All Case studies /assignments must be done in APA format with a separate sheet for references. 

Managing care in a Culturally Considerate manner

 CASE STUDY 2

Patient Profile
F.M. is a 68-year-old white man who comes to the emergency department (ED) in the early afternoon with a 2-day history of severe chest pain. The pain started on wakening the previous day. The pain increased during the night, but his wife could not convince him to go to the hospital. He comes to the ED today because the pain is severe and no longer relieved by rest.

Subjective Data

• Describes recurring chest pain for the past 6 months that was relieved by rest; the pain is a feeling of heaviness in chest with no radiating pain to arm or jaw or accompanying complaints of nausea or dizziness
• Recently the chest pain has become severe and is no longer relieved by rest; is now complaining of being slightly nauseated
• His father died of a heart attack at age 62
• Denies alcohol or drug use
• Smokes one pack of cigarettes per day
• Describes his lifestyle as sedentary

Objective Data

Physical Examination

• Blood pressure 180/96, pulse 98, temperature 99.8° F, respirations 20
• Height 5’11”, weight 210 lbs, BMI 29.3 kg/m2
• Alert and oriented to person, place, and time
• Skin diaphoretic and clammy
• Heart rhythm regular, no murmurs or extra heart sounds
• Lungs are clear to auscultation

Diagnostic Studies

• Hemoglobin 14 g/dL
• Chemistry panel is normal
• Cardiac markers – pending
• Electrocardiogram showing changes that correlate with non-ST-segment-elevation myocardial infarction (NSTEMI)

Collaborative Care

• 9% NaCl infusing into IV catheter at 75 mL/hr
• Nitroglycerin and morphine given with relief of pain

1. What are F.M.’s modifiable risk factors for coronary artery disease (CAD)? What are his non-modifiable risk factors?
2. What is the difference between chronic stable angina pain and pain associated with myocardial infarction?
3. What are diagnostic studies indicated for F.M.?
4. F.M. is diagnosed as having a myocardial infarction (MI).
5. What is the priority nursing care for F.M.?
6. What other interventions do you anticipate for F.M. at this time?

Select two clients you observed or counseled this week during a group therapy session for children and adolescents. Note: The two clients you select must have attended the same group session. If you select the same group you selected for the Week 8 or Week 9 Journal Entries, you must select different clients.

CHILDREN AND ADOLESCENTS

FIRST CLIENT 13 YEARS OLD AFRICAN AMERICAN: DISRUPTIVE MOOD DYSREGULATION( DMDD): Medication: Adderall XR 10mg

SECOND CLIENT 17 YEARS CAUCASIAN MALE : MAJOR DEPRESSIVE DISORDER (MDD) AND ATTENTION -DEFICIT HYPERACTIVITY DISORDER(ADHD): Medications: Abilify 20mg at night, Ativan 2mg as needed(Aggression), Prozasin 2mg for sleep. Depakote 500mg twice daily, Effexor 150mg daily.

Then, address in your Practicum Journal the following:.

• Describe each client (without violating HIPAA regulations), and identify any pertinent history or medical information, including prescribed medications.
• Using the DSM-5, explain and justify your diagnosis for each client.
• Explain any legal and/or ethical implications related to counseling each client.
• Support your approach with evidence-based literature.

Rubric:

Quality of Work Submitted:

The extent of which work meets the assignned criteria and work reflects graduate level critical and analytic thinking.–

Excellent (90-100) 27 (27%) – 30 (30%)Good (80-89) 24 (24%) – 26 (26%)Fair (70-79) 21 (21%) – 23 (23%)Poor (0-69) 0 (0%) – 20 (20%)

Quality of Work Submitted: The purpose of the paper is clear.–

Excellent (90-100) 5 (5%) – 5 (5%)Good (80-89) 4 (4%) – 4 (4%)Fair (70-79) 3.5 (3.5%) – 3.5 (3.5%)Poor (0-69) 0 (0%) – 3 (3%)

Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to:

Understand and interpret the assignment’s key concepts.–

Excellent (90-100) 9 (9%) – 10 (10%)Good (80-89) 8 (8%) – 8 (8%)Fair (70-79) 7 (7%) – 7 (7%)Poor (0-69) 0 (0%) – 6 (6%)

Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to:

Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.–

Excellent (90-100) 18 (18%) – 20 (20%)Good (80-89) 16 (16%) – 17 (17%)Fair (70-79) 14 (14%) – 15 (15%)Poor (0-69) 0 (0%) – 13 (13%)

Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to:

Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.–

Excellent (90-100) 18 (18%) – 20 (20%)Good (80-89) 16 (16%) – 17 (17%)Fair (70-79) 14 (14%) – 15 (15%)Poor (0-69) 0 (0%) – 13 (13%)

Written Expression and Formatting
Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.–

Excellent (90-100) 8 (8%) – 8 (8%)Good (80-89) 7 (7%) – 7 (7%)Fair (70-79) 6 (6%) – 6 (6%)Poor (0-69) 0 (0%) – 5 (5%)

Written Expression and Formatting
English writing standards: Correct grammar, mechanics, and proper punctuation–

Excellent (90-100) 7 (7%) – 7 (7%)Good (80-89) 6 (6%) – 6 (6%)Fair (70-79) 5 (5%) – 5 (5%)Poor (0-69) 0 (0%) – 4 (4%) 

Please review the course objectives for N492 (as stated in the syllabus). Please write a self-evaluation of your learning in the course and how you have personally met each of the stated course objectives. 

Course Learning Objectives:

1. Examine      nursing roles that meet the emerging health needs of individuals,      families, communities and populations.
2. Explore      historical, legal, social, cultural, political, and economic forces that      influence the client, nursing practice, and the health care system.
3. Evaluate      strategies that can be used by public and community health nurses to improve      the health status and eliminate health disparities of vulnerable      populations.
4. Predict      trends in lifestyles that will affect the health of communities and the      future challenges for nursing.
5. Plan,      analyze, implement and evaluate public health surveillance and outbreak      investigation
6. Develop      strategies to deliver nursing care in the preparedness, response, and      recovery phases of disaster management

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook.

HCA320 Assignment Mod 6:

Assignment:

Accountability in Healthcare

This assignment will be at least 1500 words. Address each bulleted item (topic) in detail including the questions that follow each bullet. There should be three (3) sections in your paper; one for each bullet below. Separate each section in your paper with a clear brief heading that allows your professor to know which bullet you are addressing in that section of your paper. Include a “Conclusion” section that summarizes all topics.

This week you will reflect upon accountability in healthcare and address the following questions:

· Briefly define an Accountability Care Organization (ACO) and how it impacts health care providers:

How do ACOs differ from the health maintenance organizations (HMOs) of earlier years

What role does health information technology (HIT) play in the newer models of care?

· What is the benefit of hospitals partnering with primary care providers?

How does bundling payments contain healthcare costs?

How does pay for performance (P4P) improve quality care?

· Briefly discuss the value-based purchasing program?

How do value-based purchasing (VBP) programs affect reimbursement to hospitals?

Who benefits the most from value-based reimbursement and why?

How does the VBP program measure hospital performance?

Assignment Expectations

Length: 1500-2000 words in length

Structure: Include a title page and reference page in APA format. These do not count towards the minimal word amount for this assignment. Your essay must include an introduction and a conclusion.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.

 Describe a time when you recognized your values had an impact on your decision. How might this affect clinical reasoning at the bedside?