Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111,  R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan:

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1.     According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.     Does he need medication(s) given his history of MI?

 Find a scholarly, peer-reviewed article no more than four years old that discusses an ethical health promotion-related issue. Use the WCU library databases to search for appropriate articles.

In your paper:

• Briefly summarize the presented issue.
• Describe your thoughts on the role health care professionals should play in resolving the ethical issue.
• Provide specific theories and refer to specific ethical codes to support your position.

Your paper should be 3 pages long. Use APA to cite and reference the article and any other optional sources you use. Adhere to APA formatting throughout your paper.

Objective: Evaluate risk management, security and safety applications in healthcare.

Introduction: Changes in the healthcare industry have been influenced by new policies and services to meet the influx of people needing  healthcare. As the industry experiences rapid growth, so does the need for healthcare organizations to address risk management, security and safety within their physical environments. This essay will give you the opportunity to apply your knowledge of risk management, security and safety in the healthcare industry.

Deliverable: The essay for this lesson is required to be a minimum of 750 words that clearly demonstrate your understanding  of the activity. Essays should have a clear introduction, thesis statement and conclusion, written in APA format (APAstyle.org). A minimum of three sources must be cited in-text and in the Reference list.

Activity Details

Step 1: Read the following scenario.

You are a member of the Blue Mountain Hospital safety committee. Blue Mountain Hospital has experienced 397 days without injury to staff, a record they would like to keep improving. Recently in the news, a number of incidents around the world have impacted the security of patients’ personal information and of medical facilities. In response to these occurrences, you have been asked to audit the hospital’s risk management plan and make recommendations that will continue to keep employees and information at Blue Mountain Hospital safe.

Step 2: Write a paper.Use what you have learned about this lesson’s objective to write a paper summarizing your responses to the scenario and the following questions/prompts:

-How will you assess the  risks Blue Mountain Hospital faces? Discuss methods, templates and processes.

-How will you manage and mitigate any impact to the  security of patients’ personal information?

-How will you manage and mitigate patient, employee and visitor safety at the medical facilities?

-Describe your recommendations for a safety program and how it would help  to protect the security of patients’ personal information and the medical facilities and to promote a safety-oriented culture.

Topic –  Nursing shortage and the need for more nurses 

Facility – Mary Manning Walsh Nursing Home (New York)

2-2 Milestone 1: Use these prompts as headers –

Organization:

Analyze the organization to determine the key characteristics (including organizational values if applicable) important for consideration when developing plans for change and implementation of quality indicator proposals.

So – tell me about your facility/organization! Is it a hospital, clinic, nursing home, etc? How many beds? What services does it provide? What type of setting is it in (rural/city)? What is its mission/vision? Hierarchy of leadership? Etc.

Improvement Opportunity:

What is the issue(s) involving patient safety and financial considerations within the organization that needs to be addressed?

Explain the connection between patient safety and financial state of the organization in terms of opportunity presented.

Purpose:

Articulate the overall purpose of your proposal/proposed initiative for improving quality of care within your organization. In other words, what is your intended initiative for addressing the issue(s)/improvement opportunity identified?

Proposal Initiative:

Detail the initiative you are proposing in terms of its application to your organization. In other words, what is it that you are proposing, and why is it relevant for your organization?

Leadership:

Articulate the role leadership plays in the current situation/environment that needs to be addressed. In other words, in presenting your proposal to leadership, you will need to articulate the overall role they play in the current environment, such as whether leadership is attempting to address the issue, is unintentionally furthering the issue, or has not yet identified your concerns as an organizational issue.

Please follow rubric attached below for further instructions and 2 sources or more neessary.