Me    6 posts   Re: Topic 4 DQ 1  I agree with you that the first step to bringing about change in the community is to know the community. One should acknowledge and understand the need for such change. It is usually very tempting to see that something needs fixing and quickly jump into a solution. One should resist this temptation and instead take the time to study the community to get a clear understanding of all the needed change.I, further, agree with you that understanding the healthcare system at the local level involves important questions such as those you mentioned. One needs to understand the services offered in the community so that they can be effective while implementing evidence-based practice. To implement the right change in the community, it is important for the healthcare professionals to put their biases aside and talk to the people on the ground, to get a good understanding of what matters most to the citizens. In the long run, this prevents the implementation of underused EBP initiatives (Saunders & Vehviläinen-Julkunen, 2018). Carrying out such an assessment for the community will help in the identification of the available community resources and how those services can be accessed for the benefit of the patient.I also agree with the insights of your mentor about the importance of focusing on lead education especially in this day and age. I think than this is an area that has not received a lot of attention and tends to be ignored yet it is very important especially for community health. Basing your research in this field will add to the exiting limited knowledge hence contribute to the future body of research. Generally, I find your post to be very informative. All the best.  References  Saunders, H., & Vehviläinen-Julkunen, K. (2018). Key considerations for selecting instruments when evaluating healthcare professionals’ EBP competencies: A discussion paper. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/30019462

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Terri O’Brien    25 posts   Alimatu – substantive credit and APA  Alimatu  As your link contains the journal name and other information, please revisit the link and then provide a complete reference in APA format so I can give you credit for this post.  Thank you.

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NO PLAGIARISM

The control process involves three phases that are cyclic: establishing standards, measuring performance, and correcting deviations. Examine the manner in which health care leaders progress through each phase of the control process to manage organizations.  What is the management function of controlling as related to performance improvement?  What tools are used to measure and monitor performance?  Please describe at least two functions and two tools in your response. 

 

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1. Explain why there are so many codes related to anemia (D50-64).

   Your response should be at least 75 words in length

2. Describe resistant infections and the official guidelines for coding and reporting. Why is it important to correctly identify and code all resistant infections? Include at least one example of a resistant-infection code.Your response should be at least 75 words in length

3 Use the Encoder Pro software to assign I-10 code(s) to the following diagnosis: Pneumocystis pneumonia in patient with HIV. 

4 Use the Encoder Pro software to assign I-10 code(s) to the following diagnosis: Combined spinal cord degeneration due to pernicious anemia. 

5 Use the Encoder Pro software to assign I-10 code(s) to the following diagnosis: Gastroenteritis due to Norwalk virus. 

6  Use the Encoder Pro software to assign I-10 code(s) to the following diagnosis: Alzheimer’s disease. 

7  Use the Encoder Pro software to assign I-10 code(s) to the following diagnosis: Hypertension with end-stage renal disease. 

8.  

QUESTION 8

1. History of Present Illness
   A 50-year-old disabled male is a resident of a nursing home who has been admitted because of marked congestion and respiratory distress. He is known to have mental retardation and frequent urinary tract and pulmonary infections. He has a recurrent epileptic disorder that is well controlled on Dilantin.

   Physical Examination
   On admission, vital signs include a temperature of 101° F, respiratory rate of 32 breaths per minute, heart rate of 82 beats per minute, and blood pressure of 120/70 mm Hg. Examination of the chest reveals bilateral crepitations. There is moderate redness and edema of the scrotal skin.

   Laboratory Data and Course in Hospital
   His white blood cell count is 8.5; hemoglobin, 12.9 g/dl; polymorphonuclear leukocytes, 64; bands, 19; lymphocytes, 10; monocytes, 6; and eosinophils, 1. A urinalysis shows moderate bacterial and white blood cell count. A urine culture shows mixed flora. The repeat urine culture shows Providencia stuartii sensitive to Fortaz. A sputum culture reveals the presence of methicillin-resistant Staphylococcus aureus, sensitive to vancomycin. A chest X-ray film shows bilateral pulmonary infiltrates. Arterial blood gases on room air show a PO2 of 48, PCO2 of 30, and pH of 7.50. When repeated with the patient on oxygen, PO2 is 66, PCO2 is 36, and pH is 7.45. The patient is treated with intravenous vancomycin and intravenous Fortaz. His pulmonary infiltrate decreases. His oral intake has been somewhat poor, and he has been given intravenous fluids off and on. The nursing staff at the nursing home note that his intake, in terms of eating and taking fluids, is much better. His medications at the nursing home include Dilantin, 200 mg twice a day; Tegretol, 400 mg at 8 a.m. and 4 p.m. and 200 mg at 8 p.m.; and Cipro, 500 mg twice a day; and his maintenance medications are continued. This patient is being discharged today.

   Use Encoder Pro software to assign I-10 code(s) for each of the final diagnosis statements below:

 

Final Diagnosis

1. Acute respiratory insufficiency
2. Bilateral pneumonia due to MRSA
3. Providencia stuartii (gram-negative bacilli) infection
4. Mental retardation
5. Epilepsy
6. UTI

 

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Post 1: Choose two terms from the Elements of Fiction lecture and apply them to “The Fall of the House of Usher.”  You learned in the Authors lecture that Poe is considered to be “the father of the modern-day short story.”  Did you find his story engaging?  Why do you think his works remain popular more than 150 years later?  Be sure to quote, cite, and reference from the text(s) using appropriate APA format.  Your post must be at least 250 words.

 

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Please respond to posts as if it were me. 

****For EACH POST ****

-150 words min, 

-1 scholarly article min (no older than 5 years), 

-APA format

Post 1 

Etiology

        Sickle cell anemia (SCA) is an inherited genetic abnormality of the oxygen-carrying protein found in red blood cells called hemoglobin S and is characterized by crescent-shaped (sickle) red blood cells and chronic anemia caused by excessive destruction of the abnormal red blood cells. Sickle cell anemia and the term sickle cell disease (SCD) are often used interchangeably; however, SCD is an umbrella term while SCA is one of 3 main genotypes (Foster & Ellis, 2018).  SCA is usually diagnosed within the first 2 years of life.  Mennella and Parks-Chapman (2018) state that SCA and sickle cell trait occur primarily in persons who are of African descent, persons with Mediterranean, Middle Eastern, Caribbean, and Asian Indian ancestry can have SCA. 

Pathophysiology

        In SCA, the red blood cells contain an abnormal form of hemoglobin called hemoglobin S.  When red blood cells contain a large amount of hemoglobin S, these red blood cells can become deformed into a “sickle” shape and are less flexible and become more prevalent when individuals have infections or decreased levels of oxygen in the blood.  The sickle cells are brittle and break apart easily.  Because the sickle cells are stiff, they have difficulty traveling through the smallest blood vessels which are called the capillaries, thus blocking blood flow and reducing oxygen supply to tissues in areas where these tiny vessels are blocked.  This blockage of blood flow can cause pain and, over time, cause damage organs such as the spleen, kidneys, brain, bones, and other organs as well as causing renal failure and heart failure.

Hallmark Signs

        Although there is no hallmark sign for an individual with SCA, the symptoms they tend to experience are generally fatigue or feeling weak.  Some individuals can even have jaundiced eyes.  The hallmark symptoms for an individual undergoing a sickle cell crisis include severe bone pain, chest pain, fever, and shortness of breath.  Some common lab results would reveal a low hemoglobin and an elevated white blood cell count, platelet count, and reticulocyte count.

Complications

        Potential complications of SCA include ischemic cerebrovascular accident, vaso-occlusion of the pulmonary vasculature, pneumonia, splenic sequestration crisis, severe infection resulting from impaired splenic function, renal dysfunction, chest pain syndrome, enlarged heart, osteomyelitis, retinopathy, blindness, transfusion-related illness due to low hemoglobin, gallstones, chronic pain, enlarged liver, bloodstream infection and aplastic crisis.

Patient Teaching

        Because there is no cure for SCA, supportive treatment is the only therapy available.  I would educate the patient to refrain from flying at high altitudes, prevent infection such as proper handwashing techniques and receiving necessary vaccinations, maintain hydration, and avoid extreme temperature fluctuations as these actions can help prevent a sickle cell crisis.  I would stress to the patient to adhere to his or her prescribed medications as indicated.  In terms of diet, I would advise the individual with SCA to consume a diet high in calories with special attention to protein, minerals such as zinc, copper, folate, and vitamins A, C, E all while spaced out into smaller, frequent meals.

Post 2 

Sickle cell disease is a group of disorders of which sickle cell anemia is the most severe. Sickle cell anemia is an autosomal recessive disorder that is caused due to a genetic mutation where the amino acid valine replaces glutamic acid to cause an abnormal form of hemoglobin within the red blood cells. “The resulting substitution of the hydrophilic amino acid glutamic acid at the sixth position by the hydrophobic amino acid valine leads to the production of hemoglobin S (HbS)” (Wun & Brunson, 2016, p. 640). When deoxygenation and dehydration occur, the red blood cell changes its shape into an elongated crescent (sickle) shape which can lead to a variety of consequences (McCance et al., 2013). Vascular occlusion, organ infarction, and pain are among the complications caused by this disorder. According to McCance et al. (2013) “sickling is an occasional, intermittent phenomenon” (p. 1065) and can be triggered by hypoxemia, a decreased pH, an increase in plasma osmolality, a decrease in plasma volume, or a low temperature. If the sickled red blood cells are not reoxygenated and rehydrated appropriately, irreversible plasma membrane damage may occur which leads to irreversible sickling.

Clinical manifestations of sickle cell anemia include the typical signs of hemolytic anemia – “pallor, fatigue, jaundice, and irritability” (McCance et al., 2013, p. 1066) and are sometimes accompanied by an acute manifestation or crises. There are four types of crises that can be triggered by extensive sickling: vaso-occlusive crisis, aplastic crisis, sequestration crisis, or hyperhemolytic crisis (McCance et al., 2013). Vaso-occlusive crisis is when sickling occurs in microcirculation and obstructs blood flow, causing vasospasm, and can lead to painful swelling of the hands and feet, priapism, severe abdominal pain, and even stroke (McCance et al., 2013). Aplastic crisis typically occurs as a result of a viral infection. Parvovirus B19 is a virus that almost always causes a person with sickle cell anemia to go into an aplastic crisis and causes the production of red blood cells to be shut down temporarily, which leads to a severe hemoglobin drop. Sequestration crisis occurs when blood becomes pooled in the liver/spleen and can lead to death if not treated with hydration and a blood transfusion. Treatment for recurrences of this crisis is the removal of the spleen after the age of 5. Hyperhemolytic crisis is characterized by red blood cell destruction at an accelerated rate, and symptoms include anemia, jaundice, and reticulocytosis.

Supportive care, which is aimed at the avoidance of these crises, is one of the key factors in the treatment and management of sickle cell disease. “Crises can be prevented by avoiding fever, infection, acidosis, dehydration, constricting clothes, and exposure to cold” (McCance et al., 2013, p. 1068). Additionally, it is recommended that all routine childhood immunizations, along with the pneumococcal and meningococcal vaccine series, and an annual influenza vaccine be given to all patients with a sickle cell disease.

For this patient, it is important to ensure that she understands the severity of her disease and how to avoid going into a sickle cell crisis, as well as the potentially life-threatening consequences if she’s not careful.

 

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