1. You are a nurse caring for a 58-year-old ironworker who has been admitted to your unit with acute hypertension. He became extremely symptomatic at work and was brought to your emergency department (ED) via ambulance. After receiving a report from the ED nurse, he is brought to your unit asymptomatic (other than his BP of 178/106) and seems in good spirits. After completing his admission paperwork, he settles in and awaits his health care provider. Four hours later, you answer his call light and he reports headache (rated 6 on a 0-to-10 scale) and dizziness. 

a. Outline the pertinent information within this case study.

b. How often would you expect to measure the patient’s vital signs based on his history?

c. What would be your first intervention upon his reporting increased symptoms? Include rationale.

d. What is the patient’s pulse pressure?

e. Describe risk factors that could be contributing to your patient’s hypertension.

2. As a nurse in a critical care unit, your newest admission is a 24-year-old victim of a motor vehicle accident (MVA). Report from the OR nurse indicates that the patient has several surgically repaired fractures, a closed head injury, and elevated temperature. Additionally, he has IV fluid running postoperatively and dressing changes scheduled every shift. The patient is intermittently alert and disoriented, with his pain adequately controlled by IV analgesics. 

a. Outline the pertinent information within this case study.

b. What factors could be causing the patient’s elevated body temperature?

c. Why is determining the fever’s cause important?

d. Indicate areas that are important to monitor in a patient with elevated body temperature.

e. Describe cause-specific interventions useful in treating the patient’s elevated body temperature.

Medicaid or Medicare: which program has greater impact in your state?  

           To determine which insurance has greater impact it is important to analysis some aspects associated with these programs (e.g., socio-demographic characteristics of the population covered). Typically, Medicare pays the major portions of medical bills, including hospitalizations and the implementation of this particular program does not result in unbound demand on the part of the recipients for covered services. In addition, it is important to keep in mind the eligible populations of both programs. For instance, Medicare is a federal program that provides health coverage for individuals who are 65+ or under 65 and have a disability, without taking into account their income. Conversely, Medicaid is a state and federal program that provides health coverage if you have a very low income. However, both programs work together to provide health coverage and lower your costs for their recipients (Leonard et al., 2017).

           According to recent data, more than 4.6 million patients are enrolled in Medicare in Florida and about 3.6 million patients in Florida are eligible for Medicaid in Florida, including approximately 235,000 children who are enrolled in the Children’s Health Insurance Program (CHIP). In my opinion, Medicare has a greater impact in Florida since this program covers the major portions of medical bills (about 80 %) and the number of people aged 65 or older in this state is higher when compared to other states. According to the results of a recent study performed by the Census Bureaus in 2018, Florida is one of the top three states with the highest percentage of elderly population in United States, in addition Texas and California. Furthermore, we have to keep in mind that patients covered by this program are 65 year-old or older or under 65 with a disability; therefore, the costs of health care are much higher since they suffer from medical chronic conditions and receive healthcare services characterized by high costs (e.g., mental health care, home health services, etc.) (Hu & Mortensen, 2018). 

References

Hu, T. & Mortensen, K. (2018). Mandatory statewide Medicaid managed Care in Florida and

hospitalizations for ambulatory care sensitive conditions. Health Research and Educational Trust, 53.1, 293-311. doi: 10.1111/1475-6773.12613.

Leonard, C. E., Brensinger, C. M., Nam, J. N., Bilker, W. B., Barosso, G. M., Mangaali, M. J. &

Hennessy, J. (2017). The quality of Medicaid and Medicare data obtained from CMS and its contractors: Implications for pharmaco-epidemiology. BMC Health Services Research (2017) 17:304, 1-7. doi:10.1186/s12913-017-2247-7.