Categories
Nursing

A 55-year-old male executive presents at the clinic for his regular checkup.

Overview
A 55-year-old male executive presents at the clinic for his regular checkup. He was diagnosed with hypertension 5 years ago and has been taking a diuretic and a β-adrenergic blocker to control his blood pressure. His blood pressure is currently being maintained at about 135/70 mm Hg. His total cholesterol level is 180 mg/dL, and his HDL cholesterol is 30 mg/dL. He is otherwise well. He is a nonsmoker. He has recently read in the media about “inflammation” and the heart and expresses concern about his risk of CHD.
Tasks
Please address the following:
Identify risk factors for atherosclerosis present in this history
Explain the role of HDL in the prevention of atherosclerosis.
Please cite your sources using APA Style 7th edition.
Identify and respond to two peer posts to explore in greater detail. Pose a question for clarification or more information.

Categories
Nursing

Follow up in 1-2 weeks or sooner as needed.

The purpose of this assignment is to practice evaluating patient encounter notes to identify appropriate Current Procedural Terminology (CPT) codes to submit for billing. This is an important skill to master as an NP.
In this assignment, you are provided with three patient SOAP notes from an encounter with an NP. Using the Required Readings and Required Resources, identify the appropriate code (i.e., 99211, 99212, 99213, etc.) that should have been billed for the visit. In addition, provide detailed rationale on how you came to this decision. Please use the Patient Billing Template below
Title of Paper Here
Author
Affiliation
Course
Instructor
Due Date
Week 4 Assignment 1: Coding
Please review the three patient visit notes provided and select the appropriate coding level for that visit. In addition, provide rationale for why you chose that code with scholarly support from your required and recommended resources.
Patient 1
Code:
Cited Rationale:
Patient 2
Code:
Cited Rationale:
Patient 3
Code:
Cited Rationale:
References (Use APA 7th edition format)
(Word).
In order for this assignment to be considered complete, you will need to complete the coding for each of the three patients and cite rationales for your decision using the most current APA format. Remember that this assignment is complete at 100 points, so make sure you review all requirements and complete the assignment in its entirety. If the assignment is not complete, it is considered incomplete and will result in a 0.
PATIENT 1 SOAP Note 1
Maria Rodriguez
Age: 25 y.o.
Ethnicity: Hispanic
Past Medical history: None
Past Surgical History: Tonsillectomy age 7
Medications: none
Family history: Mother Diabetes, Father Hyperlipidemia
Employment: works as a phlebotomist full time
S: Maria is an established patient who presents to office today for birth control. Pt is in a monogamous relationship with her current boyfriend of 4 months and is using condoms 100% of the time. Pt would like to start a more reliable form of birth control. Menarche 12 y.o menses: every 28 days and lasts for 5 days, patient denies cramps or irregular menses history. Patient is a non-smoker and does not use any substances. Last pap was 6 months ago negative for cytology. Gonorrhea and Chlamydia culture 6 months ago was neg/neg. HPV vaccine completed.
O: 5 feet 6 inches 140 pounds 98.4-80-16-122/76
General: Healthy appearing Hispanic woman in no apparent distress
Skin: No skin lesions identified
Head: Normocephalic, good hair distribution, no alopecia no nits
Eyes: Symmetrical with no erythema or discharge. Vision grossly normal
Ears: Symmetrical with gross hearing intact
Nose: midline, no septal defect, no discharge
Mouth: good dentition, moist mucous membranes
Cardiac: HR 80 normal sinuses rhythm, no S3 or S4, no arrhythmias noted
Lungs: Clear to auscultation bilaterally A & P, no use of accessory muscles
Abdomen: flat, soft, non-distended. Bowel sounds active in all 4 quadrants, tympanic throughout, no hepatosplenomegaly, no rebound or guarding.
A: Contraception Counseling
P: Diagnostics up to date
Education: During the 20-minute face-to-face visit, I discussed with patient the various forms of contraception including barrier, hormonal, non-hormonal, abstinence and natural family planning. Discussed efficacy, cost, risks and benefits of each method, using the Birth control option handout. Discussed timing to start method and how to use method to ensure efficacy. Patient decided to start oral contraceptives. Discussed Sunday start, daily dosing, missed pills, common side effect and major side effects, such as ACHES and when to call.
Continue Condom use for STD prevention
Pharm: Ortho-Tricyclen 28 day, 1 pill every day to start on Sunday after first day of menses. 3 refills
Referrals: none
Follow- up: 3 months
PATIENT 2 SOAP Note 2
Patient name: Rebecca Jones
S:This new patient is a 26-year-old woman who presents to the primary care office complaining of “a sore throat and cold that has gotten worse.” Patent states that her cough has been productive with thick yellow-green sputum. The patient explains that she has a sore throat, stuffy nose, and a fever. Patient estimates that she has had the “cold” for the past three weeks and it has not gotten any better.
Aggravating factors: ambulation (short distances) and smoke.
Relieving factors: cold beverages, cough syrup, cough drops, rescue inhaler one to two times a week, and allergy medicine with minimal effect.
She denies any known sick contacts. She explains that she does not normally get colds that last this long but usually gets them once or twice a year. The patient reports smoking a pack of cigarettes a day and denies alcohol or drug use. The patient has no known diagnosed allergies. No additional concerns at this time.
ROS- Patient denies: chills, travel, headache, chest pain, chest tightness, palpations, wheezing, nausea, vomiting, loose stools, blurry vision, floaters, nausea, vomiting, or loose stools. No foreign body visualized, new bites, flushing, pruritus, anxiety, faintness, blunt force trauma, new foods/ medications/ hygiene products, or sense of impending doom.
Medical history per chart review and patient: asthma, upper respiratory infection on 1/9/17 treated with Z-Pack. The patient denies any cardiovascular issues.
Surgical history: laparoscopic appendectomy 3/23/14, admitted for two days. Familial history, hypertension. The patient is currently employed as a receptionist.
Social History: The patient is single and lives alone in an apartment. The patient is a one pack a day smoker.
Health Promotion: due for pneumonia vaccination (PPSV23).
Medications: Paragard IUD. Albuterol 180mcg oral inhalation two puffs with spacer every six hours as needed for shortness of breath.
O:
General Survey—Alert, friendly, well-kempt woman, good historian.
Vital signs: temperature 98.4, heart rate 114, respirations 25, blood pressure 112/62, SPO2 92% room air.
Head: normocephalic, no lumps or lesions.
Face: symmetrical, no drooping.
Eyes: clear sclera, clear conjunctiva, PERRLA.
Cardiovascular: regular—elevated rate, no rubs, gallops, or murmurs, no jugular vein distention, capillary refill time less than 3 seconds.
Integumentary: skin warm, dry, intact, good turgor. Lap sites scars.
Mouth: lips intact, no caries, moist erythemic mucosa, enlarged tonsils grade 2, no lesions noted.
Nose: no polyps, erythema in both nares, no blisters, petechial, ulcerations.
Throat: erythema, thick yellow-green sputum, no lesions, no difficulty swallowing.
Neck: trachea midline, no nodules, no bruits, no stridor; swollen and tender submental, submandibular, superficial cervical and posterior cervical lymph nodes.
Lungs: tachypnea, coarse inspiratory crackles in right lower lobe, diminished lung sounds in the bases, dullness sound with percussion over right lower lobe; positive tactile fremitus, bronchophony muffled, and egophony abnormal. No nasal flaring, perioral or nail bed cyanosis, sternal, subcoastal, intercostal, or supraclavicular retractions.
A:
Community Acquired Bacteria Pneumonia, RLL
Differential Diagnosis:
⦁ Nasopharyngitis
⦁ Postnasal drip syndrome
⦁ Acute Bronchitis
Possible organisms: need sputum and nasal cultures to determine organism
Haemophilus influenza
Group A beta-hemolytic streptococcus
Group C and G streptococci
Chlamydia pneumoniae
Diphtheria
Mycoplasma pneumonia
Legionella pneumophilia
Neisseria gonorrhoeae or chlamydia trachomatis
Influenza A, B
Epstein-Barr
Coccidioidomycosis
Histoplasmosis
Blastomycosis
P:
Diagnostic tests: rapid strep test, Influenza type A and B swabs, COVID-19 swab. Consider a 2-view chest X-ray (if swabs are negative), and complete blood count with differential.
Pharmacologic interventions: azithromycin 500 mg on day 1 followed by four days of 250 mg a day, acetaminophen 650 mg by mouth as needed for fever of pain or ibuprofen 400 mg by mouth every six hours as needed for fever or pain.
Non-pharmacologic interventions: gargle with warm saltwater (1 tsp salt to 1 cup water), avoid smoking and other respiratory irritants (smoke, automotive exhaust, pollen, dust, dander, strong scents such as perfume), increase nonalcoholic fluid intake, rest, increase room humidity.
Referrals: None at this time. Pulmonology if condition does not improve with oral antibiotics.
Education: side effects of azithromycin, antibiotic teaching about finishing treatment, cough hygiene, fluids, soft foods, when to go to the emergency room, when to call the office.
Follow-up: call the office or go to the nearest emergency room if you have a fever greater than 101, shaking, chills, confusion, blue fingernaisl or lips, have increased cough, difficulty breathing at rest, or increased shortness of breath. Please follow up in the clinic in one week.
PATIENT 3
Source: MT (self) and facility staff
Reliability: good
MT is an 88-year old white male established patient, who has been in the assisted living facility for the past 2 years. He was living with his oldest son and his family for about 15 years. He said his son kept all his pension and social security money and only gave him $50 every month. He said he finally asked his doctor to help him get a referral for social services when he was hospitalized for a fall incident with no complications or sequela.
He is being seen today for his monthly follow-up visit. He said he feels fine except that he started to have on and off loose stools in the past two weeks. The facility staff put him on diapers to prevent him from soiling his pants.
Subjective: Chief Complaint: Diarrhea
Onset of diarrhea 2 weeks ago. Loose watery brown stools about 2-3 times a day but not every day. Denies blood or mucus in his stool. Denies abdominal pain or cramping. MT said he gets an “accident” sometimes and soils his pants. He said he cannot get to the bathroom on time to have a bowel movement. He said he cannot walk fast enough. Denies urinary incontinence. Denies having eaten any exotic or rotten food. He had not been out to eat in the restaurant. Denies having any antibiotics in the past 2 weeks. Facility staff denies having any gastroenteritis cases in the past two weeks. Denies fever, nausea or vomiting. Denies contact with anyone with same symptoms and denies recent travel. He said he did not take any OTC treatment.
ROS: Denies fever, fatigue or chills; Respiratory: Denies cough; Cardiovascular: Denies palpitations; GI: Denies nausea or vomiting, abdominal pain; Reported diarrhea on and off for the past 2 weeks. GU: Denies urinary frequency, urgency or dysuria
Allergies: No Known Allergies
Current medications: Donepezil 5 mg at HS (started 4 weeks ago with previous follow up visit). Vitamin D3 once daily, Vitamin B Complex once daily, Alendronate 70 mg once weekly
Medical History: Alzheimer’s Dementia; Osteoporosis
Surgical History: Inguinal hernia repair, Cataract surgery with lens implant
Social History: Lives at the assisted living facility. He was married once. His wife died about 17 years ago. He has five children.
Smoking: Never smoked; Alcohol: Denies alcohol use; Coffee: 4 cups a day
Family History: Mother died at age 93 from old age; Father died at age 48 from Malaria complications.
Vital signs: BP 108/72 mmHg Temp: 98.4 F HR: 78 bpm RR: 18 bpm
Height: 70 inches
Weight: 150 pounds
Objective:
Physical Examination: Alert awake and oriented to person, place and situation; well nourished; Pharynx: Buccal mucosa is moist, no erythema or edema; Respiratory: Lungs clear to auscultation with no adventitious lung sounds; Cardiovascular: Heart rate regular, with no murmurs; Abdomen soft, non-distended, with normal bowel sounds on all four quadrants; no tenderness, no rigidity, no rebound tenderness, no guarding; No CVA; Skin: warm, dry and intact with good turgor. Walks with a cane.
MT is appropriately dressed and well groomed. He has good eye contact and is cooperative. Mood is euthymic with full range affect. He knows the month and the year but does not remember the exact date and day of the week. Speech, language and responses are normal. Immediate recall is 3/3 and delayed memory recall is 1/3. Serial 7’s counting backwards from 100 is accurate. Spelling WORLD backwards is correct. Judgment and insight is good. Perceptual disturbances such as hallucinations and delusions are not observed. MMSE = 26/30
Clock Drawing: Correctly drew an analogue clock with minute and hour hands at 2:45
Assessment: Mild Neurocognitive Disorder due to Alzheimer’s Dementia
Drug-Induced Diarrhea
The most common side effects of donepezil are nausea, and diarrhea. The prevalence increases with higher doses. The side effects are usually transient and for most patients, the side effects resolve in 2-3 weeks (Rosenblatt, Gao, Mackell, & Richardson, 2010).
Differential Diagnosis
⦁ Infectious diarrhea is caused by enteric pathogens such as bacteria, viruses and parasites. Common pathogens are Vibrio cholerae, Clostridium difficile, Shigella, and Escherichia coli. Examples of parasites are Giardia lamblia and Entamoeba histolytica (Hodges & Gill, 2010). Although the history and pattern of diarrhea appears to be drug-induced diarrhea, infectious diarrhea still needs to be ruled out (Hodges & Gill, 2010).
⦁ Gastroenteritis is a viral infection of the intestines that usually causes watery diarrhea, abdominal cramps, nausea or vomiting. Sometimes it is accompanied by fever. Many different viruses cause viral gastroenteritis such as rotavirus and norovirus. Most viral gastroenteritis is self-limiting and does not usually last for over 2 weeks (““Stomach Flu”,” n.d.).
⦁ Functional Diarrhea is chronic diarrhea without a known cause. It is also classified as a functional gastrointestinal disorder (FGD). The Rome III diagnostic criteria for FGD is a change in stool consistency occurring in at least the last 3 months with onset at least 6 months prior to diagnosis. Functional diarrhea is different than Irritable Bowel Syndrome – diarrhea type (IBS-D) due to a lack of abdominal pain that is present in IBS-D (Bolen, 2017). MT has diarrhea on and off for the past 2 weeks.
Plan: Discontinue Donepezil
Labs: Stool C & S; O & P; CBC
Facility staff to report worsening diarrhea
Patient Education: Rehydration therapy
Follow up in 1-2 weeks or sooner as needed. Follow up when lab results are back.
Referral: None as of this time
Comments from Customer
Here is required resources
Required
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones and Bartlett Publishers.
Chapter 4: Federal Regulation of the Nurse Practitioner Profession including Appendix 4-A
Joel, L. A. (2022). Advanced practice nursing: Essentials for role development (5th ed.). F. A. Davis Company.
Chapter 9: Participation of the Advanced Practice Nurse in Health Plans and Quality Initiatives
Required Resources
CMS Evaluation and Management Services (PDF) Documentation Guideline.
Medicare Benefits Policy Manual (PDF)
Centers for Medicare & Medicaid Services (CMS). ICD-10-CM Official Guidelines for Coding and Reporting FY 2021. (PDF)
American Medical Association (AMA). CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99417) Code and Guideline Changes (PDF).
Medical Billing & Coding. 2.09: CPT Modifiers

Categories
Nursing

The surgical study case like appendectomy needs to be describe following the template requests.

The case study need to be done using the template. the surgical study case like appendectomy needs to be describe following the template requests.

Categories
Nursing

*note on one of the instructions this is only nof #1 with the 4 competencies listed above.

Directions:
Each competency should be no more than 2 pages, typed, following APA format.
A word document MUST be uploaded to Moodle to be run through Turn-It-In, a plagiarism website.
Each competency will be evaluated using the rubric.
Submission #1 NOF competencies:
– Patient-Centered Care
– Communication
– Professionalism
– Teamwork and Collaboration
*Note on one of the instructions this is only NOF #1 with the 4 competencies listed above.
Comments from Customer
483779418, 483779416, 483779412 – one writer needed

Categories
Nursing

Perception of nurses’ survey for powerpoint poster or adobe presentation to chart data.

Instructions
Choose your topic area for your possible PICOT question in EBP 2 (Educational resource… or building resilience or work in simulation lab at Labouré College of Healthcare – only 3 choices). Keep it simple. Must be completed in 6-7 week time frame! Perception of nurses’ survey for PowerPoint Poster or adobe presentation to chart data.
1. BEST PRACTICE GUIDELINES FOR NURSES, 2. BUILDING RESILIENCE IN NURSES, OR 3. ASSISTING IN SIMULATION BEST PRACTICES AT LABOURE COLLEGE of HEALTHCARE. Note these all involve nurses’ perception- no patients- no vulnerable populations! And a survey to chart some data. Think about a mentor to help guide you (meet once a week): a nurse educator, nurse manager, or NP. Student Samples are in Module 8.
Attachments
2022 Third Activity PICOT question & topic ins… (88.46 KB)

Categories
Nursing

Information and technology

NOF competencies:
Safety
Leadership
Information and technology
Quality Improvement
Comments from Customer
483779418, 483779416, 483779412 – one writer needed

Categories
Nursing

483779418, 483779416, 483779412 – one writer needed

NOF Competencies:
Evidence-Based practice (must include a primary nursing article supporting EBP that you discussed)
System-based Practice
Executive Summary
Comments from Customer
483779418, 483779416, 483779412 – one writer needed

Categories
Nursing

I think the mom needed a little education about that

My patient is a female who is 3 years old named. Xamaih with respiratory distress and intermittent asthma. She doesn’t have any allergies
Got admitted because of acute respiratory distress
mom States that her daughter does appear to breathe better, but now she has fast breathing and pulling at muscles and it’s getting worse when she’s playing or running
The PO Intake decreased, and she has cold symptoms
Obj:
Nose congestion, rhinorrhea, tachycardia, retraction present, capillary refill take 2-3 seconds
How has this illness impacted the client’s daily living?
Fatigue, Fever
Irritability
Decrease urine
activity change
appetite Change
Congestion, rhinorrhea
Tachypnea
cough, wheezing, vomiting
tachycardia.
She has 3 scheduled drugs which are
Albuterol, Azithromycin, dexamethasone, Tylenol prn
I got to give her azithromycin and Tylenol, and I had the chance to practice the math we learned about child weight and the doses
I took her Vital signs as well and I got to play with her a lot she is very adorable, she took my stethoscope and wear gloves as a nurse
Temperature: 36.7
BP: 109/62
RR: 23
SpO2: 97
Pulse: 119
When I first saw her, she was pointing at her throat, she had a very sore throat. Also, the X-Ray showed that she had a right side pneumonia
She gets discharged at 10 am. But my concern was that the child was obese, she a 25.5 kg, which made her even breathe harder. She and her mom were eating pizza in the morning, which was not helpful. I think the mom needed a little education about that

Categories
Nursing

Beck & watson subsequent childbirth after a pre… (1.02 mb)

Instructions
Article Appraisal- Chapter 2, 3, 5 (Qualitative or Quantitative Literature Review)
Read the cited article that is available as an attachment by Dickson, V., Howe, A., Deal, J., McCarthy, M. (2012). The relationship of work, self-care, and quality of life in a sample of older working adults with cardiovascular disease. Heart & Lung, 41 (1), 5-14. On eLearning. Then answer the questions below about the article.
Is this a quantitative or qualitative study?
In the first section of the article, the author cites sources related to the prevalence of cardiovascular disease. What is the purpose of citing sources related to prevalence?
In the first section, identify the source cited to support that there are differences in adherence behaviors across demographic groups.
The theory supporting the study was described in the first section. What theoretical source did the authors cite supporting that theory?
Depression was measured by the Patient Health Questionnaire (PHQ)-9. What source (reference) was cited to support the specificity of the instrument?
2. The section on Purposes of the Literature Review in Qualitative Research in the Grove, Gray, & Burns (2015) textbook or Grove & Gray (2019) textbook provides the purpose and timing of the review of the literature for qualitative studies. A list of Qualitative or Quantitative is in the content section.
2, Match the type of qualitative research and the definition under the instructions.
3. Read the attached article by Beck & Watson. What makes you think this is a Qualitative (experience, meaning) or a Quantitative (measurement, statistics) research article? List the components that make you think one or the other is true.
Attachments
Beck & Watson Subsequent childbirth after a pre… (1.02 MB)
Dickson, V. V., et al., (2012). The relationshi… (556.72 KB)
Quantitative or Qualitative Article Appraisal I… (17.32 KB)

Categories
Nursing

Follow the grading rubric for discussion boards on the downloadable syllabus, please.

Must post first. Minimum 400 word count. Explain the Impaired Professional and Opioid disuse. Your choice of Nurse, MD, or Pharmacist. How do you recognize, and report suspected diversion or problems? What clinical manifestations may be present? What are the potential risk factors? What education is required? Please, explain about the process for an impaired nurse in Massachusetts, or MD, or pharmacist returning to work. What helps to avoid diversions? What safety precautions are needed? References for evidentiary support. What about harm to patient? Minimum word count of 400 for initial post. Follow the grading rubric for discussion boards on the downloadable syllabus, please. Use APA style citations and references for evidentiary support of current knowledge and practice.