Investigate the utilization of Information Technology (IT) within Medicare/Medicaid, the Military health sector, or within your current work setting. Outline the goals of IT within the chosen setting and describe its architectural framework. Is IT being utilized efficiently within that setting? Why or why not? Offer suggestions where IT applications could be implemented for better visibility, security and privacy, usability or flexibility.
 

 

Mt. Denali, Alaska elevation 17,660 ft. The climbers slowly ascended the icy cliff in the near darkness of 4 a.m., carefully avoiding the steep crevasses that fell off sharply to either side. Several times each hour, the lead climber Tom would call out “Everyone okay?” They had stopped replying long ago, too exhausted by the supreme effort of simply placing each foot in the proper direction. Three hours into a 12+ hour climbing day, only labored breathing and the crunch of ice under crampons permeated the silence. Emily, a Registered Nurse and the only woman on the six-person expedition team, was third in line, following her friend Mark, the least experienced climber of the group. For the last couple of days, Mark had been coughing heavily, and all morning had been slowing up, causing a backlog behind them and prompting several “everyone okay”‘s from Tom. Knowing Mark’s competitive spirit, Emily was hesitant to urge him to pick up the pace, and when he pulled up to rest on a protected ledge, Emily motioned to the other climbers to pass on by. Her head was pounding anyway, and she rationalized she could use the break.
“You okay?” Emily asked.
“Yeah….I just….can’t seem to….catch my breath,” gasped Mark.
“Just rest a minute. There’s no rush, Mark. Take your time….slow, deep breaths.”
Tom appeared from the upper trail. “What’s up?”
“Mark’s having a little trouble catching his breath.” Emily was getting worried.
Tom looked sharply at her. “How much trouble?”
“Quite a bit, I think.” Emily looked over at Mark, whose breathing didn’t appear eased by the rest stop, and then back at Tom. “I think we should get him down to a lower altitude. Quickly.”
Tom nodded. “I’ll get the others.”
As they helped guide Mark down the steep trail, Mark’s breathing became increasingly labored and was loud enough to worry Emily.
“Geez, do we sound like that?” gasped one of the other climbers. “I mean, I’m out of breath, too, but he sounds horrible!”
“No, we’re not that bad. Remember, that’s why we spent the prep month at 15,000 feet. Mark was with us, so he experienced the same physiological changes we did. This,” Emily nodded at Mark, “is some sort of problem.”
Mark deteriorated rapidly and lost consciousness by the time the group reached the lower camp. The urgency of the situation strengthened the tired legs of the climbers as they carried Mark the final yards towards camp. Emily had run ahead to call for support help, and the group was told an airlift was on its way and would be there within the hour. The camp’s medical tent had some basic supplies and a resident paramedic, and he and Emily went to work stabilizing Mark with oxygen and a Gammow bag (a pressurization bag).
90 Minutes Later, Denali Valley Hospital
“We have a 28-year-old white male, unresponsive, no prior history of pulmonary disease, who became unconscious around 15,000 feet after hiking to 17,000 feet earlier today. His friends say he was having severe breathing difficulty prior to losing consciousness….” As the paramedic droned on, Emily looked around for the nearest phone so she could locate Mark’s family in case this was as serious as it looked.
1. How would the oxygen and Gammow bag help Mark?
2. Are some of the lab normal either below or above normal range as a normal result of the month spent at high elevation? Explain.
3. Which lab values appear to represent the most serious problem Mark is having? Is his situation life-threatening?
4. Compare the results of Alveolar Oxygen Tension to Arterial Oxygen levels. What might cause this type of discrepancy?
5. Come up with a possible diagnosis for Mark’s condition. What data are you using to come to this conclusion?
Here are the results of his blood and pulmonary tests.
The following tables summarize the findings of the Denali Valley Hospital Medical Team:
BLOOD LEVELS
MARK’S
NORMAL
Arterial Oxygen
52 Torr
80-100 Torr
Arterial Carbon Dioxide
30 Torr
35-45 Torr
Arterial pH
7.23
7.38-7.44
Hematocrit
58%
42-52%
Arterial glucose
102 mg/100ml
60-110 mg/100ml
Urea Nitrogen (BUN)
12 M
7-14 M
Creatinine
1.1 mg/100ml
1-1.5 mg/100ml
Potassium
4.0 meq/L
3.5-5.0 meq/L
Sodium
145 meq/L
136-145 meq/L
Bicarbonate
18 meq/L
20-24 meq/L
Chloride
100 meq/L
98-106 meq/L
No prescription medications or other pharmacological agents were found.
PULMONARY FUNCTION TESTS
Inspired Oxygen Tension
147 Torr
150 Torr
Vapor Pressure
45 Torr
47 Torr
Alveolar Oxygen
110 Torr
98-104 Torr
RQ
0.66
0.78-0.82 Torr
Tidal Volume
0.4 L
0.5 L
HEART RATE: 88 bpm (normal: 60-90 bpm) BLOOD PRESSURE: 105/60 (normal: 110-120/60-80 mm Hg)

 

Read the case study about Borderline Personality Disorder and answer the following questions in your initial posting:
Module 07 Case Study
How would you use therapeutic communication and principles of cognitive behavioral therapy with the client?
Describe your assessment process. What are some likely co-morbid conditions? List one nursing diagnosis and an appropriate nursing intervention.
What interdisciplinary referrals might be appropriate?
MODULE 07 CASE STUDY
S.is a 48-year-old divorced woman with one adult daughter and three grandchildren. She is currently working as an LPN part time in a nursing home and also works at a convenience store one or two days per week. She has had many jobs over the last 22 years, usually changing every one or two years. S notes that she has been called less often to work in the convenience store and worries that they don’t like her anymore. She reports being written up several times for arguing with customers. She also reports that her supervisor at the nursing home “is a bitch”; although she really liked her supervisor at first, she says “Now I hate her; she’s trying to get me fired.” S. reports that she has tried to get fulltime jobs five times in the last four years, was hired for three, but only lasted one or two weeks at each one.
S. reports that she is currently not talking to her daughter because “she is horribly mean to me and she needs to apologize or I won’t talk to her again”. She is upset that she hasn’t seen her three small grandchildren in about a year. She sends them presents and cards frequently that say “I still love you! Grandma”, but hasn’t called them since she stopped talking to her daughter. She is considering reporting to the county that her daughter is keeping her grandchildren from her.
S. is very unhappy that she isn’t in a relationship. She was abused by her ex-husband, and has a pattern of meeting and dating men who eventually abuse her. She states that her last relationship was very good, however; the man was not abusive and “I loved him very much”. The relationship ended for reasons that S. doesn’t understand, although she does report many arguments that ended in “scenes” such as her throwing chairs, stomping out of the house, making crank phone calls to his family, and calling the police with false reports. But S. also reports that she “couldn’t have loved him more and I showed it”. She gives examples of going to her boyfriend’s place of work with flowers, buying him expensive presents, surprising him with tickets to Mexico at the last minute – she was very upset that he wasn’t willing to drop everything and go with her. S. reports asking him why he didn’t love her and what she was doing wrong on a regular basis. When the boyfriend asked to break up, S. reports sitting outside his house for weeks, crying; she called his mother, called his boss, and called and texted him until he filed a restraining order. This occurred about 4 months ago.
S. admitted herself to the mental health unit when she felt suicidal. She reports that she had stopped her individual psychotherapy 3 months ago and stopped going to DBT. She also stopped her anti-depressant at that time, as she felt it wasn’t working, and missed her last two psychiatrist appointments.

 

Respiratory System Drugs:
Bronchodilators are used to prevent or treat bronchospasms caused by pulmonary disease, allergy exercise, or emotional factors. Other classifications includes anti-inlfammatory agents, leukotriene receptor modifier, anti-tussives, expectorants, mucolytics and nasal decongestants.
1. Give an example of each classification of respiratory system drugs and list 1-2 important key nursing actions/teaching/monitoring/assessment while the patients are on the drug.
Cardiovascular System Drugs:
One of the main one are inotropic drug because it increases the force of myocardial contraction. Therefore, they are ordered to treat heart failure and manage atrial arrhythmias. Other classifications includes anti-arrhythmics, anti-hypertensives, anti-anginals, diuretics and anti-lipemic drugs.
2. Define the following terms (no more than 2 sentence, in your own words): adrenergic, adrenergic inhibitors/blockers, beta-adrenergic blockers, vasodilators, cholinergics, and anti-cholinergic drugs. It is vital that you understand the concept of the action of these terms and how administering them will affect your patient.
3. Give an example of each classification of cardiovascular system drugs and list 1-2 important key nursing actions/teaching/monitoring/assessment while the patient is on the drug.
Anticoagulants and thrombolytics are used in the prophylaxis and treatment of thromboembolic disorders, such as myocardial infarction, pulmonary embolism, stroke, and deep vein thrombosis. Hematopoietics (iron products) supplements and replace depleted iron stores in bone marrow to assist in RBC production.
4. Give an example of Hematopoietics: Iron products and biologic response modifiers: Nursing responsibilities when administering these drugs. List one of each.
5. Give an example of each classification of anticoagulant drugs: heparin derivatives, antiplatelet, thrombolytic and list 1-2 important key nursing actions/teaching/monitoring/assessment while the patient is on the drug.

 

Review the Root Cause Analysis Topic Materials to learn more about conducting a root cause analysis. Using the “Root Cause Analysis Template,” conduct a root cause analysis of the “Root Cause Analysis Scenario.” Post a description of the problem and a summary of your root cause analysis, including recommendations for proposed action to eliminate the problem from reoccurring. Select other peers’ postings to peer review.