discussion

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Clinical Documentation Improvement (CDI)

Physician documentation is the source by which the coder begins to select the correct diagnosis and procedure codes. There has been a lot of discussion for physicians to improve their clinical documentation.

Research Clinical Documentation Improvement (CDI) related to ICD 10 and indicate how this movement benefits the clinical coding specialist /medical coder in their day to day work.

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Week 2 Assignment Patient Educational Flyer

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Details:

 

Design a 1-2 page patient education flyer/pamphlet for an alternative medicine/herbal product.

Describe the product, its intended use, side effects, adverse reactions, and safety issues (risks and benefits of using an alternative medication/herbal product versus a prescription medication).

The flyer should include at least two community and/or online resources for the patient to obtain more information.

APA format is not required, but solid academic writing is expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to Turnitin.

 

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Nursing homework help

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Discussion: Influencing Social Change

Individuals with psychiatric mental health disorders are frequently stigmatized not only by society as a whole, but also by their friends, family, and sometimes healthcare providers. In your role, however, you have the opportunity to become a social change agent for these individuals. For this Discussion, consider how you might make a positive impact for your clients and advocate for social change within your own community.

Learning Objectives

Students will:

· Apply strategies to become a social change agent for psychiatric mental health

Learning Resources

Note:  To access this week’s required library resources, please click on the link to the Course Readings List, found in the  Course Materials  section of your Syllabus.

Required Readings

 

Angermeyer, M. C., Matschinger, H., & Schomerus, G. (2013). Attitudes towards psychiatric treatment and people with mental illness: Changes over two decades. The British Journal of Psychiatry, 203(2), 146–151. Retrieved from http://bjp.rcpsych.org/content/203/2/146.full

 

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Note: Retrieved from from the Walden Library databases.

 

Dingfelder, S. F. (2009). Stigma: Alive and well. American Psychological Association, 40(6), 56. Retrieved from http://www.apa.org/monitor/2009/06/stigma.aspx

 

Jenkins, J. H. (2012). The anthropology of psychopharmacology: Commentary on contributions to the analysis of pharmaceutical self and imaginary. Culture, Medicine and Psychiatry, 36(1), 78–79. doi:10.1007/s11013-012-9248-0

 

Note: Retrieved from from the Walden Library databases.

Price, L. H. (2010). Violence in America: Is psychopharmacology the answer? Brown University Psychopharmacology Update, 21(5), 5. Retrieved from http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1556-7532

Note: Retrieved from from the Walden Library databases.

Optional Resources

 

Bennett, T. (2015). Changing the way society understands mental health. National Alliance on Mental Illness. Retrieved from http://www.nami.org/Blogs/NAMI-Blog/April-2015/Changing-The-Way-Society-Understands-Mental-Health

 

Mechanic, D. (2007). Mental health services then and now. Health Affairs, 26(6), 1548–1550. Retrieved from http://content.healthaffairs.org/content/26/6/1548.full

 

Rothman, D. J. (1994). Shiny, happy people: The problem with “cosmetic psychopharmacology.” New Republic, 210(7), 34–38.

To prepare for this Discussion:

· Reflect on how you might influence social change for psychiatric mental health.

Note : For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on  Submit !

By Day 3

Post an explanation of how you, as a nurse practitioner, might become a social change agent for psychiatric mental health. Include how you might advocate for change within your own community.

 

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final written assignment

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Project: Scholar-Practitioner Project: Public Health Leadership Theory

The Assignment (9–12 pages):
Section 1 — Abstract and Introduction (1–2 pages)
Section 2 — Revised Literature Review and Problem Statement (5–7 pages):
Literature Review to include:
A synthesis of the literature of 15–20 peer reviewed, scholarly resources
A description of theoretical gaps in the research
Problem Statement to include:
An explanation of the specific problem that addresses identified gaps within the literature
An explanation of how your problem statement incorporates implications for positive social change.
Section 3 — Personal Public Health Leadership Theory (2–3 pages):
An articulation of your personal Public Health Leadership Theory
Section 4 — Revised Visual Representation of Your Public Health Leadership Theory (3–4 pages):
Your visual representation should include:
Your personal Public Health Leadership Theory to address the gaps identified in the literature
A visual representation of the theory (e.g. table, graph, matrix)
A explanation on how the theory addresses the literature gap identified in Week 5
A description of how your theory incorporates aspects of systems thinking
Section 5 — Empirical Evaluation Plan for a Public Health Leadership Theory (3–4 pages):
You will assess if the newly developed leadership theory addresses the problem you have been working on. What methodological steps will you use? How will you collect data? Suggestion – start with how theories in our text are evaluated. It does not have to be detailed, but it must include the methods, measures and analytic techniques.
If the assignments are done correctly, there should be an alignment from the topic of choice to the evaluation:
The topic is researched in the literature
The literature review points out a theoretical gap that needs to be addressed by leadership
The gap is turned into a problem statement
A leadership theory to address the problem proposed
The theory is depicted in a visual; and finally
An evaluation plan describes how the newly developed theory resolves the problem identified in the literature
To further help, examples (Two final projects – permission given to post) are located in the Doc Sharing area for this week
Section 6 — Conclusion (1–2 pages)
Section 7 — References
An APA-formatted reference list of 15–20 peer-reviewed, scholarly journals

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Class 4 Unit 3 Topic 1

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Purpose: Comment the Discussion (Class 504 Unit 3 Comment 2)

 

Thing to Remember:

Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.

1 References, find resources that are 5 years or less

No errors with APA format 6 Edition

 

To Comment:

According to our text Melnyk and Fineout-Overholt (2015) external evidence is from research whereas internal evidence is the clinic practice as a result of a quality improvement project or evidence based practice. Porzsolt et al. (2003) define internal evidence as the clinicians “current knowledge” (n.p.).

My internal evidence for my PICOT is the knowledge that 100% of my endoscopic carpal tunnel patients in the past year have required revision with open carpal tunnel release. My external evidence are the randomized controlled trials that I found on my literature search via Ebscohost databases CINAHL and Cochrane determining there is no statistical difference in either procedure in regards to outcome in a 6-month time frame.

Searching utilizing a database to answer a PICOT questions does have its advantages over web-based search. When searching the web, you must ensure that the information is current and valid even when using and academic search engine such as google scholar. Web based searches often lead to too many results requiring more time for the clinician to weed through relevant information. The internet has made research at bedside possible however the clinician should be aware of the “soundness of the evidence, comprehensiveness and specificity, database ease of use, and access to database” when searching for literature (Hain & Kear, 2015). Although web base search engines will yield you numerous results you should be conscious as a clinician only relying on this information. Melnyk and Fineout-Overholt (2015) recommend utilizing another source when you find your research on google or google scholar. Many databases have healthcare literature allowing a clinician to narrow by certain criteria. CINAHL for example allows you to narrow by full text, peer reviewed evidence based literature results. Cochrane database is great for systemic reviews however the disadvantage is most full text articles require a fee. PubMed is a free database for clinicians to use when i the field and holds more citations then MEDLINE (Melnyk & Fineout-Overholt, 2015). However, Hain and Kear (2015) point out PubMed only produces the abstract.

 

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Nursing homework help

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Purpose: Comment the Discussion (Class 505 Unit 3 Comment 1)

 

Thing to Remember:

Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.

1 References, find resources that are 5 years or less

No errors with APA format 6 Edition

 

To Comment:

There are 3 levels of protection, primary, secondary and tertiary prevention.  Primary prevention is preventing the patient from developing by reducing and possible removing risk factors. An example would be teaching a patient who is overweight about the importance of eating healthier choices, investing in daily exercises, and avoiding unhealthy habits such as smoking and drinking to prevent type II diabetes.

The secondary level of prevention is performed after the patient has been diagnosed with the disease.  An example would be a patient who has a fasting blood glucose level of more than 125mg/dl but does not display any symptoms will be diagnose as type II diabetic.  Early detection and education of healthy eating choices, routine exercises and healthy lifestyle habits can prevent further progression of the disease and possible cure the disease.

The third type of prevention is tertiary and is for the patient who already diagnosed with the disease, symptomatic, and requires treatment.  This patient is no longer at risk for disease but is at risk for further complications.  This type of prevention would be practice with a patient diagnosed with diabetes who has not yet developed other common comorbidies like hypertension, cardiovascular disease, and kidney disease.  Adhering to medication instructions, checking blood glucose as recommended, healthy eating habits, routine exercising, avoiding unhealthy habits like smoking and or alcohol consumption, life changes to expect, and importance of life change to avoid further complications.

References

Bhattacharya, P., & Roy, A. (2017). Primary prevention of diabetes mellitus: current strategies and future trends. Italian Journal of Medicine, 11, 15-22. Retrieved from http://italjmed.org/index.php/ijm/article/view/itjm.2016.634/821

Fletcher, R. (2013). Clinical epidemiology (5th ed.). Retrieved from [Chegg] https://ereader.chegg.com/#/books/9781469829784/

Thomas, M., & Atkins, R. (2006, September 1,). Blood pressure lowering for prevention and treatment of diabetic kidney disease. Drugs. Retrieved from http://web.a.ebscohost.com.lib.kaplan.edu/ehost/pdfviewer/pdfviewer?vid=7&sid=a4a3ed7e-b2de-4e84-b203-5a9151725e0f%40sessionmgr4006

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Article

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This is the first of three Journal Article Assignments that you will complete in this course. For this assignment, you will locate one peer-reviewed journal article related to a topic covered in Module 1 and create a professionally designed PowerPoint presentation. In the presentation, you must identify and explain the purpose of the study (article), interpret definitions and variations in definitions, if any. Length of the presentation should be at least five minutes long and include audio embedded on each slide.

 

Further information about this assignment, including a grading rubric, can be found in the Start Here folder.

 

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Nursing homework help

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What health risks associated with obesity does Mr. C. have?

 

Nearly one third of the adult population of the United States is overweight or obese (Centers of Disease Control and Prevention, 2015). Obesity and diabetes are major health problems that are rapidly getting worse in the United States. In addition, obese people have an increased risk for the development of cardiovascular disease because obesity is often accompanied by elevated serum lipid levels. Obesity is also associated with hypertension. Obesity places an increased workload on the heart, which increases oxygen demand. According to the Centers of Disease Control and Prevention “the estimated cost of obesity in the United States was 147 billion in 2008 and the medical costs of people who are obese were $1,429 higher than those of normal weight” (Centers of Disease Control and Prevention, 2015). Obese people are also more likely to have delayed wound healing and wound infection because adipose tissue impedes blood circulation and its delivery of nutrients, antibodies, and enzymes required for wound healing. Obese clients also have difficulty breathing when sedated (Orlando Sentinel, 2012).

 

Is bariatric surgery an appropriate intervention? Why or why not?

 

 

 

According to the American Nurses Association “bariatric surgery provides dramatic improvement” to obese people that suffer from chronic diseases such as heart disease, hypertension, sleep apnea, degenerative joint disease, gastroesophageal reflux disease, asthma, and depression (American Nurses Association, 2009).

 

 

 

Bariatric surgery can be very effective when combined with a comprehensive treatment plan according to the American Society for Metabolic and Bariatric Surgery (American Society for Metabolic and Bariatric Surgery, 2015). The combined treatment can be an effective tool to provide a client with a long term weight-loss and help the client increase the quality of their health. Bariatric surgery has shown to help improve or resolve many obesity-related conditions, such as type 2 diabetes, hypertension, and heart disease it also helps in reducing the need to continue taking so many medications for these co-morbidities.

 

 

 

According to the US National Library of Medicine National Institutes of Health the following are some pros and cons of bariatric surgery (US National Library of Medicine National Institutes of Health, 2012):

 

 

 

Pros Cons
Initial and sustained weight loss Initial failure to lose weight
Resolution of obesity-related comorbidities Potential complication: preoperative, surgical, gastrointestinal, nutritional, and psychological
Improved mortality Initial costs
Reduction in obesity-related health risks Weight regain
Improved quality of life Permanency
Psychosocial benefit  

 

Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered: (a) Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime; (b) Ranitidine (Zantac) 300 mg PO at bedtime; and (c) Sucralfate / Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime.

The patient reports eating meals at 7 a.m., noon, and 6 p.m., and a bedtime snack at 10 p.m. Plan an administration schedule that will be most therapeutic and acceptable to the patient.

Carafate Mylanta Zantac
0600    
  1000  
1100    
  1500  
1700    
  2100  
2300   2300

Assess each of Mr. C.’s functional health patterns using the information given (Hint: Functional health patterns include:

Health-perception – health management – Based on the information provided in the case study Mr. C has always been heavy since he was a child but has gained 100 pounds in the last 2-3 years. With the limited information and the increase weight in the last 2-3 years I can only presume that Mr. C might live a sedentary lifestyle that might be related to lack of motivation or lack of education or readiness.

 

Nutritional – metabolic – Mr. C  is 5 feet 5 inches and weighs 295.9 pounds. According to Premier Health, Mr. C has a BMI of 47.6 and is considered morbidly obese (Premier Health, 2015). He also claims that he has gain 100 pounds in the last 2-3 years.  Based on the information he falls under Nutrition, Imbalanced, More Than Body Requirements as evidenced by reported higher baseline weight.

Elimination – Mr. C has a peptic ulcer and symptoms include passing of bloody stools or black tarry stools. Possible nursing diagnoses can be constipation/diarrhea related to effects of medications on bowel function.

Activity-exercise – Mr. C has an office job and based on his increased weight of 100 pounds in the last 2-3 years lives a sedentary lifestyle. The case study does not specify if Mr. C performs any type of exercise activities but we can assume that he is able to perform activities of daily living.

Sleep-rest – Mr. C is morbidly obese and suffers from sleep apnea due to his overweight.

Cognitive-perceptual – Mr. C appears alert and oriented and able to make his needs known.

Self-perception – self-concept – Mr. C claims that he has been heavy all his life and has gained 100 pounds in the last 2-3 pounds.  Mr. C is looking into bariatric surgery as a solution to his morbid weight.

Role-relationship – Based on the case study Mr. C is a single man not involved in a relationship.

Sexuality – reproductive – is a young man but the case study doesn’t offer any other information.

Coping – stress tolerance – Mr. C is able to identify that he has a problem with his weight. He is taking initiative by reducing salt intake to control his hypertension and he is looking into bariatric surgery to reduce his weight problem.

What actual or potential problems can you identify?  Describe at least five problems and provide the rationale for each.

 

1) Health maintenance ineffective related to sedentary lifestyle (Ackley & Ladwig, 2011).

2) Imbalanced nutrition more than body requirements related to lack of basic nutritional knowledge (Ackley & Ladwig, 2011).

3) Disturbed sleep pattern related to sleep apnea (Ackley & Ladwig, 2011).

4) Deficient knowledge related to his obesity, disturbed body image by verbalization of his weight gain (Ackley & Ladwig, 2011).

5) Ineffective coping related to lack of knowledge of weight gain resources (Ackley & Ladwig, 2011).

References

 

Ackley, B., & Ladwig, G. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care (9th ed.). St. Louis: Mosby, Elsevier

American Nurses Association. (2009). Weight-loss surgery. Retrieved from

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TasbleofContents/Vol142009/No1Jan09/Weight-Loss-Surgery.html

American Society for Metabolic and Bariatric Surgery. (2015). Benefits of bariatric surgery. Retrieved from https://asmbs.org/patients/benefits-of-bariatric-surgery

Centers of Disease Control and Prevention. (2015). Adult Obesity Facts. Retrieved from

http://www.cdc.gov/obesity/data/adult.html

Orlando Sentinel. (2012). Obese patients create big problems for surgeons. Retrieved from

http://articles.orlandosentinel.com/2012-07-25/news/os-obese-patients-20120724_1_obese-patients-normal-weight-person-bmi

Premier Health. (2015). BMI calculator. Retrieved from

http://www.premierhealthspecialists.org/phspractice.aspx?id=64848

US National Liberty of Medicine National Institutes of  Health. (2012). Quick fix or long-term cure? Pros and cons of bariatric surgery. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470459/

            

 

 

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Essentials of Public Health Class

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A poem by T.S. Eliot (1943) says, “We had the experience but missed the meaning.” As your experience in this course comes to a close, I don’t want you to miss the meaning of the materials you have read, papers you have written, and discussions we have had throughout the session. They are more than a series of assignments and grades – the end result should be an improvement in your higher-order thinking and your ability to make connections between thoughts and ideas.

You can achieve that through reflection, the art of taking charge of your own mind. Reflection is a mental process that challenges you to use critical thinking to examine the course information, analyze it carefully, make connections with previous knowledge and experience, and draw conclusions based on the resulting ideas.

A well cultivated critical thinker (Paul & Elder, 2008): raises vital questions and problems, formulating them clearly and precisely; gathers and assesses relevant information, using abstract ideas to interpret it effectively comes to well-reasoned conclusions and solutions, testing them against relevant criteria and standards; thinks open-mindedly within alternative systems of thought, recognizing and assessing, as need be, their assumptions, implications, and practical consequences; and communicates effectively with others in figuring out solutions to complex problems.  

For this discussion, take some time to reflect upon 2 concepts that you learned in this course. What are the concepts? What insight or ideas did you gain from learningeach of these concepts? Were there aspects of the concepts that you would challenge? What is the importance of these concepts to public health? How will you use this new wisdom in your current or future career?  In order to earn maximum credit, the comment should be more than your opinion, and more than a quick “off the top of your head” response. Be sure to support your statements, cite sources properly within the text of your comments, and list your reference(s). The response must be a minimum of 250 words.

Britton, B. & Serrat (2013). Reflective Practice. Retrieved from http://www.slideshare.net/Celcius233/reflective-practice-27714069

Eliot. T.S. (1944) Four Quartets, The Dry Salvages, pt.2. London. Paul, R. & Elder, L. (February, 2008). The Miniature Guide to Critical Thinking Concepts and Tools. Foundation for Critical Thinking Press

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Nursing homework help

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Hi Autumn, excellant post. I can see how people with weight problems   can get frustrated with diets and weight loss not happening fast   enough. There are many benefits to bariatric surgery, but there are   also risks, and long term complications. Bariatric surgery is not   always the best option to lose weight. It will require discipline and   compliance to keep the weight from coming back. One would think that   if you have discipline, one could lose weight without surgery. This is   major surgery that comes with risks. Surgical risks are bleeding,   blood clots, infection, and much more, including death. Long term   risks include bowel obstruction, dumping syndrome, malnutrition,   vitamin deficiency, nausea, vomiting, low blood sugar. and even death.   Bariatric surgery can help improve sleep apnea, hypertension,   diabetes, and prevent stroke, but there is a tradeoff for other health   problems. If possible, it would be best would be best to change eating   habits and exercise.

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