1. Imagine that your hospital has recently merged with a group of clinical centers. As a high-level executive, you and your team have been asked to combine the two cultures. 
2. Create a 3 powerpoint slides with speaker notes 
3. Identify the following in your presentation: 

• The challenges in merging the two cultures  

Will be run through plagiarism checker 

Include 1 reference

 

Develop and Concept Map, using the form provided, on the following patient. Include Diagnostic data and medical orders that you expect to be ordered on the patient.

T.J., a 30-year-old African American client, is in his last year of law school and is clerking for a prestigious law firm. He and his fiancé plan to marry as soon as he graduates. During the last week he has had four dizzy spells and a headache at the base of his skull upon awakening for the last 2 days. His father has a history of hypertension, so T.J. is aware that his symptoms may indicate high blood pressure. On his way home from work, T.J. stops by the clinic and asks the nurse to check his blood pressure. The nursing assessment yields the following data.

Subjective data: States he has had four dizzy spells and has awakened with a headache in the occipital lobe the last two mornings. T.J. has 1 glass of wine at lunch and 2-3 beers in the evening to relax from the tension of school and work. Most of his meals are at fast-food establishments and have a high fat content. T.J. does not smoke. He used to jog 4 mornings a week but quit when he started clerking. He has had nocturia for the last 3 weeks. He is not taking any medication. T.J. states he is concerned about having hypertension because he does not want to take medication.

Objective data: T 98.6°F(37°C), AP 78 beats/min, R 16 breaths/min, BP 142/92 mm Hg, Wt 190 lbs (optimum weight 160). No edema noted in hands, feet, or legs.

Please include 3-4 references

please, provide a response to the following discussion in one or two paragraphs.

  

The response requires one reference from a peer-reviewed NURSING journal less than 5 y/o.  (not from the internet but from Database).Professional, governmental, or educational organizations (.org, .gov, or .edu) may be used as supplemental references.

APA format required. 

Money rules everything is one of the quotes that some companies stand by.  There is evidence to suggest that money does change decisions, and lots of money does alter the future for these companies. However, companies try to incorporate decisions not only using money but also using customer feedback. Some of that customer feedback can ultimately aid in gaming more money. Companies’ goals are to try to make money to provide more for the customers and pay employees. In the healthcare system hospitals, doctors offices, and pharmacies all have to make money to pay employees and keep providing customers/ patient with excellent service. Some of these institutions are for-profit and some are nonprofit. These institutions still need to have some sort of cash flow in order to work. The biggest economic impact on these healthcare institutions are insurance companies. Insurance companies are the driving force of how these institutions get paid for the most part. However, with insurances there is a huge disparity on who has insurance and who can afford insurance. That is why universal healthcare is at the forefront of all economic conversations specifically here in the United States of America. Universal healthcare can allow all citizens of the US to be seen by a doctor and thus maintaining or bettering their health. Nevertheless, universal healthcare comes at a great economic cost. With the longer life span of Americans and the constant spending on health promoting products the United States spends almost 3 trillion dollars yearly on healthcare (Blais & Hayes, 2015). If universal healthcare were to be provided then the United States economy would be affected. That is why it is such hot and heavy economic and social issue. Most healthcare workers take oath to providing some sort of betterment two societies health overall. It is important that healthcare be delivered to everyone no matter the circumstances so that the oath can be upheld. With this in mind economics cannot be separated. Currently almost half of healthcare spending is used to just treat 5% of the population in the United States (Boudreau, 2017). In addition, healthcare costs are rising almost 2% every year (Boudreau, 2017).  All things considered, it is important to start planned out the future of healthcare and healthcare economics. Universal Health Care is definitely an option on the table that can allow the US population and its citizens to receive healthcare no matter what. A plan however needs to be in place so that economic disaster does not overwhelmed the country. Additionally to the economics of universal healthcare, the delivery of healthcare to all the newfound people is another hurdle (Blais & Hayes, 2015). Hospitals and other facilities need to be prepared to deal with the vast influx of people seeking healthcare treatment once universal healthcare is adapted. By hundreds of thousands of people gaining healthcare and them coming into the system it can bombard and potentially crippled the healthcare system. Regardless of the new influx of individuals within the system the type of health received should always be universal. No matter what economic factors might come into play the delivery of the services should never be questioned. Every patient should get the same attention, treatment and procedures no matter what is in place.

  

Episodic Note Case Study:

Assessment of the Abdomen and Gastrointestinal System ABDOMINAL ASSESSMENT Subjective: • CC: “My stomach hurts, I have diarrhea and nothing seems to help.” • HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards. • PMH: HTN, Diabetes, hx of GI bleed 4 years ago • Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs • Allergies: NKDA • FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD • Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys) Objective: • VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs • Heart: RRR, no murmurs • Lungs: CTA, chest wall symmetrical • Skin: Intact without lesions, no urticaria • Abd: soft, hyperactive bowel sounds, pos pain in the LLQ • Diagnostics: None Assessment: • Left lower quadrant pain • Gastroenteritis PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. 

Assignment: Assessing the Abdomen

A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CT scan. The CT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.

Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions

To Prepare

Review the Episodic note case study your instructor provides you for this week’s Assignment. 

· With regard to the Episodic note case study provided:

o Review this week’s Learning Resources, and consider the insights they provide about the case study.

o Consider what history would be necessary to collect from the patient in the case study.

o Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

o Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Assignment

1. Analyze the subjective portion of the note. List additional information that should be included in the documentation.

2. Analyze the objective portion of the note. List additional information that should be included in the documentation.

3. Is the assessment supported by the subjective and objective information? Why or why not?

4. What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?

5. Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

Resource for references

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 6, “Vital Signs and      Pain Assessment”

       This chapter describes the experience of pain and its causes. The authors      also describe the process of pain assessment.

• Chapter 18, “Abdomen”

       In this chapter, the authors summarize the anatomy and physiology of the      abdomen. The authors also explain how to conduct an assessment of the      abdomen.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 3, “Abdominal Pain”
This chapter outlines how to collect a focused history on abdominal pain. This is followed by what to look for in a physical examination in order to make an accurate diagnosis.

Chapter 10, “Constipation”
The focus of this chapter is on identifying the causes of constipation through taking a focused history, conducting physical examinations, and performing laboratory tests.

Chapter 12, “Diarrhea”
In this chapter, the authors focus on diagnosing the cause of diarrhea. The chapter includes questions to ask patients about the condition, things to look for in a physical exam, and suggested laboratory or diagnostic studies to perform.

Chapter 29, “Rectal Pain, Itching, and Bleeding”
This chapter focuses on how to diagnose rectal bleeding and pain. It includes a table containing possible diagnoses, the accompanying physical signs, and suggested diagnostic studies.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.

These sections below explain the procedural knowledge needed to perform gastrointestinal procedures.

Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487)

Chapter 115, “X-Ray Interpretation of Abdomen” (pp. 514–520)

Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Document: Midterm Exam Review (Word document)

Optional Resource

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

• Chapter 9, “The Abdomen,      Perineum, Anus, and Rectosigmoid” (pp. 445–527)

       This chapter explores the health assessment processes for the abdomen,      perineum, anus, and rectosigmoid. This chapter also examines the symptoms      of many conditions in these areas.

   

• Chapter 10, “The Urinary System” (pp. 528–540)

       In this chapter, the authors provide an overview of the physiology of the      urinary system. The chapter also lists symptoms and conditions of the      urinary system.