to help the patient and or the family to cope with feelings of loss as well as confusion, a referral for a clergy person .

 4. Comfort Measures

 Hygiene and Comfort: Hygiene care should be continued and comfort measures that are non-pharmacological should be administering clean physical environment and appropriate dressing or mattress.

 Temperature Regulation: : Adjust the temperature of the rooms and where needed bring in a blanket for the patient or an air conditioning equipment.

 5. End-of-Life Planning

 Advance Directives: Coordinate: The specifics of the patient’s advance care decision and the patient’s treatment in the final stage of the disease.

 Family Support: There are suggestions that, let the families participate in care planning and provide them with information and incentives as to patients’ care.

 Seventy-Five-Year-Old Man has just caught Flu and the Wife of him Deceased One Year Ago

 1. Health Promotion for Clients with Intellectual Disability

 Symptom Relief: Heal flu through fever, coughs and fatigue with the appropriate medications and other interventions appropriately.

 Hydration and Nutrition: Closely observe the state of the client in regard to the possibility of sufficient fluid intake and consistently provide nutrition to the clients for health and against disease.

 2. Emotional Support

 Bereavement Support: One has to empathise with him and the loss of his wife that he had mentioned. Offer or prescribe an individual or a group counseling if there is a problem of grief or loss.

 Active Listening: Take him and have conversations with him that shall allow him to release his anger and on the same note, gain some closure in terms of emotional reassurance.

 3. Social Interaction

 Encouragement of Social Engagement: If you feel lonely, go for a social interaction so that you can be able to minimize on the feeling of loneliness or you can spend sometime with friends or relatives.

 Community Resources: Make him understand that there are facilities where he can go like a center for senior citizen or a volunteer bureau where individuals can offer him company.

 4. Safety and Fall Prevention

 Environmental Safety: Make sure that the home surrounding is free from threats of falling and ensure the environment is safe due to his recent sickness and weakness.

 Assistive Devices: Make walking aids in the event the patient falls realistic in anticipation of a fall; things like walking stick or a wheelchair.

 5. Health Education and Self-Care

 Education: Teach the patient on precautions to be taken during flu and procedures of resting, fluid intakes and consulting a doctor.

 Follow-Up: Ensure to make the next appointments and assist in enquiring with regard to any prescription or treatment that was provided.

 Closeness to patients’ appropriate physical and emotional requirements can enhance comfort and benefit general well-being in these transmutable situations.

I am taking the RN VATI predictor assessment for my final green light for datapoint.

I am taking the RN VATI predictor assessment for my final green light for datapoint. Please I need help which exam do you suggest to study and work to pass the exam.

For the RN VATI predictor assessment, it's essential to focus on several key areas to ensure you’re well-prepared:To maximise your chances of success in the RN VATI predictor assessment, the following facets must be considered:

 Review the RN VATI Predictor Study Guide: This guide will contain precise examples of the process of the VATI exam and sample questions and explanations. It has to be read carefully so as to get the maximum result.

 Focus on Key Topics:

 Pharmacology: Assess: Drug classes, Effects & combined effects

 Med-Surg: Such situation as ordinary illnesses, their treatment, and everything connected with providing service to patients.

 Maternal and Pediatric Care: This year a short revision of prenatal, labor and delivery and some basic pediatric problems.

 Mental Health: Understanding of certain facts about symptoms and possible treatments of the primary mental disorders.

 Nursing Process and Critical Thinking: Some sample questions created on the basis of the application of the nursing process and thinking critically.

 Practice NCLEX-Style Questions: Here we suggest general acquaintanceship at least so that the candidate knows what type of content and question format NCLEX is going to present.

 Take Practice Exams: Full-length practice exams thus assist takers in planning their time and at the same time increasing their confidence levels.

 Review Test-Taking Strategies: Priority, delegation and other can raise you to the next level – knowing how to answer them.

Step 1 From your home address write the distance (in miles or partial miles) to the following places.

Here is a more detailed table of all the data collected from the questions given above. These are imaginary responses of a typical server given merely on what can be expected in most neighborhoods and using general but plausible services. Depending on your location and available resources, you will have to bring corresponding changes to these aspects.

  Geriatric Windshield Survey Table

.

  Notes:

 - Distance: Distances are in approximate to the nearest 100 meters. If one wishes to get exact distances then he or she can use mapping equipments to determine the distances or be physically be able to travel to the various locations.

 - Services: Be sure to confirm all the above services with the respective facilities or from their websites.

 - Crime Rate: For proper crime statistics, consult the available data of the concerned local police department or any official crime reports.

 - Sidewalks/Parks: To inspect sidewalks and parks provide the best assessment, one has to do it in person.

  References:

 1. Local Police Department. (2024). Crime Statistics Report.

 2. [Pharmacy, Grocery Store, Senior Center, etc. ] own website and local phone books.

 3. Fire, Police, and/or other Emergency Services /contact info/ Emergency Services offered [by the local Fire Station/Police Station/EMT Department].

  Professional Considerations:

 - Make the service needs convenient for an elderly person and all that they might require.

 - For transportation and delivery services, think if the elder person will be ok using apps or calling the service.

Why is it important to identify childhood adversity?

Identifying childhood adversity is crucial for several reasons:Identifying childhood adversity is crucial for several reasons:

 1. Early Intervention and Prevention

 Prevention of Long-Term Effects: Causal indicators for childhood adversity include physical abuse, neglect, sexual abuse, exposure to violence or combat, and more. This results in early identification, precluding the various effects that are associated with chronic diseases or mental disorders, therefore any adverse effect resulting from the disease is preventable.

 Targeted Support: Interpreting distress early chance to provision of delivery support services such as counseling, social services, and educational support to cover the particular need of children and families.

 2. Improved Health Outcomes

 Reducing Health Risks: Adverse experiences in childhood place a child on the precariously dangerous position to develop diseases associated with cardiovascular diseases, diabetic conditions, substance abuse and many more. The excellence of early identification assists in providing early intervention to minimize the risks associated as well as an ongoing evaluation of health results to prevent such dangers.

 Mental Health: Child abuse has earlier been associated with a higher risk of depression, anxiety as well as PTSD. This results in early identification of such issues hence assisted in offering right mental health support and therapy.

 3. Better Educational and Development Assistance

 Academic Achievement: Hear how ACEs affects one’s brain, learning, and then school achievement. Early detection also enables the educators and child care givers to address the disabled children and give them extra support in case they have learning difficulties.

 Behavioral and Social Skills: It also includes anxiety, aggression, achievement problems and behavior and social competence in children who experienced adversity in the past. Early detection of such problems makes it possible to make appropriate changes to enhance children’s propensity for appropriate social behavior, appropriate and acceptable patterns of actions and development.

 4. Families and caregivers of people living with disability have been provided support.

 Resource Allocation: It is easier to locate the struggling families so resources and support can be rendered to them. This can entail, for example, involvement of the parents with parenting programmes, scholarships, and welfare services.

 Family Dynamics: Researching possible effects of adversity for family functioning can result in the development of solutions that help improve the role and functioning of a family for the sake of the child and the caregivers involved.

 5. Reducing Future Societal Costs

 Long-Term Savings: The costs associated with early favourable treatment of childhood adversity are much less than the cost of not treating adversity and the subsequent costly health, social and legal implications down the track.

 Breaking the Cycle: Interventions in childhood and throughout may greatly reduce the continuation of adverse experience across generations, ending the chain of negative experience and in the end the functionality of the society will increase.

 6. Promoting Resilience and Recovery

 Building Resilience: Fostering positive development for childhood resilience involves finding ways on how to manage adversity so as to treat children with appropriate care to prevent them from being affected by traumatic events.

 Fostering Positive Outcomes: The effect of these early supportive services and the early intervention will assist children to have positive results even if they have had negative past experiences.

 Thus, screening, diagnosing, and evaluating childhood adversity is crucial in order to initiate early and effective interventions aimed at early childhood health and development as well as to support families and reduce the costs of prolonged adverse impacts on society. A key task that it has is to support the children’s coping mechanisms and general physical and emotional health while in its care.

Critical Thinking Question (5 pts.)

Critical Thinking Question (5 pts.) (use the back of the page to write your answer) Today you have

learned about carbohydrate metabolism. Take a look at the diagram you saw earlier today 1. Eat Carbs, like bread,

rice, potatoes, etc. Iuliale gif exhale Eat starch 4B. Co) 8. The CO2 Inhaled air brings diffuses out of the... Show more"

Carbohydrate Metabolism Overview

 Ingestion and Digestion:

 Ingestion: Carbohydrates are taking in by food and beverages such as bread, rice, potatoes, and more.

 Digestion: Carbohydrates that are taken for digestion are divided into the basic sugars by the help of the digestive enzymes. For example, if the foods that contain starches are swallowed, these are broken down by enzymes such as amylase to glucose.

 Absorption:

 Small Intestine: These are absorbed through the pile of small intestine into the blood stream in case of the simplified sugars. Glu is the most abundant sugar and often transported to other tissues as aeras.

 Transport and Utilization:

 Bloodstream: These transport glucose in the blood to cells that located in several parts of the body.

 Cellular Uptake: Glucose is an everyday sugar that in the human body is taken into cells with the help of insulin which is released by the pancreas.

 Metabolism in Cells:

 Glycolysis: In cells glucose is fused through glycolysis to form pyruvate and in so doing ATP is generated.

 Aerobic Respiration: In aerobic condition it goes to the mitochondria and through Krebs cycle and oxidative phosphrylation ATP and CO₂ is formed in large amount.

 Anaerobic Respiration: Under anaerobic conditions pyruvate is converted to lactate. Online Etymology.

 Exhalation of CO₂:

 Carbon Dioxide Production: Meanwhile in aerobic respiration the by product formed is CO2.

 Transport to Lungs: CO₂ is then taken back to the lungs in the blood stream of the body The diagrams of Stella’s respiratory system Below are the diagrams of Stella respiratory system File Stella Respiratory System. pptx.

 Exhalation: It dissolves into the blood type, and disperses in the alveoli in the lungs before exhaling it out of the body.

 Subject to the problem field diagram shown in Appendix A, each of the following subproblems has a detailed explanation:Subject to the problem field diagram shown in Appendix A, each of the following subproblems has a detailed explanation:

 Eating Carbohydrates:

 Carbohydrates when consumed, are being processed in the body and are converted into glucose in the body system.

 Transport and Energy Production:

 Glucose enters in the blood and is delivered to cells.

 In the intracellular maters glucose is used to synthesize ATP through glycolisis and other related processes.

 CO₂ Production and Removal:

 The by products of glucose used for energy production in aerobic respiration includes CO₂.

 It removes it from the cell to the blood stream of the body.

 From here it gets distributed within the body and finally gets to the lungs were it goes from the blood to the alveoli and out of the body through the lungs.

 Diagram Insights:

 Possibly the graph depicts how the complexes of carbohydrates are assimilated and transformed into glucose and the last process of elimination of CO₂ from the body.

 Some of the include; breaking down of starches into glucose, glucose utilization in the cells, expelling of CO₂ as a by product of aerobic respiration.

 This structure of this draft outline should reflect the processes in carbohydrate metabolism, and the role of CO₂.

What is informatics in nursing?

What is informatics in nursing? What is the significance of informatics in health care? How has it changed the healthcare industry?

How has information technology improved or hindered patient care? How has this technology affected the advanced practice nurse in providing quality care?

How is informatics creating new roles for nurses within the healthcare field? What changes will we see in the role that informatics nurses play?

What are some of the major trends and their implications for future developments in health care, health informatics, and nursing informatics research?"

What is Informatics in Nursing?

 Nursing informatics is the application of information and communication technology and data processing in the delivery of nursing services, advancement of recherche, and health care delivery. It is the task of employing EHRs, decision support, telehealth, and other informatics technologies for acquiring, processing, and utilizing patient concerning data.

 If there is one profession that has continued to prayed its worth in the advancement of informatics and its applicability within the American health care system it is the nursing profession.

 Improved Patient Safety: Instruments such as the EHR assist in decreasing medication errors as well as improving documentation and also alerting on potential problems such as drug interaction.

 Enhanced Care Coordination: As one of the largely benefits of implementing digital systems, (5) it enhances the flow of communication between the professionals in the delivery of healthcare services.

 Data-Driven Decision Making: Availability of patient information in detail and contemporarily help in arriving at improved results informed clinical decision making.

 Increased Efficiency: The mundane activities such as documentation, ordering tests would be automated; this would brighten up the working environment of the healthcare individuals.

 Effect on the Healtchare Sector

 Improved Patient Outcomes: Informatics has promoted care of chronic illness, reduction in jerking hospitalizations, and improved additional patient care by means of early expedition and surveillance.

 Cost Reduction: Reducing manual interventions in data processing coupled with optimal data storage improve operational expenses for healthcare organizations as well as decrease wastage and inefficiencies.

 Accessibility and Convenience: Application of social technologies and video conferencing has enhanced health care accessibility especially for those living in the rural areas or those with limited access to health care facilities.

 Impact on Patient Care

 Improvements:

 Enhanced Communication: Interprofessional communication and EHRs allow for the timely and efficient handing of the patient’s records between the providers.

 Timely Interventions: Information that is in real time and has alerting enhances timely response to patients’ requirements.

 Personalized Care: Personalised care and risk-supportive treatment plans are benefited from the data analytic support.

 Hindrances:

 Technology Overload: Though the utilization of technology with patients is advantageous, there is always a disadvantage that comes with it, and that is the fact that the interaction that is had with the patients may at times be limited.

 Privacy Concerns: Being exposed to a data breach or other security problems, the information about the patient can be comprised.

 Learning Curve: But while new systems are introduced, it can complicate trainings, and in the short term impact on care.

 Impact to Advanced Practice Nurses

 Enhanced Role in Data Analysis: Informatics is essential in the practice to analyze the data of the patients and ensure that the APN makes the right decisions and the interventions that are most appropriate.

 Improved Patient Management: An APN is armed with informatics tools that assist her in addressing complicated cases, integrating care and even offering extensive information to the health consumer.

 Expanded Scope of Practice: Telehealth, remote monitoring and other more intricate forms of care can be delivered by APNs as a result of technology.

 Implication of Informatics to the Creation of New Roles for Nurses

 Clinical Informatics Specialist: Informatics nurses provide leadership in developing and initiating healthcare technology systems that are fit for clinical use.

 Health Information Manager: This job entails supervision of the patient data and governance of their information to conform to certain rules.

 Telehealth Nurse: Focusses on providing care through telecommunications technology with a view of increasing reach and access to remote care.

 Data Analyst: Is specialized in processing and reporting results for the purpose of enhancing health care performance.

 Future Changes and Trends

 Artificial Intelligence and Machine Learning: Predictive analysing outcomes will be boosted, clinical decisions will be assisted by AI, and patient care will be personalized.

 Interoperability: Future attempts oriented to the desynchronization of various health information systems will work on the enhancement of data exchange and synchrony.

 Patient-Centered Technologies: Creation of the frameworks to support the empowered patient, being an active participant and decision maker in the process.

 Blockchain for Health Records: There is the possibility of secure and clear patient information management.

 Implications for Nursing Informatics

 Increased Demand for Expertise: Since the advancement in technology, there will be need for nurses who are specialize in informatics skills.

 Enhanced Education and Training: It will be also essential to complete the ongoing education of nursing informatics as it is vital to comprehend modern shifts.

 Greater Collaboration: Although the details of the involvement of nursing informatics are still vague, its broad involvement in interdisciplinary teams is apparent in planning and executing the developments of new technologies.

 In conclusion, nursing informatics is essential in the promotion of patients as well as the improvement of the health systems through technology. It provides pen load of opportunities for Advanced Practice Nurses, it has introduced new roles in the field, and it is dynamic in the growth of newer trends and innovations.

84 year old woman who is been feeling fatigues for last 3 days and has had fever the last 24 hours

84 year old woman who is been feeling fatigues for last 3 days and has had fever the last 24 hours. she reports painful, burning sensation when she urinates as well as frequency of urination the last week. She is brought to the ED by her daughter and daughter states her mother didn't know what day it was. patient is mentally alert with no history of confusion.

Patient have History of: Diabetes type II, hyperlipidemia, hypertension, Gout.

patient medication: allopurinol 100mg BID, Colchicine 0.6 prn, Aspirin 81 mg once a day, simvastatin 20 mg once a day, metoprolol 25 mg two times a day, Lisinopril 10 mg daily.

patient Vital signs:  temp: 101.8, RR: 24, BP 128/82, O2: 98%, in room air. patient complains of right flank pain, achy, rated 5/10 and indicates continuous . When obtain orthostatic vital sign, supine BP 103/50, pulse 110. standing 92/42, pulse 132.

WBC: 13.2

Hgb:14.4

platelets: 246 u/L

Neutrophils: 93%

sodium: 140

potassium: 3.8

glucose: 184

BUN: 35

creatinine: 1.6

UA: abnormal results, cloudy, specific gravity 1.032, protein 2+, WBC greater than 200, nitrate positive, bacteria large .

What are clinical finding should be recognize and why?

what vitals sign is clinically significant and relevant and why?

Based on the data collected, patient will be diagnosed with what condition.

provider order:

initiate and maintain PIV

0.9% 1000 mL IV bolus

Acetaminophen  650 po q4 h prn

Ceftriaxone 1g IVPB

Morphine 2 mg IV push q2 h prn

what is the relationship between the following orders and the primary problems"

For the 84-year-old woman with fatigue, fever, dysuria, confusion, and abnormal lab results, here's a detailed analysis:Here is a detailed analysis regarding the 84-year-old woman complaint of fatigue, fever, dysuria, confusion and featuring abnormal lab results as follows;

 Some of the clinical findings described in this paper will also be explained.

 Fever (Temp: 101.  8°F):

 Significance: Goes to possible infection and this is in line with the dull abdominal pain dysuria and flank pain that she presented with. The higher temperature is a deep sign which can be used confirm an infection existing among a number of people.

 Confusion:

 Significance: New confusion in geriatric patient may be due to severe infection or sepsis in case other features of systemic inflammation like fever are also present.

 Right Flank Pain:

 Significance: Closely related to possible implication of the kidneys, for instance, acute pyelonephritis or acute kidney infection.

 Orthostatic Vital Signs:

 Supine BP: Cholesterol has been recorded as 103 for total cholesterol, 50 for LDL cholesterol while, pulse was 110.

 Standing BP: Refer to Core 92/42 and Pulse: 132

 Significance: Orthostatic hypotension is a reduction of bin BP when the individual is in a standing position and this is lower than the usual normal value for the patient and the cause includes both dehydration, sepsis and the two combined. It should be closely observed because it defines volume status or possibility of hypovolemia, sep mis.

 Lab Results:

 WBC: 13. 2 (Elevated): May indicate that microbial organisms or irritation of the area involved is present.

 Creatinine: 1. 6 (Elevated): Filters include evidence of kidney harm which may be secondary to infection or lack of volume in the body fluids.

 UA Abnormal Results: Infection presence of bacteriuria, cloudy urine, specific gravity greater than 1015, hematuria, WBC greater than 5 /BPF, nitrites and bacteria suggest in acute pyelonephritis.

 Clinically Significant Vital Signs

 Temperature:

 Relevance: If the patient’s temperature is rising the presence of infection is confirmed and may help in the diagnosis of UTI or pyelonephritis.

 Orthostatic Hypotension:

 Relevance: May reflect hypovolemia or severe infection as in sepsis The patient’s pulse rate also reflects that, therefore should not be left without attention.

 Elevated Pulse:

 Relevance: Tachycardia maybe physiological for several reasons including infection, dehydration or acute pain.

 Diagnosis

 Primary Diagnosis: Pyelonephritis. Therefore, fever, flank pain, dysuria, and chemical analysis assuring that UA is suspicious point at the probable UTI complicated with kidney.

 Overview of Orders by the Provider and as to How They Relate to Significant Issues

 Initiate and Maintain PIV (Peripheral Intravenous Line):IV (Peripherally Inserted Central Catheter) Insertion and and maintenance WHEN LABORING:

 Relationship: Very useful for the administration of fluids and medicine together assessing the patinet’s response to the administered treatment.

 0. 9% Normal Saline 1000 mL IV Bolus:9% Normal Saline 1000 mL IV Bolus:

 Relationship: For dealing with the possible symptoms of hydration and increasing the blood volume due to her orthostatic hypotension and raised creatinine levels.

 Acetaminophen 650 mg PO q4 h PRN:Acetaminophen 650 mg per os every four hours as needed:

 Relationship: In cases where there is fever or other complications which are associated with the fever with an aim of improving the comfort of the patient and in the process trying to reduce on the period of the fever.

 Ceftriaxone 1g IVPB (Intravenous Piggyback):Ceftriaxone 1g IVPB (Intravenous Piggyback):

 Relationship: Acute UTI to manage the infection and any renal inflection.

 Morphine 2 mg IV Push q2 h PRN:Morphine 2 mg IVP q 2 h as needed:

 Relationship: In order to manage moderate to severe pain particularly for her flank pain that was rated as on the level of 5. Pain management is vital due to patient’s comfort and to maintain health.

 Summary

 Due to recurrent fever, flank pain, dysuria, confusion, and other peculiar changes in urine examination, pyelonephritis can be considered prospectively. These are such orders as infection control orders, rehydration orders, pain management orders and any other orders to improve status of the patient.

Mountain View Community Hospital

Introduction

This case is included to provide you an opportunity to apply the concepts and techniques you will learn in each chapter. The case can also be used to support a semester-long database project built throughout the term that results in a complete application. We have selected a hospital for this case because it is a type of organization that is at least somewhat familiar to most persons and because health-care institutions are of such importance in our society today. A segment of the case is included at the end of each chapter in this text. Each segment includes a brief description of the case as it relates to the material in the chapter followed by questions and exercises related to the material. Additional requirements, assignments, and project deliverables are provided in support of a semester project.

Case Description

Mountain View Community Hospital (MVCH) is a not-for-profit, short-term, acute care general hospital. It is a relatively small hospital, with some 150 beds. Mountain View Community Hospital strives to meet the needs of a community of about 60,000 with an annual growth rate of 10 percent, a trend that is expected to continue since the surrounding area is attracting many retirees. To serve the health-care needs of this growing community, Mountain View Community Hospital plans to expand its capacity by adding another 50 beds over the next five years, and opening a managed care retirement center with independent apartments and assisted living facilities. The basic goal is to provide high-quality, cost effective health-care services for the surrounding community in a compassionate, caring, and personalized manner.

Within the last fiscal year, the hospital performed more than one million laboratory procedures and over 110,000 radiology procedures. During that time, the hospital had 9,192 admissions and 112,230 outpatient visits, brought 1,127 babies into the world, and performed 2,314 inpatient and 1,490 outpatient surgeries. Patients who receive outpatient surgeries do not remain in the hospital overnight. With an average of 2,340 patients a month, the emergency department experienced approximately 28,200 visits throughout the year. Approximately 30 percent of the patients admitted to the hospital were first treated in the emergency room, and about 13 percent of emergency room visits resulted in hospital admission. The hospital employs 740 full-time and 439 part-time personnel, among them 264 fulltime and 176 part-time registered nurses, and 10 full-time and 6 part-time licensed practical nurses. The hospital's active medical staff includes over 250 primary physicians, specialists, and subspecialists. Volunteers are an integral part of MVCH's culture and contribute greatly to the well-being of patients and their families. Approximately 300 volunteers from different backgrounds and of all ages devote their time, energy, and talents to many areas of the hospital. They greet visitors and patients and help them find their way through the hospital, deliver mail and flowers to patient rooms, escort patients, aid staff with clerical duties, work in the gift shop, assist at community and fund-raising events, and help out in a host of other areas.

Mountain View Community Hospital provides a number of key services, including general medical and surgical care general intensive care, a cardiology department, open-heart surgery, a neurology department, pediatric medical and surgical care, obstetrics, an orthopedics department, oncology, and a 24-hour emergency department. The hospital also offers a wide range of diagnostic services. A specialty service within the neurology department is the recently opened Multiple Sclerosis (MS) Center, which provides comprehensive and expert care for patients with multiple sclerosis in order to improve their quality of life. Using an interdisciplinary team approach, the center emphasizes all aspects of MS care from diagnosis and treatment of MS symptoms and secondary complications, to individual and family counseling, rehabilitation therapy, and social services. Headed by Dr. Zequida, called Dr. ""Z"" by staff and patients, the MS Center is a member of a consortium of MS centers.

The current organizational chart for Mountain View Community Hospital is shown in MVCH Figure 1-1. Like most other general hospitals, Mountain View Community is divided into two primary organizational groups. The physicians, headed by Dr. Browne (chief of staff), are responsible for the quality of medical care provided to their patients. The group headed by Ms. Baker (CEO and president) provides the nursing, clinical, and administrative support the physicians need to serve their patients. According to Ms. Baker, the most pressing issues affecting the hospital within the last year have been financial challenges such as bad debt, personnel shortages (particularly registered nurses and imaging technicians), and malpractice insurance. Other critical issues are the quality of care, patient safety, compliance with HIPAA, and technological innovation, which is seen as a major enabler for decreasing costs and improving quality. The trend toward managed care and the need to maintain costs while maintaining/improving clinical outcomes requires the hospital to track and analyze both clinical and financial data related to patient care services.

Goals and Critical Success Factors

In response to the steady growth and expansion plans at Mountain View Community Hospital, a special study team including Mr. Heller, Mr. Lopez, Dr. Jefferson, and a consultant has been developing a long-term strategic plan, including an information systems plan for the hospital. Their work is not complete, but they have begun to identify many of the elements necessary to build the plan. To meet the goals of high-quality health care, cost containment, and expansion into new services, the team concluded that the hospital has four critical success factors (CSFs): quality of medical care, control of operating costs, control of capital costs, and recruitment and retention of skilled personnel. The development of improved information systems is viewed as an enabler in dealing with each of these CSFs.

The team is currently at work to generate two to four short- or long-term objectives for each CSF. So far they have developed the following four objectives related to the control of the operating costs CSF:

1. Reduce costs for purchased items

2. More efficiently schedule staff

3. Lower cost of liability insurance

4. Expand volunteer services

The study team has developed a preliminary list of business functions that describe the administrative and medical activities within the hospital. These functions consider the organizational goals and CSFs explained in the prior section. At this point, the study team has identified five major business functions that cut across all of the organizational units:

1. Patient care administration Manage the logistical and record-keeping aspects of patient care

2. Clinical services Provide laboratory testing and procedures, and patient monitoring and screening

3. Patient care services Provide patients with medical care and support services

4. Financial management Manage the financial resources and operations of the hospital

5. Administrative services Provide general management and support services not directly related to patient care.

The study team has been able to break each of these high level business functions into lists of more detailed functions (see MVCH Figure 1-2), but the team knows that these lists are not complete nor well defined at this point.

Mountain View Community Hospital has computer applications that support the following areas (among others): patient care administration, clinical services, financial management, and administrative services. Many of these applications have been purchased from outside vendors, but a few have been developed internally. Most of the computer applications are implemented using relational database and client/server technology. In the client/server environment, the client runs the database applications that request the data. The server runs the DBMS software, which fulfills the requests and handles the functions required for concurrent, shared data access to the database. Most of the databases (as well as the applications) are two tier, using the classification introduced in this chapter.

Enterprise Modeling

The study team identified a preliminary set of 11 entity types that describe the data required by the hospital in support of the various business functions: FACILITY, PHYSICIAN, PATIENT, DIAGNOSTIC UNIT, WARD, STAFF, ORDER, SERVICE/DRUG, MEDICAL/SURGICAL ITEM, SUPPLY ITEM, and VENDOR. From discussions with hospital staff, reviewing hospital documents, and studying existing information systems, the study team developed a list of business rules describing the policies of the hospital and nature of the hospital's operation that govern the relationships between these entities. Some of these rules are:

1. A FACILITY maintains one or more DIAGNOSTIC UNITS (radiology, clinical laboratory, cardiac diagnostic unit, etc.).

2. A FACILITY contains a number of WARDs (obstetrics, oncology, geriatrics, etc.). 3. Each WARD is assigned a certain number of STAFF members (nurses, secretaries, etc.); a STAFF member may be assigned to multiple WARDs.

4. A FACILITY staffs its medical team with a number of PHYSICIANs. A PHYSICIAN may be on the staff of more than one FACILITY.

5. A PHYSICIAN treats PATIENTs, and a PATIENT is treated by any number of PHYSICIANs.

6. A PHYSICIAN diagnoses PATIENTs, and a PATIENT is diagnosed by any number of PHYSICIANs.

7. A PATIENT may be assigned to a WARD (outpatients are not assigned to a WARD). The hospital cares only about the current WARD a patient is assigned to (if assigned at all).

8. A PATIENT uses MEDICAL/SURGICAL ITEMS, which are supplied by VENDORs. A VENDOR also provides SUPPLY ITEMs that are used for housekeeping and maintenance purposes.

9. A PHYSICIAN writes one or more ORDERS for a PATIENT. Each ORDER is for a given PATIENT, and a PATIENT may have many ORDERs.

10. An ORDER can be for a diagnostic test (lab tests such as lipid profile, CBC, liver function tests; diagnostic imaging such as MRIs and X-rays) or a drug.

They recognized that certain business functions, such as risk management and volunteering, were not adequately represented in the set of data entities and business rules, but they decided to deal with these and other areas later. The study team stored descriptions of these data entities and the business rules in the CASE repository for later analysis. Using the identified entities and business rules, the study team developed a preliminary enterprise data model (see MVCH Figure 1-3). Again, this conceptual model is preliminary and does not follow all the conventions used in the information systems department for drawing data models, but the purpose of this enterprise model is to give only a general overview of organizational data.

Case Questions

1.      What are some of the costs and risks of using databases that the hospital must manage carefully?

2. How could the hospital use Web-based applications?"

Charges and Hazards Demanded in Applying Databases

 1. Costs:

 Initial Setup Costs: Database involves tremendous costs, which comprises of hardware cost, software and other costs which are required for initial setup of a database system.

 Maintenance and Upgrades: They are the costs incurred in the day to day running and sustaining of the software such as update of the software and hardware, maintenance of the systems and any improvement on the systems.

 Training: A database can be an expensive investment and therefore the staff needs to be trained on how to apply as well as manage the database.

 Data Storage: Mass storage of huge volumes of data especially in a health facility with many records is very absorbing and demanding.

 Security Measures: Security measures that are to be put in place to ensure that patient data is not compromised are costly when one has to factor encryption of data, restricted access to patient data, and security check-ups.

 2. Risks:

 Data Breaches: Action by or on behalf of an unauthorized party can lead to violation of patient right to privacy, legal consequences and fines.

 System Downtime: Production mishaps cause breakdowns in hospital activities and services for patients and business management.

 Data Loss: These risks include and have the potential of the contract, erasure, or damage to capability hardware bringing about probable loss of important patient data.

 Compliance Issues: Oblivion to laws such as HIPAA attracts legal consequences as well as fines.

 Integration Challenges: One of the challenges of implementing new database systems is the time that it takes to adapt it to the current applications and this in most cases results in data dilemmas or operational problems.

 Using Web-Based Applications

 1. Enhanced Accessibility:

 Remote Access: Web applications have flexibility and responsiveness if the healthcare staff obtain the patients’ information and working from distant places.

 Real-Time Updates: Information is real time, and this can improve care co-ordination as well as the ability to make sound decisions.

 2. Improved Patient Engagement:

 Patient Portals: Health Record may allow more patient engagement through self service portals on the Internet and establish a better way of communication through web applications for Health Records, Appointment and more satisfactory feedback.

 3. Cost Efficiency:

 Reduced IT Costs: Being web-based mostly, usually they do not require a significant amount of on-site hardware and IT personnel, which could bring overall costs down.

 Scalability: Some of these applications can be scaled easily to the next level when the company grows and this is without requiring much capital investment.

 4. Integration and Collaboration:

 Interoperability: Computerized web applications can typically link up with different healthcare systems and databases, improving on the flow of information between different departments and healthcare organizations.

 Collaborative Tools: Such web-based tools may bring in elements of team work in the provision of healthcare at various center stages.

 5. Security Considerations:

 Data Encryption: Where patients ‘ details are captured, it’s important that web-based applications have high security measures including encryption.

 Access Controls: Enforcing strict access control measures also means that only the approved individuals can get to certain information.

 In general, with the help of proper cost and risk control concerning database systems and by taking the advantages of Web applications, MVCH can focus on the organization improvement, better patient care and proper function of the hospital.

What could be 1 nursing diagnosis with 1 outcome/smart goal

What could be 1 nursing diagnosis with 1 outcome/smart goal, 5 interventions, 5 rationales, 5 evaluations for a patient who is 67 years old and is diagnosed with Dysphagia 2. The patient is in risk of ineffective airway clearance RIT neurological dysfunction evidenced by the patient's CVA dysphagia present. History of present illness: The patient was brought to the hospital for generalized edema. Past medical and surgical history: Hypothyroidism, rheumatoid arthritis."

Dysphagia, Specific Perimeters, Actions, Reasons, Checks for a Nursing Care Plan on a Particular Client

 Patient Profile:

 Age: 67 years old

 Diagnosis: Hear burn, risk for impaired gas exchange associated with CVA resulting in neurological changes.

 History: Swelling throughout ,low thyroid hormone, Rheumatoid arthritis.

 Nursing Diagnosis:

 Immobility and potential for chronic medical condition that adds risk for Ineffective Airway Clearance due to dysphagia and neurological dysfunction.

 SMART Goal:

 Specific: The patient will have success in clearance of the airway.

 Measurable: The patient will not exhibit aspiration (coughing, choking during meals) and will show signs of better swallowing.

 Achievable: Depending on the necessary and sufficient intercessions and evaluations.

 Relevant: Critical to avoiding such conditions such as aspiration pneumonia.

 Time-bound: In 1 week of performing the care plan.

 Interventions:

 You should screen the patient’s swallowing function before each meal.

 Rationale: Assessing swallowing function is done to determine challenges that are usually present prior to meals and directs the correct diet and feeding techniques that should not result to aspiration.

 Evaluation: Patient presentation indicate that the patient has a better swallowing function since there was no coughing or choking during feeding time.

 Consult with an SLP for the administration of swallowing therapy plan as this would be used for all patients undergoing a swallowing therapy.

 Rationale: Therefore, SLPs can adjust therapy and perform exercises to help enhance swallowing mechanisms that will prevent aspiration.

 Evaluation: The patient of swallowing therapy- The SLP evaluation and the recommendations of the patient progress in swallowing.

 Teach the patient and the family member about the correct methods of feeding and the symptoms of aspiration.

 Rationale: Education therefore enables the patient as well as the family to understand what gives cause for aspiration principally and when they are likely to encounter difficulties.

 Evaluation: Patient and family clearly show correct technique for feeding and stated knowledge of how to identify signs of aspiration.

 Use of aspiration precautions including, offer of thickened liquids and use of a modified diet according to SLP advice.

 Rationale: Liquid diets are thickened special for minimizing aspiration possibilities in patients with dysphagia.

 Evaluation: The patient enjoys meals with no aspiration identified they also report improved comfort during meal time.

 Respiratory status those should be assessed frequently and oxygen saturation levels as well.

 Rationale: Self-assessment enables identification of any violation of the normal process of airway clearance or any aspiration related complication.

 Evaluation: As for respiratory status and oxygen saturation: Airway patency is maintained and patients’ breathing is adequate or improved.

 Evaluation:

 Patient has negative history of aspiration during meals the patient did not choked or cough during the meals.

 Measure: A observation of the students during their meal time.

 The patient shows enhanced swallowing abilities as observed the patient and other health care staff of the health facility.

 Measure: Monthly clinician and nursing staff follow-up by the SLP.

 The patient and family are able to identify appropriate techniques of feeding as well as identifying signs of aspiration.

 Measure: Teaching aids and handling during educative sessions.

 Simple changes in food and fluid consistency help in lowering aspiration because incidents of difficulty during meal taking were reduced.

 Measure: Collection on the changes in food intake and the patients’ feedback.

 Although the subjects presented a few episodes of abnormal breathing accompanied by C/S rales, the respiratory status and oxygen saturation levels are within normal values suggesting adequate clearance of the airways.

 Measure: Follow-up of preformed care plan charting of assessments of respiratory rate and oxygen saturation.

 The interventions of this effective and systematic care plan relate to the patient’s potential for compromised airway clearance because of dysphagia and neurological issues.

What are home health care and the types of services they provide?

The range of home health care services a patient can receive at home is limitless. Depending on the individual patient's situation, care can range from nursing care to specialized medical services, such as laboratory workups. You and your doctor will determine your care plan and services you may need at home. At-home care services may include:

Doctor care. A doctor may visit a patient at home to diagnose and treat the illness(es). He or she may also periodically review the home health care needs.

Nursing care. The most common form of home health care is some type of nursing care depending on the person's needs. In consultation with the doctor, a registered nurse will set up a plan of care. Nursing care may include wound dressing, ostomy care, intravenous therapy, administering medication, monitoring the general health of the patient, pain control, and other health support.

Physical, occupational, and/or speech therapy. Some patients may need help relearning how to perform daily duties or improve their speech after an illness or injury. A physical therapist can put together a plan of care to help a patient regain or strengthen the use of muscles and joints. An occupational therapist can help a patient with physical, developmental, social, or emotional disabilities relearn how to perform such daily functions as eating, bathing, dressing, and more. A speech therapist can help a patient with impaired speech regain the ability to communicate clearly.

Medical social services. Medical social workers provide various services to the patient, including counseling and locating community resources to help the patient in his or her recovery. Some social workers are also the patient's case manager--if the patient's medical condition is very complex and requires the coordination of many services.

Care from home health aides. Home health aides can help the patient with his or her basic personal needs such as getting out of bed, walking, bathing, and dressing. Some aides have received specialized training to assist with more specialized care under the supervision of a nurse.

Homemaker or basic assistance care. While a patient is being medically cared for in the home, a homemaker or person who helps with chores or tasks can maintain the household with meal preparation, laundry, grocery shopping, and other housekeeping items.

Companionship. Some patients who are home alone may require a companion to provide comfort and supervision. Some companions may also perform household duties.

Volunteer care. Volunteers from community organizations can provide basic comfort to the patient through companionship, helping with personal care, providing transportation, emotional support, and/or helping with paperwork.

Nutritional support. Dietitians can come to a patient's home to provide dietary assessments and guidance to support the treatment plan.

Laboratory and X-ray imaging

Certain laboratory tests, such as blood and urine tests, can be performed in the comfort of the patient's home. Also, portable X-ray machines allow lab technicians to perform this service at home.

Pharmaceutical services. Medicine and medical equipment can be delivered at home. If the patient needs it, training can be provided on how to take medicines or use the equipment, including intravenous therapy.

Transportation. Some companies provide transportation to patients who require transportation to and from a medical facility for treatment or physical exams.

Home-delivered meals. Often called Meals-on-Wheels, many communities offer this service to patients at home who are unable to cook for themselves. Depending on the person's needs, hot meals can be delivered several times a week.

Describe the reimbursement process for home health agencies by Medicare.

Under prospective payment, Medicare pays home health agencies (HHAs) a predetermined base payment. The payment is adjusted for the health condition and care needs of the beneficiary. The payment is also adjusted for the geographic differences in wages for HHAs across the country. The adjustment for the health condition, or clinical characteristics, and service needs of the beneficiary is referred to as the case-mix adjustment. The home health PPS will provide HHAs with payments for each 60-day episode of care for each beneficiary. If a beneficiary is still eligible for care after the end of the first episode, a second episode can begin; there are no limits to the number of episodes a beneficiary who remains eligible for the home health benefit can receive. While payment for each episode is adjusted to reflect the beneficiary's health condition and needs, a special outlier provision exists to ensure appropriate payment for those beneficiaries that have the most expensive care needs. Adjusting payment to reflect the HHA's cost in caring for each beneficiary including the sickest, should ensure that all beneficiaries have access to home health services for which they are eligible.

What is the purpose of the Medicare Home Health Face-to-Face requirement?

The Medicare Face-to-Face Home Health requirement, a regulation by the Affordable Care Act, requires an in-person physician's visit to certify a patient's home health benefit, according to cms.gov. This means that under the law, a physician must assess and document a patient's condition and provide a brief narrative verifying their eligibility for the home health Medicare benefit. While revisions to this requirement were later made, some important initial provisions of this requirement are as follows:

A physician or allowed non-physician practitioner (NPP) must document having met with a patient face-to-face and certify them for Medicare home health benefits

The certification for service eligibility must be related to the physician's assessment of a patient's clinical condition

Patients beginning care on or after January 1, 2011, require this documentation on their certification

The visit must occur within 90 days before, or within 30 days after the beginning of home health care

?

Under the law, insurance companies and group health plans will provide consumers with a concise document detailing, in plain language, simple and consistent information about health plan benefits and coverage. This summary of benefits and coverage document will help consumers better understand the coverage they have and, for the first time, allow them to easily compare different coverage options. It will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions. People will receive the summary when shopping for coverage, enrolling in coverage, at each new plan year, and within seven business days of requesting a copy from their health insurance issuer or group health .

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Readand understand the article

Provide solution to the conflict"

Home Health Care Services

 1. Types of Services Provided:

 Doctor Care: Doctors visits to the homes of the patients for disease diagnosis, management and regular follow ups.

 Nursing Care: Services comprise of wounds, ostomy, intravenous, hydromorphone and other drug administration and observation of health changes and alleviation of pain.

 Therapies:

 Physical Therapy: Muscle and joint relief.

 Occupational Therapy: Provides care to the patients who have physical or mental challenges in their ability to execute their daily activities.

 Speech Therapy: Helps in enhancement of skills of communicating.

 Medical Social Services: Offers psychotherapy plus service coordination/coordination/ brokerage for mental health problems that are severe and/or chronic.

 Home Health Aides: Helps in washing and dressing of patients or clients.

 Homemaker Services: This encompasses taking care of the meal, doing the laundry and any other housely chores.

 Companionship: Provides security to the patient who stays at home alone since they can be monitored by the nurses.

 Volunteer Care: Offers necessities such as food, shelter, clothing and some sort of companionship among other things.

 Nutritional Support: The assessments of the diets taken and the advice given by the dietitians.

 Laboratory and Imaging: A home based laboratory testing and portable X-ray services.

 Pharmaceutical Services: Delivery of medicines and equipment, with staff training if required.

 Transportation: It provides transportation to and from medical centres.

 Home-Delivered Meals: Other disservices include home delivered meals for those patients who cannot prepare their meals.

 How Medicare reimburses Home Health Agencies

 Medicare reimburses Home Health Agencies (HHAs) under a prospective payment system:Medicare reimburses Home Health Agencies (HHAs) under a prospective payment system:

 Base Payment: A flat fee paid for each 60 day episode of care.

 Case-Mix Adjustment: Changes that would depend on the current state of the patient as well as the kind of care he/she requires.

 Geographic Adjustment: It also true reflect regional wage differences of many countries.

 Outlier Provision: Makes correct billing for patients with cost-intensive requirements.

 Episodes: There is no limit on the number of episodes within a treatment centre; further episodes are included as long as the patient still qualifies for the service.

 In Medicare Home Health Face-to-Face Requirement

 Purpose: To make sure that a physician or non-physician practitioner allowed by Medicare certifies a beneficiary for home health care:

 In-Person Visit: Documentation of a face-to-face visit with a patient is required to be done by a physician or a NPP.

 Certification Documentation: It is also obligatory to connect those parameters with the clinical condition assessed.

 Timing: Home health care condition for visit to occur is that patient Start home health care withing 90 days before or 30 days after a visit.

 Applicability: For patients new to the care of CPI and who commence care on or after January 1, 2011.

 Issues and Solutions

 Issues:

 Complexity of Reimbursement Process: Being able to make correct and timely adjustments for a patient’s care plan can be difficult.

 Compliance with Face-to-Face Requirement: Adhering to document writing and timing standards can sometimes be a challenge.

 Coverage Limitations: Patients can be rationed access in proportion to their own requirements and in consideration to geographic location.

 Potential Solutions:

 Streamlined Documentation: Install electronic health records (EHR) systems for effective documentation to enhance self reporting.

 Training and Resources: Ensure the care managers have received adequate training in the aspects of the special needs of Medicare and EHR systems.

 Policy Review: Some of the tips they suggest include: The policies should be reviewed and updated to reflect the new needs and also enhance efficient reimbursement.

 Thoughts on Face-to-Face Requirement:

 The face-to-face requirement is envisaged to prevent circumstances that would lead to giving people health care services they do not need at their homes. On the one hand it provides for better control and regulation, on the other hand it can, at times, present logistical problems. The mixture and high quality documentation with the practical application of means and methods is the key to maintaining the high level of care while avoiding excessive paperwork