Quality Metrics For Chronic Disease Management

Quality Metrics for Chronic Disease Management

 According to the CDC, chronic diseases are the leading cause of death in the United States, with almost 50% of the population suffering from at least one chronic illness. As a result, almost 80% of health care spending is devoted to its management (CDC, 2010). To this end, the National Committee for Quality Assurance (NCQA) developed performance measures. These performance measures allow organizations to compare yearly quality improvement outcomes in the management of chronic diseases. As a nurse engaged in advanced practice, you may find yourself at the forefront of prevention and care management efforts.
 

To prepare:

  • Review      the National Committee for Quality Assurance report, presented in the      Learning Resources, and examine current trends and measures associated      with at least two chronic diseases. This information will form the basis      for this Discussion.
  • Review      examples of measures that address the management of chronic diseases for      an inpatient setting that might not be relevant in an outpatient setting.      Be sure to explore the companion metrics that influence a patient’s      ability to manage chronic disease.
  • Consider      how these metrics facilitate change and improve the management of chronic      disease.
  • Examine      the efficiency of current automated trigger systems for managing patient safety.      Ask yourself: How do these automated trigger systems help improve quality      of health care, patient education, and management of chronic illnesses?

By tomorrow 12/27/2017, write a minimum of 550 words essay in APA format with 2 references from the list below. Include the level one headers as numbered below:

post a cohesive response that addresses the following:

1) Compare one quality metric for managing chronic disease that applies to your practice setting to a metric that applies in a different practice setting (i.e. hospital nurse compared to home health nurse).

2) Evaluate how these quality metrics facilitate change and improve the management of chronic disease.

3) Take a stance on the efficiency of current automated trigger systems to help manage patient safety. Do you believe these to be proactive or reactive responses when educating patients on disease management?

 Required Readings

Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Administration Press.

Chapter 9: “Measuring and Improving Patient Experiences of Care”

Frith, K. H., Anderson, F., & Sewell, J. P. (2010). Assessing and selecting data for a nursing services dashboard. Journal of Nursing Administration, 40(1), 10–16. doi:10.1097/NNA.0b013e3181c47d45

This article highlights the benefits of nurses using dashboards to help with staffing issues. It considers the sharing of data that dashboard can facilitate from the perspectives of nurses, units, hospitals, and patients.

Grossmeier, J., Terry, P. E., Cipriotti, A., & Burtaine, J. E. (2010). Best practices in evaluating worksite health promotion programs. American Journal of Health Promotion, 24(3), TAHP 1–9.

In this article, the authors discuss how to measure success when analyzing worksite health promotion (WHP). They then cover how to organize these measurements, assess WHP programs, and determine factors related to best-practice evaluation frameworks.

Stanley, R., Lillis, K. A., Zuspan, S. J., Lichenstein, R., Ruddy, R. M., Gerardi, M. J., & Dean, J. M. (2010). Development and implementation of a performance measure tool in an academic pediatric research network. Contemporary Clinical Trials, 31(5), 429–437.

The details of this article focus on a multi-center research network that initiated an evaluation method using balanced scorecards. The first three years of the measurement tool’s implementation are covered, and the achievements and challenges are discussed.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: Benchmarking outcomes. Baltimore: Author.

Note: The approximate length of this media piece is 10 minutes.

In this program, Barbara Epke and Carrie Brady discuss methods that health care organizations use to gather data for measuring outcomes, and explain how data are used to measure key indicators of quality and safety.

 
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Project Topic Selection And Approval

In collaboration with your approved course mentor, you will identify a specific evidence-based practice proposal topic for the capstone project. Consider the clinical environment in which you are currently working or have recently worked. The capstone project topic can be a clinical practice problem, an organizational issue, a quality improvement suggestion, a leadership initiative, or an educational need appropriate to your area of interest as well as your practice immersion (practicum) setting. Examples of the integration of community health, leadership, and an EBP can be found on the “Educational and Community-Based Programs” page of the Healthy People 2020 website.

Write a 750-1000 words description of your proposed capstone project topic. Make sure to include the following:

  1. The problem, issue, suggestion, initiative, or educational need that will be the focus of the project . {Problem:Childhood Obesity]
  2. The setting or context in which the problem, issue, suggestion, initiative, or educational need can be observed.
  3. A description providing a high level of detail regarding the problem, issue, suggestion, initiative, or educational need.
  4. Impact of the problem, issue, suggestion, initiative, or educational need on the work environment, the quality of care provided by staff, and patient outcomes.
  5. Significance of the problem, issue, suggestion, initiative, or educational need and its implications to nursing.
  6. A proposed solution to the identified project topic

You are required to retrieve and assess a minimum of 8 peer-reviewed articles. Plan your time accordingly to complete this assignment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

 
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Comprehensive Health Assessment

Select a patient that you examined during the last four weeks. With this patient in mind, address the following in a SOAP Note:

  • Subjective: What details did the patient provide regarding or her personal and medical history?
  • Objective: What observations did you make during the physical assessment?
  • Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
  • Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan.
  • Reflection notes: What would you do differently in a similar patient evaluation?

(THE TOPIC HERE IS URINARY TRACT INFECTION (UTI) )

please use this format

Comprehensive SOAP Template

Patient Initials:  Age:  Gender: F

Introduction –Purpose:

SUBJECTIVE DATA: 

Chief Complaint (CC): 

History of Present Illness (HPI): 

Medications: 

Allergies: Seafood, iodine

Past Medical History (PMH):

Past Surgical History (PSH): Denies.

Sexual/Reproductive History (Obstetric)

Personal/Social History: 

Immunization History and Preventive Care: 

Significant Family History: 

.

Review of Systems: 

General

HEENT

Respiratory

Cardiovascular: 

Breasts: 

Gastrointestinal: 

Genitourinary

Musculoskeletal

Psychiatric

Neurological

Dermatological

Hematological and Lymphatic

Endocrine

Allergy and Immunology

OBJECTIVE DATA: 

Physical Exam:

Vital signs: 

General appearance:

HEENT: 

Neck: 

Lymphatics: 

Breasts: 

Chest: 

Heart: 

Abdomen: 

  Neurological:

  Musculoskeletal:

 Extremities: 

 Skin: 

Labs, X-rays, and Diagnostics 

ASSESSMENT:

Priority Diagnosis  

Differential Diagnosis

For each priority diagnosis, list at least three differential diagnoses, each of which must be supported with evidence and guidelines. For holistic care, you need to include previous diagnoses and indicate whether these are controlled or not controlled. These should also be included in your treatment plan.

PLAN:

Treatment Plan: If applicable, include both pharmacological and non-pharmacological strategies, alternative therapies, follow-up recommendations, referrals, consultations, and any additional labs, x-ray, or other diagnostics. Support the treatment plan with evidence and guidelines.

Health Promotion: Include exercise, diet, and safety recommendations, as well as any other health promotion strategies for the patient/family. Support the health promotion recommendations and strategies with evidence and guidelines.

Disease Prevention: As appropriate for the patient’s age, include disease prevention recommendations and strategies such as fasting lipid profile, mammography, colonoscopy, immunizations, etc. Support the disease prevention recommendations and strategies with evidence and guidelines.

REFLECTION:Reflect on your clinical experience, and consider the following questions: What did you learn from this experience? What would you do differently? Do you agree with your preceptor based on the evidence? 

                                                                      References

 
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NUR6550 Final Exam

NUR6550 Final Exam

1. The Valsalva maneuver and the squat-to-stand maneuver are likely to increase the sound of a cardiac murmur associated with which of these conditions?

2. Which of the following conditions may result in lower extremity edema?

Nephrotic syndrome

Decompensated congestive heart failure

Cirrhosis

Renal failure

Deep venous thrombosis

Late-stage pregnancy

All of the above

3. Art Bakke is a 46-year-old male who is being treated for an acute myocardial infarction. He has now developed significant dyspnea at rest and, per physical exam, has coarse rales involving the lower 2/3 of the lung fields bilaterally. You suspect acute pulmonary edema due to papillary-muscle rupture and acute mitral-valve regurgitation.

Question: Which of the following physical findings would support this diagnostic hypothesis?

A palpable diastolic murmur maximal in the second intercostal space (ICS) at the left sternal border

A harsh, rumbling, diastolic murmur heard maximally in the fourth ICS at the left sternal border

A holosystolic systolic murmur heard maximally in the fifth ICS at the midclavicular line

4. The most common ECG finding in a patient with a cardiomyopathy is an ST-elevation MI.

True

False

5. Nina Martinez is a 70-year-old female who experienced an episode of acute pulmonary edema following an endovascular aneurysm repair. She was discharged on furosemide 60 mg daily and instructed to follow up with cardiology. She is now seen in the office at 2 weeks post discharge. Her metabolic panel includes the following lab values:

·          Na 126 mEq/L

·          K 4.0 mEq/L

·          Cl 93 mEq/L

·          CO2 28 mEq/L

·          BUN 40 mg/dL

·          Cr 1.3 mg/dL

Question: This patient has which of the following abnormalities as a likely consequence of diuretic overuse?

Hyponatremia

Hypokalemia

Metabolic acidosis

6. Which of the following are primary cardiomyopathy categories, as described by the World Health Organization (WHO) in 1995?

Dilated cardiomyopathy

Symbol Hypertrophic cardiomyopathy (HCM)

Symbol Restrictive cardiomyopathy

Symbol Arrhythmogenic right ventricular dysplasia

Symbol Unclassified

All of the above

7. What is the most common cause of sudden cardiac death in young people?

What is the most common cause of sudden cardiac death in young people?

Myocardial infarction

Hypertrophic cardiomyopathy

Supraventricular tachycardia

Arrhythmogenic right ventricular dysplasia; aka arrhythmogenic right ventricular cardiomyopathy (ARVC)

8. Which of the following are treatment options for a patient who presents with peripartum cardiomyopathy while still carrying the fetus? (Select all that apply.)

ACE inhibitors

Induction if stable

Emergent cesarean section if unstable

Digoxin

Nitroglycerin

9. What are the 3 major clinical complications related to cardiomyopathies?

Arrhythmias; including ventricular tachycardia and ventricular fibrillation

Thromboembolic complications; including DVT, PE, and ventricular thrombi

Acute pulmonary edema

10. Some patients with primary cardiomyopathies remain asymptomatic throughout their lifetime.

True

False

11. A 38-year -old woman comes to the emergency department complaining of a rapid heartbeat, tremors, and chest tightness. She reports earlier in the day she was feeling a migraine starting so she took a pill given to her by her friend who also experiences migraines. Her medical history reveals that she is currently taking a monoamine oxidase inhibitor for depression. Which migraine medication did she most likely take?

Acetaminophen and caffeine (Excedrin ® Migraine)

Naproxen sodium (Aleve ® )

Almotriptan (Axert ® )

Butalbital, acetaminophen and caffeine (Fioricet ® )

12. You are seeing a 68-year-old woman for treatment of an uncomplicated urinary tract infection (UTI). She has well-controlled hypertension, type 2 diabetes mellitus, and dyslipidemia and takes an angiotensin-converting enzyme inhibitor (ACEI), statin, biguanide, and low-dose aspirin (ASA). She worked in a dry cleaning facility until approximately 8 years ago. During her evaluation, she mentions that she sometimes has difficulty understanding conversation, especially in noisy environments. This is likely a:

Drug-related reaction.

Consequence of occupational chemical exposure.

Early sign of dementia.

Normal age-related change in hearing

13. While evaluating a 33-year-old female with a 2-day history of dysuria, which of the following findings in urinalysis is most suggestive of urinary tract infection (UTI) caused by a Gram-negative organism?

Nitrites

30 mg/dL protein

Epithelial cells

pH>8

14. All of the following are examples of primary prevention strategies except:

Counseling an elderly patient prior to discharge about fall risk at home and how to prevent falls through adequate illumination.

Performing a hemoglobin A1C for all patients admitted to the hospital.

Conducting a study to identify the leading cause of mortality in teenagers and how to reduce risk.

Immunizing all adults ?60 years with zoster vaccine.

15. A 23-year-old woman is being evaluated for an upper respiratory tract infection. As you prepare for auscultation, the patient states “I have a benign murmur that has been with me my whole life”. Anticipating a physiologic murmur, you would expect which of the following characteristics?

Usually obliterates S2.

Becomes softer when going from a supine to standing position.

Occurs late in systole.

Has localized area of auscultation

16. You see a 73-year-old woman with a 40 pack- year smoking history, chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD) who presents with an ulcer on the sole of her left foot. The ulcer has an irregular edge and pale base and a punched out appearance, with the surrounding skin white and shiny. The patient states that the pain is worse at night in bed and when the legs are elevated. The most likely diagnosis is:

Pressure ulcer

Pyoderma gangrenosum

Venous ulcer

Arterial ulcer

17. You see a 76-year-old woman living at home who is accompanied by her home care provider. She has COPD and type 2 diabetes mellitus. An example of a secondary prevention strategy is:

Administering the seasonal influenza vaccine.

Screening for physical or financial abuse/Checking her blood glucose level.

Checking her blood pressure.

Adjusting her insulin dosing regimen.

18. A 43-year-old woman is being evaluated in the emergency department with a complaint of a severe headache. She describes a unilateral, pulsing headache that was preceded by a gradual onset of paresthesia affecting the ipsilateral face and arm. The patient stated she noticed a “funny smell” prior to the symptoms starting. This description is most typical of:

Migraine with aura.

Cluster headache.

Transient ischemic attack.

Tension-type headache.

19. You see a 54-year-old man living in subsidized housing with a history of hypertension. He states that he stopped taking his blood pressure medication about 4 months ago because of costs. He is concerned because his blood pressure is high whenever he checks it, though he does not report any symptoms. His BP at this visit is 196/104 mm Hg. Upon examination of this patient, you would expect to detect an S 4 sound heard during:

Early systole.

Late systole.

Early diastole.

Late diastole.

20. 32-year-old man requires evaluation for hepatitis infection prior to taking a job as a restaurant cook. He presents with the following laboratory results:

Hepatitis A Panel Hepatitis B Panel Hepatitis C Panel

Anti-HAV Negative HBsAg Negative Anti-HCV Positive

IgM Negative Anti-HBc Negative HCV RNA Negative

IgM NegativeAnti-HBs Positive

You recognize the patient is susceptible to:

Hepatitis A and B

Hepatitis B and C

Hepatitis B only

Hepatitis A only

21.  When evaluating illness symptoms in older patients, the disease will often present differently from younger adults due to:

The likelihood of polypharmacy.

Decreased compensatory mechanisms in the elderly.

An increased physiologic response to illness in the elderly.

Presence of comorbid conditions.

22. When prioritizing risk factors for bacterial endocarditis, the nurse practitioner knows who among the following patients has the highest risk.

A 55-year-old man with 3-vessel coronary artery bypass grafts with stents.

A 23-year-old woman with mitral valve prolapse without tissue redundancy.

A 65-year-old man with nonobstructive cardiomyopathy.

A 75-year-old woman with a nonorganic prosthetic aortic valve.

23. The legal authority for NPs to perform healthcare services as defined by state law is called:

Duty of care.

Non-malfeasance.

Autonomy.

Scope of practice.

24. When developing a management plan for patients with genitourinary infections, which of the following would you most likely recommend for follow-up imaging following resolution of their infection?

A 27-year-old nonpregnant woman with acute, uncomplicated urinary tract infection (UTI). 

A 38-year-old nonpregnant woman with 2 acute, uncomplicated UTIs in the past 9 months. 

A 57-year-old man with acute bacterial prostatitis.

A 43-year-old man with type 2 diabetes mellitus and recurrent pyelonephritis.

25. The NP is called to evaluate Jane, a 43-year- old woman, who presents with a diffuse maculopapular rash that began on the trunk but now covers the entire body, including the palms and soles. The rash is not itchy but wart-like sores are present in the mouth and genital area as well as skin folds. Initial evaluation reveals generalized lymphadenopathy and a low-grade fever, and she complains of lethargy and headache. The patient reports that she had a painless genital ulcer that healed on its own about 3 weeks earlier. Which of the following is the most likely diagnosis?

Primary syphilis.

Secondary syphilis.

Genital herpes.

Gonorrhea.

26. A 27-year-old man presents with a chief concern of an abnormal mass within his left scrotum. He describes it as feeling like a “bag of worms” and is present when he is standing but disappears when he lies down. His past medical history is unremarkable and his BMI is 29 kg/m 2 . He has been in a monogamous relationship for the past 4months. The most likely diagnosis is:

Testicular torsion.

Syphilis.

Varicocele.

Testicular cancer.

27. An 18-year-old man is being evaluated for a severe exacerbation of asthma. He is currently taking an inhaled corticosteroid, a long- acting beta-agonist, and a short-acting beta-agonist on an as needed basis. The most important component of the initial assessment includes a(n):

Continuous pulse oximetry reading

Peak expiratory flow reading

Chest X-ray

Arterial Blood Gas

28. A 67-year-old man is being evaluated for shortness of breath. His medical history reveals that he experienced a myocardial infarction about 2 years ago and a history of hypertension, which is well controlled by diet.. Otherwise, his medical history is unremarkable. Which of the following would you expect to find on electrocardiogram (ECG)?

T wave inversion.

Pathologic Q wave.

ST segment elevation.

Tall R wave.

29. A 74-year-old male with asymptomatic atrial fibrillation underwent electrical cardioversion that successfully restored the heart’s rhythm. Which of the following medications can be considered for the purpose of maintaining the heart’s rhythm?

Sotalol (Betapace ® )

Digoxin (Lanoxin ® )

Dabigatran (Pradaxa ® )

Enalapri

30. A 14-year-old male is brought in for evaluation after he reportedly collapsed during a tennis match, though he quickly regained consciousness. His medical history is otherwise unremarkable. You suspect hypertrophic cardiomyopathy. Which of the following heart murmur characteristics would support the diagnosis?

Occurs late in systole.

Widely split S?.

Becomes louder when going from a supine to standing position.

Murmur follows mid-systolic click.

31. You see a 64-year-old man with an area of erythema concentrated on the left side of his neck with clusters of vesicles forming a line. He reported pain in the area a couple of days before the eruption of the lesions. He states that he recently initiated biologic therapy for rheumatoid arthritis. Which of the following is the most likely diagnosis?

Impetigo.

Herpes zoster.

Drug-related adverse reaction.

Viral exanthem.

32. An NP’s duty of care can be established:

Only in the setting of a healthcare institution (e.g., hospital, clinic, etc.).

When the NP gives professional advice or treatment in any setting.

Only when a fee is charged, either to the patient or third-party payer, for services.

Only when both the NP and patient acknowledge a patient-provider relationship.

33. In managing a 58-year- old woman who is admitted for deep vein thrombosis, caution should be used with which of the following medications due to a risk of drug-induced thrombocytopenia?

Warfarin (Coumadin®)

Clopidogrel (Plavix®)

Dabigatran (Pradaxa®)

Unfractionated heparin

34. An 84-year-old female patient is admitted from a local long-term care facility (illnes). The patient is normally awake, alert, and oriented. She resides in the LTCF because she has not fully recovered from a broken hip resulting from a fall 4 months ago; otherwise she is in relatively good health. She can walk short distances with a walker, though she primarily stays in a wheelchair. Today, however, the nursing staff found her to be acutely confused and unable to ambulate without falling. She was transferred to the emergency department for evaluation. Initial laboratory testing must include:

2 sets of blood cultures.

Serum thyroid stimulating hormone (TSH) level.

Urinalysis.

Lumbar puncture.

35. A 23-year-old college student presents with a 2-day history of severe sore throat and difficulty eating or drinking due to trouble swallowing. A physical examination reveals exudative pharyngitis and minimally tender anterior and posterior cervical lymphadenopathy. The NP suspects infectious mononucleosis and would expect which of the following laboratory findings?

Neutrophilia with reactive forms.

Thrombocytosis.

Lymphocytosis with atypical lymphocytes.

Diminished ALT/AST levels.

36. “Incident-to” services are defined as those which are “an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness”. As long as certain criteria are met, “incident to” billing is an option in all of the following settings except:

Office visits.

Hospital.

Nursing home.

Home visits.

37. A 78-year- old male is being treated for a hypoglycemic episode. He has a long history of type 2 diabetes mellitus as well as congestive heart failure and COPD. He is currently taking basal insulin with a sulfonylurea. What is the acceptable A1C goal for this patient?

≤ 6.5%

≤ 7.0%

≤ 8.0%

≤ 9.0%

38. You see a 74- year-old male who is accompanied by his granddaughter who lives with him. He has hypertension, a prior myocardial infarction, long-standing type 2 diabetes, and recently underwent a lower limb amputation secondary to diabetes. He is currently taking an ACE inhibitor, statin, low-dose aspirin, biguanide, and insulin. The granddaughter reports that since the amputation, her grandfather sometimes becomes withdrawn, irritable and moody for no apparent reason, does not want to participate in the typical activities he enjoys, and often does not appear to eat much during the day. She also states that he often complains of being tired but normally wakes up in the early morning hours. The most appropriate action is to evaluate the patient for:

Dementia.

Depression.

Delirium.

Drug interaction.

39. You see a 58-year-old man who complains of a persistent dry, hacking cough. He reports that he recently started taking a medication to treat high blood pressure. He is most likely taking a(n):

Angiotensin-converting enzyme (ACE) inhibitor

Alpha-adrenergic antagonist

Angiotensin receptor blocker

Beta-adrenergic antagonist

40. A 77-year-old woman is accompanied by her husband for evaluation. She is currently being treated with metoprolol (Lopressor ® ) for hypertension and digoxin (Lanoxin ® ) for atrial fibrillation. He reports that his wife is becoming increasingly forgetful over the past year, failing to note important family events such as birthdays, and sometimes becomes confused with driving directions to familiar locations. She has no previous psychiatric history. The most likely diagnosis is:

Parkinson’s disease.

Delirium.

Dementia.

Early stage of congestive heart failure.

41. Mrs. Conner is a 76- year-old woman living in a long-term care facility and has been bedridden with a respiratory infection for the past 4 days. She is brought in for evaluation and you note signs of dehydration as well as a section of epidermal skin loss about 3 cm in diameter on her right hip. The dermal layer appears intact. This would be considered a pressure ulcer of Stage:

1

2

3

4

42. Which of the following represents the highest level of scientific evidence when evaluating clinical research?

A randomized controlled trial.

Systematic review/ Meta-analysis of randomized controlled troals.

Observational study.

Cohort study.

43. A 64-year- old woman with chronic kidney disease presents with a chief complaint of lethargy. His hemogram is as follows:

-Hemoglobin (Hg)=9.9 g/dL (12–14 g/dL

-Hematocrit (Hct)=30% (36%–42%)

-Mean cell volume (MCV)=81 fL (80–96 fL

-Reticulocytes=0.7% (1%–2%)

These findings are most consistent with:

Iron deficiency anemia.

Anemia of chronic disease.

Folate deficiency anemia.

Thalassemia trait.

44. You see a 68-year-old woman who is being treated for moderate depression. She complains that her medication is causing symptoms of dry mouth and constipation. She is most likely taking which of the following medications?

Venlafaxine (Effexor ® )

Citalopram (Celexa ® )

Fluoxetine (Prozac ® )

Nortriptyline (Pamelor ® )

45. All of the following persons are eligible for Medicare services except:

A 74-year-old ex-smoker with COPD and high income from assets.

A 69-year-old undocumented resident in the US with atrial fibrillation.

A 62-year-old with a permanent physical disability due to a motor vehicle accident. 

A 72-year-old permanent legal resident (non-US citizen) with type 1 diabetes mellitus.

46. When initiating therapy with spironolactone for a patient who is also on an ACE inhibitor, you advise the patient to return in 5 days to check which of the following laboratory parameters?

Sodium

Calcium

Potassium

Chloride

47. When considering an end-of-life decision for a terminally ill person with Alzheimer-type dementia who can no longer communicate, all of the following can be used as an advanced directive except:

Testimony from a family member or close friend

A living will.

A “do not resuscitate” order.

A durable power of attorney for healthcare.

48. Which of the following types of clinical studies represents the lowest level of evidence used to guide medical decisions?

Clinical experience of renowned expert in field.

Non-randomized controlled study.

Observational study.

Case-control study.

49. Which of the following electrocardiogram (ECG) changes do you expect to find in a person with myocardial ischemia?calcium

Pathologic Q wave

Tall R wave

T wave inversion

ST segment elevation

50. Which of the following statements is false regarding end-of-life decision-making for a patient that is hopelessly and terminally ill?

A durable power of attorney for healthcare can be used to authorize another person to make healthcare decisions. 

A videotaped or audiotaped discussion with the patient can include advanced directives.

Advanced directives are legally binding and recognized in all 50 states.

Living wills and do not resuscitate orders are examples of advanced directives.

51. The nurse practitioner is evaluating a 19-year- old male suffering from a severe headache. He has a history of headaches that tend to occur in clusters over a few days. He has unsuccessfully tried several therapeutic modalities. A positive response to which of the following interventions supports the diagnosis of cluster headache?

Oxygen therapy.

Beta-adrenergic blockade.

Tricyclic antidepressant.

Dietary reduction of amines.

52. All of the following are required Medicare terms and conditions for paying NP services except:

The services are within the NP’s scope of practice as defined by state law.

The services performed are those for which a physician would be able to bill Medicare. The services are performed in collaboration with a physician.

Separate charges are billed for NP services and facility charges.

53. A 28- year- old male with asthma presents with a chief complaint that he has to use his rescue inhaler multiple times each day. An evaluation reveals that he has moderate-to-severe asthma and requires Step 4 treatment. An appropriate regimen would include:

Low-dose inhaled corticosteroid (ICS)

Medium-dose ICS

Medium-dose ICS plus a long-acting beta?-agonist (LABA)

High-dose ICS plus LABA plus omalizumab (Xolair ® )

54. A 62-year-old woman presents in the emergency department complaining of severe toe pain that originated overnight. She has a history of renal disease and is currently taking a thiazide diuretic. Her BMI is 37 kg/m 2 . In considering a diagnosis of acute gouty arthritis, the nurse practitioner knows that the best diagnostic indicator is:

Serum uric acid.

Joint X-ray.

Erythrocyte sedimentation rate (ESR).

Analysis of joint aspirate for urate crystals.

55. Which of the following is the most appropriate antibiotic for a 57-year-old man with acute bacterial rhinosinusitis and who has type 2 diabetes mellitus, COPD and a beta-lactam allergy?

Cephalexin (Keflex ® ).

Amoxicillin-clavulanate (Augmentin ® ).

Trimethoprim with or without sulfamethoxazole (Primsol ® , Bactrim ® ).

Levofloxacin (Levaquin ® )

 
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Nursing Finances


Throughout this course, you’ve examined the importance of anticipating financial fluctuations that may impact your organization’s ability to provide services. While financial managers have no time machines or crystal balls, they do have expense forecasts. Expense forecasting is one of the preeminent tools that financial managers can use to prepare their organizations for future fiscal turbulence. In this Assignment, you will examine a scenario and generate a corresponding expense forecast in Excel.

Before pursuing an opportunity or making a major purchase, financial decision makers must first ascertain if the expenditures are justified. Determining whether a new process, system, or purchase will yield worthwhile returns is no easy task. However, managers have a variety of tools to help them decide whether the new expenditure is warranted. Analyzing a venture’s benefit/cost ratio, marginal profit and loss statement, and break-even points enable nurse managers to make educated decisions about how they choose to commit their funds.

Note: For those Assignments in this course that require you to perform calculations you must:Use the Excel spreadsheet template for the Week 3 assignment
Show all your calculations and formulas in the spreadsheet.
Answer any questions included with the problems (as text in the Excel spreadsheet).

Expense Forecasting

In this Application Assignment you calculate scenarios focusing on benefit/cost ratio analysis, marginal profit and loss statements, and break-even analysis. For these scenarios, you will utilize the provided figures to perform calculations and then make recommendations about the viability of the investment opportunities 

Expense Forecasting Scenario

Your department has performed 20,000 procedures during the first six months (January–June) of 20X1. Spending during that period of time was $210,000 for fixed expense items and $1,200,000 for variable expense items. Of those amounts, $50,000 of fixed expense money was spent on preparing for a Joint Commission survey. Volume is anticipated to be 10% higher in the second half of the year. On November 1st, two new procedure technicians will begin work. The salary and fringe benefit costs for each are $96,000/year. Based on the information provided, prepare an expense forecast for 20X1.

Annualization for Fixed:  (Adjusted Total for Year to Date Expense/6) * 12 =Total Annualized Amounts

Annualization for Variable (Adjusted Total for Year to Date Expense/ 20,000) * 40,000 =Total Annualized Amounts.

Financial Analysis Cycle

Marginal Profit and Loss Statement Scenario

You are examining a proposal for a new business opportunity – a new procedure for which demand is expected to be 1,400 units the first year, growing by 600 units a year thereafter. The price charged per procedure is $1,000. The collection rate is anticipated to be 80%. Each procedure consumes $300 of supplies. Salary cost is estimated to cost $540,000 each year, fringe benefits are 25% of salaries, rent for the facility is $55,000/yr and operating cost are $120,000/yr.

Questions:

  1. Develop a marginal profit and loss statement for this business opportunity.Based on that analysis, should this opportunity be pursued?

Break-Even Analysis Scenario

You can charge $1,075 for a new service. Demand is anticipated to be 8,000 units a year. Your business is able to handle up to 16,500 units annually, so capacity should not be a problem. The average collection rate is 80%. The new service has annual fixed costs of $4,700,000. Variable cost per unit of service is $420.

Question: Use break-even analysis to determine if this new service is financially viable. If the business is not financially viable, what steps could you take to make a case to proceed with implementation?  Explain your decision.

Benefit/Cost Ratio Analysis Scenario

You are considering the acquisition of a new piece of equipment with a useful life of five years. This new technology will make your clinical operation more efficient and allow for a reduction of 10 FTEs. The equipment purchase price is $4,500,000 plus 10% installation fee. The purchase price includes service for the first year, an item that has an annual cost of $10,000. There is a potential for additional volume of 150,000 units in the first year, growing by 30,000 each year thereafter. The price charged per unit is $15.00 with a 50% collection rate. The staff being eliminated are paid $12.50 per hour. The fringe benefits rate is 20%. The hurdle rate is 7.5%.

Questions: After reviewing Dr. Ward’s Video and the calculations below, please answer the following questions:

  • What is meant by  benefit/cost ratio, average payback period and ROI  and why are the all  important to understand when purchasing new equipment?
  • Based on this information, would you pursue this opportunity?
  • Explain your decision  in 250-500 words in the text box below.

References:

Baker, J. J., Baker, R. W., & Dworkin, N. R.  (2018). Health care finance: Basic  tools for nonfinancial managers (5th ed.). Burlington, MA: Jones and  Bartlett Learning.

Chapter 14, “Trend Analysis, Common Sizing, and Forecasted Data” (pp. 149-160)
The focus of this chapter is the use of trend analysis and forecasting to develop future budgets and make financial decisions about capital purchases, programs, and personnel.
Chapter 15, “Using Comparative Data” (pp. 161-173)
In this chapter, you are introduced to the criteria for identifying other health care organizations that are comparable to your own. Data from these organizations can then be used to evaluate your own organizational performance.
Chapter 19, “Estimates, Benchmarking, and Other Measurement Tools” (pp. 223-231)
In this chapter, you continue exploring the concept of financial benchmarking. The chapter focuses on the importance of benchmarking for identifying performance gaps.

Zelman, W., McCue, M., & Glick, N. (2009). Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications (3rd ed.). Hoboken, NJ: Jossey-Bass.
Retrieved from the Walden Library databases.
Chapter 5, “Working Capital Management” (pp. 187–231)
This chapter examines the concept of working capital. The authors explore the specifics of current assets and the management of the working capital cycle.
Chapter 11, “Responsibility Accounting” (pp. 468–497)
Review: This chapter explores the trend toward the decentralization of health care organizations and the challenges this presents. This chapter also describes responsibility centers, or organizational units intended to achieve specific tasks.

Mulva, S., & Dai, J. (2009) Health care facility benchmarking. HERD, 3(1), 28–37.
Reprinted by permission of Sage Publications via the Copyright Clearance Center.

This article describes a national health care facility’s benchmarking program. It is designed to compare measures of capital project performance.

Agency for Healthcare Research and Quality. (2013). Measuring and benchmarking clinical performance. Retrieved from www.ahrq.gov

Ettorchi-Tardy, A., Levif, M., & Michel, P. (2012). Benchmarking: A Method for Continuous Quality Improvement in Health. Healthcare Policy, e101-e119. Retrieved fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359088/

 
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Assignment: Cooperate. Collaborate. Connect.

Many nongovernmental organizations (NGOs) and government organizations often work side by side on the same problem.

To prepare for this Application Assignment, explore the web pages of the organizations provided in your Learning Resources, this week, to learn about the work they are doing. Look for one health issue that you can see in both the NGO and government organizations for this assignment.

To complete this Application Assignment, write a 2 page paper that summarizes and compares the roles and function of one governmental and one nongovernmental organization (NGO) public or global health organization for a specific health issue. Be sure that your summary includes information about the following:

  1. Where are the organizations’ headquarters located?
  2. What is the mission or purpose of these organizations?
  3. What populations do they serve? And what do they do?
  4. How are the organizations funded? Are they part of a larger public health infrastructure?
  5. Do these organizations mention collaboration with any other agencies or organizations?
  6. Are there any major public health issues these organizations are currently focusing on?
  7. What might be some ethical issues that are related to the mission of these organizations? (If the organizations have a code of conduct or ethics statement, provide a brief summary in your description.)
  8. Summarize what you learned in researching these organizations: What were the most interesting things you learned in this application? How are the organizations you selected similar or different?

Be sure to support your work with specific citations from this week’s Learning Resources and additional scholarly sources, as required. Refer to the Essential Guide to APA Style

Resources:

(U. S. Government)

https://www.hhs.gov/
https://www.hrsa.gov/
https://www.cdc.gov/
https://www.nih.gov/
https://www.fda.gov/

(GNO)

http://www.ifrc.org/
https://www.unicef.org/
http://www.unaids.org/en/
http://www.care.org/
 
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Leadership In Nursing And Healthcare


Empathy, motivation, self– and social awareness—what thoughts or images arise as you read these words? These terms relate to skills for understanding, expressing, and managing emotions in self and others, which are attributes of emotional intelligence.

Research frequently demonstrates the importance of emotional intelligence for leaders and managers. In health care, nursing leaders who demonstrate emotional intelligence can positively influence organizational outcomes by contributing to improved nurse retention, increased job satisfaction, and better health outcomes for patients (Codier, Muneno, Franey, & Matsuura, 2010).

To further your self–knowledge, you examine your own emotional intelligence and consider strategies for developing this important leadership characteristic.

To Prepare

  • Review the leaning resources for Week 10. There are 2 tests that are available to you to assess your personal Emotional Intelligence. Take both the tests and consider your personal attributes of emotional intelligence..
  • Identify strategies for developing any areas of opportunity or areas for enhancing your emotional intelligence. What do you need to do to achieve or sustain a high level of performance in this area?
  • Also consider how to work with leaders who do not demonstrate strong emotional intelligence (EI) or whose EI strengths differ from yours. Include these strategies as well.

To Complete

Write a 2– to 3–page paper that describes the results of your emotional intelligence assessment and include your strategies for developing your EI. Be sure to refer to your week 10 resources to develop these strategies and of course cite any references that you use. Also consider how to work with leaders who do not demonstrate strong emotional intelligence (EI) or whose EI strengths differ from yours. Include these strategies as well. Refer to your assignment rubic for grading criteria.

Resources:

Trivella, P., Gerogiannis, V., & Svarna, S. (2013). Exploring Workplace Implications of Emotional Intelligence (WLEIS) in Hospitals: Job Satisfaction and Turnover Intentions. Procedia–Social and Behavioral Sciences 73(27). 701–709.

Retrieved from the Walden Library databases.

Van der Linden, D., Tsaousis, I., & Petrides, K. V. (2012). Overlap between General Factors of Personality in the Big Five, Giant Three, and trait emotional intelligence. Personality and Individual Differences53(3), 175–179.

Retrieved from the Walden Library databases.

https://greatergood.berkeley.edu/quizzes/take_quiz/ei_quiz
https://www.mindtools.com/pages/article/newCDV_59.htm
 
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NR 511 Week 4 Midterm (Exam Version 2)

Question 1: Women are at the highest risk for developing postpartum depression for up to how long after childbirth?

2 weeks

1 month

3 months

6 months

Question 2: CPT coding offers the uniformed language used for reporting medical services and procedures performed by physician and nonphysician practitioners. Clinicians are paid based on calculated resource costs that are calculated based on practice components.

a. Clinician education loans
b. Clinician practice liability and malpractice expense
c. Clinician reported cost reduction efforts
d. Clinician volume of patients treated

Question 3: Janet is a 30-year-old woman who has been recently diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression.
Which of the following is a sign or symptom of cauda equina compression?
a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks

Question 4: A 58-year-old woman who had a total abdominal hysterectomy at the age of 45 is diagnosed with atrophic vaginitis. Which of the following is the most appropriate treatment?
a. Conjugated estrogen 0.625 mg/day oral
b. Estradiol 7.5 mcg/24 hr vaginal ring
c. Medroxyprogesterone 10 mg/day oral
d. Conjugated estrogen 0.3 mg + medroxyprogesterone 1.5 mg/day oral 

Question 5: Which of the following is a specific test for multiple sclerosis (MS)?

a. Magnetic resonance imaging (MRI)
b. Computed tomography (CT) scan
c. A lumbar puncture
d. There is no specific test.

Question 6: Most adult poisonings are:

a. intentional and self-inflicted.
b. accidental.
c. caused by someone wishing to do harm to the person.
d. not attributed to any reason.

Question 7: A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find?

a. The scrotum will be dark.
b. The scrotum will appear light pink or yellow.
c. The scrotum will appear milky white.
d. The internal structures will be clearly visible.

Question 8: Which clinical feature is the first to be affected in increased intracranial pressure (ICP)?What is the normal number for the Glascow Coma Scale?

a. 7 

b. 9 

c. 10
d. 15

Question 9: S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician suspect in the initial test results for this patient?

a. Elevated uric acid level
b. Elevated blood urea nitrogen (BUN) 
c. Decreased urine pH
d. Decreased C-reactive protein (CRP)

Question 10: Which solution should be used when irrigating lacerated tissue over a wound on the arm?

a. Dilute povidone-iodine solution
b. Hydrogen peroxide (H2O2)
c. Saline solution infused with an antibiotic
d. Saline irrigation or soapy water

Question 11: Which ethical principle reflects respect for all persons and their self-determination?

a. Autonomy

b. Beneficence

c. Justice
d. Veracity

Question 12: During a digital rectal exam (DRE) on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

a. An enlarged rubbery gland 

b. A hard irregular gland 

c. A tender gland
d. A boggy gland

Question 13: How often should the clinician examine the feet of a person with diabetes?

a. Once a year 
b. Every 6 months 
c. Every 3 months
d. Every visit

Question 14: Which of the following medications is the treatment of choice for trichomonas? (Points: 2)

a. Metranidazole 

b. Ceftriaxone 

c. Diflucan
d. Doxycycline

Question 15: Immunizations are an example of which type of prevention? (Points: 2)

a. Primary 
b. Secondary
c. Tertiary

Question 16: What is the treatment of choice for a patient diagnosed with testicular cancer?

a. Radical orchidectomy 

b. Lumpectomy 

c. Radiation implants
d. All of the above

Question 17: George, aged 59, complains of a flulike illness, including fever, chills, and myalgia after returning from visiting his grandchildren in New England. He reports having discovered a rash or red spot that grew in size on his right leg. What disease are you considering?

a. A viral syndromes 
b. Lyme disease 
c. Rocky Mountain spotted fever
d. Relapsing fever

Question 18: A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease (STD) has she most probably been exposed to?
a. Gonorrhea 
b. Human papillomavirus (HPV) 
c. Chlamydia
d. Trichomonas

Question 19: What is usually the first sign or symptom that a patient would present with that would make you suspect herpes zoster?

a. A stabbing type of pain on one small area of the body
b. A vesicular skin lesion on one side of the body
c. A pain that is worse upon awakening
d. A lesion on the exterior ear canal

Question 20: Which drug commonly prescribed for burns is active against a wide spectrum of microbial pathogens and is the most frequently used agent for partial- and full-thickness thermal injuries?
a. Clotrimazole cream (Lotrimen) 
b. Mafenide acetate (Sulfamylon) 
c. Silver nitrate
d. Silver sulfadiazine (Silvadene)

Question 21: Which of the following is a role of the advanced practice nurse in palliative cancer care?

a. Detecting cancer in asymptomatic patients or those with specific symptoms
b. Arranging for follow-up care, including psychosocial and spiritual support
c. Identifying and managing complications of care
d. All of the above

Question 22: Which type of burn injury results in destruction of epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?

a. Superficial burns 
b. Superficial partial-thickness burns
c. Deep partial-thickness burns 
d. Full-thickness burns

Question 23: The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (text revision) (DSM-IV-TR) state that excessive worry or apprehension must be present more days than not for at least:

a. 1 month. 
b. 3 months. 
c. 6 months.
d. 12 months.

Question 24: In the United States, what is the second most common connective tissue disease and the most destructive to the joints?

a. Osteoarthritis 
b. Systemic lupus erythematosus (SLE) 
c. Rheumatoid arthritis (RA)
d. Sjogren’s syndrome

Question 25: A sunscreen with a sun-protection factor (SPF) of at least what number will block most harmful ultraviolet (UV) radiation?

a. 4 

b. 8 

c. 10
d. 15

Question 26: The hallmark of an absence seizure is:

a. No activity at all.
b. A blank stare.
c. Urine is usually voided involuntarily.
d. The attack usually lasts several minutes.

Question 27: The effectiveness of benzodiazepines in treating anxiety disorders suggests that which of the following neurotransmitters plays a role in anxiety?

a. Acetylcholine 
b. Gamma-aminobutyric acid (GABA)
c. Dopamine
d. Serotonin

Question 28: Which characteristic of delirium helps to distinguish delirium from dementia?

a. Abrupt onset 
b. Impaired attention 
c. Affective changes
d. Delusions

Question 29: A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?

a. Pregnancy test 

b. Pelvic ultrasound 

c. Endometrial biopsy
d. Platelet count

Question 30: The clinician should question the patient with suspected gout about use of which of these medications that may be a risk factor?

a. Low-dose aspirin 

b. Thiazide diuretics 

c. Ethambutol
d. All of the above

Question 31: A bulla is:

a. A vesicle larger than 1 cm in diameter.
b. An elevated solid mass with a hard texture, and the shape and borders can be regular or irregular.
c. A superficial elevated lesion filled with purulent fluid.
d. Thinning of the skin (epidermis and dermis) that appears white or translucent.

Question 32: Sam is a 25-year-old man who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination.
As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
a. Morning stiffness and limited mobility of the lumbar spine
b. Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain
c. Fever, chills, and elevated erythrocyte sedimentation rate
d. Pathologic fractures, severe night pain, weight loss, and fatigue

Question 33: Which of the following statements is true concerning the musculoskeletal exam?

a. The uninvolved side should be examined initially and compared to the involved side.
b. The part of the body that is causing the patient pain should be examined first.
c. The patient should not be asked to perform active range-of-motion (ROM) exercises whenever possible to avoid causing pain.
d. Radiographs should always be obtained prior to examination so as not to cause further injury to the patient.

Question 34: The current goal of treatment for a patient with HIV infection is which of the following?

a. Viral suppression of HIV to undetectable levels in the peripheral blood
b. Compete eradication of the virus
c. Encouraging the person to have no contact with uninfected individuals
d. Complete abstinence

Question 35: Which of the following classes of drugs should be used as first-line therapy for treatment of delirium?
a. Benzodiazepines 
b. Antipsychotics
c. Anticonvulsants
d. Antidepressants

Question 36: After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient?

a. Suggest she use a heating pad to improve circulation
b. Refer to a podiatrist for a foot care treatment plan
c. Send her for acupuncture treatments
d. All of the above

Question 37: Which of the following statements is true concerning the management of the client with a herniated disc?

a. Muscle relaxants and narcotics can be used to control moderate pain but should be discontinued after 3 weeks of use.
b. An epidural injection is helpful in reducing leg pain that has persisted for at least 3 weeks after the herniation occurred.
c. Intolerable pain for more than a 3-month period is an indication for surgical intervention.
d. All of the above

Question 38: Which patient is more likely to have a cluster headache?

a. A female in her reproductive years
b. A 40-year-old African American male
c. A 55-year-old female who drinks 10 cups of coffee daily
d. A 45-year-old male awakened at night

Question 39: The main mechanism for avoiding a lawsuit involves:

a. Good liability insurance 
b. A collaborating physician 
c. Good documentation
d. Open communication skills

Question 40: A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding? 

a. Trichomonas 
b. Bacterial vaginosis 
c. Human papillomavirus (HPV)
d. Herpes simplex virus (HSV)

Question 41: Which of the following laboratory findings should the clinician expect in a patient with untreated Graves’ disease?

a. Elevated thyroid-stimulating hormone (TSH)
b. Elevated T4
c. Elevated TRH
d. All of the above

Question 42: A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her exam?

a. Human papillomavirus (HPV) 
b. Endometrial hyperplasia
c. Vagismus
d. Polycystic ovarian syndrome

Question 43: When may confidentiality be overridden?  

a. When personal information is available on the computer
b. When a clinician needs to share information with a billing company
c. When an insurance company wants to know the results of a breast cancer gene test
d. When a patient has a communicable disease

Question 44: A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram (ECG) changes should the clinician expect as a manifestation of the disease?

a. Sinus bradycardia 

b. Atrial fibrillation 

c. Supraventricular tachycardia
d. U waves

Question 45: The most cost-effective screening test to determine HIV status is which of the following?

a. Western Blot
b. Enzyme-linked immunosorbent assay (ELISA)
c. Venereal Disease Research Laboratory (VDRL) test
d. Viral load

Question 46: After 6 months of synthroid therapy, the clinician should expect which of the following in the repeat thyroid studies?

a. Elevated thyroid-stimulating hormone (TSH)
b. Normal TSH
c. Low TSH
d. Undetectable TSH

Question 47: The vegetarian patient with gout asks the clinician about food that he should avoid. The clinician should advise the patient to avoid which of the following foods?

a. Rice 
b. Carrots 
c. Spinach
d. Potatoes

Question 48: A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment?

a. Tricyclic antidepressants 
b. Capsacin cream 
c. Vitamin B12 injections
d. Insulin

Question 49 : In the consensus model for Advanced Practice Registered Nurse (APRN) regulation, the “C” of LACE represents?

a. Commitment 

b. Consensus 

c. Certification
d. Collaboration

Question 50: Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?

a. Decreased C-reactive protein
b. Hyperalbuminemia 
c. Morning stiffness
d. Weight gain

 
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Evaluating And Sustaining Improvement


Evaluating and Sustaining Improvement

 The downfall of many quality improvement initiatives is the inability to sustain improvements. Last week, you considered the use of evidence-based practice models as a method for sustaining practice changes to improve quality. This week’s Discussion builds on those concepts of sustainability. You evaluate measurement mechanisms and explore strategies that leadership and improvement teams can use to sustain improvement efforts.
 

To prepare:

  • Review      the evaluation tools presented in the Learning Resources and how the tools      can be used to promote sustainability.
  • Select      a measurement mechanism that can be used to evaluate your quality      improvement initiative. You may wish to conduct additional research on the      use of measurement mechanisms to sustain outcomes of improvement      initiatives.
  • Consider      the influence of leadership and improvement teams in sustaining      improvement efforts. Ask yourself: What specific strategies can leaders      and my improvement team use to sustain our improvement initiative?

By tomorrow Wednesday February 7, 2018 by 12 noon, post a minimum of 550 words essay in APA format with at least 2 references from the list below. Include the levels one headings as numbered below:

post a cohesive scholarly response that addresses the following:

1) Evaluate the influence of leadership and improvement teams in sustaining improvement efforts. 

2) Present a succinct analysis of three or more strategies leaders and teams can use in your response.

Required Readings

Richardson, A., & Storr, J. (2010). Patient safety: A literative review on the impact of nursing empowerment, leadership and collaboration [corrected] [published erratum appears in INT NURS REV 2010 Mar;57(1):158]. International Nursing Review, 57(1), 12–21. doi:10.1111/j.1466-7657.2009.00757.x 

This article analyzes how nurses can improve patient safety. It identifies certain knowledge gaps that inhibit nurses’ ability to improve patient safety that must be addressed before they can effectively make contributions.

Bigelow, L., Wolkowski, C., Baskin, L., & Gorko, M. (2010). Lean Six Sigma: Sustaining the gains in a hospital laboratory. Clinical Leadership & Management Review, 24(3), 1–14.

In this article, a health care organization uses Lean Six Sigma to improve performance, but it does not initially achieve the desired results. It then utilizes an Operational Performance Improvement office from within the organization to receive better training in Lean Six Sigma and it is finally able to improve performance.

Murphree, P., Vath, R. R., & Daigle, L. (2011). Sustaining Lean Six Sigma projects in health care. Physician Executive, 37(1), 44–48. 

The authors of this article consider ways to keep Lean Six Sigma projects operating instead of closing them. They distinguish between closing and controlling, the latter being the last phase in Lean Six Sigma. According to the authors, many organizations close Lean Six Sigma projects when they should be controlling them.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: Organizational change. Baltimore: Author.

Note: The approximate length of this media piece is 10 minutes.

This video examines factors that enhance and impede organizational change. Dr. Wooden and Dr. Freshman discuss change models that can be used to manage the change process and to assist individuals through the transition period 

 
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4-6 Page Paper On Managing Health Care Quality Needed ASAP

Managing Health Care Quality

Imagine that you are a hospital administrator at the Sunlight Hospital in California. The main complaint among the patients is the quality of care. Your job is to understand the state of the hospital, create value, increase efficiency, and turn the facility into a local hospital of choice. Whenever you are making visits in various wards to meet the employees and the patients, you hear how the patients love the hospital, but they would like to see certain improvements in care. The employees seem to be very busy executing their duties and not interacting much with the patients. The hospital board has asked you to compile a report of your findings and suggested strategy for achieving the hospital’s current goals.

Note: You may create and / or make all necessary assumptions needed for the completion of this assignment.

Write a four to six (4-6) page paper in which you:

  1. Classify five (5) measurements of quality of care in a hospital, and justify the major reasons why you believe these measurements matter to patients in their process of choosing a hospital for emergency or inpatient care.
  2. Specify four (4) main features in health care organizations that can be used to design a successful quality improvement plan. Articulate the significant manner in which the specified features can lead to failure or success of quality of care in Sunlight Hospital.
  3. Suggest the salient reasons why quality of care would add value to and create a competitive advantage for the Sunlight Hospital. Justify your response.
  4. Use four (4) recent (within the last five [5] years) quality academic resources in this assignment.
    Note: Wikipedia and other websites do not qualify as quality academic resources.

Your assignment must follow these formatting requirements:

  • Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
  • Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

The specific course learning outcomes associated with this assignment are:

  • Propose methodologies that have been proven to increase value in health care delivery systems
  • Examine leadership and management frameworks that are most applicable to a certain organization type within the health care industry.
  • Craft a strategic plan that leads to a competitive advantage within a certain market.
  • Use technology and information resources to research issues in health care management.
  • Write clearly and concisely about health care management using proper writing mechanics.
 
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