About Coding Into Practice

Diagnostic Coding: ICD-10-CM

Assignment 1.3

Diagnostic Coding: ICD-10-CM

W6: Coding

Your Name:

Part 1

Instructions: Review each case and identify the first-listed diagnosis.

1. Pain, left knee. History of injury to left knee 20 years ago. Patient underwent arthroscopic surgery and medial meniscectomy, right knee (10 years ago). Probable arthritis, left knee.

FIRST-LISTED DIAGNOSIS: ________

2. Patient admitted to the emergency department (ED) with complaints of severe chest pain. Possible myocardial infarction. EKG and cardiac enzymes revealed normal findings. Diagnosis upon discharge was gastroesophageal reflux disease.

FIRST-LISTED DIAGNOSIS: ______

3. Female patient seen in the office for follow-up of hypertension. The nurse noticed upper arm bruising on the patient and asked how she sustained the bruising. The physician renewed the patient’s hypertension prescription, hydrochlorothiazide.

FIRST-LISTED DIAGNOSIS: _______

4. Ten-year-old male seen in the office for sore throat. Nurse swabbed patient’s throat and sent swabs to the hospital lab for strep test. Physician documented “likely strep throat” on the patient’s record.

FIRST-LISTED DIAGNOSIS: _____

5. Patient was seen in the outpatient department to have a lump in his abdomen evaluated and removed. Surgeon removed the lump and pathology report revealed that the lump was a lipoma.

FIRST-LISTED DIAGNOSIS: _____

Part 2

Instructions: Match the diagnosis in the right-hand column with the procedure/service in the left-hand column that justifies medical necessity.

E 6. allergy test a. bronchial asthma

B 7. EKG b. chest pain

A 8. inhalation treatment c. family history, cervical cancer

C 9. Pap smear d. fractured wrist

G 10. removal of ear wax e. hay fever

I_ 11. sigmoidoscopy f. hematuria

J 12. strep test g. impacted cerumen

F 13. urinalysis h. jaundice

H 14. venipuncture i. rectal bleeding

D 15. X-ray, radius and ulna j. sore throat

Part 3

Instructions: Review the following SOAP notes or Operative reports to select the diagnoses that should be reported on the CMS-1500 claim. Then assign ICD-10-CM codes to diagnoses. (The level of service is indicated for each visit.)

16.

S: A 53-year-old new patient was seen today for a level 2 visit. The female patient presents with complaints of polyuria, polydipsia, and weight loss.

O: Urinalysis by dip, automated, with microscopy reveals elevated glucose.

A: Possible diabetes.

P: The patient is to have a glucose tolerance test and return in three days for her blood work results and applicable management of care.

17. PREOPERATIVE DIAGNOSIS: Ventral hernia

POSTOPERATIVE DIAGNOSIS: Ventral hernia

PROCEDURE PERFORMED: Repair of ventral hernia with mesh

ANESTHESIA: General

PROCEDURE: The vertical midline incision was opened. Sharp and blunt dissection was used in defining the hernia sac. The hernia sac was opened and the fascia examined. The hernia defect was sizable. Careful inspection was utilized to uncover any additional adjacent fascial defects. Small defects were observed on both sides of the major hernia and were incorporated into the main hernia. The hernia sac was dissected free of the surrounding sub- cutaneous tissues and retained. Prolene mesh was then fashioned to size and sutured to one side with running #0 Prolene suture. Interrupted Prolene sutures were placed on the other side and tagged untied. The hernia sac was then sutured to the opposite side of the fascia with Vicryl suture. The Prolene sutures were passed through the interstices of the Prolene mesh and tied into place, ensuring that the Prolene mesh was not placed under tension. Excess mesh was excised. Jackson-Pratt drains were placed, one on each side. Running sub- cutaneous suture utilizing Vicryl was placed, after which the skin was stapled.

18.

PREOPERATIVE DIAGNOSIS: Intermittent exotropia, alternating fusion with decreased stereopsis

POSTOPERATIVE DIAGNOSIS: Intermittent exotropia, alternating fusion with decreased stereopsis

PROCEDURE PERFORMED: Bilateral lateral rectus recession of 7.0 mm

ANESTHESIA: General endotracheal anesthesia

PROCEDURE: The patient was brought to the operating room and placed in the supine position where she was prepped and draped in the usual sterile fashion for strabismus surgery. Both eyes were exposed to the surgical field. After adequate anesthesia, one drop of 2.5 percent Neosynephrine was placed in each eye for vasoconstriction. Forced ductions were performed on both eyes, and the lateral rectus was found to be normal. An eye speculum was placed in the right eye and surgery was begun on the right eye. An inferotemporal fornix incision was performed. The right lateral rectus muscle was isolated on a muscle hook. The muscle insertion was isolated, and checked ligaments were dissected back. After a series of muscle hook passes using the Steven’s hook and finishing with two passes of a Green’s hook, the right lateral rectus was isolated. The epimesium, as well as Tenon’s capsule, was dissected from the muscle insertion and the checked ligaments were lysed. The muscle was imbricated on a 6-0 Vicryl suture with an S29 needle with locking bites at either end. The muscle was detached from the globe, and a distance of 7.0 mm posterior to the insertion of the muscle was marked. The muscle was then reattached 7.0 mm posterior to the original insertion using a cross-swords technique. The conjunctiva was closed using two buried sutures. Attention was then turned to the left eye where an identical procedure was performed. At the end of the case the eyes seemed slightly exotropic in position in the anesthetized state. Bounce back tests were normal. Both eyes were dressed with tetracaine drops and Maxitrol ointment. There were no complications. The patient tolerated the procedure well, was awakened from anesthesia without difficulty, and was sent to the recovery room. The patient was instructed in the use of topical antibiotics, and detailed postoperative instructions were provided. The patient will be followed up within a 48-hour period in my office.

Copyright©2009. Cengage Learning. All Rights Reserved.

Copyright©2012. Cengage Learning. All Rights Reserved. Page 1

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13psy

n this week’s activity you will have an opportunity to play a clinician and diagnose fictitious individuals with mental disorders. Please answer the questions below;

• Susan, a college student, is anxious whenever she must speak. Her anxiety motivates her to prepare meticulously and rehearse material again and again. Is Susan’s reaction normal, or does she have an anxiety disorder? Explain the criteria you used in arriving at your answer.
•  In recent years, several best-selling books have argued that most emotional problems can be traced to an unhappy or traumatic childhood (an abusive or dysfunctional family, “toxic” parents, suppression of the “inner child”). What are two possible benefits of focusing on childhood as the time when emotional problems originate, and what are two possible drawbacks?
• Some mental health professionals (though not most psychologists) think that PMS should be classified as a mental disorder. Drawing on evidence from Chapter 5 of your textbook and information in Chapter 11, write a paragraph giving some arguments against this position.

This assignment must be submitted in “doc” or “ docx.” format. Additionally, it must be typed, double spaced, Times New Roman font (size 12), one inch margins on all sides. Type the question followed by your answer to the question. A title page is to be included. The title page is to contain the title of the assignment, your name, the instructor’s name, the course title, and the date.All assignments must be submitted in “Blackboard by by clicking on the Assignment link under the appropriate weekly unit and clicking on Browse to attach your work as a .doc or .docx.

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 Patient’s Spiritual Needs:

Patient’s Spiritual Needs:

Details:

In addition to the topic study materials, use the chart you completed and questions you answered in the Topic 3 about “Case Study: Healing and Autonomy” as the basis for your responses in this assignment.

Answer the following questions about a patient’s spiritual needs in light of the Christian worldview.

1. In 200-250 words, respond to the following: Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James, or would that mean a disrespect of a patient’s autonomy? Explain your rationale.
2. In 400-500 words, respond to the following: How ought the Christian think about sickness and health? How should a Christian think about medical intervention? What should Mike as a Christian do? How should he reason about trusting God and treating James in relation to what is truly honoring the principles of beneficence and nonmaleficence in James’s care?
3. In 200-250 words, respond to the following: How would a spiritual needs assessment help the physician assist Mike determine appropriate interventions for James and for his family or others involved in his care?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

This benchmark assignment assesses the following competencies:

BS Nursing (RN to BSN)

5.2: Assess for the spiritual needs and provide appropriate interventions for individuals, families, and groups.

Different Methods For Evaluating Evidence.

Name two different methods for evaluating evidence. Compare and contrast these two methods.

Name Two Different Methods For Evaluating Evidence. Compare And Contrast These Two Methods.

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Electronic Health Record Implementation

Electronic Health Record Implementation

Electronic Health Record Implementation

Electronic Health Record Implementation

Electronic Health Record Implementation

Electronic Health Record Implementation

Benchmark – Electronic Health Record Implementation Paper
This benchmark assignment assesses the following programmatic competencies:

2.3:        Develop leadership skills to collaborate on interprofessional teams in the provision of evidence-based, patient-centered care.

5.2:     Apply professional, ethical, and regulatory standards of practice in the provision of safe, effective health care.

One way informatics can be especially valuable is in capturing data to inspire improvements and quality change in practice. The Agency for Healthcare Research and Quality (AHRQ) collects data related to adverse events and safety concerns. If you are working within a practice setting to implement a new electronic health record (EHR) system, this is just one of the many considerations your team would need to plan for during the rollout process.

In a paper of 1,250-1,500 words, address the following questions related to the advanced registered nurse’s role during this type of scenario:

1) What key information would be needed in the database that would allow you to track opportunities for care improvement?

2) What role does informatics play in the ability to capture this data?

3) Which systems and staff members would need to be involved in the design and implementation process and team?

4) What professional, ethical, and regulatory standards must be incorporated into the design and implementation of the system?

5)How would the EHR team ensure that all order sets are part of the new record?

6) How would you communicate the changes, including any kind of transition plan?

7) What measures and steps would you take to evaluate the success of the EHR implementation from a staff, setting, and patient perspective?

8) What leadership skills and theories would facilitate collaboration with the interprofessional team and provide evidence-based, patient-centered care?

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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Freud, Mahler & Adler Evaluation Paper

Paper Help

Prototypes of Ethical Problems

Objectives

The reader should be able to:

• Recognize an ethical question and distinguish it from a strictly clinical or legal one.

• Identify three component parts of any ethical problem.

• Describe what an agent is and, more importantly, what it is to be a moral agent.

• Name two prototypical ethical problems.

• Distinguish between two varieties of moral distress.

• Compare the fundamental difference between moral distress and an ethical dilemma.

• Describe the role of emotions in moral distress and ethical dilemmas.

• Describe a type of ethical dilemma that challenges a professional’s desire (and duty) to treat everyone fairly and equitably.

• Discuss the role of locus of authority considerations in ethical problem solving.

• Identify four criteria to assist in deciding who should assume authority for a specific ethical decision to achieve a caring response.

• Describe how shared agency functions in ethical problem solving.

NEW TERMS AND IDEAS YOU WILL ENCOUNTER IN THIS CHAPTER

legal question

disability benefits

ethical question

prototype

clinical question

agent

moral agent

locus of authority

shared agency

moral distress

moral residue

ethical dilemma

Topics in this chapter introduced in earlier chapters

Topic

Introduced in chapter

Ethical problem

1

Integrity

1

Interprofessional care team

1

Professional responsibility

2

A caring response

2

Accountability

2

Social determinants of care

2

Justice

2

Introduction

You have come a long way already and are prepared to take the next steps toward becoming skilled in the art of ethical decision making. The first part of this chapter guides you through an inquiry regarding how to know when you are faced with an ethical question instead of (or in addition to) a clinical or legal question. A further question is raised: How do you know whether the situation that raised the question is a problem that requires your involvement? This chapter helps you prepare to answer that question too. You will learn the basic components of an ethical problem and be introduced to two prototypes of ethical problems. We start with the story of Bill Boyd and Kate Lindy.

 The Story of Bill Boyd and Kate Lindy

Bill Boyd is a 25-year-old soldier who lives in a large city. Bill served in the U.S. Army for more than 6 years and was deployed to both Iraq and Afghanistan for multiple military missions in the past 4 years. During his final deployment, Bill suffered a blast injury in which he sustained significant shoulder and neck trauma and a mild traumatic brain injury (TBI) and posttraumatic stress. He was treated in an inpatient military hospital and transitioned back to his hometown, where he moved into his childhood home with his mother.

Kate Lindy is the outpatient psychologist who has been treating Bill for pain and posttraumatic stress. Bill is in a structured civilian reentry program. This competitive program is administered by a government subcontractor; its goal is to help injured veterans find meaningful careers or employment on return from the front lines. Bill reports that he is struggling with the transition to civilian life. He originally was prompt in keeping his appointments but recently has missed almost all of his sessions. Twice Bill has arrived for his appointment more than 30 minutes late and smelling of alcohol. Kate informed Bill that she could not treat him in this condition and that if he continued to arrive in this state, she would need to discontinue therapy. Bill responded to Kate and said “You have no idea what all of this is like. And don’t even go there on the alcohol; like you have never had a drink on a bad day.”

Kate is concerned about Bill. She calls his home and gets no answer. She then calls the case manager listed on his intake form. Kate tells the case manager about Bill’s regularly missed appointments (three in the last 4 weeks). She also tells the case manager that Bill has been charged for the missed visits because he has not called to cancel, which is the billing policy of the institution where Kate is employed.

The manager responds that Bill does not qualify for transitional career/employment services unless he is compliant with all outpatient care. She adds that in her experience patients like Bill have a hard time adjusting to the fact that they are no longer eligible for active duty.

The case manager says she will talk to Bill about the unacceptability of his failing to let the therapist know when he decides not to keep his appointment. In fact, if Bill keeps that up, the case manager continues, he will be kicked out of the civilian reentry program because the government cannot be expected to pay for his lack of responsibility. Kate responds that maybe Bill was unclear about the policy. The manager replies, “It doesn’t matter. He’s an army man; he knows better than that.”

A week goes by. At the scheduled time for Bill’s appointment, he again does not appear. Kate has been uneasy about the conversation with the manager, and when the time comes for her to fill out the billing slip for another missed appointment, she feels positively terrible.

 Reflection

Do you share Kate’s feelings that something is not right? If yes, what do you think the problem is? Jot down a few thoughts here and refer back to them as the chapter progresses.

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Recognizing an Ethical Question

Health professionals face all types of questions in clinical practice. Some are ethical questions, but others are not. Many times, what may appear to be an ethical question is in fact something else, such as a miscommunication or a question about a clinical fact or a legal issue. Often, complex clinical situations include clinical, legal, and ethical questions; part of your challenge is to distinguish them and sort them out for their relevance to the patient and the delivery of care.

The following exercise is designed to walk you through one example of an issue that includes clinical, legal, and ethical dimensions, with a description of why the last is an ethical question.

Is this an ethical question? Answer Yes or No:

Can a person status post TBI drive?

If you answered “no,” you are correct. This is a clinical question because clinical tests and procedures can help answer it. Patients who pass various cognitive assessments and an on-road driving evaluation have the clinical ability to drive, and those who fail do not. Refer back to the story at the beginning of this chapter. In the narrative about Bill Boyd, Kate Lindy, and the case manager, what additional clinical information can help you better evaluate the situation?

Now consider the following question:

Must patients with TBI comply with medical advice in this type of situation if they want to continue to drive?

Is this a clinical, legal, or ethical question? If you said “a legal question,” you are on the right track. A tip-off is the word “must.” As you learned in Chapter 1, the laws of the state and other laws are designed to monitor public well-being and enforce practices that protect the public good. Almost all states include procedures to help ensure road safety. Relevant information about people who are dangerous behind the wheel is found in part through clinical examinations. Clinical and legal systems are interdependent in that and other situations, so the decision to ignore clinical recommendations is not always up to an individual patient.

Now, go to the specific legal implications of Bill Boyd’s situation. When the physician referred Bill for therapy, she assessed that the patient’s discomfort was from a combat-related injury. The time may come when Bill wants to apply for disability benefits for his condition. Veterans disability benefits are legally enforced governmental programs in the United States to help protect members of the military from financial duress when injured during service duty. And so, a related legal question relevant to this situation is: Do patients have the right to benefits provided by the government if for any reason they miss prescribed treatment and the professional reports this?

Eligibility usually requires that a patient comply with treatments that are prescribed; the fact that Bill missed multiple treatments may compromise his case. The case manager may choose to fight Bill’s claim for disability benefits now that Kate has contacted the manager with this information.

Finally, consider this question, which is an ethical question. As you read it, think about why it is an ethical question.

Should people with TBIs who refuse to take a recommended onroad driving assessment be allowed to continue driving? If so, under what circumstances?

The word “should” is the tip-off here. It points to something in society all have agreed to support and each individual has a responsibility to help do so. Kate’s reflection on whether she should have talked with Bill’s case manager and her ambivalence about having to charge for treatments that she did not administer are examples of ethical questions about the wrongdoing or rightness of her actions that she was pondering.

 Summary

Ethical questions can be distinguished from strictly clinical or legal questions, although all of these questions often arise in health professional and patient situations. An ethical question places the focus on one’s role as a moral agent and those aspects of the situation that involve moral values, duties, and quality-of-life concerns in an effort to arrive at a caring response.

For your continued learning, we now introduce several prototypes of ethical problems, into which many different everyday ethical questions will fit.

Prototypes of Ethical Problems: Common Features

What is a prototype? Prototypes are a society’s attempt to name a basic category of something. Prototypes can be objects, concepts, ideas, or situations.1 Prototypes of ethical problems are recognizable as a group by three features they have in common. Each of the prototypes in this chapter appears different from the others; in fact, each has a different role to play when ethical questions have arisen. That said, the first step into this venture is to become familiar with the same basic structural features found in all the prototypes of ethical problems:

A: A moral agent (or agents)

C: A course of action

O: An outcome

Each feature is discussed in turn.

The Moral Agent: A

Which of the following best describes your idea of a health professional as an agent?

A. A person with more than one basic loyalty; a deeply divided loyalty (e.g., a double agent).

B. A person who has the moral or legal capacity to make decisions and be held responsible for them (e.g., a signee on a contract).

C. A person who plans schedules or events (e.g., a booking agent).

If you answered “B,” you are most clearly focused on the meaning of agency in the health professions roles you will assume. In ethics or law, an agent is anyone responsible for the course of action chosen and the outcome of that action in a specific situation. Obviously, being an agent requires that a person be able to understand the situation and be free to act voluntarily. Acting as an agent also implies intention: The person wants something specific to happen as a result of that action. A moral agent is a person who “acts for him or herself, or in the place of another by the authority of that person, and does so by conforming to a standard of right behavior.”2

 Reflection

This book emphasizes your role as a moral agent in the health profession setting because as a professional, you must answer for your own actions and attitudes. If you have observed a situation in which someone in your chosen field has had to act courageously, then you have observed a moral agent at work. Briefly describe what you observed and why you feel the responsibility fell to that person to be on the front line of the decision.

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Pathophysiology

Pathophysiology

D. D. is a 66 year-old female suffering from shortness of breath. She smoked 2 packs a day until she quit 2 years ago. She has a history of bronchiolitis, hyperinflated lungs, pulmonary edema, and syncope. Her primary care practitioner suspects she also has pulmonary hypertension (PH). After examination, D. D. has a PAP of 35 mm Hg and mild CHF.

For this week’s discussion, answer ALL questions below:

1.  What is the prevalence of COPD in the United States?  Use the most recent data available and provide a citation for your data.(2 pts)

2.  Do COPD sufferers die of respiratory causes or other causes? Why? (2 pts)

2.  What are the three different medication classes/types of bronchodilators, and how do they EACH function to alleviate the symptoms of COPD? (4 pts)

3.  Is lung transplantation a solution for emphysema patients like D.D.? Why or why not? (2 pts)

Please need done within the next hour, its not paragraph require just questions answered.

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Cases Study

I- Case Study: Care of the Child in Inpatient and Outpatient Settings

Jordan is 9-year-old male who is a direct admit for observation. He has a history of vomiting and diarrhea for 48 hours.

Subjective Data

• Nausea and vomiting for 24 hours
• Has not voided today
• Unable to tolerate oral fluids

Objective Data

• Vital signs: T 37.8° C, P 120, R24, BP 110/60
• Weight: 34 kg
• Hyperactive bowel sounds to auscultation

1. Question 1

When should the discharge teaching begin for Jordan and his family?

2. Question 2

What is the best way to approach Jordan regarding the IV that has been ordered.

3. Question 3

What would be good distractions for a child of Jordan’s age?

II- Case Study: Pediatric Cancer

Mario is a 7-year-old male who presents with a 1-week history of body aches and pallor. He has a 2-day history of fever to 103° F and a 1-day history of bruising and lethargy.

Subjective Data

• Complains of hurting all over
• States he feels very tired
• States he feels dizzy when he stands up

Objective Data

• Weight 26.1 kg
• Vital signs: T 38.9° C, P 140, R 40, BP 108/54, O2 sat 100%
• Purpural rash on extremities
• WBC 0.7
• HGB 3.1
• Hct 8.5
• Plt .08
• ANC 0.1

4. Question 1

Which of Mario’s presenting symptoms must be treated and stabilized before chemotherapy induction?

5. Question 2

What testing is required for a definitive diagnosis of meningitis?

6. Question 3

What should the nurse do in this clinical situation? Prioritize actions.

III-  Case Study: Pediatric Respiratory System

Will is a 4-month-old infant born at 34 weeks of gestation. Will’s mother states that he has not been able to go to day care because he has been coughing with a fever for the past 3 days. She states today he is unable to feed well from the bottle because of nasal secretions.

Subjective Data

• Mother complains that infant has had cough for 3 days
• Mother states that infant is having trouble sleeping
• Not voided in past 6 hours

Objective Data

• Birth Weight: 1.9 kg
• Today’s Weight: 5.5 kg
• Vital Signs: T 38° C, P 186, R 60, BP 90/52, Pulse Oximetry 93%
• Thick yellow nasal secretions
• Nasal flaring with moderate intercostal retractions
• Breath sounds decreased with crackles bilaterally to auscultation

7. Question 1

What risk factors does Will have for contracting bronchiolitis?

8. Question 2

What is the first priority for Will’s treatment?

9. Question 3

What should the nurse do in this clinical situation? Prioritize actions.

IV-  Case Study: Pediatric Gastrointestinal System

Lucy is a 44-day-old formula-fed infant who presents with a 4-day history of vomiting.

Subjective Data

1. Mother states infant has been vomiting undigested formula after feedings
2. Mother states that infant has not had fever or diarrhea
3. Mother states that infant has had 8 wet diapers in the past 24 hours

Objective Data

1. Weight 4.8 kg (birth weight 3.5 kg)
2. Vital signs: T 37.1° C (rectal), P 130, R 30, BP 92/52
3. Mucous membranes moist, anterior fontanel flat and soft
4. Awake and alert, lusty cry
5. Good muscle tone
6. Olive-sized mass palpated at epigastrium

10. Question 1

What test will be used to diagnose pyloric stenosis?

11. Question 2

What should the nurse do in this clinical situation? Using the case study above, the first prioritization step the nurse would take is ____.

12. Question 3

The second prioritization step the nurse would take is ____.

13. Question 4

The third prioritization step the nurse would take is ____.

14. Question 5

The fourth prioritization step the nurse would take is ____.

15. Question 6

The fifth prioritization step the nurse would take is ____.

16. Question 7

The sixth prioritization step the nurse would take is ____.

17. Question 8

The seventh prioritization step the nurse would take is ____.

18. Question 9

The eighth prioritization step the nurse would take is ____.

V- Case Study: Pediatric Cardiovascular System

Michael is a 7-week-old breastfed infant who presents with a 2-day history of irritability and poor feeding.

Subjective Data

• Mom states patient has been “fussy” for past 2 days
• Only feeds for a “few” minutes at a time
• Breathing heavily and fast for 2 days

Objective Data

• Weight: 4.8 kg
• Vital Signs: T 36.8° C, P 250, R 65, BP 84/58
• Breath sounds clear to auscultation
• Oxygen Saturation 95%
• Central capillary refill 4 sec

19. Question 1

What is the treatment for an unstable patient with SVT?

20. Question 2

Decreased cardiac output from prolonged SVT will produce what complication?

21. Question 3

In this clinical situation what should the nurse do? Prioritize actions.

VI-  Case Study: Hematologic System

Liam is an 8-year-old male with a history of hemophilia. Liam presents today with a 1-day history of right elbow pain.

Subjective Data

• Right elbow pain for 1 day
• Patient states he hit his right elbow on desk yesterday
• Patient complains that he cannot move his elbow

Objective Data

• Weight 31.6 kg
• Vital sighs: T 37.4° C, P 82, R 20, BP 108/68
• Rates pain 6 on scale of 10

22. Question 1

How should the nurse respond when Liam’s father explains that they watched and waited to see if Liam needed treatment after his injury?

23. Question 2

Why are neuro checks an important part of Liam’s physical exam?

24. Question 3

What should the nurse do in this clinical situation? Prioritize actions.

VII- Case Study: Common Disorders of the Red Blood Cells

Susan is a 26-year-old G1P0 at 6 weeks of gestation with type 2 diabetes. Her BMI is 32. Her hemoglobin A1C is 9. She uses glyburide 10 mg PO daily. The physician has switched her to insulin at this time.

1. Question 1

What is the nursing priority at this time?

2. Question 2

What should Susan be taught about insulin needs during pregnancy?

3. Question 3

What additional risk factor does Susan have?

4. Question 4

How should Susan be counseled regarding weight gain in pregnancy?

5. Question 5

What advice can be given to Susan regarding exercise?

VIII-  Case Study: Pediatric Genitourinary System

Lilly is a 3-year-old female who presents with complaints of abdominal pain and fever since yesterday.

Subjective Data

• Complains of lower abdominal pain
• Fever for 24 hours
• Lilly has ‘wet her pants’ despite being recently potty trained

Objective Data

• Vital signs: T38.5° C, P 114, R 32, BP 104/62
• Urine positive for WBCs, nitrites, blood

6. Question 1

What risk factors does Lilly have for UTI?

7. Question 2

What might prevent Lilly from a recurring UTI?

8. Question 3

What should the nurse do in this situation? Prioritize actions.

IX-  Case Study: Pediatric Neurologic System

Abby is a 1-year-old female who presents after a reported seizure at day care.

Subjective Data

• Fever for 1 hour
• Eating and drinking normally per mother

Objective Data

• Vital signs: T 40° C, HR 160, R 44, BP 104/68
• Awake and alert
• Skin hot to touch, otherwise normal physical examination

9. Question 1

How should the nurse respond to Abby’s mother when she asks if Abby has epilepsy?

10. Question 2

How should the nurse respond to Abby’s mothers question about brain damage?

11. Question 3

In this clinical situation what should the nurse do?

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Community Assessment And Analysis Presentation

Community Assessment

This assignment consists of both an interview and a PowerPoint (PPT) presentation.

Assessment/Interview

Select a community of interest in your region. Perform a physical assessment of the community.

1. Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.”
2. Interview a community health and public health provider regarding that person’s role and experiences within the community.

Interview Guidelines

Interviews can take place in-person, by phone, or by Skype.

Develop interview questions to gather information about the role of the provider in the community and the health issues faced by the chosen community.

Complete the “Provider Interview Acknowledgement Form” prior to conducting the interview. Submit this document separately in its respective drop box.

Compile key findings from the interview, including the interview questions used, and submit these with the presentation.

PowerPoint Presentation

Create a PowerPoint presentation of 15-20 slides (slide count does not include title and references slide) describing the chosen community interest.

Include the following in your presentation:

1. Description of community and community boundaries: the people and the geographic, geopolitical, financial, educational level; ethnic and phenomenological features of the community, as well as types of social interactions; common goals and interests; and barriers, and challenges, including any identified social determinates of health.
2. Summary of community assessment: (a) funding sources and (b) partnerships.
3. Summary of interview with community health/public health provider.
4. Identification of an issue that is lacking or an opportunity for health promotion.
5. A conclusion summarizing your key findings and a discussion of your impressions of the general health of the community.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA format ting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Attachments NRS-428VN-RS4-FunctionalHealthPatternsCommAssessment.doc
NRS-428VN-RS4-ProviderInterviewAcknowledgementForm.doc
Rubric