Disorders of Hemostasis

Case Study 1: Disorders of Hemostasis

Leona is 52 years old and smokes. She is also overweight and has atherosclerosis. When she was given a 2-week vacation from work, she packed up her bags and flew from Minnesota to Sydney, Australia, for the trip she always wanted to take. Unfortunately, just 3 days after she arrived, she was hospitalized when her left calf became inflamed, causing her considerable pain. The physician attending to her told her she developed a deep vein thrombosis.

  1. Explain, using your knowledge of hypercoagulability, why the trip to Australia contributed to Leona’s DVT? Why was Leona already at risk for thrombus development?
  2. How does Leona’s atherosclerosis affect platelet function? Conversely, what is the effect of increased platelet activity on the development of atherosclerosis?
  3. How do atherosclerosis and immobility promote changes in blood coagulation?
  4. When Leona was in hospital, she received heparin therapy. Explain why this course of action was taken to treat her DVT. Why was she not given heparin tablets to take back to the hotel with her?

Understanding influenza vaccination behaviors

Summarize in detail and thoroughly each article / journal below

Jeremy Ward & Jocelyn Raude (2014) Understanding influenza vaccination behaviors: a comprehensive sociocultural framework, Expert Review of Vaccines, 13:1, 17-29, DOI: 10.1586/14760584.2014.863156.

Casalino, E., Ghazali, A., Bouzid, D., Antoniol, S., Pereira, L., Kenway, P., & Choquet, C. (2018). Patient’s behaviors and missed opportunities for vaccination against seasonal epidemic influenza and evaluation of their impact on patient’s influenza vaccine uptake. Plos One, 13(3), e0193029. https://doi.

Yokum, David & Lauffenburger, Julie & Ghazinouri, Roya & Choudhry, Niteesh. (2018). Letters designed with behavioural science increase influenza vaccination in Medicare beneficiaries. Nature Human Behaviour. 2. 743-749. 10.1038/s41562-018-0432-2.

Jackson, M. L., Chung, J. R., Jackson, L. A., Phillips, C. H., Benoit, J., Monto, A. S., … & Murthy, K. (2017). Influenza vaccine effectiveness in the United States during the 2015–2016 season. New England Journal of Medicine, 377(6), 534-543.

Sagor, K. H., & AlAteeq, M. A. (2018). Beliefs, attitudes, and barriers associated with the uptake of the seasonal influenza vaccine among patients visiting primary healthcare clinics. Saudi Medical Journal, 39(7), 690–696. https://doi-org.chamberlainuniversity.idm.oclc.org/10.15537/smj.2018.7.22293.

Amnon M, Adi S (2020) Attractive Flu Shot: A Behavioral Approach to Increasing Influenza Vaccination Uptake Rates doi.org/10.1177/0272989X20944190.

characteristics of emotional intelligence

Reflect on the worldview of how family, friends, and others see you. Think about the historical markers that influenced your life perspective. Think about your religious or other belief systems. Review the extent to which others with diverse ideas and beliefs were a part of your life experience. As you journal these thoughts, how do they affect your emotional intelligence? What role can a mentor and continuing education play in advancing your life perspective? Which of the characteristics of emotional intelligence is the most developed and which is the least developed? How might you further enhance your emotional intelligence?

 

Cite and reference in current APA Style any resources used.  Minimum 250 words.

Coding Project

Page one will include the title “Coding Project ”, your name, class name, and date of the project, centered on the page.

Each topic will have its own page with the topic name at top and center, followed by your 250 to 300 words summary of your research (word count does not include reference ), and the references used for each topic.

As you have noticed, guidelines vary for different modalities of coding.  Outpatient has a set of guidelines, and Inpatient has their own guidelines.  For each of the following topics I want you to research each one to see if coding differs or if there are specific coding guidelines.   Compare and contrast coding from inpatient/outpatient coding guidelines.

The topics are as follows

  • Home Health
  • Long-term Acute Care (LTAC)
  • Outpatient Rehabilitation
  • Inpatient Rehabilitation
  • Skilled Nursing Facility (SNF)

The last page you will write a summary (100 to 150 words) of what you learned about your research for each topic and state if you would consider working in one of the fields of coding.  This section is worth 5 points for content, spelling and grammar.

technological advancements

Throughout history, technological advancements have appeared for one purpose. Before finding applications elsewhere that lead to spikes in its usage and development. The internet, for example, was originally developed to share research before becoming a staple of work and entertainment. But technology—new and repurposed—will undoubtedly continue to be a driver of healthcare information. Informaticists often stay tuned to trends to monitor what the next new technology will be. Or how the next new idea for applying existing technology can benefit outcomes.

In this Discussion, you will reflect on your healthcare organization’s use of technology. And offer a technology trend you observe in your environment.

To Prepare:

Reflect on the Resources related to digital information tools and technologies.
Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
Reflect on current and potential future trends, such as use of social media. And mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking, or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.

Post a brief description of general healthcare technology trends, particularly related to data/information you have observed in use in your healthcare organization or nursing practice. Describe any potential challenges or risks that may be inherent in the technologies associated with these trends you described. Then, describe at least one potential benefit and one potential risk associated with data safety, legislation, and patient care for the technologies you described. Next, explain which healthcare technology trends you believe are most promising for impacting healthcare technology in nursing practice and explain why. Describe whether this promise will contribute to improvements in patient care outcomes, efficiencies, or data management. Be specific and provide examples.

Healthcare-Acquired Infections

My clinical interest topic is looking at Healthcare-Acquired Infections (HAIs) in regard to nurse staffing.  HCAIs are infections that patients receive while receiving care in a healthcare facility (Thandar et al., 2021). All settings of healthcare, for example, long-term care facilities, ambulatory clinics, surgical centers, and hospitals, can report HAIs. All hospitalized patients can contract HIAs; however, there are vulnerable populations such as the elderly, young children, and people whose immune system has been weakened. Other factors characterizing HAIs are overuse of antibiotics, failure of healthcare workers to wash their hands, the use of indwelling catheters, and long hospital stays (Thandar et al., 2021).

In the United States, at least 1.7 million HAIs are reported each year, with corresponding 99,000 associated deaths. Of the 1.7 million HAIs, 32 percent are urinary tract infections, 22 percent are surgical site infections, 15 percent are pneumonia, and 14 percent are bloodstream infections (Thandar et al., 2021). HIA are also financially stressing. Thandar et al. (2021) report that the general direct cost of HAIs to hospitals in the United States is approximately $35 billion. Lastly, emotional consequences can also impact healthcare providers, patients, and families.

Healthcare providers

In research, PICOT questions are important because they add structure to what is being researched. This saves time and effort as more relevant research is retrieved. Healthcare providers are making great strides towards reducing, and in some cases eliminating, HAIs (Cawthorne & Cooke, 2021). The PICOT question for my focus is: For patients that have acquired HAIs, can proper hand hygiene by healthcare staff, compared to adequate nurse staffing, reduce the infection rates withing 12 months? In this PICOT Question, the population is patients that have acquired HIAs, the intervention is proper hand hygiene, the comparison is adequate nurse stuffing, the outcome is the reduction of HAIs rates, and time- 12 months. This question is an intervention question as it specific and relevant to the specified issue comparing two interventions to see which is most effective.

The first database that I used was CINAHL Plus with Full Text.  I searched for “staffing and healthcare-associated infections.” This only yielded me with 12 articles.  From the resources, I learned that Boolean operators consists of “AND”, “OR”, or “NOT” and can assist with searches by searching combinations of words or phrases.  I then added the Boolean operator “OR” and put in “HAIs” and 309 articles came up. I placed limits by clicking on “peer-reviewed” and my search was reduced to 232 articles.

Healthcare providers

Then I set limits on the dates and requested research only from 2015-2020.  This took my articles to 118.  The second database I used was MEDLINE with Full Text.  This time I searched one key phrase at a time.  Searching for “healthcare-associated infections” gave me 5,764 articles. Once I added “AND staffing”, 44 articles appeared.  Then I added “OR HAIs” and was given 143 articles.  I set the same limits with dates and “peer-reviewed” as the previous database.

Using Boolean operators, adding limits, and searching multiple databases are a few ways to add rigor and effectiveness to researching PICO(T) questions.  Dias et al. (2021) discuss the spirit of inquiry having an ongoing curiosity about why things are done the way they are.  They state that interventions should pique curiosity about evidence supporting their use.  Evidence-based practice leads to the highest quality of care, better patient outcomes, and lower costs (Dias et al., 2021).

the care of diabetic patients

I am interest in the care of diabetic patients. As diabetes is on the rise it is important that nurses have the knowledge. And skills to care for those who live with diabetes and its treatments.  My clinical issue of interest specifically, it to address whether patients being treated with metformin are at risk for vitamin B12 deficiency.  Metformin is frequently prescribed to diabetic patients.  Vitamin B12 is important to the health of the nervous system and nerve cells (Mayo Foundation for Medical Education and Research, 2021). My PICO question will be developed around the idea of prescribing a vitamin B12 supplement to diabetic patients on metformin.

Using database resources to search key words such as, metformin. Vitamin B12 deficiency, and diabetes, I was able to retrieve lots of information.  According to McGonigle & Mastrian (2018), for best patient care healthcare workers must be able to retrieve evidence-based information to achieve best practices.

filters to limit results by limiting information

The first data base I used was CINAHL & Medline Combined search and the Boolean/phrase used was metformin and vitamin B12, this search resulted in 238 articles.  Next, I used the filters to limit results by limiting information to peer-reviewed, full-text resources published between 2017-2021.  This resulted in 92 resources. With filters still activated I also used the Boolean, diabetes. And vitamin B12 and metformin, this further reduced findings to 64 results.

The second database I used was PubMed.  I used the same Boolean words. Diabetes and vitamin B12 and metformin which resulted in 313 articles.  One thing I really enjoyed about PubMed filters is that you can check mark the randomized control trial.  After, I filtered the PubMed database to the randomized control trial information, I had 5 results.

Strategies one may use to increase the rigor. And effectiveness of a database search is to search for evidence by level of evidence. For example, the best evidence design is a systematic review that includes a randomized control trial (McGonigle & Mastrian, 2018). An example of a lower-level evidence would be a descriptive study (i.e., a qualitative study).  Another strategy to increase effectiveness of a database search in MEDLINE database is to use the subject set box. And select systematic reviews (Walden University, 2020).

Strengths category

Assignment: Now you try it!! Develop your own SWOT for the following:

HCA was founded in 1968, in Nashville, Tennessee by Dr. Thomas F. Frist, Sr., Jack C. Massey

and Dr. Thomas F. Frist, Jr.. Frist Sr. is the father of former U.S. Senate majority leader Bill

Frist. Milton Johnson is the CEO of HCA.

The first hospital that HCA owned was Park View Hospital, near downtown Nashville.[3] The

small group of founders worked out of a small house not far from Park View for the first few

years of operation.[4]

In 1969, HCA conducted its first Initial Public Offering (IPO) on the New York Stock Exchange

(NYSE).[3] As HCA grew, the small house that served as office space for the company no longer

provided enough space. In 1972, the company built a new office to house corporate operations

behind Centennial Park in Nashville.[5]

Parkview Hospital circa 1968

Growth & merger

During the 1970s and 1980s the corporation went through a tremendous growth period acquiring

hundreds of hospitals across the United States which numbered 255 owned and 208 which HCA

managed.

In 1988, the hospital operator was acquired for $5.3 billion in a management buyout led by

Chairman Thomas F. Frist, Jr.[6] and completed a successful initial public offering in the 1990s.

In 1993 HCA merged with Louisville-based Columbia Hospital Corporation to form

Columbia/HCA. In April 1998, Birmingham, Alabama-based HealthSouth Corporation

announced it was acquiring the majority of HCA’s surgical division.

Fraud & investigation

In 1997, the company was part of a fraud investigation initiated by a number of governmental

departments in the United States. Later that year, Rick Scott resigned as Chairman. He later

became the 45th and current Governor of Florida. The case was settled in 2002 at a reported cost

The Cali Clinic Case Study”

Written Assignment Requirements:

  1. 12 pt. Times New Roman
  2. Double Space
  3. All margins must be one inch each

Instructions:  Read “The Cali Clinic Case Study”

An important part of your answer is to identify the issues/actions in the case which may be problematic. The following questions may help you to do this:

What actions were taken in the case?

Were these actions the most appropriate and why?

Were there any consequences of the action taken?

Was anything omitted or not considered?

Were actions/procedures in line with existing codes of practice, policy or theories?

Do you see any challenges?

Discuss the element of external validation of quality and how important this issue is among the international market (Chapter 3).

Include the role of transparency and ultimately quality metrics.

Discuss why you think the other senior partners are against this more “sophisticated management approach”.

NOTE: For additional study in the use of “sophisticated media”, you may examine some medical groups in Colombia, preferably Bogota and Cali.

Please upload your review of this case study in a WORD document. The review must be two pages. Refer to rubric for writing assignments in course syllabus. Case studies are exercises to help you apply the concepts from your reading.  Don’t skip your chapter reading!

The Cali Clinic

Javier Perez Ornalez has called a meeting of his five partners. As one of the largest gastroenterology groups in Cali, Colombia, Javier and his partners have always been viewed as leaders in the medical community. For the past 2 years, Javier took a leave of absence and studied in the United States at a well-respected business school where he received an MBA with a concentration in health care management. Now, returning to Cali, he wants to move his group to a more sophisticated management approach. “We need to be more sophisticated in our management strategy,” he says, we have always just gotten patients to our clinic as a function of the fact that we exist and we are good doctors. I am not sure that strategy will continue to work. We need to change our approach.

Senior Marquez, one of the founding partners interrupts, “Javier,” it is great that you have been to the United States, but to come back now and want to change what we have built seems loco. Why? What are we doing wrong? In fact, more Americans are finding their way to Cali for care. Just last week, I did bariatric surgery on five Americans right here in the clinic. Ten years ago, I am not sure I saw any American patients. Yes, you are right, the world is changing, but in my 30 years of being a doctor, the world has always spun, the world has always changed. You too will learn this.

“I think we cannot assume patients will just come to us, they can also go to Medellin and Bogota if they even come to Colombia.” Javier continues, “Yes, we are growing, but so too is everyone else. We need to recognize that in the past 3 years in Cali as in all of Colombia. The environment has changed. Look at our neighbors in Brazil and elsewhere in South America. Medical tourism is on the rise. Can we assume that we will get business just because we are good?”

“It has worked in the past,” says Don Marquez a specialist in reflux diseases, “why should we assume that now, because you have seen the light, it should not continue. The endoscopy business has steadily grown. I think we will continue to ride this curve of growth into the future by being good.”

“Please Javier,” says Maria, the most recent partner who trained at a U.S. medical facility and also practiced with a large multi-specialty group in the United States for several years before returning home for family reasons. “What do you think we should do if we were to be more sophisticated, as you say, can you lay out some of those tactics? Maybe that could help us all and then we could respond more specifically.”

“That is a good suggestion, thank you Maria, I have thought about it,” Javier said. “Let me tell you what I think we need to consider. Foremost, of course we need to develop a far more sophisticated website, where patients can see our surgi-center and take a virtual tour. We should get the Surgical Review Corporation (www.surgicalreview.org) to give us their stamp of approval. This will help our quality positioning. As doctors, we should all become members of the American Society of Bariatric Surgery and we can then display that on our website as another indicator of our excellence. I wonder if we should mount a promotional campaign on YouTube. And, should we hire a salesperson to give talks in Miami and the southeastern part of the United States for us with a targeted strategy.”

“This is absurd!” says Dr. Echiverra, the most senior partner in the group. “You will bankrupt us and there is no need to change what we have always done. See patients, do our procedures and provide good care. The patients will come. I have heard enough. I have patients to see.”

patient factors that may impact your decision making when prescribing medication for this patient.

The Assignment: 5 pages

Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

  • Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

  • Which decision did you select?
  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

  • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.