Please refer to the attachment to answer this question. This…

*Main Procedure Steps Pts. Score P/F 1. Read the article and summarize the key points, identify the barriers to care. 40 2. Identify the cultural safety issues pertaining to one ethnic group, and state how awareness of cultural differences would affect them as medical 40 assistants. 3. The report is well organized and correctly formatted. There are no errors in grammar, spelling, and sentence structure. The report was completed 20 during the specified time frame.

CASE ANALYSIS

A 29-year-old woman, G1P1, was referred to a private hospital because of vaginal bleeding after cervical cerclage. She had previously delivered vaginally her first female infant (3,536 g) after cervical cerclage under the diagnosis of cervical incompetency. In the pregnancy discussed here, cervical cerclage was performed at 15 weeks gestation for the prevention of preterm delivery. Ultrasonography at that time demonstrated no abnormal findings. Twelve days after surgery sudden vaginal bleeding occurred. On admission in the 17th week of gestation, slight bleeding from the external cervical os was noted, and ultrasonography in our hospital demonstrated placenta previa. The placenta overlapped the internal cervical os and the distance from the lower placental edge to the internal os was 28 mm (2.8cm). Despite the administration of oral ritodrine hydrochloride, a β-adrenergic stimulant, bleeding continued in the amount of approximately 800 ml per day. The position of the placenta did not change. After appropriate counseling, the patient chose to terminate the pregnancy because she did not want to undergo the risk of life-threatening bleeding. Cervical os was still closed, and emergency cesarean section was performed at 18 weeksí gestation, 6 days after admission. OB-Gynecologist opened the abdomen with a vertical midline incision. A transverse incision of the lower uterine segment was made, and an infant weighing 175 g was delivered. The placenta covered the internal cervical os and was ablated easily. A double-layer closure was performed as usual. The operative bleeding, including amniotic fluid, was 900 ml, but bleeding continued after surgery. The hemoglobin value was decreased from 8.3 g/dl to 5.6 g/dl, and 5 units of banked concentrated red blood cells were transfused with prophylactic administration of gabexate mesilate for disseminated intravascular coagulation. After blood transfusion, bleeding decreased gradually. The patient was discharged in good condition 12 days after surgery. Two years later, she had a normal pregnancy, with the placental position being normal, and delivered by cesarean section a male infant weighing 3,010 g. No uterine abnormalities were evident during the surgery.
Questions;

1. Based on the case above, discuss the risk factors and signs and symptoms of placenta previa that are presents in the patient.

2.Is cervical cerclage done with the patients was the predisposing factor of placenta previa? Why? Why not?

3.Discuss and enumerate the nursing management of a patient having massive blood loss and undergoing blood transfusion due to placenta previa.

Where does the Affordable Care Act fit into the overall U.S. health care payment system?

• How has it affected private insurance and Medicaid?
• Did it go far enough in providing access to health care for all U.S. citizens?  Too far?  Explain your position.

Report from home health nursing manager: Red is an 80-year-old farmer

and war veteran who lives by himself, 20 miles from the nearest city. He has been a widower for 10 years but his son and daughter-in-law, Jon and Judy, live nearby. He was diagnosed with type 2 diabetes about six months ago and recently began taking insulin. We (nurses from the home health agency) have been asked to see him to evaluate a wound caused by wearing shoes that were too tight. The toe was injured about three weeks ago. Red has been treating it by soaking his foot in water. His daughter-in-law, Judy, expressed concerns about his ability to manage diabetes self-care, and he has agreed that she can be present for the conversation. We know he is very independent, alert, and oriented. He drives himself into town at least once a week and spends a lot of time on his computer. Patient Details Patient Data: Male- Age: 80 years. Weight: 109 kg (240 lbs). Height: 183 cm (72 in). Allergies: No known Past Medical History: Diabetes type 2, diagnosed six months ago. Initially treated with oral antidiabetics, but a few weeks ago shifted to insulin. History of Present Illness: The patient developed an ulcer on his big toe three weeks ago. He has been soaking his foot to heal the wound. Recently, he revealed the wound to his family, who called Dr. Baker. Social History: Widower, his son Jon and daughter-in-law Judy live nearby. Primary Medical Diagnosis: Pressure ulcer, right great toe. Type 2 diabetes. Surgeries/Procedures & Dates: L4-5 laminectomy 25 years ago, transurethral resection of the prostate six years ago. Describe 5 statements re this health problem here Describe the purpose of each assessment tool and what the scoring means for care planning. 1. 2. list at least two problems (apply 3 step process: problem, R/T, AEB) you anticipate the patient in the vSim may present:(nursing Diagnosis) 1. 2. Drug Name/Drug Class How the drug works/ is this a safe dose? Indication (For what specific reason is this drug ordered for your resident? Nursing assessments What nursing actions must be done when administering this medication? Side effects/ adverse reactions/ lab monitoring Lab Tests (blood, urine, sputum, cultures, etc): Please complete below for laboratory tests listed TEST Normal Range Purpose Why ordered for this health problem Nursing actions that require assessment or follow up (npo, diet changes, med change) PROCEDURES and DIAGNOSTIC TESTS (oxygen, O2 Sat level, radiography, etc.). Please complete the table for procedures listed in the preparation for vSim. TEST/DATE What is the purpose of this test (text reference) Why ordered for this patient (related to primary dx?) Plan of care implications? Nursing actions that require assess or follow up (npo, diet changes, med change)