86 Years Old Asian Male Annual Physical Test and Results

Specific Socioeconomic, Spiritual, Lifestyle, and other Cultural Factors that are related to the Health of our Patient 

The patient comes from a low socio-economic background. This is proven by the fact that the patient depends on his daughter for his survival. This type of background negatively affects the patient type of medication and diets taken. On the spiritual background, the patient comes from an Asian country where most people are Muslims. The religion dictates some aspects of diets and health practices to be done on their people (Ball et al., 2015). The patient has a simple lifestyle on his lifestyle, considering he does not have the capital capability, and the culture dictates so. Many patients about his age are demanded by their religion to be role models and look after their own families. Lastly, the health of our patients may be dictated by the facts of his social organization. The patient seems to have no other people who can support him apart from his daughter, thus worrying more about his life. Patients about his age are supposed to have a family that is taking care of him. 

The Domain I would utilize on my Patient when Conducting a Comprehensive Nutritional Assessment.

When conducting a comprehensive nutritional assessment, the best domain to utilize to my patient is better communication and questionnaires. Other domains are health, behavior, and mental state (Ball et al., 2015). Many patients feel free to answer written questions rather than face to face questions. I would consider presenting my patient with a questionnaire and giving them quality time to answer. Also, when communicating, I would avoid maintaining a firm gaze since the patients may feel uncomfortable. 

More so, I would research my patient language preference and try to speak to them accordingly. Many people prefer to come open to nurses who understand them better. On other matters, as a nurse, I would consider knowing my patient’s environment as it impacts their health (Sullivan, 2012). As a nurse, I would consider knowing all the patients’ diets to create a comprehensive nutritional assessment table for my patient. Lastly, a good nurse researches the health history of the patient. This dearly helps the nurse to know the drugs to administer to the patient. For example, a patient history clearly outlines the effects of a certain medicine; thus, the nurse will avoid administering it. 

Discussion of the Functional Anatomy and Physiology of a Psychiatric Mental Health Patient Together with the Key Concepts, a Nurse must know to Assess Specific Functions.

The patient’s functional anatomy seems to be out of normal, with bruises on his upper arm and back. Also, there is chronic prostatitis, frequent falls, unexplainable weight loss, and elevated blood pressure (Ball et al., 2015). In my opinion, the patient may be undergoing physical abuse or an unpleasant environment. These symptoms may also point to malnutrition or much medication as the patient is enlisted to various medications types. 

His body seems to be normal on our patient’s physiology, with his various parts functioning normally. His pupils seem well-positioned and normal. Also, his extraocular movements are intact and well-positioned. More so, his arcus senilis seems high, with this disorder been common with older adults. Moreover, his conjunctiva and scleral have inflammation. Furthermore, his bowels sound normal, and his objective data are ranging correctly. His blood pressure, pulse, temperature, and his body mass index all ranging normally.

For a nurse to assess a patient well, they should familiarize themselves with the following key factors; firstly, the nurse should know the systems of administering medications. Secondly, the nurse should create a better relationship with the patient (Sullivan, 2012). The nurse should also learn the art of knowing all given symptoms and coming up with a precise treatment.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th edition.). St. Louis, MO: Elsevier Mosby.

Sullivan, D. D. (2012). Guide to clinical documentation (2nd edition.). Philadelphia, PA: F. A.  Davis.

Students will complete the following scenario as an essay.

As you are completing your audits you observe Mary Johnson’s chart and notice the following:

Mary Johnson saw Dr. Nichols today for a well-woman exam. Total charges are $185.00. Mary has two insurance companies:

Primary Insurance

Secondary Insurance

BCBS

Cigna Health Care

Copay: $25.00

Deductible: $200.00 (already met)

100% benefit after copay

80% benefit after deductible

Allowed amount: $150.00

Allowed amount: $125.00

Both claims were submitted at the same time in error.

Money collected from the patient: $0.00

1. Complete the following questions providing rationales for your responses:
   1. How much money did Dr. Nichols receive?
   2. How much should BCBS have paid?
   3. How much should Cigna have paid?
   4. How much is this claim overpaid?
   5. Who overpaid on this claim?
   6. What would be your next steps?
2. Address how this situation might be avoided in the future: be specific and provide steps.
3. The well-woman exam showed this patient due to family history of cancer would benefit from BRCA genetic testing and both insurance companies denied this claim. Format a letter of appeal or BRCA testing.

This assignment is completed as an APA style paper, and should be at least 2-3 pages in length. Demonstrate your business knowledge and professional ethics in your response.

Assignment Expectations:  

• Length:
  • answers must thoroughly address each question in a clear, concise manner; complete answers will likely take 2-3 pages
• Structure:
  • Title and reference page required
  • address each question in a numbered list
• References:
  • References required to be cited if used

reply 1

The term “negotiate” implies conferring with another to reach a compromise. Conflict exists if health professionals blindly advise patients, expecting them to follow the recommendations without understanding patients’ feelings or identifying barriers to patient adherence. Negotiation identifies areas of agreement and disagreement and provides a forum for discussion of solutions. (Falvo, 2011). Patient education is one of the important roles of nursing. Patient teaching can be effective only if patient understand and agrees to follow the instruction. Negotiation is a way to work collaboratively with the patient to establish mutually acceptable goals and problem solve to assist patients’ ability to reach them. Negotiation helps to create effective teaching learning environment. Back in the day, the doctor was considered the last word when it came to a patient’s decision making. Today, physicians share the decision-making with their patients because patients have other things going on in their life that they must include in their healthcare decisions such as careers, families, time constraints and other realities. They need to work with physicians to establish effective, individualized treatments that works for the patient and the provider. The term negotiation, when applied to health care, indicates that a back and forth discussion is occurring where proposed treatment options are presented by the health care professional, considered by the patient, and either accepted, rejected, or altered to fit the patient’s needs (Falvo, 2011). By negotiating with patients, physicians and patients can reach a healthy decision for both parties.

In my practice with the increase of social media on the public’s decisions on healthcare matters, it is important to talk to the patient about their fears and reasons why they want or do not want. By educating them and providing them with evidence-based practice but still letting them make the decision will make them feel more included in the decision process.

Falvo, D. R. (2011). Effective patient education: A guide to increased adherence. (4th ed.). Jones & Bartlett Publishers. Retrieved from: https://viewer.gcu.edu/RQBKXW

reply2

According to the reading “negotiate implies conferring with another to reach compromise” (Falvo, 2011). The reading also points out there are different levels of negotiation by providers. Some (providers) may feel that negotiation interferes with what they consider to be the major goal of patient teaching: to offer information that will help patients improve or maintain health (Falvo, 2011).

Negotiation is part of building a partnership between the provider and patient. Negotiation is a way to work collaboratively with the patient to establish mutual goals and identify problems. Identifying the problems will allow patient’s the ability to reach the goals (Falvo, 2011). Providers also can find areas in the treatment plan the patient may not agree with, this important because this correlates with compliance as well as expectations of outcomes.

I would say that negotiation is a tool that can better or assist in relationships/partnerships between providers and patients. When providers are willing to accept that patients as partners, listen to their side of things and negotiate or meet somewhere in between there is responsibility on both parties. Patients must be honest with providers however and providers must be more flexible. Although the provider is expected to communicate and educate the patient is also responsible for their actions such as following the treatment plan.

An example would be a patient sees a physician the physician says the patient has high cholesterol. Educates on what this finding means, the risks, and suggests medication to correct the problem. The patient voices that she doesn’t want to take medication for the high cholesterol. The physician than explains alternatives to decrease the cholesterol. The patient chooses a non-medication route, the physician then based off this tells the patient they have one month to decrease their cholesterol. The patient and provider agree on the number expected for cholesterol in one month. The physician suggests that the patient decreases trans fats in their diet, adds fiber, adds exercise, and completes smoking cessation (Thorpe, 2017). If the patient goes back and there is not a change the physician tells the patient the medication will need to be started. The patient agrees. The key is now that the patient must be honest whether or not they held them self-accountable and made changes or not when following up. The patient also must express any concerns or difficulties they face with the provider. If the cholesterol is not lower the patient must also follow through on their part of the negotiation.

Critical thinking: Negotiation works in healthcare like it would in any type of relationship. If you tell someone everything is my way and I don’t care about what you think. Most likely that person isn’t going to do what you ask compared to if you said ok, I could see your point can we find a common ground to a solution we agree on. This type of relationship is beneficial for the provider and patient to increase better patient outcomes. Another benefit is the responsibility on the patient as well as the provider. The roles of patient and provider have changed and allows many different levels of acceptance as well as ways to in cooperate better health and patient centered care.

References:

Falvo, D.R. (2011) Effective patient education: A guide to increased adherence. Retrieved from http://gcumedia.com/digital-resources/jonesandbartlett/2010/effective-patient-education_-a-guide-to-increased-adherence_ebook_4e.php

Thorpe, M. (2017). 10 ways to naturally lower cholesterol. Retrieved from https://www.healthline.com/nutrition/how-to-lower-cholesterol

Question one 

Evidence Based Practice on Managing Hypertension

Hypertension can lead to more serious cardiac disorders such as CHF so interventions to prevent it from progressing are important. Here is a Cochran’s Report below that analyzed Research on management of hypertension with recommendations on interventions that are effective. In 100 words, Review the summary and share some of the findings and recommendations to earn credit. link https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005182.pub4/full

Question two

Evidence Based Practice Integration to Nursing Practice

Research using Cochrane Systematic Reviews or Guidelines from the AHRQ. This is the type of source/database you should use when asked to provide EBP or research. Explore the sites, look over an area related to Cardiac/ CHF or respiratory disorders that interests you and in 100 words, share an EBP intervention from the site that nursing could use and share a link to the article or guideline. Replying with EBP from the sites will count as one substantial post for the week.Link 

https://www.cochranelibrary.com/cdsr/about-cdsr

Question three

Scholarly Sources for Academic Work and Practice

Class for your academic undergraduate work you should be using assigned readings and other scholarly sources designed for the health care professional. Posts that use consumer web sites, patient ed sites or news stories designed for the layman do not earn credit. It is important that you understand what constitutes a scholarly source. GCU has a wonderful tutorial on evaluation sources.

To earn credit for one substantive reply post for the week:

1. Visit GCU’s evaluating resources library guide , https://libguides.gcu.edu/EvaluatingSources

2. Review the site. In 100 words Briefly discuss two things you learned. 

Question four

 Evidence Based Practice Guidelines CHF and other Cardiac Complexities

Class here is a link to research from 2019 that seeks to reduce readmission rates for CHF patients. The article has links to EBP in the reference section that may be useful for your study this week. The Clinical section of the American College of Cardiology also provides EBP on common cardiac disorders. In 100 words,review the article and site and share something new that you learned. 

https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/wvn.12336

Question five

Risk Factors for Alzheimer’s Disease

1. Research scholarly sources designed for health care professionals, and provide a ONE risk factor for Alzheimer’s.

2. State the risk factor

3. State whether it is a modifiable risk factor.

4. Summarize why it is a risk factor.. ie the physiological impact

5. Include your reference/source with the required doi or url/ web link

Question 6

 Types of Stroke

 In 100 words describe one type of cerebrovascular accident/stroke (CVA)  the cause and related physiology. In short, what occurs within the body to cause the stroke? Use our text and other scholarly sources to research your answer (Include the reference in your reply). Posts that use consumer web sites like Mayo Clinic and Web MD will not earn credit.

    Generally speaking, Nursing has the largest representation within an acute hospital setting. Nursing is involved in the care of every patient that comes into the hospital. That being said, how nursing document their interactions with patients is a large part of their day. Integrating a new health information technology system should require the input of nursing. Nursing’s input is essential in understanding how the system could require additional workflow changes or updates. Poorly implemented systems can lead to unintended consequences that may have a negative impact on clinical processes and patient outcomes. (Piscotty, 2011)

            When integrating a new system, the System Development Life Cycle (SDLC) model is used. This cycle has five different stages: Planning, Analysis, Design, Implementation, and Maintenance. Each of these stages is essential as you integrate new systems. During the analysis phase, the requirements for the system are teased out from a detailed study of the business needs of the organization. As part of this analysis, workflows and business practices are examined. It may be necessary to consider options for changing the business process. (McGonigle, 2017)

            Nursing is especially crucial when you enter into the implementation stage. The system also was tested by three nurses before implementation. To ensure that the nurses could operate the CDSS correctly, a training manual was developed and provided to the nurses 3 weeks before the implementation date. (Lyerla, 2008) Once you have planned, analyzed, and implemented any new system, occasionally maintenance is required. We need to constantly be evaluating our systems to make sure that we are using it effectively and to its max potential.

            During my time at Homestead Hospital, the operating systems were changed. Nursing was not consulted at the hospital level. The decision to change these systems was made at the corporate level and rolled out to the different facilities in stages. Our hospital was the first and the rollout was rough. We had representatives from the OS company to help facilitate the roll-out 24/7 for 1 week. We needed to constantly refer to them whenever we needed to address a concern or be reminded of how to mitigate certain situations. I think that transition would have been a bit smoother if there were training sessions with the staff prior to roll out. Physicians and nursing could have been trained with time before “go live” and a few issues could have been avoided. Any time that changes are made within an existing system or a new one is implemented, there will be hang-ups. Involving those that would be the most significant users helps in finding any conflicts or adjusting workflows prior to them impacting patient care.

Lyerla F. (2008). Design and implementation of a nursing clinical decision support system to

promote guideline adherence. CIN: Computers, Informatics, Nursing, 26(4), 227–233.