Critical Thinking Questions 

1. Why was this patient placed on immunosuppressive therapy? 

2. Why was the Meckel scan ordered for this patient? 

3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards) 

4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease?  

 

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In 1999 and 2001, the Institute of Medicine published two reports on patient safety concerns and identified alarming problems within our healthcare system during this time. To Err is Human (IOM, 1999) identified high levels of avoidable medical errors in our hospitals resulting in many patients dying. Six aims to improve patient safety were identified in the Crossing the Quality Chasm(IOM, 2001).

Examine the ways in which the U.S. healthcare system has improved since the publication of these reports. What still needs to be done to make our healthcare system better? Discuss whether or not the U.S. healthcare system is meeting all of the six aims (safe, effective, patient-centered, timely, efficient, and equitable) necessary to improve quality of care delivered to our patients. You will also assess the role of patient care technologies in meeting the six aims. Include at least two references in your responses and analysis. 

You Must Read and use Chapter 2 as a reference of E-book which is attached below – Crossing the Quality Chasm: A New Health System for the 21st Century
Chapter Two, “Improving the 21st Century Healthcare System,” outlines the Institute of Medicine’s six aims for improving patient care and offers methods to improve healthcare delivery.

It is a follow-up on the IOM’s 1999 report on medical errors, “To Err is Human: Building a Safer Health System

For additional details, please refer to the Case Study Guidelines and Rubric document.

 

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  Lyme Disease 

Case Study 

A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaints of headache, fever, chills, myalgia, and arthralgia. According to the history, the patient’s symptoms began shortly after a camping vacation. He recalled a bug bite and rash on his thigh immediately after the trip. The following studies were ordered: 

Studies Results 

Lyme disease test, Elevated IgM antibody titers against Borrelia burgdorferi (normal: low) 

Erythrocyte sedimentation rate (ESR), 30 mm/hour (normal: ≤15 mm/hour) 

Aspartate aminotransferase (AST), 32 units/L (normal: 8-20 units/L) 

Hemoglobin (Hgb), 12 g/dL (normal: 14-18 g/dL) 

Hematocrit (Hct), 36% (normal: 42%-52%) 

Rheumatoid factor (RF), Negative (normal: negative) 

Antinuclear antibodies (ANA), Negative (normal: negative) 

 Diagnostic Analysis 

Based on the patient’s history of camping in the woods and an insect bite and rash on the thigh, Lyme disease was suspected. Early in the course of this disease, testing for specific immunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosing Lyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seen early in this disease. RF and ANA abnormalities are usually absent. 

Critical Thinking Questions 

1. What is the cardinal sign of Lyme disease? (always on the boards) 

2. At what stages of Lyme disease are the IgG and IgM antibodies elevated? 

3. Why was the ESR elevated? 

4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment 

 Peripheral Vascular Disease 

Case Studies 

A 52-year-old man complained of pain and cramping in his right calf caused by walking two blocks. The pain was relieved with cessation of activity. The pain had been increasing in frequency and intensity. Physical examination findings were essentially normal except for decreased hair on the right leg. The patient’s popliteal, dorsalis pedis, and posterior tibial pulses were markedly decreased compared with those of his left leg. 

Studies Results 

Routine laboratory work Within normal limits (WNL) 

Doppler ultrasound systolic pressures Femoral: 130 mm Hg; popliteal: 90 mm Hg; posterior tibial: 88 mm Hg; dorsalis pedis: 88 mm Hg (normal: same as brachial systolic blood pressure) 

Arterial plethysmography Decreased amplitude of distal femoral, popliteal, dorsalis pedis, and posterior tibial pulse waves 

Femoral arteriography of right leg Obstruction of the femoral artery at the midthigh level 

Arterial duplex scan Apparent arterial obstruction in the superficial femoral artery 

 Diagnostic Analysis 

With the clinical picture of classic intermittent claudication, the noninvasive Doppler and plethysmographic arterial vascular study merely documented the presence and location of the arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography to document the location of the vascular occlusion. The patient underwent a bypass from the proximal femoral artery to the popliteal artery. After surgery he was asymptomatic. 

Critical Thinking Questions 

1. What was the cause of this patient’s pain and cramping? 

2. Why was there decreased hair on the patient’s right leg? 

3. What would be the strategic physical assessments after surgery to determine the adequacy of the patient’s circulation? 

4. What would be the treatment of intermittent Claudication for non-occlusion? 

 

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Required Resources
Read/review the following resources for this activity:

• Textbook: Chapter 4, 5
• Lesson
• Minimum of 2 scholarly sources (in addition to the textbook)

Instructions
For this assignment, select one of the following options.

• Option 1: Chronicle Adolf Hitler’s rise from failed art student to political speaker to eventually gain control over Germany.
• Option 2: Describe Benito Mussolini’s revival of European Imperialism in North Africa and how he came to be Adolf Hitler’s ally.
• Option 3: Chronicle the rise of extreme militarism in Japan and how it led them to conquer huge chunks of land in Asia and so many islands in the western Pacific basin, and how this led to their conflict with Great Britain and the United States
• Option 4: Describe Joseph Stalin’s rise to total power in the USSR and how his paranoia and desire for total control led to the terrible purges of the 1930s.

Writing Requirements (APA format)

• Length: 2-3 pages (not including title page or references page)
• 1-inch margins
• Double spaced
• 12-point Times New Roman font
• Title page
• References page

 

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Write a 750-1000 word analysis of “Case Study: Fetal Abnormality.” Be sure to address the following questions:

1. Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? Explain.
2. How does the theory determine or influence each of their recommendation for action?
3. What theory do you agree with? How would that theory determine or influence the recommendation for action?

Prepare this assignment according to the guidelines found in the APA Style Guide

 

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