Here is the list of medication that I have been taking as the patient for a week.

1. Captopril 25mg tabs, take by mouth twice a daily.

2. Senokot 8.6 mg tabs, take by mouth twice a daily.

3. Acetaminophen 500mg caps, take by mouth twice daily.

4. Furosemide 40mg tabs, take by mouth daily.

5. Simvastatin 10mg tabs by mouth twice daily.

So my diagnosis for this medication is Congestion heart failure. Based on these medications that am taking

I took these meds for one week. The Furosemide1 I had to weight myself daily. Started Sunday my weight was 151. 1 Monday 151.4, Tuesday was 151.3, Wednesday 151.5, Thursday 151.0, Friday 151.1 Saturday 150.3.

The Captopril, I had to take my pulse every time I took this med. If less than 60 cannot take it if above 100 cannot take it. Sunday it was 64, Monday 72, Tuesday 68 Wednesday 66 Thursday 70, Friday 78 Saturday 76. Answer these questions

Write a 3 page (APA, not including title or reference Page) reflective paper about your experience. Specifically address: A) any barriers you encountered in being adherent to your medication regimen B) any barriers you encountered in following dietary guidelines C) any tools you utilized to help you complete the exercise, which could improve patient safety D) the importance of patient preferences, values and background in providing patient centered care, and E) any other lessons you learned from tis exercise.

Discussion: Improving Quality

Improving the quality of health care delivery and patient safety continues to be a political concern and has been at the heart of reform issues for many years. The American Nurses Association (ANA) and the Institute of Medicine (IOM) have increased awareness of health care quality and safety issues, as well as advocated for health care reform. The documents featured at the ANA and IOM websites listed in this week’s Learning Resources focus on many of the current issues surrounding quality and safety in the health care industry.

To prepare:

Review this week’s Learning Resources, focusing on the Six Aims for Improvement presented in the landmark report “Crossing the Quality Chasm: The IOM Health Care Quality Initiative.”

Consider these six aims with regard to your current organization, or one with which you are familiar. In what areas have you seen improvement? What areas still present challenges? As a nurse leader, how can you contribute to improving the organization’s achievement of these aims?

Select one specific quality or safety issue that is presenting a challenge in the organization. Consider at least one quality improvement strategy that could be used to address the issue, as well as which of the six aims for improvement would then be addressed.

Reflect on your professional practice and your experiences with inter-professional collaboration to improve quality and safety. How has inter-professional collaboration contributed to your organization’s efforts to realize the IOM’s six aims for improving health care? Where has inter-professional collaboration been lacking?

Post a description of the quality or safety issue you selected and a brief summary of the impact that this issue has on health care delivery. Describe at least one quality improvement strategy used to address this issue. Then explain which of the six “aims for improvement” are addressed by the strategy. Finally, explain how inter-professional collaboration helps improve quality in this area.

 Required Readings

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.

Chapter 13, “High Quality Health Care” (pp. 273–295)

Chapter 2, “A Visual Overview of Health Care Delivery in the United States” (pp. 13–27) 

These chapters discuss the current state of health care quality, as well as efforts to measure and improve quality.

Chapter 14, “Managing and Governing Health Care Organizations” (pp. 297–309)

This chapter details the vital importance of developing a better understanding of why and how heath care organizations are governed and managed in order to improve accountability.

CHECK THE BOOK,  DOCUMENT, AND MEDIA PRESENTATION VIDEO  ATTACHED BELLOW TO COMPLETE THE DISCUSSION QUESTION

USE REFERENCES

Case Study for Care Plan  Assignment:

A retired 69-year-old man “Mr. Casey” with a 5-year history of type 2 diabetes. Although he was diagnosed 5 years ago he had symptoms indicating hyperglycemia for 2 years before diagnosis. His fasting blood glucose values of 118–127 mg/dl, which was explained to him as “borderline diabetes.” He also states he has had past episodes of nocturia with large pasta meals and Italian pastries. At the time of diagnosis, he was advised to lose 10 lbs.

Referred by his family physician to the diabetes clinic, Mr. Casey presented with recent weight gain, suboptimal diabetes control, and foot pain. He has been trying to lose weight and increase his exercise for the past 6 months without success. He had been started on glyburide (Diabeta), 2.5 mg every morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon.

Mr. Casey also takes atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia. He has tolerated this medication and adheres to the daily schedule. During the past 6 months, he has also taken OTC medications to try to control his diabetes. He stopped these supplements when he did not see any positive results.

He does not test his blood glucose levels at home and expresses doubt that this procedure would help him improve his diabetes control.

Mr. Casey states that he has “never been sick a day in his life.” He is retired and volunteers locally. He lives with his wife of 48 years and has two married children. Although both his mother and father had type 2 diabetes, Mr. Casey has limited knowledge regarding diabetes self-care management and states that he does not understand why he has diabetes since he never eats sugar. In the past, his wife has encouraged him to treat his diabetes with herbal remedies and weight-loss supplements, and she frequently scans the Internet for the latest diabetes remedies.

During the past year, Mr. Casey has gained 22 lb. Since retiring, he has been more physically active, playing golf once a week and gardening, but he has been unable to lose more than 2–3 lb. He has never seen a dietitian and has not been instructed in self-monitoring of blood glucose.

Mr. Casey’s diet history reveals excessive carbohydrate intake in the form of bread and pasta. His normal dinners consist of 2 cups of cooked pasta with homemade sauce and three to four slices of Italian bread. During the day, he often has “a slice or two” of bread with butter or olive oil. He also eats eight to ten pieces of fresh fruit per day at meals and as snacks. He prefers chicken and fish, but it is usually served with a tomato or cream sauce accompanied by pasta. His wife has offered to make him plain grilled meats, but he finds them “tasteless.” He drinks 8 oz. of red wine with dinner each evening. He stopped smoking more than 10 years ago.

The medical documents that Mr. Casey brings to his appointment indicate that his hemoglobin A1c(A1C) has never been <8%. His blood pressure has been measured at 150/70, 148/92, and 166/88 mmHg on separate occasions during the past year at the local senior center screening clinic. Although he was told that his blood pressure was “up a little,” he was not aware of the need to keep his blood pressure ≤130/80 mmHg for both cardiovascular and renal health.

Mr. Casey has never had a foot exam as part of his primary care exams, nor has he been instructed in preventive foot care. However, his medical records also indicate that he has had no surgeries or hospitalizations, his immunizations are up to date, and, in general, he has been remarkably healthy for many years.

Physical Exam

A physical examination reveals the following:

• Weight: 178 lb; height: 5′2″; body mass index (BMI): 32.6 kg/m2
• Fasting capillary glucose: 166 mg/dl
• Blood pressure: lying, right arm 154/96 mmHg; sitting, right arm 140/90 mmHg
• Pulse: 88 bpm; respirations 20 per minute
• Eyes: corrective lenses, pupils equal and reactive to light and accommodation, Fundi-clear, no arteriolovenous nicking, no retinopathy
• Thyroid: nonpalpable
• Lungs: clear to auscultation
• Heart: Rate and rhythm regular, no murmurs or gallops
• Vascular assessment: no carotid bruits; femoral, popliteal, and dorsalis pedis pulses 2+ bilaterally
• Neurological assessment: diminished vibratory sense to the forefoot, absent ankle reflexes, monofilament (5.07 Semmes-Weinstein) felt only above the ankle

Lab Results

Results of laboratory tests (drawn 5 days before the office visit) are as follows:

• Glucose (fasting): 178 mg/dl (normal range: 65–109 mg/dl)
• Creatinine: 1.0 mg/dl (normal range: 0.5–1.4 mg/dl)
• Blood urea nitrogen: 18 mg/dl (normal range: 7–30 mg/dl)
• Sodium: 141 mg/dl (normal range: 135–146 mg/dl)
• Potassium: 4.3 mg/dl (normal range: 3.5–5.3 mg/dl)
• Lipid panel
  • Total cholesterol: 162 mg/dl (normal: <200 mg/dl)
  • HDL cholesterol: 43 mg/dl (normal: ≥40 mg/dl)
  • LDL cholesterol (calculated): 84 mg/dl (normal: <100 mg/dl)
  • Triglycerides: 177 mg/dl (normal: <150 mg/dl)
  • Cholesterol-to-HDL ratio: 3.8 (normal: <5.0)
• AST: 14 IU/l (normal: 0–40 IU/l)
• ALT: 19 IU/l (normal: 5–40 IU/l)
• Alkaline phosphotase: 56 IU/l (normal: 35–125 IU/l)
• A1C: 8.1% (normal: 4–6%)
• Urine microalbumin: 45 mg (normal: <30 mg)

Please use the attached Care Plan outline for this assignment and post in the “Drop Box” under “Instructional”.

Credit of care study to: Geralyn Spollett, MSN, C-ANP, CDE

Reference:

American Diabetes Association. (2003, January 1). Case Study: A Patient With Uncontrolled Type 2 Diabetes and Complex Comorbidities Whose Diabetes Care Is Managed by an Advanced Practice Nurse. Retrieved from http://spectrum.diabetesjournals.org/content/16/1/32

No Plegarism please,  will be checked with Turnitin. 

Will need minimum of 300 words, APA Style, double spaced, times new roman, font 12, and and Include: 3 references with intext citations.

Topic: Cough

Respiratory System

You will be assigned one topic from the list below.

For your assigned topic (Cough), you are to discuss:

the incidence and prevalence of the disorder

pathophysiology from an advanced practice perspective

physical assessment and examination,

evidence-based treatment plan and patient education, as well as follow up and evaluation to assess the efficacy and outcomes of the evidence-based treatment plan for management of an episodic, acute, and chronic case involving the pathology(s) you are sharing.

Read chapter 3 of the class textbook and review the attached PowerPoint presentation.  Once done work on the following assignment;

1.  Write a two-page summary, 1000 words minimum (excluding first and reference page) of the process for completing an accurate cultural assessment of a patient with newly diagnosed leukemia.

a.  Include both the health history and the physical examination.

b.  Develop a comprehensive cultural assessment checklist that includes all the elements of culturally

competent nursing care.

c.  Include the assessment of greater family and community.

As stated in the syllabus present your assignment in a word document, Arial 12 font APA format attached to the forum in the discussion tab of the blackboard titled “Week 3 discussion questions”.  You must cited at least two evidence-based references (excluding the class textbook) and post two replies to any of your peers assignments sustained with the proper references.