Due to increased patient volumes in the facility, the coding manager at Community Hospital is faced with an increased discharge not final bill (DNFB) rate.  The management staff of the HIM department needs to brainstorm possible solutions to rectify this problem.  You have been asked to assist in this process.  

     1.  Brainstorm at least 7 ideas of ways to address this problem.  

     2.  Categorize them into no less than 3 categories. 

  

Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal

One critical element of any physical exam is the ability of the examiner to put the patient at ease. By putting the patient at ease, nurses are more likely to glean quality, meaningful information that will help the patient get the best care possible. When someone feels safe, listened to, and cared about, exams often go more smoothly. This is especially true when dealing with issues concerning breasts, genitals, prostates, and rectums, which are subjects that many patients find difficult to talk about. As a result, it is important to gain a firm understanding of how to gain vital information and perform the necessary assessment techniques in as non-invasive a manner as possible.

For this week, you explore how to assess problems with the breasts, genitalia, rectum, and prostate.

Reading.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 17, “Breasts and      Axillae”

       This chapter focuses on examining the breasts and axillae. The authors      describe the examination procedures and the anatomy and physiology of      breasts.

• Chapter 19, “Female      Genitalia”

       In this chapter, the authors explain how to conduct an examination of      female genitalia. The chapter also describes the form and function of      female genitalia.

• Chapter 20, “Male Genitalia”

       The authors explain the biology of the penis, testicles, epididymides, scrotum,      prostate gland, and seminal vesicles. Additionally, the chapter explains      how to perform an exam of these areas.

• Chapter 21, “Anus, Rectum, and Prostate”

       This chapter focuses on performing an exam of the anus, rectum, and      prostate. The authors also explain the anatomy and physiology of the anus,      rectum, and prostate.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 5, “Amenorrhea”
Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.

Chapter 6, “Breast Lumps and Nipple Discharge”
This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam.

Chapter 7, “Breast Pain”
Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.

Chapter 27, “Penile Discharge”
The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.

Chapter 36, “Vaginal Bleeding”
In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.

Chapter 37, “Vaginal Discharge and Itching”
This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

• Chapter 3, “SOAP Notes” (Previously      read in Week 8)

Cucci, E., Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127. doi:10.12659/PJR.892706. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356184/  

Sabbagh , C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045

Westhoff , C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5–10.

This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.

Centers for Disease Control and Prevention. (2019). Sexually transmitted diseases (STDs). Retrieved from http://www.cdc.gov/std/#

This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.

ASSIGNMENT

GENITALIA ASSESSMENT

Subjective:

• CC: “I have bumps on my bottom that I want to have checked out.”

• HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

• PMH: Asthma

• Medications: Symbicort 160/4.5mcg

• Allergies: NKDA

• FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

• Heart: RRR, no murmurs

• Lungs: CTA, chest wall symmetrical

• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia 

• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney

Diagnostics: HSV specimen obtained

Assessment: Chancre

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

· Analyze the subjective portion of the note. List additional information that should be included in the documentation.

· Analyze the objective portion of the note. List additional information that should be included in the documentation.

· Is the assessment supported by the subjective and objective information? Why or why not?

· Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?

· Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

Please do not write the paper in soap note format. PLEASE ANSWER ONLY THE QUESTIONS. DO NOT REWRITE THE CASE STUDY. Title page and Reference page required ( APA format ).

• Tom Joserine, a nurse manager of a 36-bed orthopedic unit, has decided that he is too busy to complete all the work that needs to be done. Nurse Joserine has recently read an article on delegation and has decided that delegating tasks to others is an excellent way to accomplish the mound of work that he has to complete. He believes that there are two tasks that take most of his time, disciplinary problems and quality improvement activities. Nurse Joserine calls the nursing coordinator, Janet Jeleen, into the office and informs her that she will now be responsible for all evaluations and handling of incident reports. Nurse Jeleen tells him that she will need some guidance on this new activity. Nurse Joserine informs her that the hospital has managerial classes in which she can enroll to help her with this new duty.

  Nurse Joserine also calls Jo Ellen Mae, a clinical nurse specialist for the orthopedic unit, and informs her that she will now be responsible and accountable for the quality improvement activities on the unit. Monthly reports are due on the 10th of each month. He informs Nurse Mae that if she has any questions, she can call the head of the quality improvement committee. When Nurse Joserine leaves the hospital that day, he feels good that he has decreased his workload and happy that he found the article on delegation.

  1. 1. Did Nurse Joserine delegate tasks appropriately? Why or why not? (PLEASE INCLUDE THE 5 STEPS OF DELEGATION)

• 2. Who will be held accountable for the outcomes of the roles/tasks that Nurse Joserine has delegated?

  Please answer all assignments using font size 10. Points will be taken off if not done. Thanks 

   

   

   

 

 

CASE INTRODUCTION

Huddles are such an important part of nursing – they relay pertinent information, increase safety, offer team building opportunities, promote better outcomes for the patient, and ultimately can reduce costs.

Here is your scenario:

Your nurse manager identifies that the staff on your rehabilitation unit, and particularly that you as the evening charge nurse, are resistant and oppositional to an important new patient safety strategy of implementing huddles to improve staff communication.

BRIEF SUMMARY OF CASE 

Paragraph 1  Your nurse manager meets with you, the evening charge nurse, (and with you he had previously begun a disciplinary action process because you refused to implement huddles on the shifts when you was in charge).   You now understands that you (and the staff) were wrong, and you begin to explore with the manager how better to implement huddles on your shift.

Paragraph 2  In a quarterly staff development in-service for the rehab facility’s leaders, a group of nurses and charge nurses, including you, learn about implementing change using Lewin’s five-step Stages of Change (SCM) Model. The nurse manager and you apply this model to their failed implementation of huddles.

Paragraph  3 – You return to your unit and share with the staff that you—and they—were wrong to refuse to implement huddles. You begin to start the process as a change agent.

DISCUSSION GUIDE – QUESTIONS  Worth 2 points each (16 points)

Paragraph 1

1. How does your nurse manager know that you are ready to learn and be a part of the unit change?
2. How was the decision to implement the huddles handled?
3. What is the importance of a huddle?

Paragraph 2

1. What would you do prior to implementing a staff meeting to best communicate new information to the staff?
2. How would you describe Lewin’s Theory of Change? Can you give an example where you have used this theory?
3. What other theories of change are you familiar with, in addition to Lewin’s?

Paragraph 3

1. How would you manage conflict with the other unit staff?
2. How would you handle the resistance to change as noted by the unit staff?

  

Reflection, Assignment #1 (10 pts.)

Read film assigned, The Social Network in Netflix.

Objective

To relate the material in Chapter One, “Thinking,” to the assigned film(s). Your paper (3-4 pages) will consist of three sections as follows. 

Introduction Paragraph (2 pts.)

Briefly summarize the film in five sentences or less.

Thinking (6 pts.)

What was Mark’s short term and long term goal in creating Facesmash?

In establishing Facesmash, was Mark thinking critically? Why or why not?

How might Mark have analyzed his decision?

Was Mark being creative according to our text?

How would you have gone about making a plan for Facesmash?

What is thinking?

Conclusion Paragraph (2 pts.)

Briefly explain how the film relates to the text in Chapter One, Thinking. 

Follow MLA format in writing your paper. Include a reference page and a cover page.

Look for ‘MLA style guide’ on the Internet for rules and examples.

Your grade will be based on clarity, specificity and how well you establish connections to the text in ChapterOne.