Collaborative learning community

/in /by

Running head: CLC YELLOW GROUP: HOME VISIT WITH SALLIE MAE FISHER

 

 

6

CLC YELLOW GROUP: HOME VISIT WITH SALLIE MAE FISHER

 

 

 

 

 

 

CLC Yellow Group: Home Visit with Sallie Mae Fisher

Sarah Jade Anacion, Idalmis Espinosa, Karan Kortlander, Daisy Kuriakose

Grand Canyon University: NRS-410V

August 27, 2017

 

 

 

 

 

 

 

 

 

 

 

Introduction

The authors of this paper will isolate complications based on the nurse’s interview with Sallie Mae Fisher. Upon reviewing the objective and subjective aspects of the interview we will offer assessment information that supports the problem, along with interventions and rationales to help the patient achieve the best possible outcome.

Using a series of five phases we will begin the nursing process: Assessment, Diagnosis, Planning, Implementation, and Evaluation. In the assessment we will include the subjective and objective data. Based on this information we make our nursing diagnosis and identify what the priority problems our patient is dealing with. Once a diagnosis is made we develop a plan based on priorities with set goals and outcomes. We implement this by activating the plan. This can be done by the nurse, physician or a combined effort of both. The final step is evaluating if we have achieved the goals that were set forth. If the patient’s outcome did not meet the goal, we must reevaluate and readjust our goals to suit the patient’s current needs. Critical thinking is used by the nurse throughout this entire process.

Upon viewing the video provided of the home visit with the nurse and nursing student, the following was observed: Sallie Mae Fisher lost her husband last year; she appears to still be grieving. She has a history of congestive heart failure (CHF), atrial fibrillation (AF) and hypertension. Ms. Fisher was recently hospitalized with chest pain, SOB and a several pound weight gain,( most probably due to her CHF and water retention). She was discharged from the hospital last Saturday. When the nurses came from Mountain Home Health to evaluate Sallie Mae, she revealed that she has not been hungry, and she feels run down and tired. She mentioned that she really has not taken care of herself since her husband’s passing. She appears to be non-compliant she refused delivery of the home oxygen she was prescribed to be on 2L per nasal cannula PRN. She said “she did not need it and was worried about the cost”. Her daughter Thelma Jean is identified as her contact and support system. Thelma however works full time and has a family so her availability to her mother appears limited; she was not able to pick up her mother’s prescriptions until a few days after she was discharged. Sallie’s vital signs that were taken during the home visit were: BP 90/56, HR 58 and R24. She was prescribed medications upon discharge; however it appears she is continuing to take her old prescriptions as well. This could cause possible interactions and runs a risk of over medicating the patient (About Health, 2014).

Her diuretic was prescribed Lasix 80 mg BID, however she was already taking 40 mg per day. She should be on a total of 160 mg per day and she is taking 200 mg per day. This could contribute to weakness and nausea (RXList, 2015).This also could cause and imbalance in her electrolyte levels causing arrhythmias. Sallie weighed 136 lbs upon discharge and her current weight is 122 lbs, which constitutes a 14 pound weight loss which is alarming. Her physician should be notified immediately.

Ms. Fisher was prescribed Digoxin 0.25mg once daily for her ( AF ) upon discharge, at home she was already taking Lanoxin 0.125mg every other day. These are also the same medication. This medication is not to be taken if HR is less than 60 BPM. Sallie’s HR was 58 BPM. Ms. Fisher’s weight is 55kg based on that she can take 3.4-5.1mcg/kg which is 0.25mg per day (Drugs.com). The safe dose for this drug is being exceeded, which could lead to toxicity. She should have her Digoxin levels tested with a blood test (U.S. National Library of Medicine, 2015). This could further contribute to her fatigue.

Using both subjective and objective information that was gathered from the home visit with Sallie Mae Fisher, The Yellow Group identifies the following issues that need to be addressed along with interventions and rationales.

 

First problem, intervention and rationale

Ms. Fisher is a fall risk. Given her low BP, HR, medications, lack of appetite, as well as low energy level, There is a loose scatter rug in the Living room and she is wearing improper shoes, newspapers are laying all over the sofa and floor which poses a hazard of tripping and falling. The nurses need to go through her entire home and identify potential risk factors. Clutter needs to be removed and proper lighting needs to be in place (Ackley & Ladwig, 2011). Having client wear non-slip shoes instead of slippers would help prevent falling. Wearing appropriate footwear in the house would prevent her from slipping. Evaluate failure to use assistive aids such as a cane or walker, due to her weakness this would help her navigate through her house(Potter, Perry, Stockert, & Hall, 2011).

 

Second problem, intervention and rationale

 

 

Third problem, intervention and rationale

 

 

Fourth problem, intervention and rationale

 

 

 

Conclusion

 

 

 

 

References

Ackley, B., & Ladwig, G. (2011). Nursing diagnosis handbook: An evidence-based guide to

planning care (9th ed.). St. Louis: Mosby, Elsevier.

About Health. (2014). What is polypharmacy? Retrieved from

http://longevity.about.com/od/agingproblems/f/polypharmacy.htm

Potter, P., Perry, A., Stockert, P., & Hall, A. (2011). Basic nursing (7th ed.). St. Louis, Missouri:

Mosby, Elsevier.

RxList. (2015). Lasix. Retrieved from

http://www.rxlist.com/lasix-drug/indications-dosage.htm

U.S. National Library of Medicine. (2015). Digitalis toxicity. Retrieved from

https://www.nlm.nih.gov/medlineplus/ency/article/000165.htm

COMMENT IJEOMA

/in /by

I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

Choose one legislator on the state or federal level who is also a nurse, and discuss the importance of their role as advocate for improving health care delivery. What specific bill(s) have they sponsored or supported that has/have influenced health care?

Congressman Diana Black, representing Tennessee’s 6th Congressional district. She practiced as a nurse for 40 years.

It is important to have a nurse represented in the house, where laws and policies are passed, because an insider who knows the needs of nurses and healthcare system would be passionate to vote and advocate for the healthcare. There are millions of topics been discussed in the house on state and federal levels, but healthcare issues are very important, because health is universal, everyone use the healthcare system. It is very crucial for a nurse to be part of lawmaking process, not only to speak out for the nurses and make a positive impact on nursing profession, but also as a role model to other nurses, aspiring nurses to go for legislative positions where they can be part of change-making process in the society; which could be beneficial to the patients.

Black supported the passing of Increased   Telehealth Access to Medicare Act, this bill increases access to telehealth services for Medicare Advantage users, in this age of technology, health care access is made easier and affordable using technology. Telehealth focuses on the use of innovative technology for the convenience of patients and caregivers to enhance the quality of care while saving money for both Medicare program and the patients (Black, 2017). This service enhances access to healthcare and reduces the number of in-patient visit to healthcare providers, covered by traditional Medicare plans under the current law (Black, 2017)

Reference

Black. D (2017) Committee Votes to Increase Telehealth Access for Medicare Enrollees. Health. Retrieved September 25th. From https://black.house.gov/media/press-releases/committee-votes-increase-telehealth-access-medicare-enrollees

Define the political economies of a low income & high income countries and describe how governments impact global public health, both positively and negatively?

/in /by

Social Policy & Global Health

Chapter 6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Key Ideas

A nation’s political and economic structures help shape the way social services including health care are delivered

Nations commonly are grouped according to the way they pay for social services

Democracy plays an important role in health but some authoritarian governments also maintain good health among their people

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Traditional Policy Making Cycle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Problem presented

 

 

Solution proposed

 

 

Proposal accepted

 

 

Policy implemented

 

 

Policy monitoring & modification

 

 

 

 

 

 

 

 

 

Policy Development Considerations

Policy environment: cultural, legal, and political context in which policies are made

Solutions sometimes proposed before problem is clearly defined

Even with accurate cost-effectiveness data decisions may not be data-based

Window of opportunity often relevant

More similar to program evaluation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Defining the Problem

First step in policy making

Role of burden of disease analysis

May be challenging to quantify in marginalized or mobile populations (selection bias)

Making private issues public

Domestic violence

Media coverage, public attention

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Program/Policy Evaluation

Program should be based on causal evidence

Cost-effectiveness analyses are helpful but usually not stand alone

Politically powerful constituents can influence decisions

Risk and risk perception are important, and prediction is challenging

Balance of objective data and narrative interpretations

Health may be secondary to other goals (e.g., economy) for decision-makers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Measurement Issues

Selection bias: people included in the study do not represent the underlying population of interest

Randomized controlled trials: the exposure of interest is assigned to participants at random

Reduces confounding

Sensitivity analysis: limiting the analysis to a specific group of people or definition of exposure/outcome to see if findings hold

Can be used to calculate upper and lower bounds

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Political Economy & Health

Economies reflect the allocation of resources within society

Political economy: how political and economic institutions interact in a given environment

Market socialist countries tend to provide social services directly through government agencies

Corporatist states typically provide social services in collaboration with associations

Local politics and social norms influence how social services are delivered

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Political Economy & Health: Low & Middle Income Countries

Typically governments are challenged to provide social protections and services

Low income, low tax revenue

Informal workers may get few or no services

Formal: government jobs

Colonial histories may have contributed to underdeveloped institutions

Services not for locals, civil wars

Clinton & Blair “third way”: markets exist but social programs are emphasized

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Three Forms of Social Democracy in Low & Middle Income Countries

Feature Radical Social Democratic Classical Social Democratic “Third Way”
Unit of organization Class Entire society Individual or society
Social goals Equity Solidarity, growth Market-based growth
Social policies Universal entitlements, redistributive policies Universal policies, no eligibility requirements Means-tested benefits, accessible education, poverty reduction
Benefit levels Traditionally high, now variable Pretty high universally Fairly low but with subsidies
Example countries Kerala, West Bengal Costa Rica, Mauritius Chile, Uruguay

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Health-Optimizing Social Policies

State understands the needs of the population

Well organized state with multilevel communication, adequate resources, and strong infrastructure

A robust civil society to demand some distribution of new wealth

A history of competition, compromise, accountability, and feedback

A strong political party with health sector allies to coordinate efforts and lead program development

Medical Coding Corrections

/in /by

HIT205, Advanced Medical Coding Scenarios

 

Research project number (38166400)

 

 

Part 1

Review each of the following medical coding scenarios. Assign the ICD-10-CM codes for the diagnoses indicated in each scenario. Also assign the ICD-10-PCS code if any procedures are performed, unless otherwise indicated.

 

1. A 61-year-old female patient is seen for a complaint of severe heartburn, lightheadedness, skin reddening, and shortness of breath. The physician renders a diagnosis of GERD, sickle cell anemia, lymphangitis, and diaphragmatic paralysis. What code(s) should be assigned?

ICD-10: K21.9, D57, I89.1, J98.6 Comment by Joyce, Barbara: -1Incorrect I-10 code missing digit D57._

 

2. A 37-year-old patient comes in complaining of swollen joints and headaches. The physician’s diagnosis is SLE. The patient also has rheumatoid arthritis and asthma with status asthmaticus. What code(s) are assigned?

ICD-10: M32.9, M06.80, J45.902 Comment by Joyce, Barbara: -3.5Incorrect I-10 code digits M32._ _ / M06._

 

3. A 52-year-old patient is seen for mouth pain, knee pain, and fluid buildup in the chest. The physician renders a diagnosis of pulp degeneration, old disruption of the posterior cruciate ligament, and pleural effusion. The physician also performed a chest tube insertion (draining the right pleural cavity with a drainage device using a percutaneous approach) prior to diagnosing the patient’s pleural effusion. What diagnosis and procedure code(s) are assigned?

ICD-10: K04.2, M23.50, 0W9930Z, J90

 

4. A 30-year-old male is admitted to the hospital with lymphadenitis, acute lymphoid leukemia in relapse, and von Willebrand disease. What code(s) are reported?

ICD-10: I88.9, C91.02, D68.0

 

5. A 47-year-old male is involved in a motor vehicle accident. He was driving on the highway when his car collided with another vehicle. He was brought to the hospital with a lower arm injury. The physician obtained an x-ray of the arm and, after careful review and interpretation of the x-ray, rendered a diagnosis of lower arm fracture. The physician repaired the arm fracture using open reduction and internal fixation (reposition of the right radius with internal fixation using a percutaneous endoscopic approach). What diagnosis and procedure code(s) are reported?

ICD-10: S52.91XA, 0XQD4ZZ Comment by Joyce, Barbara: -4Missing two other I-10 codesIncorrect I-10 procedure code digits 0_ _ _4_Z

 

Part 2

Review each of the following medical coding scenarios. Assign the CPT code for the services and procedures indicated in each scenario.

1. A 48-year-old male patient comes to the emergency room with complaints of GERD. The physician performs a laparoscopic fundoplasty with a Collis gastroplasty. What CPT code(s) should be assigned? CPT: 43280, +43338 Comment by Joyce, Barbara: -2.5One incorrect cpt code digits 43_ _ _

 

2. A 40-year-old female patient is diagnosed with cervical cancer. She also complains about difficulty breathing. She is admitted to the hospital, where the physician begins to perform a bronchoscopy after anesthesia administration. However, the procedure is discontinued due to unforeseen complications. Later the same day, a bilateral cervical lymphadenectomy is performed to address the patient’s cervical cancer. What CPT code(s) are assigned?

CPT: __31635 -74, 38720 -50 Comment by Joyce, Barbara: -2.5One incorrect cpt code digit with incorrect modifier316_ _ – _ _

 

3. A 50-year-old patient is admitted for a repair of a laceration to the diaphragm resulting from an accident involving a bus that ran into a ditch. She also received eight trigger point injections into the transverse abdominus muscle due to pain resulting from the accident. What CPT code(s) are assigned? CPT: 39501 , 20552

 

4. A 23-year-old patient comes to the emergency room after being physically assaulted by her boyfriend. She complains of nasal pain and bleeding from the left nostril. The physician obtains an x-ray of the nasal cavity, and the x-ray confirms a nasal septum fracture. The physician performs an open treatment of the nasal fracture with a concomitant open treatment of the fractured septum. What CPT code(s) should be assigned?

CPT: 21335

 

 

5. A 33-year-old patient is seen in the emergency room due to complaints of headaches and congestion. The final diagnosis is maxillary sinus infection. The physician performs a nasal endoscopy with a maxillary antrostomy. She also removes some tissue from the maxillary sinus. What CPT code(s) should be assigned?

CPT: 31267

 

Part 3

Review each of the following medical coding scenarios. Assign the HCPCS code(s) required for each coding scenario. 1. A 49-year-old patient is admitted to the hospital for repair of an ankle fracture. On the day of discharge, the physician prescribes a dynamic ankle extension and flexion device with a soft interface material. The ankle device is adjustable. What HCPCS code(s) are assigned?

HCPCS: E1815

 

2. A 26-year-old patient was admitted to the hospital with acute exacerbation of allergic asthma. During the course of the hospitalization, the patient received 5 mg of omalizumab administered subcutaneously. What HCPCS code(s) are assigned?

HCPCS: J2357

 

3. A 58-year-old patient is admitted to the hospital due to severe anemia. He receives six units of fresh frozen plasma on the first day of admission. What HCPCS code(s) should be assigned?

HCPCS: Comment by Joyce, Barbara: -5incomplete

 

4. A 26-year-old patient comes to the emergency room complaining of watery diarrhea for five days. She receives 25 mcg of octreotide acetate administered intravenously. What HCPCS code(s) are assigned? HCPCS: J2354

 

5. A patient is brought to the emergency room after ingesting a bottle of verapamil as a suicide attempt. The physician ordered 10mg of glucagon HCL to be administered as an antidote mixed in 100 ml of D5W in an IV over 2 minutes. What HCPCS code(s) should be assigned?

HCPCS: J1610

 

Part 4

Review the following medical coding scenario. Assign all of the ICD-10 and CPT codes for the diagnoses and procedures indicated in the scenario. After being evaluated by his gastroenterologist, Mr. Jackson was sent to the hospital for a diagnostic esophagogastroduodenoscopy. He is having several symptoms that indicate a potential gastrointestinal condition. As a result, he was admitted in observation. His symptoms include vomiting, weight loss, and dysphagia. The esophagogastroduodenoscopy reveals that the patient has low-grade Barrett’s esophagus, GERD with reflux esophagitis and a non-obstructing hiatal hernia. Patient was also incidentally diagnosed with Crest Syndrome (CRST), which correlates with his complaint of dysphagia. After the procedure, the patient was noted to have several PVC’s on his EKG. These resolved shortly after the patient arrived in the recovery room. Based on the results of the detailed history, detailed, exam, and straight forward medical decision making, it was decided that the patient could be discharged home on the same day with instructions for a follow up office appointment in 2 days. Code this scenario.

ICD-10: ___ODJ08ZZ_________________________________________________

CPT: ______43233-43270______________________________________________ Comment by Joyce, Barbara: -25Highlighted codes and/or digits are incorrectMissing five I-10 codesMissing one E/M code with modifierIncorrect cpt code digit 4323_