...February 2, 2008 CONSULTATION Seen in consultation because of chest pain and cardiac irregularity. This patient tells me that about 10 years ago he had a severe episode of chest pain and was hospitalized for a heart attack. About three days ago, he started having more shortness of breath. He also began having chest pains plus nausea and vomiting. His breathing was quite difficult, and so he came in to the emergency room, was found to be in congestive heart failure with cardiac irregularity, and was admitted to the hospital for further care. The rest of his history can be obtained from his previous record. On physical examination the patient does appear older than his stated age of 69 by at least five years. His blood pressure is 186/80, his pulse is 100 to 178, and he has runs of paroxysmal atrial tachycardia, frequent premature ventricular contractions, and he has had a couple of short runs of ventricular tachycardia. During one of his runs of PAT, I gave him 5 mg of verapamil intravenously, and this reduced the rate dramatically. His neck veins are distended. He has moist rales over both lungs. The heart is at the midclavicular line in the fifth interspace, and there is a systolic murmur at the apex. His abdomen is soft. No masses can be felt. He has 2 + edema in the lower extremities. Both of his knees have bruises from a previous fall. I did not do a rectal exam because of his respiratory difficulty. It is my impression that he has a combination of...
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...1. Guidelines for care of a person with with cardiovascular disease is Encourage your patient to rest Make sure your patient follows the doctor's orders. Make sure that your patient takes the required medication every day. Help your patient avoid future heart problems by helping them avoid these high risk factors smoking, high blood pressure, high blood cholesterol level, physical inactivity and alcohol. Take care of yourself. Limit the amount of fluids that the person gets. Give the person a low salt diet. Salt holds water and fluids. Take daily body weights. These weights should be done in the morning before breakfast, after the person has voided and using the same scale Measure intake and output. Position the person in a sitting position when they are short of breath. Elevate the person's leg when they have fluid build up (edema). 2. ECGs electrocardiographs are used to measure the heartbeat by recording the electrical impulses in the heart. This is especially helpful in determining whether or not there is an abnormal heartbeat (arrhythmia) present. Ultrasound equipment, such as echocardiographs, allow for the examination of a patient's heart in much the same way that they allow for the observation of a fetus in a womb, which is their other primary medical use. Defibrillators Defibrillators are used by cardiologists on patients who are having a heart attack. It supplies electrical energy to the heart in an attempt to jump start the heart into once again beating...
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...A1. Considering all the facts, the most feasible option is to develop oncology services and building space for it within Trinity Community Hospital. The facts are as follows: Currently, Trinity Community Hospital (TCH) does not offer any formal oncology, orthopedic, or cardiology programs. There are no cancer specialists at TCH; however, there are a few cardiologists and orthopedic surgeons that maintain privileges at the hospital. Little work is done at TCH for orthopedic services, as the specialty groups are located to a competing facility. There are also several orthopedic groups interested in opening practices near the hospital. Several cardiology services around the hospital offer more sophisticated services than at TCH, drawing most of the cardiology patients away from the hospital. There is no oncology services mentioned. In terms of competition, there are two hospitals within close proximity. One has strong orthopedic and cardiology programs, but a poorly organized oncology program. The second hospital also has a strong orthopedic program and existing cardiology program. This hospital also has a poorly organized oncology program. Building space for oncology service will allow patients to easily coordinate with services already within the hospital and make use of the newly improved and more developed resources within Trinity Community Hospital. The Community Health Needs Assessment identified that the orthopedic cases are expected to rise by over 46%, inpatient joint...
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...Community Health Needs Assessment Trinity Community Hospital AMT Task 2 Community Health Needs Assessment Trinity Community Hospital conducted a community health needs assessment (CHNA) to identify the needs of the local population. The assessment focused on oncology, orthopedic, and cardiovascular services. The following report will analyze the community health needs assessment by identifying the major risk factors in the community, and discussing if the needs defined in the evaluation are being addressed. The report will also outline recommendations for any outstanding community needs. Major Risk Factors Oncology Services The community health needs assessment identified that new cancer cases are expected to increase by 34% due to the aging population that will be over 65 within the next five years and a rise in expectation of men and women developing cancer. The assessment also identified that the current services are already stressed.; physician practices are at capacity, facilities and equipment are not keeping pace with the patient volume, services are fragmented, and there is little emphasis on prevention education and control. Orthopedic Services Another risk factor for the community is the sharp increase in the need for orthopedic services forecasted over the next five years. The need for orthopedic procedures in the next five years are expected to increase by 46%, inpatient joint and spine cases will increase by 30%, and outpatient spine and joint...
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...The role of interventional radiology has played a significant part in the diagnosis and treatment of patients. There have been many advances with instrumentation, and equipment, promoting excellent care to patients in the cardiac catheterization laboratory. Ultrasound has been an exceptional tool in assisting physicians with selection of coronary balloons, and stents for percutaneous coronary interventions. As a critical piece of data collection, ultrasound measurements have emerged as a frontrunner in evaluating vessel diameter and intra-lumen irregularities. This measurement and visualization has become paramount in the cardiac arena, when choosing proper sizing for stent selection. The influence of ultrasound in cardiology has shown...
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...OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOOOO o oooooooooooooooooooooooooooooooooo o oooooooooooooooooooooooooooooooooooo o ooooooooooooooooooooooooooooo o o ooooooooooooooooooooooo o oooooooooooooooo o ooooooooooooooooo o ooooooooooooooooooo o oClinic, who is lead author of the report in the July 29, 2008 issue of the Journal of the American College of Cardiology. Most heart attacks occur in the day, generally between 6 A.M. and noon. Having one during the night, when the heart should be most at rest, means that something unusual happened. Somers and his colleagues have been working for a decade to show that sleep apnea is to blame. 1. If you take an aspirin or a baby aspirin once a day, take it at night. The reason: Aspirin has a 24-hour "half-life"; therefore, if most heart attacks happen in the wee hours of the morning, the Aspirin would be strongest in your system. 2. FYI, Aspirin lasts a really long time in your medicine chestClinic, who is lead author of the report in the July 29, 2008 issue of the Journal of the American College of Cardiology. Most heart attacks occur in the day, generally between 6 A.M. and noon. Having one during the night, when the heart should be most at rest, means that something unusual happened. Somers and his colleagues have been working for a decade to show that sleep apnea is to blame. 1. If you take an aspirin or a baby aspirin once a day, take it at night. The reason: Aspirin has a 24-hour "half-life";...
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...services * Arnold Palmer is able to develop custom products that require collaboration down to the third tier of the supply chain. * Arnold Palmer Hospital is the only hospital in the central Florida area with an emergency/trauma department dedicated to pediatric patients. The hospital’s Congenital Heart Institute (CHI), created by a partnership with Miami Children’s Hospital, is well known for its pediatric cardiovascular services. The Congenital Heart Institute combines a select group of cardiologists, cardiac anesthesiologists, cardiovascular surgeons, physicians, nurses, intensivists and technicians to diagnosis and offer treatment to infants and children with heart disease or congenital heart disorders. The CHI is the only pediatric cardiology center to offer real time web-based surgical outcome data. 2. Managing quality * Arnold Palmer supports efforts to make hospital comparison data as transparent and available to the public as possible. * Many quality measurements types to form the most complete picture of a hospital’s total quality of care before making a final decision are used, such as, AHCA, the Joint Commission, Hospital Compare and Patient Satisfaction Surveys. 3. Process and capacity design 35 planning teams study issues such as service, process, staffing and capacity design. 4. Location strategy Arnold Palmer is located in a populous area serving 18 central Florida counties delivering the equivalent of a kindergarten class of babies’ every day. ...
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...Independent Case Analysis Paper: Open Heart at Cabarrus NAME College Abstract In this activity, I will analyze The Case for Open Heart Surgery at Cabarrus Memorial Hospital by using the tools and skills previously learned in my Health Science curriculum. I will provide a brief summary of the case, discuss the major problems, use two case analysis tools and provide a detailed report with a decision. Independent Case Analysis Case Summary The board of trustees at Cabarrus Memorial (CMH) gathered in October for its monthly meeting. The meeting opened by stating the fact that (CMH) did not have an open heart surgery program. The Chairman mentions the fact that a quick decision is needed since Dr. Christy needs to make a decision regarding where he will be working. Dr. Christy was previously a staff member that left CMH to complete a fellowship in cardiovascular surgery and wants to return to work at CMH after his fellowship is complete. Dr. Christy needs to make a decision by the first of January. Should CMH add the open heart surgery program? SWOT The SWOT tool has been utilized to help determine the strengths, weaknesses, opportunities and threats of opening a heart surgery program at CMH. The use of this tool has identified several strengths. One of the strengths includes the fact that CMH and Duke have an affiliation. CMH had several educational affiliation programs and extensive in-service and continuing education programs, including a...
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...Adult Cardiology 11th Floor POB Adult Cardiology at RUMC • Treat a variety of congenital and chronic cardiac conditions – Range in acuity • Has 8 specialized programs that focus on disease and prevention • Ranked 21st in the nation by U.S. News and World Report Clinical Staff • 20 Cardiology M.D.s at Rush – 2 Cardiology M.D.s at Rush Oak Park Hospital • 1 Nurse Practitioner • 2 Check-In Clinic Coordinators • 3 Discharge Clinic Coordinators • 5 Certified Medical Assistants • 2 Call Center Coordinators • 3 Registered Nurses – Coumadin Clinic – Phone Triage Physician Education • Medical Degree or Doctor of Osteopathic Medicine • Residency in Internal Medicine – 3 years • Cardiology Fellowship Training – 3-4 years per ACGME guidelines 4 Outpatient Clinic Volumes • On average the clinic will see between 115-140 per day • Staffed with 5-7 Attending seeing patients per day • Roughly a patient volume of 29,000 outpatient visits per year – Monday-Thursday: 115-150 patients – Friday: 80 patients Outpatient Check-In Patients are greeted by two Clinic Coordinators • Verify patients appointment by asking for their name and date of birth • Scan a copy of patients insurance card • If the patient has not verified their insurance with hospital Registration prior to appointment, they would do so at this time • Patient is called to their clinic room by Medical Assistant Check-Out Cardiology utilizes 3-4 Clinic Coordinators who check out patients following...
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...Running head: CARDIOLOGY PRACTICE Cardiology Practice HCM201-0903A-01 Toni Phillips-Wright Cardiology A Cardiologist is certified to treat problems of the cardiovascular system which includes the heart, arteries and veins of the body. Cardiologist treats: Angina – discomfort felt when a blockage in a coronary artery prevents enough oxygen rich blood from reaching part of the heart. Aortic Stenosis – A condition in which one of the valves in the heart (the aortic valve) has become sticky and does not open normally Aerial Fibrillation – An abnormality of the heart rhythm in which chambers of the heart no longer contract in an organized manner. Heart rate often becomes irregular and may be very fast. Congestive Heart Failure – A term used to describe any condition in which the heart is unable to adequately pump blood throughout the body. Endocarditic – A medical term that refers to infection of a heart valve. (Cardiochannel 2009) Systems of Systems of the Body The Circulatory System – the heart, the lungs, and the blood vessels work together to form the circle part of the articulator system. The Respiratory System – supplies the blood with oxygen in order for the blood to deliver oxygen to all parts of the body. (www.stronghealth.com) Common procedures performed Angioplasty – cardiac catheter based procedure Ventricular Arterial Device – Heart Assist Device Implantation Electrophysiology – an invasive diagnostic test CPT Codes 92980 – Transcatheter...
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... Pathophysiology Atrial Fibrillation is a supraventricular tachyarrthymia. In the heart, ventricular rate is controlled by the conduction and refractory properties of the AV node and the progression of wave fronts entering the AV node. Calcium channels are accountable for the major depolarizing current in AV nodal cells. Beta-adrenergic receptor stimulation boosts AV nodal conduction, whereas vagal stimulation impedes AV nodal conduction. Sympathetic activation and vagal withdrawal, as with illness or exertion, speeds up the ventricular rate. After each atrial excitation wave that depolarizes AV nodal tissue, those cells become refractory for a time, preventing subsequent impulses from propagating in the node (American College of Cardiology/American Heart Association/Heart Rhythm Society Task Force, 2014). Loss of atrial coordination will decrease cardiac output and cause contractions to be ineffective. This leads to a disruption in the flow of the blood through the ventricular chambers of the heart. As a result, blood often pools in the ventricles leading to the formation of clots....
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...Chief Complaint: “I am having chest pain.” Question One: Please describe your chest pain in terms of it being a new or prior symptom, onset, duration, radiation, quality, what makes it worse or better, and describe the location(s) felt. Rationale: Understanding the patient’s pain gives a perspective of potentially what or where the underlying etiology could be, or where to start as a focal point for the assessment. Priest (2012) assert that there is a multiplicity of conditions that could cause chest pain, which includes an acute myocardial infarct, pulmonary embolus, thoracic-aortic aneurysm or dissection, gastroesophageal-reflux disease, chest-wall pain, a muscle pull, inflammation in the lining of the lung from a viral infection, and gallbladder or pancreas problems. Dodaro (2015) states that the experience of chest discomfort lasting longer than a couple of minutes or chest discomfort that comes and goes might signal an emergent condition and the clinician should test for the most urgent causes first. Diagnostic testing should be the focus of ruling out the potential differential diagnosis associated with the highest morbidity and mortality is the nature of the chest pain is unknown, which is AMI, PE and aortic dissection. Associated potential normal and abnormal findings: • Coronary angiograms will indicate an abnormal finding of a blockage in one or more of the coronary arteries. • Women's heart attack symptoms, signs, and treatment differ from men's, international...
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...Atherosclerosis: A Perspective for the 1990s. Nature , 362, 801-809. Runciman, A., Xu, D., Pelton, A. R., & Ritchie, R. O. (2011). An Equivalent Strain/Coffin-,amsopm Approach to Multiaxial Fatigue and Life Prediction in Superelastic Nitinol Medical Devices. Biomaterials . Santillo, M. (2008). Fracture and Crack Propagation Study of a Superficial Femoral Artery Nitinol Stent. University of Pavia. Simulia. (n.d.). Abaqus Analysis User's Manual. Simulia. (n.d.). Abaqus Theory Manual. Simulia Central. (2011). Adjustable Rigid Torus (ART). (Simulia) Retrieved January 2, 2012, from Extensions for Abaqus: http://www.simulia.com/products/rsurf.html Sirol, M. (2006). Atherosclerosis Plaque Imaging and Characterization Using Magnetic Resonance Imaging. US Cardiology , 1-5. Suri, J. S., Yuan, C., Wilson, D. L., & Laxminarayan, S. (2005). Plaque Imaging: Pixel to Molecular Level. Amsterdam: IOS Press. Suter, Y., Schoenenberger, W., Toggweiler, S., Jamshidi, P., Resink, T., & Erne, P. (2009). Intravascular Ultrasound-Based Left Main Coronary Artery Assessment: Comparision Between Pullback from Left Anterior Descending and Circumflex Arteries. 21 (9). Tang, D., Yang, C., Zheng, J., Woodard, P. K., Saffitz, J. E., Sicard, G. A., et al. (2005). Quantiying the Effect of Plaque Structure and Material Properties on Stress Distributions in Human Atherosclerotic Plaques Using FSI Models. 127. The A to Z of Materials. (1999). Stainless Steel-Grade 316L-Properties, Fabrication, and Applications. Retrieved February...
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...A nursing assistant wheels Margie Whitson back to her room at Golden Oaks Rehabilitation Center and helps her back into bed. Golden Oaks is located on the grounds of Marion General Hospital, owned and operated by the hospital board of directors. It has been a very difficult day. Margie takes a deep sigh as she leans back into bed and says, “I’ll get into night clothes in a few minutes if that’s alright. I’d just like to sit here and think for a little while.” The nursing assistant nods in agreement Margie has just attended the funeral of her son William, who died this week after several years of poor life quality in the same nursing facility. William’s first stroke happened 3 years prior; two more strokes followed, and he lingered in poor health at the center over the intervening time. Margie is now 95 years of age, and William was 73 when he passed this week. The last 5 years have simply been devastating for Margie. First her husband Earl passed on at the age of 88. They had been married for 68 years, most of them wonderful and successful years together, until the medical problems began. They had one other son, Jacob, who died in a motor vehicle accident in his 30s. As Margie sits in the quiet of her nursing home room, she faces the reality that she is utterly and completely alone in the world. She and Earl had hoped for grandchildren, but that never happened, and Margie’s family is simply all gone now. Margie’s own health is poor. A hip fracture 10 years ago...
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...professional services? Suppose the percentage Dr. Greber paid to the physicians had not exceeded Medicare’s guideline? Would that payment still amount to prohibited remuneration in this court’s eyes? Yes. I think Dr. Gerber is still responsible. Although the payments made had legitimate purposes, they could still be viewed as intent to induce referrals. And as long as one purpose among all was intended to induce referrals then a statute becomes violated. Secondly, the law views remuneration as anything that has monetary value. Therefore, I would agree the court would view that payment as a prohibited remuneration. 2. Suppose you were a lawyer or a compliance officer advising a hospital cardiology department. The department has a contract under the terms of which it will pay a certain cardiology group a fixed dollar amount for every electrocardiogram (ECG) interprets, and the hospital will bill Medicare accordingly. The dollar amount is equal to Medicare’s allowable charge for ECG’s (less $10 at this writing), and all readings are medically necessary. You ask why the hospital does not just let the doctors bill Medicare themselves, and the reply is, “ Oh, it’s such a hassle for them. We already have a billing department, and we can do it for them easily.” What is your response, and why? I would respond in this way: I would prefer that the Doctors be the ones involved in the billing but if the Hospital imposes then they must follow all regulatory guidelines. I will remind them that...
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