CLINICAL CASE DECISION INSTRUCTIONS

Grading Criteria for Clinical Case Decisions:

The highest potential points for each Clinical Case Decision Question are 15-points. Students are required to upload their response as a word document attachment to the assignment drop box.

Each uploaded response is worth a possible 15 points.

1.       Your comments should be substantiated and substantive. Postings require two citations from 1 scholarly journal and/or 1 outside text book           Text books assigned to this course may be used for an additional citation only.   
2.       Each of the two references must be from a different reference source.
3.       To gain full credit for the assignment, the response must be a full page discussion, but no more than three (3) pages in length, which                   includes the reference list.
4.       Students are required to use APA format, proper citations, and references.  Students using direct quotes from referenced sources in the body       of the paper must include quotations.
5.       Students will be assigned to a question.

Clinical Cases

You have been assigned two (2) cases to provide analysis.  All cases should include the following:

a. Pathophysiology and pharmacology of the disease

b. Expected signs and symptoms of the disease.

c. Nursing Diagnosis with a plan of care.

d. All questions pertaining to the case are listed under each case. 

Clinical Decision Cases

C1.   Mr. Appel has a severe chronic obstructive pulmonary disease (COPD). He is admitted to the hospital with a respiratory infection and increased dyspnea; yellow, purulent sputum; anxiety; and diaphoresis. He states he feels weak and tired. He routinely takes a diuretic (furosemide) and his pulmonary medications. The following laboratory values are obtained:

Arterial blood gases:

pH 7.25                                         Serum sodium (Na+) 140 mEq/L

PaO2 60 mmHg                             Serum potassium (K+) 2.0 mEq/L

PaCO2 78 mmHg                           Serum chloride (Cl–) 105 mEq/L 

HCO3– 34 mEq/l

a. What type of electrolyte imbalance does Mr. Appel have?

b. Interpret his ABGs.

C2.   Mr. Jones is admitted to the hospital with an exacerbation of heart failure. He has +3 peripheral edema of the lower extremities.

a. What are the possible causes of his peripheral edema?

Assignment: Application: Planned Change
in a Department or Unit

Health care organizations are continuously immersed in change from the emergence of new policies, to promote quality care and improve patient safety to keeping pace with the rapid growth in knowledge and best practices. Establishing a solid framework for planning and implementing change is a wise move, as it provides a foundation for the extensive coordination that will be needed to successfully facilitate the change.

For this Assignment, you propose a change at the department or unit level and develop a plan for guiding the change effort.

To prepare:

• Review Chapter 8 in the course text. Focus on Kurt Lewin’s change theory, and contrast it with other classic change models and strategies.
• Reflect on problems, inefficiencies, and critical issues within a specific department, unit, or area in your organization or one with which you are familiar. Select one issue as a focal point for this assignment, and consider a change that could be made to address the issue.
• Think about how the change would align with the organization’s mission, vision, and values as well as relevant professional standards.
• Using one of the change models or strategies discussed in Chapter 8, begin formulating a plan for implementing the change within the department/unit. Outline the steps that you and/or others should follow to facilitate the change effort. Align these steps to the change model or strategy you selected.
• Determine who should be involved in initiating and managing the change. Consider the skills and characteristics that are necessary to facilitate this change effort.

Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:

• Identify a problem, inefficiency, or issue within a specific department/unit.
• Describe a specific, realistic change that could be made to address the issue.
• Summarize how the change would align with the organization’s mission, vision, and values as well as relevant professional standards.
• Identify a change model or strategy to guide your planning for implementing the change. Provide a rationale for your selection.
• Outline the steps that you and/or others would follow to facilitate the change. Align these steps to your selected change model or strategy.
• Explain who would be involved in initiating and managing this change. Describe the skills and characteristics that would be necessary to facilitate the change effort.

  

The American Cancer Society estimates that by the end of 2012, more than 226,000 women will be diagnosed with breast cancer and more than 241,000 men will be diagnosed with prostate cancer (American Cancer Society, 2012a; American Cancer Society 2012b). With such prevalence of women’s and men’s cancers, patient education and preventive services are essential. In clinical settings, advanced practice nurses must assist physicians in educating patients on risk factors, preventive services, and for patients diagnosed with cancer, on potential drug treatments. The clinical implications of women’s and men’s cancer greatly depend on early detection, which is primarily achieved through preventive services. In this Assignment, you consider the short-term and long-term implications of cancer and drug treatments associated with women’s and men’s health, as well as appropriate preventive services.

To prepare:

• Select a type of cancer associated      with women’s or men’s health such as breast, cervical, or ovarian cancer      in women and prostate cancer in men.
• Locate and review articles examining      the type of cancer you selected.
• Review the U.S. Preventive Services      Task Force article in the Learning Resources. Think about available      preventive services that providers might recommend for patients at risk of      this type of cancer.
• Select two of the following factors:      genetics, gender, ethnicity, age, or behavior. Reflect on how these      factors might impact decisions related to preventive services.
• Consider drug treatment options for      patients diagnosed with the type of cancer you selected including      short-term and long-term implications of the treatments.

Write a 2- to 3- page paper that addresses the following:

• Describe available preventive      services that providers might recommend for patients at risk of the type      of cancer you selected.
• Explain how the factors you selected      might impact decisions related to preventive services.
• Describe drug treatment options for      patients diagnosed with the type of cancer you selected. Explain the short-term      and long-term implications of these treatments.

– This work should have Introduction and conclusion

– This work should have at 4 to 6 current references (Year 2012 and up)

– Use at least 2 references from class Learning Resources

The following Resources are not acceptable:

1. Wikipedia

2. Cdc.gov- nonhealthcare professionals section

3. Webmd.com

4. Mayoclinic.com

Required Readings

 Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

• Chapter 33, “Prostatic           Disorders and Erectile Dysfunction” (pp.      527-544)
            This chapter examines the causes,      pathophysiology, and drug treatment of      four      disorders: prostatitis, benign prostatic hyperplasia, prostate           cancer, and erectile dysfunction. It also      explores the importance of      monitoring      patient response and patient education.
• Chapter 34, “Overactive           Bladder” (pp. 545-564)
            This chapter describes the causes, pathophysiology,      diagnostic criteria,      and evaluation of      overactive bladder. It also outlines the process of           initiating, administering, and managing drug      treatment for this disorder.
• Chapter 55, “Contraception”           (pp. 959-970)
            This chapter examines various methods of      contraception and covers drug      interactions,      selecting the most appropriate agent, and monitoring patient           response to contraceptions.
• Chapter 56, “Menopause” (pp.           971-994)
            This chapter presents various options for      menopausal hormone therapy and      examines the      strengths and limitations of each form of therapy.
• Chapter 57, “Osteoporosis” (pp.           985-994)
            This chapter covers various options for      treating osteoporosis. It also      describes      proper dosages, potential adverse reactions, and special           considerations of each drug.
• Chapter 58, “Vaginitis” (pp.      995-1006)
            This chapter examines various causes of      vaginitis and explores the      diagnostic      criteria and methods of treatment for the disorder.

Holloway, D. (2010). Clinical update on hormone replacement therapy. British Journal of Nursing, 19(8), 496–504

This article examines the purpose, components, and administration of hormone replacement therapy (HRT). It also presents benefits, risks, potential side effects, and alternative treatment options of HRT.

Mäkinen, J. I., & Huhtaniemi, I. (2011). Androgen replacement therapy in late-onset hypogonadism: Current concepts and controversies—A mini-review. Gerontology, 57(3), 193–202. 

This article examines the role of testosterone levels in the development of hypogonadism. It also explores health issues that are impacted by testosterone levels and the role of testosterone replacement therapy.

Drugs.com. (2012). Retrieved from http://www.drugs.com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

U.S. Preventive Services Task Force. (2014). The Guide to Clinical Preventive Services: Section 2. Recommendations for Adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html

This website lists various preventive services available for men and women and provides information about available screenings, tests, preventive medication, 

1. Lab Assignment: Tickler System (For Medical Coding and Billing)

Research tickler systems online. Create a 5-slide presentation, using Power Point, describing a tickler system and showing some system examples. 

2. Lab Assignment: Healthcare Cash Flow 

Below are some articles introduced in this lesson that provide tips and techniques for managing a medical office’s revenue and collections. Look through the articles, then write a 4-paragraph paper that summarizes the following:

Today you are the manager of ABC Clinic. You are facing issues in your collection department and need a solution to help increase your revenue. What are some ways it might do this?

Feel free to make assumptions about how ABC Clinic operates. Enter your ideas into a Word document labeled “CashFlow” 

Helpful links:

• Increase Your Revenue Tip #1 – Prescription Refills
• The 9 Essentials for an Effective Year End (and year to come)
• Seven Ways to Improve Your Patient Collections
• Take a Closer Look at Your Superbill to Ensure Accurate Billing
• Hidden Ways Medical Billing Shortcomings Hurt Your Practice
• Top 6 Medical Billing Tips and Best Practices

3. Lab Assignment: Financial Report Worksheet 

Look at the financial statements for Middlesex Hospital, then answer the questions in the Finance Statement Worksheet.  or download it below.

Personal Class Design Project – Part 1    

Details: Complete this assignment according to the following: 

1.Design a class that you would like to teach someday. The class must be at least 4 hours in length and must be multiple sessions. It can be four sessions of 1 hour each, or two sessions of 2 hours each, depending on your topic and target audience. 

2.Begin by describing the institution that is sponsoring the class (e.g., academic, hospital, or community agency). Include the philosophy of the sponsoring organization and how that will affect the course you are developing. 

3.Explain how you determined a need for this class (needs assessment). 

4.Write a one-paragraph description of the class.

 5.Identify the target audience. 

6.Identify the learning resources you will use for the class (textbooks or other resources). 

7.Write the program outcomes for the course and the learner objectives for each class session. Indicate which domains of learning are represented by each learner objective.  

There is no predetermined length criterion for this assignment. It is intended that each student will develop a class that they can use in their selected area of education.