1-Mr. C has a variety of health issues related to his obesity. He has an elevated fasting blood glucose which indicate that he could be diabetic, an A1C level should be drawn to follow up with that. He also has elevated triglycerides, normal levels for a male should be between 40-170, his is 312. His total cholesterol are elevated as well, which normal levels should be less than 200, and his is 250 (Comprehensive Guide to Normal Lab Values, 2019).  Keeping that in mind, he probably has high cholesterol diagnosis as well. His blood pressure is also elevated, which means that he needs more than just sodium restriction in his diet to control. Without him being on any medication, he is asking for a stroke in my opinion. Further education needs to be provided for him especially in needing to change his diet. Not only does he need to control his sodium intake, he also needs to monitor, carbs and sweets. 

Personally, I would not recommend bariatric surgery until I am convinced that he is ready for the change. I would recommend that he loses some weight first since it would be risky with him being obese, to even undergo anesthesia. 

1. Health      perception- Mr. C has a poor general health as evidenced by his lab levels      and vitals. It seems that with his sedentary lifestyle, he is lacking      exercise which would be very beneficial for him at this point. He is      realizing that he needs help with his obesity and is considering bariatric      surgery, so that is a positive. 

Nutritional-Metobolic Pattern- It seems that with his high BMI, high HDL and cholesterol levels, he has a poor eating habits. He did mention that he attempts to control his blood pressure with sodium restriction. 

Elimination- This category was not discussed. 

Activity-Exercise Pattern- He works at a catalog telephone center, which means that he probably does not get much exercise with this job. He lives a sedentary lifestyle. 

Sleep-Rest Pattern- He mentioned that he has sleep apnea. 

Cognitive-Perceptual Pattern- He did not mention any cognitive deficits or hearing difficulties. He works at a telephone center so he must have good communication skills. 

Self perception- He did not mention much of his life outside of his job, so he may have low self-esteem associated with the obesity. 

Sexuality reproductive pattern- This was not discussed. 

Coping stress tolerance pattern- This was not discussed but he is seeking help with his obesity. 

Values Beliefs pattern- This was not discussed. 

1. 5      problems- His sedentary lifestyle is a problem that needs to be addressed.      Mentioning that including even walking on his lunch break could make a      huge difference in losing weight. Him not being able to control his blood      pressure with just restricting sodium from his diet alone. With this high      of blood pressure and high cholesterol he is a major risk for a stroke, as      I mentioned above. Getting him started on medication would be crucial for      him. I would also address that sleep apnea a little further as well.      Asking if he is using a CPAP machine at home and how deligiant he is at      using it. Another problem, is his diet. I would have him be referred to a      nutritionist or further educate him on learning to maintain his diet. I      would recommend weight watchers, they have a great program that is easy to      manage with just an app. They even have support groups as well so he can      meet people through it. If he does not control his diet and continue      gaining weight, he would be at risk for many other diseases that cause a      shorter life and could be life threatening. 

Reference 

Comprehensive Guide to Normal Lab Values. (2019). Meditec. Retrieved from https://www.meditec.com/resourcestools/medical-reference-links/normal-lab-values/

 

 
 

2-I agree that these days people look for a quick pill to take care of their problems. There are so many fad diets and they are just not realistic in helping people to maintain a healthy lifestyle. A family friend once did an all shake diet and of course lost several pounds because of the lack of caloric intake. He maintained the weight loss for less than a year before quickly regaining it plus some. Changing lifestyle behaviors and educating yourself on the importance of a well-balanced diet is extremely important for making positive and long-term changes for yourself. I think the same would go for Mr. C. He needs to know how to continue to strive for a healthy lifestyle after the surgery in order to maintain his weight after.

 Reply  |  Quote & Reply 

 
 

3-it can be tough to face things like obesity and hypertension, especially at such a young age. It is good that she has you and your family for support. It is also good that she is identifying that she has issues that need to be addressed and taking the steps to make better choices. Weight watchers can help to teach individuals about healthy nutrition and portion control. Walking her dog everyday is also a good step towards getting more steps in and living a healthier lifestyle. It can be hard I’m sure to sit behind a desk all day and then come home and find the energy to exercise. Keep on encouraging her!

 

4-Yes the follow through of diet is so important. When my sister had the surgery several years ago she had to lose about 50# prior to the actual surgery. Part of that process was to shrink the stomach and get used to smaller meals. One of the complications after the surgery can be”dumping syndrome”. This is when a rapid emptying of the stomach occurs and moves into the small intestine. Many people experience this and can have symptoms of bloat, diarrhea, dizziness, nausea and sweating (Rovito, 2019). Ways to prevent this is to have no refined sugar or unnecessary fat, eat 5-6 smaller meals and no liquids between meals (Rovito, 2019). I read that doctors actually don’t mind when thsi occurs in patients because it helps them to try and to eat better. I know for my sister she had to really learn how to eat..she intiially lost an incredible amount of weight and looked quite unhealthy but then it stabilized. She started to gain her weight back but the physician put her on some medication to reduce her appetite and that helped and she lost more weight. She goes to a physician every 6 months and this has helped to keep her on track. She eats very little because she gets so full but she doesn’t mind..her brain has learned to be okay with smaller amounts.

Reference

Rovito, P. (2019, February 4). Complications of gastric bypass surgery 22 potential problems. Retrieved from https://www.bariatricsurgerysource.com

 

 
 

   5- Weight loss has to do with burning more calories than you take in.  You could theoretically eat junk food that totals 1200 calories a day and loose weight.  The problem comes in when you are hungry shortly after eating that junk food.  The trick is to eat foods that help you feel full for a longer amount of time and use portion control.  I would rather eat foods that keep me from feeling hungry.  With bariatric surgery, your stomach is shrunk down so you should only ingest teaspoons of broth at a time.  If you have psychological need to eat foods, you will stretch your stomach out again and regain all the weight you lost.  Eating for most people in this country is not a survival thing….it is an emotional thing.  You tie your emotions to food.  People in Africa or India do not have the luxury of eating due to stress.  Until you recognize food as fuel, you will not likely keep off the weight you lost.  

    I think it is important to teach our children a different way of looking at food.  It should be gas for your body and we should be putting in unleaded.  We should teach them to not overfill the tank; stop associating food with love or other emotions.

 

 
 

   6- I would say most of the people in this class already understand the difference between type 1 and type 2 diabetes.  Type 1 being an autoimmune disease that attacks individuals who are genetic carriers of HLA type genes.  Type 2 has a genetic component however, it is an acquired disorder that becomes active due to obesity and lack of exercise causing insulin resistance.

    There is a very long and detailed explanation regarding your question about obesity and type 1 diabetes.  In the past, type 1 diabetes was only diagnosed in childhood and these children were diagnosed after a significant weight loss.  Children in general were already thin, active and healthy eaters because this was the lifestyle.  In recent times, the increase in technology and junk food has caused a rise in obesity in all populations but especially children.  Type 1 diabetics do not escape this trend.  One article even says that there is a higher incidence of obesity in type 1 diabetics than any other people group (Mottalib et al., 2017).  This article goes further into detail about insulin and the growth hormone along with how they affect the basal metabolic rate.  You can read the details for yourself, but to sum it up, type 1 diabetes does not make your body immune to fat accumulation anymore than anyone else.  If you left type 1 diabetes untreated with insulin for a long period of time, you would have weight loss from cell starvation.  Of course, you would go into significant keto acidosis and could die.

    Treating the type 1 diabetes with insulin reverses the effects of weight loss.  In fact, hyperinsulinemia causes obesity and increases the growth hormone.  This is seen particularly in mothers with gestational diabetes.  The mother has increased glucose levels that increases her need for insulin.  Her body cannot meet the demand, but the fetus has no problem with insulin production.  Glucose crosses the placenta, but insulin does not.  The baby produces the correct amounts of insulin to cover the increased glucose that crossed the placenta.  This hyperinsulinemia causes the baby to grow to an alarming size.  This causes macrosomia.; a baby that is too large for the gestational age.  As a side note, this increases the baby’s risk of developing type 2 diabetes later in life.

    A trend that has been seen in recent years is to have double diabetes.  Now that we are able to do extensive diagnostic testing, we can see that a patient could have the antibodies present with type 1 diabetes and the insulin resistance seen with type 2 diabetes.  Incidentally, obesity in a person with the antibodies that are seen with the type 1 diabetes causes that person to become an actual diabetic sooner.  I would think in layman’s terms it is from placing undue stress on the pancreas to produce higher levels of insulin and the islet cells run out of juice.

    I could go on, but I am guessing this answers your question. 

References

Mottalib, A., Kasetty, M., Mar, J. Y., Elseaidy, T., Ashrafadeh, S., & Hamdy, O. (2017, August 23). Weight management in patients with type 1 diabetes and obesity. Current Diabetes Reports, 17(10). https://doi.org/10.1007/s11892-017-0918-8

 

Introduction

• Topic area
• Research question
• Significance

Assignment details:

Topic Area: Begin by stating the type of facility in which, or about which, the research will focus [for example: hospital, physicians’ office, urgent care center, etc.]

Then, follow with a strong introduction that will share a brief overview that will inform the reader about the specific topic on which the research will focus. This section should also include a brief explanation of why the results are expected to be relevant to the facility, and its ability to be effective and efficient.  

Research Question: Once the topic area is established, repeat and elaborate on what you wrote about your research question in week one’s assignment. What specific issue or question will your work investigate? What can be learned from this research project?

Significance: Why is this study, and its statistically significant results, important to this facility and its ability to provide quality health care services? Explain why it will be beneficial to answer this question with facts. What are the implications of completing this study? How might these facts [statistically significant results] affect the policies and procedures of this facility? This section should also include why the reader should find value in the completion of the project.

Submit your original work on a Microsoft Word document. Estimated length: two-to-three pages

 

Respond  using one or more of the following approaches:

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings, or after synthesizing multiple postings.

 

                                                  INITIAL POST 

             Using evidence-based practice (EBP) is an essential tenant of nursing  practice. Therefore it is imperative to develop the skills necessary to  gather, interpret, and evaluate scientifically based data. To begin my  research for this week’s assignment, I first did a Google search of  nursing research topics to help myself generate ideas and narrow down a  problem that interested me. After considering several topics, I decided  to write about delirium in acutely ill patients.  Acute Delirium is  something that I have a lot of experience with, both personally and  professionally. The aim of my research will be to find out how  non-pharmacological interventions compare to pharmacological treatment  of acute delirium.

Search Results Analysis

             Once my topic was selected, I went to the Walden library to search for  evidence-based literature on delirium management. According to Walden  University (2018), the levels of evidence pyramid determines the quality  and amount of evidence available. The top three sections of the pyramid  are referred to as filtered results. Filtered results are comprised of  systematic reviews at the pinnacle of the pyramid, followed by  critically appraised topics, and critically appraised individual  articles. The next three sections of the pyramid are referred to as  unfiltered results and include randomized controlled trials, cohort  studies, and case-controlled studies. Background information and expert  opinions make up the base of the pyramid (Walden University, 2018). 

           I began searching for resources from the top of the evidentiary  pyramid, systematic reviews. I used the Joanna Briggs Institute EBP  Database, and then limited my search results to systematic reviews, and  set a date range of 2014 to current. I used the keywords “delirium” and  “interventions” this search yielded four systematic reviews. When I  search the term “acute confusion” I found three results. I also utilized  the Cochrane Database of Systematic Reviews, and found two systematic  reviews by searching for “delirium” in the first text box, and “nursing  interventions” in the second text box, again searches were limited to  full text with a date range of 2014 to current. I also used the Joanna  Briggs Institute EBP Database to search for critically appraised topics.  My search for “delirium interventions” yielded just one result.  However, when I searched for “delirium” I found ten results. I also  searched those same terms on Guideline Central and found four critically  appraised topics results. Finally, I searched for critically appraised  individual articles using the Evidence Alerts database, and the terms  “delirium and acute confusion” this search yielded 23 critically  appraised individual articles.

Next,  I searched for nonfiltered resources utilizing the CINAHL Plus  database. I first looked for randomized controlled trials by searching  for the terms “delirium” and “nursing interventions” in the first and  second text boxes respectively; this search query yielded four  randomized controlled trials. To find cohort studies, I typed “delirium”  in the first text box, “interventions” in the second text box, and  “cohort studies” in the third text box, this search resulted in 27  articles. I searched for case studies using the same search terms in the  first and second text boxes and limited the publications to case  studies, this search yielded 56 results.  However, when I adjusted the  filters to include case studies published within the past five years,  the number of results reduced to 14 case studies.  

Comparative Value

             I found congruency between the evidentiary pyramid and my  search results; the further down the pyramid, the more resources I  found; but, the quality of the information decreased concurrently. While  the systematic reviews were not as numerous, they are superior in terms  of scientific rigor and evidentiary support. Moreover, the information I  found within the systematic reviews were very consistent with my chosen  topic compared to information further down the period like cohort and  case studies. When search terms were altered, for example, searching for  “delirium” versus “acute confusion,” the results remained more  consistent when searching for the higher level filtered results whereas  alteration of search terms would create a wide variation in results  further down the pyramid, in the unfiltered resources. 

Polit  and Beck (2017), contend that systematic reviews are the best resources  for EBP because they contained synthesized information about a topic  from numerous evidenced-based studies. However, it is important to  recognize that the quality of evidence can vary significantly regardless  of its position within the evidentiary hierarchy (Pilot & Beck,  2017). Overall, I found greater quality and consistency of information  within the systematic reviews and critically appraised topics and  articles. Nonetheless, I found several high quality randomized  controlled trials and cohort studies that provide high-quality  information for making a comparison between pharmacological and  non-pharmacological interventions for managing delirium. 

Helpful Tips for Literature Reviews

             I found the course guide for this discussion post extremely helpful. I  followed the guide to conduct my searches, find my articles, and  evaluate the information. I also like to use Google Scholar because the  search algorithm pulls a lot of information, it does have some  drawbacks, the main one being that the articles are not always available  in full text. But, it is very user-friendly, and because it casts a  wide net, I can easily find pertinent information. If I see an article  that peaks my interest that is not available in full text, I copy the  title or other vital information and then plug that information into the  Walden University Library. I have always been able to find the article I  want using this method. I also find it helpful to organize my search  results within folders, and to tag my articles with the types of  studies. I also find that the National Center for Biotechnology  Information (2019) is a great resource for locating free, full text,  peer-reviewed, scholarly articles (National Center for Biotechnology  Information, 2019). If I find a study I know that I definitely want to  use in my work, I will create a citation and save it in a word document.  When I begin writing, I can use my reference list that I started during  my literature review as a guide. I have found that this method of  source organization is both helpful and time-saving. 

References 

National Center for Biotechnology Information. (2019). Retrieved March 4, 2019, from https://www.ncbi.nlm.nih.gov/

Polit, D. F., & Beck, C. T. (2017). Nursing research generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.

Walden  University. (2018). Evidence-Based Practice Research: Levels of  Evidence Pyramid. Retrieved from  https://academicguides.waldenu.edu/healthevidence/evidencepyramid#s-lg-box-8700027

 

hi dear,

can help me to finish this assignment with good quality and be on time please?

Please follow the instructor carefully. There are 2 Discussions ,your response to classmates should be at least one paragraph for each Discussion, address the discussion topic or question, be respectful, and add to the discussion. You may draw upon personal experience, course or scholarly references, citing appropriately. Restating the primary response, or agreeing or disagreeing without supporting statements will result in a lower grade. 

In reference to including a paragraph for both primary and peer responses, 4-5 sentences constitute a paragraph.

Discussion one, 

 

hi dear,

can help me to finish this assignment with good quality and be on time please?

Please follow the instructor carefully. There are 2 Discussions ,your response to classmates should be at least one paragraph for each Discussion, address the discussion topic or question, be respectful, and add to the discussion. You may draw upon personal experience, course or scholarly references, citing appropriately. Restating the primary response, or agreeing or disagreeing without supporting statements will result in a lower grade. 

In reference to including a paragraph for both primary and peer responses, 4-5 sentences constitute a paragraph.

Discussion one, 

 

hi dear,

can help me to finish this assignment with good quality and be on time please?

Please follow the instructor carefully. There are 2 Discussions ,your response to classmates should be at least one paragraph for each Discussion, address the discussion topic or question, be respectful, and add to the discussion. You may draw upon personal experience, course or scholarly references, citing appropriately. Restating the primary response, or agreeing or disagreeing without supporting statements will result in a lower grade. 

In reference to including a paragraph for both primary and peer responses, 4-5 sentences constitute a paragraph.

Discussion one, 

 Dear Senator Feinstein,

I am writing as a man in support of women’s constitutional rights and respectfully request that you do not sign Senate Bill S. 109

Birth control is health care, and I want everyone who wants or needs it to have it — no matter where they live, how much money they make, or who employs them. I oppose the administration’s latest attempt to let bosses and schools decide who gets birth control coverage. The rules unlawfully discriminate against women in violation of the Constitution by impeding access to women’s health care while leaving men’s health care untouched and requiring women to pay more for basic health care.

S. 109 is the latest attempt by anti-abortion politicians to eliminate insurance coverage of abortion.  This bill could result in entire private insurance market dropping abortion coverage and would make permanent existing, harmful restrictions on Medicaid coverage of abortion. Nobody should be penalized for seeking or providing comprehensive health coverage.

S.109 would force millions to go without abortion coverage and provides very narrow exceptions only for when the pregnancy is the result of rape or incest and when a physician has certified that the person’s life is in danger. Without coverage for abortion and not letting women and their families control their futures we can force people to pay for the procedure out of pocket and it may force them into bankruptcy.

Thank you for your long-standing support for women’s rights. I urge you to stand against S. 109.

Discussion two,

  

Dear Governor Newsom,

I am writing this letter today to address some concerns I have with the nutritional options being given to our youth within the California school system.  As an employee of Etiwanda School District, I work closely with the students and have had the opportunity to join them in their meal time activity. To say that I was appalled by the choices that were given is an understatement. The National School Lunch Program was created to provide the funding for nutritional lunches for students at an affordable cost. With a program such as this in place, parents are led to believe their children are being offered healthy meal options at school.

Upon entering the lunch room the students are presented with choices for their meals. Some of these choices include pizza, hot dogs, hamburgers, and french fries. Most of the items on the menu are extremely high in fat and sodium. While each of these items has the option of fruit or salad on the side, nearly all students refuse them. Furthermore, their beverage options are either milk or chocolate milk. The sugary choice filled with chocolate is usually the preferred option by children. The only students who are given an alternative are those with milk allergies. While milk is supposed to be a healthier option, The Australian Government Department of Health shows that chocolate milk actually contains more sugar than a juice alternative.  

In writing this letter it is my hope that you are able to fit our children’s nutritional wellbeing into your agenda. There have been many other modifications made to school lunches, such as limited condiments and no soda or candy being allowed. This however is not enough. As a parent I would hope that the schools would have the ability to provide healthy options for my children, but this may require more funding for our schools nutrition program on the states part. With your assistance our youth will have the ability to grow in a healthier manner.

I want to thank you for your time and consideration, as well as your support in this matter.

Thanks,

Assignment 2: Middleville Regional Healthcare

Due Week 9 and worth 130 points

Middleville Regional Health Care is one (1) of three (3) hospitals serving a community of 350,000 people. Summary statistics on Middleville and its competitors, from the AHA Guide, are shown below in Table 1. All three organizations are not-for-profit.

Table 1: Middleville, Brierfield, and Greystone Health Care Systems

Name

Beds

Admissions

Census

OP Visits

Births

Expenses (000)

Personnel

Middleville

575

13,000

350

221,000

2,300

$125,000

2,000

Brierfield

380

17,000

260

175,000

1,200

$130,000

1,875

Greystone

350

10,000

180

40,000

900

$80,000

1,200

The governing board of Middleville hired a consulting company to evaluate its strategic performance, specifically in the areas of Human Resources, Information Technology, Financing, and Marketing. As part of the consultant’s evaluation, several leaders of Middleville’s units were asked their perspective of the organization’s performance.

You are working for the consultant. Your job is to identify the issues from the response that should be considered further by the consultant team and possibly discussed with the governing board and the CEO. The firm has a rule, “Never offer a criticism or negative finding without suggesting how the client organization can correct it,” so you must indicate what sort of correction you would recommend as part of your list. Because you know there were about two (2) dozen other interviews, you decide you should rank your issues in importance, to make sure the most critical are discussed.

Write a six to eight (6-8) page paper in which you:

1. Explain the governing board’s role in these strategic initiatives, determining its responsibility and involvement.
2. Evidence-based management means that operational and strategic decisions are made based upon the evidence that goals and objectives are actually being met. Quantitative measurements must be identified and measured. This data is then used to evaluate the HCO’s performance. Name three (3) performances Middleville can use to measure its success in providing quality healthcare to the community, and identify quantifiable, measureable indicators that can be used to do so. Explain the importance of each performance measurement.
3. Given the statistics of Middleville and its two (2) competitors provided in Table 1, recommend to the HCO what areas it should focus on to maintain its competitive market share as well as continue to provide healthcare to the community in the 21stcentury.
4. Some of Middleville’s Board members are very interested in pursuing advanced technology systems over the next five (5) years, while others are concerned about the enormous expense and need assurance that the investment in technology will be worthwhile. In both monetary and process terms, describe the costs and benefits associated with implementing EMR and associated health data systems. Lay out a plan for how various systems can be implemented.
5. Middleville has faced many challenges in recruiting and retaining nurses and other clinical employees. The economy has hit the area very hard and budgetary limitations have reduced the amount of money available for salary increases. The Board knows it needs to provide other benefits to their valued employees. Provide at least two (2) suggestions to Human Resources to promote employee satisfaction and, therefore, retain experienced personnel.
6. Use at least three (3) quality resources in this assignment. Note:Wikipedia and similar Websites do not qualify as quality resources.
7. Format your assignment according to the following formatting requirements:

 Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page is not included in the required page length.

  Include a source list. Citations and sources must follow SWS format. The source list is not included in the required page length.

The specific course learning outcomes associated with this assignment are:

• Examine how healthcare management concepts and theories are applied to critical issues in healthcare organizations.
• Analyze the critical management issues, purpose, functions, and performance measures of different departments within healthcare organizations.
• Explain how public policy has shaped the development of the U.S. healthcare system.
• Use technology and information resources to research issues in health services organization management.
• Write clearly and concisely about health services organization management using proper writing mechanics.