Discuss the importance of creating networking and information-sharing arrangements among regional health information organizations (RHIO), health information exchanges (HIE), and health information organizations (HIO). How can improving interfacing and communication among these entities improve the quality and standards of healthcare delivery?
A 55-year-old man with a history of hypertension comes to the clinic to establish care. The patient has a history of hypertension and hyperlipidemia. He is currently taking hydrochlorothiazide 25mg PO daily and amlodipine 5mg PO daily for hypertension. He has been working on lifestyle modifications to help normalize his cholesterol level. The current lipid panel shows that this patient’s total cholesterol is 200 mg/dL and HDL is 40 mg/dL. The patient does not drink alcohol but smokes a pack of cigarettes per day. His vital signs today are as follows: BP 134/88mmHg; HR 74bpm; RR 18/min; T98.2F; BMI 31/kg/m2. QUESTIONS:
1. Calculate the patient’s ASCVD risk?
2. What does the NP prescribe for this patient’s hyperlipidemia? Provide a rationale.
3. What does the NP include in the medication (question #2) education plan?
4. What laboratory studies does the NP order? Provide a rationale. The Patient returns for follow up and the home BP readings average 140’s/88-92mmHg. The NP considers modifying the patient’s BP medications. The patient is adherent with the above prescribed medications.
5. List the patient’s pharmacological regimen for the treatment of this patient’s hypertension? Provide a rationale for your choices.
6. What are the side effects of the medications listed above?
7. What is the hypertension management plan for the patient? List patient education, monitoring (what & when) and follow-up?
8. The patient now has a diagnosis of type 2 diabetes and is started on metformin 500mg PO QD and semaglutide (Ozempic)? Does this change the patient’s hypertension management? Provide a rationale.
Case Study
Just prior to closing out your day as the HIM Director of Maryland Ambulatory Clinic, you receive a call from a revenue cycle management. The specialist is concerned about lost revenue resulting from documentation errors. After reading “The Importance of Clinical Documentation Improvement” by Amanda Shanty Balas et all and conducting a google search list your top ten clinical document improvement best practices, and strategies.
End Product
Demonstrate the group’s ability to abstract information from medical records by drafting a final list of the top ten clinical document improvement best practices and strategies based on current literature.
Assignment
Each student is to conduct an online literature search and report out their top ten clinical document improvement best practices and strategies for improving a facility’s revenue cycle. The
Your initial individual list should be submitted by Friday at 11:59 PM. Your initial post is to include at least two external citations. One article has been included to assist you. Students will work within there group to draft a final list of best practices by Sunday at 11:59 P
A Decision Support System (DSS) is an information system that guides the provider in the process of making clinical, financial, and operational decisions. A typical healthcare facility, like a hospital, may use several DSS to support its diverse operations. Evaluate the impact of various Decision Support System in any healthcare facility (hospital, ambulatory, urgent care, nursing home) with clinical, operational, financial, supply chain and human resources functions. What could be the possible risks of not using these decision-making tools for the organization? Why? Cite an example of using DSS and assess its reliability in decision-making. Explain your reasoning. Provide in-text citations and references.
Explore the role of genetics in understanding human health and disease. Discuss the principles of genetic inheritance, the impact of genetic variation on susceptibility to diseases, and the applications of genetic testing and personalized medicine in healthcare.
DISCUSSION FORUM–REQUIRED: Pharmacokinetic Considerations Pharmacokinetics At this point in the course, we have considered many aspects of pharmacokinetics. We have studied “rapid metabolizers” of codeine in unit 2, and you are currently studying renal drugs and the most important determinant of drug dosing in the elderly–creatinine clearance. Recently, new renal markers have been identified that can help monitor kidney function (and ostensibly, drug clearance) even before serum creatinine levels increase. In the cardiac drugs, we have examined the different aspects of warfarin metabolism in patients who have varying responses to that drug.
And by now, hopefully, you are also getting an appreciation for a certain handful of drugs that you must always be mindful and careful of–the drugs that are potent inhibitors or inducers of certain P450 enzymes and P-glycoprotein. When you consider that the average 65-year-old American takes 13-16 medications at any given time, the worry of polypharmacy, drug interactions, and adverse reactions is very real! In this post, I would like you to share a clinical experience you may have had where pharmacokinetics have had to be considered and why. It is not enough to post “I had to measure CrCl because the patient was old”. Think about
Quiz – Module 3 Knowledge Check
Knowledge Check: Gastrointestinal and Hepatobiliary Disorders
• In this exercise, you will complete 5-essay-type questions in the Knowledge Check to gauge your understanding of this module’s content.
• Each question will hold one to two parts asked to be addressed and each part will need at least one citation, at least two citations if asked two parts to the question from the textbook and/or current peer-reviewed journals.
• Each question is worth 4 points. I would expect substantive paragraphs per answer (a paragraph would include 6-10 sentences).
KC each essay needs a citation(s) and reference(s), if using textbook apply correct page(s)
Basic book citation format
The APA in-text citation for a book includes the author’s last name, the year, and (if relevant) a page number.
In the reference list, start with the author’s last name and initials, followed by the year. The book title is written in sentence case (only capitalize the first word and any proper nouns). Include any other contributors (e.g. editors and translators) and the edition if specified (e.g. “2nd ed.”).
Format Last name, Initials. (Year). Book title (Editor/translator initials, Last name, Ed. or Trans.) (Edition). Publisher.
Reference entry Anderson, B. (1983). Imagined communities: Reflections on the origins and spread of nationalism. Verso.
In-text citation (Anderson, 1983, p. 23)
Possible topics covered in this Knowledge Check include:
• Ulcers
• Hepatitis markers
• After HP shots
• Gastroesophageal Reflux Disease
• Pancreatitis
• Liver failure—acute and chronic
• Gall bladder disease
• Inflammatory bowel disease
• Diverticulitis
• Jaundice
• Bilirubin
• Gastrointestinal bleed – upper and lower
• Hepatic encephalopathy
• Intra-abdominal infections (e.g., appendicitis)
• Renal blood flow
• Glomerular filtration rate
• Kidney stones
• Infections – urinary tract infections, pyelonephritis
• Acute kidney injury
• Renal failure – acute and chronic
QUESTION 1
1. Scenario 1: Peptic Ulcer
A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks. The pain described as burning, non-radiating and worse after meals. Denies N&V, weight loss or obvious bleeding. She admits to frequent belching with bloating.
PMH: seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,
Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and 6-7 cups of coffee per day. She denies illicit drug use, vaping or unprotected sexual encounters.
Breath test in the office revealed urease.
The healthcare provider suspects the client has peptic ulcer disease.
Questions:
1. Explain what contributed to the development from this patient’s history of PUD?
QUESTION 2
1. Scenario 1: Peptic Ulcer
A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks. The pain described as burning, non-radiating and worse after meals. Denies N&V, weight loss or obvious bleeding. She admits to frequent belching with bloating.
PMH: seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,
Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and 6-7 cups of coffee per day. She denies illicit drug use, vaping or unprotected sexual encounters.
Breath test in the office revealed urease.
The healthcare provider suspects the client has peptic ulcer disease.
Question:
1. What is the pathophysiology of PUD/ formation of peptic ulcers?
QUESTION 3
1. Scenario 2: Gastroesophageal Reflux Disease (GERD)
A 44-year-old morbidly obese female comes to the clinic complaining of “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. She says she has started coughing at night which has been interfering with her sleep. She denies palpitations, shortness of breath, or nausea.
PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2)
FH:non contributary
Medications: Lisinopril 10 mg po qd, Bentyl 10 mg po, ibuprofen 800 mg po q 6 hr prn
SH: 20 PPY of smoking, ETOH rarely, denies vaping
Diagnoses: Gastroesophageal reflux disease (GERD).
Question:
1. If the client asks what causes GERD how would you explain this as a provider?
QUESTION 4
1. Scenario 3: Upper GI Bleed
A 64-year-old male presents the clinic with complaints of passing dark, tarry, stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.
Question:
1. What are the variables here that contribute to an upper GI bleed?
QUESTION 5
1. Scenario 4: Diverticulitis
A 54-year-old schoolteacher is seeing your today for complaints of passing bright red blood when she had a bowel movement this morning. She stated the first episode occurred last week. The episode today was accompanied by nausea, sweating, and weakness. She states she has had some LLQ pain for several weeks but described it as “coming and going”. She says she has had a fever and abdominal cramps that have worsened this morning.
Diagnosis is lower GI bleed secondary to diverticulitis.
Question:
1. What can cause diverticulitis in the lower GI tract?
Pathophysiology of acute renal failure in rhabdomyolysis; A 28-year-old male presents to the primary care office for evaluation of left calf pain, swelling, and redness. He reports that this started one day ago and worsened today. He ran a 27-mile marathon 2 days ago and traveled for 3 hours in a car today.
He reports slight pain on walking and a swollen red calf. He took Ibuprofen 600 mg twice today without relief. Patient reports being an experienced runner, running 3-5 miles daily. He trained for the marathon for 4 months. The patient also reports a history of exercise-induced asthma and uses albuterol sulfate HFA as needed.
On physical exam, the patient appears in good health T 99 P 68 R 18 BP 118/78 wt. 175 lb, height 72 in. BMI 23.1. Heart rate is regular without murmurs, rubs, or gallops. Lungs clear bilaterally. HEENT WNL. Strength lower extremities 5 and DTRs 2. Left calf erythematous, edematous, warm, and tender on palpation. Pulses 3
Should Public sector employment reflect political demographics (that is, workforce 47 percent Democrats if community 47 percent Democrats), ethnic demographics, partisan patronage, political responsiveness, or politically neutral competence? Defend your answer, Political demography is the study of the relationship between politics and population change. Population change is driven by classic demographic mechanisms – birth, death, age structure, and migration.
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