...10/27/16 1800 Patient was sitting in the wheelchair and eating supper at dinner room and talking to tablemates very social. Regular diet. Left hand hold and use silverware without difficulty. Right hand was shaking when holding the spoon due paralysis on the right side. Drank two glasses of milk and 1 cup of coffee. Patient reported reasoned to came to this facility because needs physical therapy to recovery from the fall at home. Pt complains she has a lot of pain rating to 7 at leg and tired due went to have physical therapy and occupation therapy at before supper. Reported to nurse about the pain. Administer 1 tablet of Norco 5/325 mg. Teach pt to take a good rest before go tonphysical therapy to reduce the tired. Tell pt to requested prn...
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...As medical assistants, it is not our job to diagnose patients, but when the doctor comes up with a diagnosis, we must write the code for the patient's billing. We must pay close attention to all details when writing anything down. Within the coding, prices are determined to see how much a procedure will cost that the patient will need. Coding is one of the most important things we should pay attention to. Coding is the actual diagnosis of the patient. If there are any errors when writing down the codes, we could misdiagnose the patient. A misdiagnosis could lead to the patient undergoing a procedure that was not even necessary or pertained to anything they had initially. Also, a misdiagnosis can lead to malpractice, and then there would be...
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...DOI: 4/24/2008. Patient is a 59-year old male chief manager who sustained a work-related injury while standing on a ladder and it collapsed on him causing him to fall backwards catching himself with his left arm. Per OMNI, he is status post left shoulder rotator cuff repair on 11/02/09 and manipulation under anesthesia on 06/14/10. Based on the medical report dated 10/14/16, the patient has continued to do quite well, since the last visit although recently because of the cold, damp weather, he has had a little bit of increase in the aching pain in the neck, but this seems to be well controlled with current conservative care. He had been using ice packs and hot packs and daily stretching and strengthening exercises. He feels that it is currently...
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...Impact of damaged sterile wrapping on hospitals finances and patient care. Key words: sterile wraps, sterile processing, contaminated surgical instruments. Introduction: Orthopedics relies strict sterilization procedure to prevent infections. A lot of this depends upon the inspection of sterile wraps and detection of damages in the wraps. Even though, there have been studies on detection rates and financial impact of training staff, nothing has been financial impact of damaged wraps and their impact on delivery of patient care. Our study is a novel attempt in this direction, which has a potential to impact the financial and service aspect of health care. Aim: • Our aim was to investigate the incidence of damaged wrappings of sterilized...
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...Patient is a 26-year-old male who presented to the ED with alleging suicidal threats and assaulting his mother during an argument. Patient stated: "we had an argument and she tried to hit me so I put my hands up to keep her from hitting me." LEO brought patient into the ED. At the time of assessment, patient reports family conflict as the primary stressors contributing to her current distress. The patient mother was unable to be contacted due to an unrelated incident. However, the patient reports he is not concerned about his mother. He states, " karma is real and she got hers for doing this to me." Patient reports having a history Bipolar/Schizophrenia. Patient express he does have some anger issues. During the assessment the patient appears more talkative and describes his mood as being happy. Per nursing staff the patient on arrival was more irritable and pacing his room. Patient currently denies homicidal ideations and having any visual or auditory hallucinations. He states, " I'm just trying to say the right things because I don't want to be here." Patient does not appear to be exhibiting signs of agitation, aggression, or responding to internal stimuli. The...
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...The art of nursing is very critical in caring for new patients, especially those with newly diagnosis. Quality nurses use theories of caring and compassion as they listen to their patients’ stories, while learning from their patients best ways to provide quality nursing care. Mrs. Levine’s case study is a great example of patient and nurse’s interaction that demonstrate ways nurses can engage patients in way that improves data collection, planning for a successful nursing care plan and alleviate some of the anxiety that newly diagnosed patients might have. In the case of Mrs. Levine case study, we will look at her situation and analyze her first interaction with her nurse as they discuss her new medical diagnosis, her worries and the type of...
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...To obtain a position as a phlebotomy/patient intake representative, with 24years of combined experience as a highly committed individual who works well independently or as a team member. Dedicated to customer satisfaction and able to work well under pressure, an adaptable and quick learner seeking a position that offers challenging opportunities while using my knowledge and skills to further professional growth. Awarded 3 labor medals for hard word and long term serving worker. EMPOLYMENT HISTORY Patient service technician PST/patient intake representative, phlebotomist Protestant hospital ngaoundere Cameroon. Responsibilities Obtained patient collection and specimen for processing, shipping, and packing. Performed occupational drug testing...
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...In the healthcare setting pressure sores (pressure ulcers) represent an ongoing challenge to health care professionals providing care to patients in diverse health-care settings. The incidence of pressure ulcers/sores is reported to be 2.5 million patients each year causing cost burden of 9.1 to 11.6 billion dollars each year in the United States (AHRQ, 2011). One of the foundation study conducted to address this challenge was by Dr. Nancy Bergstrom in collaboration with Dr. Barbara Braden to develop and test the effectiveness of use of Braden Scale for assessing risk of pressure sores. In their study, the tool was tested in a multisite clinical trial involving hospitals, Veterans Administration (VA) medical centers and skilled nursing facilities. The study concluded Braden Scale as an effective tool in determining risk of pressure sores in patients (NNIR, n.d). This research has served as a milestone in identifying and preventing pressure sores in high risk patient population. The Braden Scale is among the most widely used tools used for predicting the risk of development of pressure sores. It assesses patient risk in six areas i.e. sensory perception, skin moisture, activity, mobility, nutrition and friction/ shear. The Braden Scale gives an item score in each subgroup ranging from one (highly impaired) to three/four (no impairment).Summing score of each subgroup yields a total overall risk for pressure ulcers ranging from 6-23 (Stotts, & Gunningberg...
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...Case Study: Keep Patients Waiting, Not in My Office Questions: 1) The key to successful scheduling is to allot the proper amount of time for each visit, depending on the services required, and then stick to it. This means that the physician must pace himself carefully, receptionists must be corrected if they stray from the plan, and patients must be taught to respect their appointment times. By actually timing a number of patient visits, I found that they break down into several categories. We allow half an hour for any new patient, 15 minutes for a well-baby checkup or an important illness, and either 5 or 10 minutes for a recheck on an illness or injury, an immunization, or a minor problem like warts. You can, of course, work out your own time allocations, geared to the way you practice. When appointments are made, every patient is given a specific time, such as 10:30 or 2:40. It's an absolute no-no for anyone in my office to say to a patient, "Come in 10 minutes" or "Come in a halfhour." People often interpret such instructions differently, and nobody knows just when they'll arrive. There are three examining rooms that I use routinely, a fourth that I reserve for teenagers, and a fifth for emergencies. With that many rooms, I don't waste time waiting for patients, and they rarely have to sit in the reception area. In fact, some of the younger children complain that they don't get time to play with the toys and puzzles in the waiting room before being examined, and their...
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...Nurses use research to provide evidence based care that promotes quality health outcomes for the patients, families, communities, and the health care system. Nurses and other healthcare personnel are able to use the skills learned through evidence based research to decrease a patient’s length of stay, decreases morbidity and mortality, and healthcare cost. Nursing research is a scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice (Burns & Grove, 2011). Extensive research is needed to develop sound empirical knowledge for synthesis into the best research evidence needed for practice. This research evidence might be synthesized to develop guidelines, standards, protocols, or policies to direct the implementation of a variety of nursing interventions (Burns & Grove, 2011). One example of nursing research that has improved patient outcomes is through the use of VAP (ventilator associated pneumonia) bundles in an intensive care unit setting for patients that are intubated for more than twenty four hours. VAP is pneumonia that occurs in a patient who was intubated and ventilated at the time of or within 48 hours before the onset of event (Centers for Disease Control and Prevention, n.d.) The Institute of Health Improvement (IHI) developed a ventilator bundle that incorporates several strategies to prevent morbidity associated with being on a ventilator. These strategies included: elevation...
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...which results in chronic hyperglycemia. Patients with diabetes require adequate self- management skills, life style changes and continued support along with pharmacological management to improve and maintain optimal glycemic control. Occasionally, patients develop severe insulin resistance and transition to U-500 concentrated regular insulin (U-500 insulin) to maintain adequate control of their rising blood glucose levels. The cost and care requirements of patients using U-500 insulin are markedly higher. There are approximately 3000 Veterans receiving care at the Madison Veterans Healthcare Administration Hospital (Madison VHA) outpatient diabetes clinic, and 67 patients are currently using U-500 insulin (Personal communication B. Babler 7/23/14; D. Nyland, 10/29/14)....
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...Nursing practice is the expectation of nurses, established by nursing staff and patients, which is the general standard accepted. Reflection allows a nurse to improve and advance their experiences.This essay aims to discuss patient abuse within aged care facilities and a nurses duty of care are two issues that allow a nurse to reflect and develop their practice skills and person-centered practice. The World Health Organisation (WHO) defines elder abuse as a separate or continuous action, or where care is absent within a relationship that requires trust, resulting in physical and emotional violence towards the patient.(World Health Organization, 2018). Nurses hold a duty of care to their patients. They additionally carry a legal obligation...
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...Case Study of DKA Patient Anonymous Student Name College or University Name Your Nursing Class # Instructor’s Name November 18, 2011 R.C. is a 42 year old Native-American male that presents to the ER today generally looking ill and, appears to be 10 years older than his stated age. He is dehydrated, and has had Type 1 diabetes, which was diagnosed ten years ago. He has been sick for the last 2 days; as stated by his wife, “I brought him in today (ER) because he is just not getting any better.” Mrs. C. also said that her husband has vomited, over the last 2 days. R.’s chief complaint (c/c) is abdominal pain, voiding frequently, and hasn’t been taking insulin due to nausea. Vital signs (RR) 32, and oxygen saturation (SAO2) 95%. He is alert & orientated (A&O) A&O x 1 (oriented only to person), and his mouth and mucous membranes are very dry. Doctor’s Orders: After seeing Mr. C. the doctor orders: CBC, Chem Panel, Electrolytes, UA with ketones, ABG, 12 lead EKG, and sliding scale insulin to be given IVP, oxygen at 2L/min per nasal cannula, and IV bolus of 500 cc/NS. After initiating a peripheral IV catheter, blood samples are drawn for labs and the nurse administers the 500 cc/NS and rechecked VS: Temperature (T) 100.3, P-106, BP-92/56, and RR-28. Labs The labs return with blood glucose of 625, K+5.3, bicarb (HCO3) 8 mEq/l, large amounts of ketones in urine and serum. ABG of pH-7.19, PO2-89, CO2-25, and HCO3-15. EKG The EKG is noted for...
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...he would do so. After the wedding, the doctor accepted the fiancée as a patient. The fiancée was pregnant and a blood test revealed that she wa HIV positive. The doctor respected the fiancée’s request to share the result of the blood test infront of her husband and her mother-in-law, as family input is important in the Hispanic culture. After revealing the results, the wife was attacked by Mateo, who accused her of cheating on him, and the mother. The wife was a virgin before her marriage. Identification of...
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...diagnosed with hypertension, which has had an impact on her kidneys. S.W. is currently not a diabetic but is at risk of developing diabetes from her life choices such as diet and lack of exercise. The decreased perfusion that was occurring because of the gastroenteritis caused her Acute Kidney Injury (AKI). This was also causing renin to be secreted from the kidney in an attempt to combat the drop in fluid volume within her body. When the renin was released from her kidney it activated the liver to release Angiotensin I, which was then converted to angiotensin II by Ace-Converting Enzyme. Once this occurred angiotensin II stimulated aldosterone to retain both sodium and water to elevate the circulating volume and blood pressure. In a normal patient this system would have been effective in preventing severe symptoms of dehydration, however because S.W. has a history of hypertension, it further exacerbated the condition. S.W was recently diagnosed with ADHD in the last six months. According to Targum and Adler (2014), this is a fairly rare occurrence to be diagnosed this late in life. Targum and Adler (2014) state that only ten to twenty-five percent of adults that fit the criteria to be diagnosed as an adult are actually diagnosed. According to Halter (2014) individuals with ADHD show an inappropriate amount of inattention, impulsiveness and hyperactivity. It was very obvious from just talking with S.W. that she suffered from a certain level of inattention, and hyperactivity. The...
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