WK #5 DQ:

Apply information from the Aquifer Case Study to answer the following discussion questions:

· Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

· Describe the physical exam and diagnostic tools to be used for Mr. Payne. Are there any additional you would have liked to be included that were not? 

· Please list 3 differential diagnoses for Mr. Payne and explain why you chose them.  What was your final diagnosis and how did you make the determination?

· What plan of care will Mr. Payne be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.

You and Dr. Lee take a few minutes to review Mr. Payne’s chart:

Vital signs:

· Temperature: 98.6° Fahrenheit

· Heart rate: 80 beats/minute

· Respiratory rate: 12 breaths/minute

· Blood pressure: 130/82 mmHg

· Weight: 170 pounds

· Body Mass Index: 24 kg/m2

Past Medical History: Diabetes, well controlled. Hypertension, fair control. Hyperlipidemia, fair control.

Past Surgical History: None

Social History: Works as a truck driver, which involves lifting 20-35 lbs 4 hours of the day, married with 2 daughters,

Habits: Quit smoking two years ago, drinks 1 to 2 beers occasionally on the weekends, no history of IV drug use.

Medication:

· metformin 500mg 2 twice daily

· glyburide 5mg 2 twice daily

· amlodipine 2.5 mg daily

· lisinopril 40 mg daily

· simavastin 40 mg daily

Allergies: No known drug allergies.

Can you tell me about your back pain?”

“As I told the nurse, the pain started two weeks ago after I lifted a box at work. Right away, I got this sharp pain on the left side of my back. The box wasn’t even that heavy.

“I talked to the nurse at work; she said to ice it and to take ibuprofen. It got better after three days. But, I was playing softball with my daughter last weekend, and the pain came back. This time it was worse than before. This week, the pain is so bad I can hardly get out of bed. I get a sharp pain in my back which goes down my left leg to my ankle.”

“On a scale of 0 to 10, 10 being the worst, how severe is the pain?”

“It’s probably a 7.”

“Have you found anything that improves the pain?”

“Ibuprofen and Naproxen worked at first, but they are not helping much anymore.”

“What about positions that make things better or worse?”

“The pain is worse with any movement of my back or sitting for a long time. It is better when I lie down.”

“Have you had back pain before?”

“Yes, I have back pain from time to time. But I’m usually better after 2 to 3 days. This is the worst pain I have ever had.”

Review of Systems

Mr. Payne does not have numbness or weakness in his legs. The pain is better when he lies down. He denies urinary frequency, dysuria, problems with bowel or bladder control, fever or chills, nausea or vomiting, or weight loss. He denies any specific trauma, except for when he lifted a 10-pound box at work. He denies unrelenting night pain.

Based on your differential, you determine that it is highly likely that Mr. Payne is experiencing a mechanical cause of back pain with nerve involvement such as a disc herniation. It is possible that he has spinal fracture, but a lack of trauma history makes the latter unlikely. It is important to consider cauda equina syndrome, as it calls for immediate surgical investigation, but it is unlikely in the absence of neurological symptoms like loss of bowel or bladder control. Finally, infectious etiology, such as pyelonephritis, is unlikely without fever and chills, urinary frequency and dysuria.

Back Exam – Standing:

Mr. Payne has normal curvature, tenderness on palpation on the left lumbar paraspinous muscle with increase tone. Full range of motion, but has pain with movement. His gait is normal. He can walk on his heels and toes. He can do deep knee bends.

Back Exam – Seated:

Mr. Payne denies feeling pain when checked for CVA tenderness. He has no pain in his right leg with the modified version of SLR. While he does not exhibit a true tripod sign, he does complain of pain when his left leg is raised. Mr. Payne’s reflexes are 2+ and equal at the knees and 1+ at both ankles. The motor exam reveals no weakness of the muscles of the lower extremities. His sensory exam is normal.

Pulmonary Exam: His lungs are clear.

Cardiovascular Exam: His cardiac exam demonstrates a regular rhythm, no murmur or gallop.

Three weeks later, Mr. Payne returns for his follow-up appointment and you discover the following:

Pertinent History

Mr. Payne has had little relief with the treatment prescribed. He is frustrated that he has been in pain for more than a month. His pain has been progressively worse. It radiates down the lateral part of his left leg and side of his left foot. This pain is worse than the back pain. He does not have any problems with bowel or bladder control and there is no weakness of his leg.

Pertinent Exam Findings

Vital signs: stable

Neurologic: Normal gait, but moves slowly due to pain; range of motion is full, with pain on flexion; SLR is positive at 45 degree on the left; motor strength intact; reflexes 2+ bilaterally at the knees, absent at the left ankle, 1+ at the right ankle.

Dr. Lee agrees with your diagnosis of radiculopathy of S1 nerve root with progression. She orders an MRI and sets up an appointment to see Mr. Payne after the MRI.

You and Dr. Lee now return to Mr. Payne’s exam room to talk about treatment options with him. Dr. Lee tells Mr. Payne to avoid strenuous activities but to remain active. Dr. Lee increases the dosage of naproxen to 500 mg BID to take with food. Since his pain is intense (7/10), he is given a prescription for acetaminophen with codeine to take at night, when his pain is severe. Mr. Payne declines a muscle relaxant because they usually make him drowsy. He would like to be referred to physical therapy as it was helpful in the past.

FOLLOW-UP TREATMENT

MANAGEMENT

One week later, Mr. Payne returns for follow-up. You review the results of the MRI report.

MRI report:

1. Moderate-size, herniated disc at L5-S1 with associated marked impingement on the left S1 nerve root and mild to moderate impingement on the right S1 nerve root. There is mild central canal stenosis.

2. Annular tear with a small central disc herniation at L4-5 causing mild central canal stenosis.

You review the findings with Dr. Lee. She agrees with your diagnosis of radiculopathy of S1 nerve root due to a large herniated disc at L5-S1.

You call Mr. Payne two weeks later to see how he is doing. He reports that he is doing quite a bit better. He went to an osteopathic physician who did some manual therapy and started him on a strict walking program. He is very encouraged and plans on losing weight through exercise and diet.

 

Identifying Research Components

Week 4 Tasks

Use the Week 4 research template/////PLEASE SEE ATTACHED/// to complete the following assignment tasks.

• Choose the assigned research articles from W2 Project.PLEASE SEE ATTACHMENTS//// BELOWW ARE THE TWO ARTICLES USED IN WEEK 2

 

Bortz, A., Ashkenazi, T., & Melnikov, S. (2015). Spirituality as a predictive factor for signing an organ donor card.Journal of Nursing Scholarship, 47(1), 25-33. doi: 10.1111/jnu.12107

Dinkel, S., & Schmidt, K. (2015). Health education needs of incarcerated women. Journal of Nursing Scholarship, 46(4), 229-234. doi: 10.1111/jnu.12079

•  Describe the sample with demographics, data collection process, and identification of variables; sampling design; instruments, tools, or surveys.
• Summarized the discussion about the validity and reliability of the instruments, tools, or surveys.
• Discussed legal/ethical concerns.
• NOTE: If a component is absent, student receives a zero for that component.

Submission Details

• Cite all sources in APA format.

 
Details:

Review the Topic Materials and the work completed in NRS-433V to formulate a PICOT statement for your capstone project.

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. 

The intervention should be an independent, specified nursing change intervention. 

The intervention cannot require a provider prescription. 

Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. 

The PICOT statement will provide a framework for your capstone project.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

1. Evidence-Based Solution
2. Nursing Intervention
3. Patient Care
4. Health Care Agency
5. Nursing Practice

Prepare this assignment according to the guidelines found in the APA Style Guide.

This assignment uses a rubric, SEE RUBRIC ATTACHMENT!!!. 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 Turnitin.  

1. A 61-year-old female patient is seen for a complaint of

severe heartburn, lightheadedness, skin reddening, and

shortness of breath. The physician renders a diagnosis of

GERD, sickle cell anemia, lymphangitis, and diaphragmatic

paralysis. What code(s) should be assigned?

ICD-10: __________________________________________

2. A 37-year-old patient comes in complaining of swollen

joints and headaches. The physician’s diagnosis is SLE.

The patient also has rheumatoid arthritis and asthma

with status asthmaticus. What code(s) are assigned?

ICD-10: __________________________________________

3. A 52-year-old patient is seen for mouth pain, knee pain,

and fluid buildup in the chest. The physician renders a

diagnosis of pulp degeneration, old disruption of the posterior

cruciate ligament, and pleural effusion. The

physician also performed a chest tube insertion (draining

the right pleural cavity with a drainage device using a

percutaneous approach) prior to diagnosing the patient’s

pleural effusion. What diagnosis and procedure code(s)

are assigned?

ICD-10: __________________________________________

4. A 30-year-old male is admitted to the hospital with

lymphadenitis, acute lymphoid leukemia in relapse, and

von Willebrand disease. What code(s) are reported?

ICD-10: __________________________________________

5. A 47-year-old male is involved in a motor vehicle accident.

He was driving on the highway when his car

collided with another vehicle. He was brought to the hospital

with a lower arm injury. The physician obtained an

x-ray of the arm and, after careful review and interpretation

of the x-ray, rendered a diagnosis of lower arm

fracture. The physician repaired the arm fracture using

open reduction and internal fixation (reposition of the

right radius with internal fixation using a percutaneous

endoscopic approach). What diagnosis and procedure

code(s) are reported?

ICD-10: __________________________________________

Review each of the following medical coding scenarios. Assign

the CPT code for the services and procedures indicated in

each scenario.

1. A 48-year-old male patient comes to the emergency room

with complaints of GERD. The physician performs a

laparoscopic fundoplasty with a Collis gastroplasty. What

CPT code(s) should be assigned?

CPT: _________________________________________________

2. A 40-year-old female patient is diagnosed with cervical

cancer. She also complains about difficulty breathing.

She is admitted to the hospital, where the physician

begins to perform a bronchoscopy after anesthesia

administration. However, the procedure is discontinued

due to unforeseen complications. Later the same day, a

bilateral cervical lymphadenectomy is performed to

address the patient’s cervical cancer. What CPT code(s)

are assigned?

CPT: _________________________________________________

3. A 50-year-old patient is admitted for a repair of a laceration

to the diaphragm resulting from an accident

involving a bus that ran into a ditch. She also received

eight trigger point injections into the transverse abdominus

muscle due to pain resulting from the accident.

What CPT code(s) are assigned?

CPT: _________________________________________________

4. A 23-year-old patient comes to the emergency room after

being physically assaulted by her boyfriend. She complains

of nasal pain and bleeding from the left nostril.

The physician obtains an x-ray of the nasal cavity, and

the x-ray confirms a nasal septum fracture. The physician

performs an open treatment of the nasal fracture

with a concomitant open treatment of the fractured septum.

What CPT code(s) should be assigned?

CPT: _________________________________________________

5. A 33-year-old patient is seen in the emergency room due

to complaints of headaches and congestion. The final

diagnosis is maxillary sinus infection. The physician performs

a nasal endoscopy with a maxillary antrostomy.

She also removes some tissue from the maxillary sinus.

What CPT code(s) should be assigned?

CPT: _________________________________________________

Review each of the following medical coding scenarios. Assign

the HCPCS code(s) required for each coding scenario.

1. A 49-year-old patient is admitted to the hospital for

repair of an ankle fracture. On the day of discharge, the

physician prescribes a dynamic ankle extension and flexion

device with a soft interface material. The ankle device

is adjustable. What HCPCS code(s) are assigned?

HCPCS: ______________________________________

2. A 26-year-old patient was admitted to the hospital with

acute exacerbation of allergic asthma. During the course

of the hospitalization, the patient received 5 mg of omalizumab

administered subcutaneously. What HCPCS

code(s) are assigned?

HCPCS: ______________________________________

3. A 58-year-old patient is admitted to the hospital due to

severe anemia. He receives six units of fresh frozen

plasma on the first day of admission. What HCPCS

code(s) should be assigned?

HCPCS: ______________________________________

4. A 26-year-old patient comes to the emergency room complaining

of watery diarrhea for five days. She receives 25

mcg of octreotide acetate administered

intravenously. What HCPCS code(s) are assigned?

HCPCS: ______________________________________

5. A patient is brought to the emergency room after ingesting

a bottle of verapamil as a suicide attempt. The

physician ordered 10mg of glucagon HCL to be administered

as an antidote mixed in 100 ml of D5W in an IV

over 2 minutes. What HCPCS code(s) should be

assigned?

HCPCS: ______________________________________

Review the following medical coding scenario. Assign all of

the ICD-10 and CPT codes for the diagnoses and procedures

indicated in the scenario.

After being evaluated by his gastroenterologist, Mr. Jackson

was sent to the hospital for a diagnostic esophagogastroduodenoscopy.

He is having several symptoms that indicate a

potential gastrointestinal condition. As a result, he was admitted

in observation. His symptoms include vomiting, weight

loss, and dysphagia. The esophagogastroduodenoscopy reveals

that the patient has low-grade Barrett’s esophagus, GERD

with reflux esophagitis and a non-obstructing hiatal hernia.

Patient was also incidentally diagnosed with Crest Syndrome

(CRST), which correlates with his complaint of dysphagia.

After the procedure, the patient was noted to have several

PVC’s on his EKG. These resolved shortly after the patient

arrived in the recovery room. Based on the results of the

detailed history, detailed, exam, and straight forward medical

decision making, it was decided that the patient could be discharged

home on the same day with instructions for a follow

up office appointment in 2 days. Code this scenario.

ICD-10: ____________________________________________________

CPT: ____________________________________________________

I have a test on medical ethics, I need to read 7 articles , and then open the test wich has a time limit 2 hour and half , the test has 5 small essay questions , so I have 250 word or more to write on each questions  .  I will attache the articles for you to read them ,and you have to tell me whenever you ready to can open the test to give you the questions , remember whenever I open the test the time will runing , so you have to answer all 5 questions on 2 hours , also you may use books and notes. Just remember that you always need to cite all sources , the due date is 6 june , so you have to be ready before the 6th of june