D.G. is a 74-year-old woman who arrives at the emergency room complaining of shortness of breath, palpitations (for 2 days), and lower extremity edema. Her medical history includes diabetes mellitus,

D.G. is a 74-year-old woman who arrives at the emergency room complaining of shortness of breath, palpitations (for 2 days), and lower extremity edema. Her medical history includes diabetes mellitus, hypertension, heart failure with reduced ejection fraction, and osteoarthritis. She had a left heart catheterization and coronary angiography last year and has no significant coronary artery disease. She has a biventricular pacemaker/implantable defibrillator for heart failure symptom treatment and sudden cardiac death prevention. The patient’s current medications are losartan 100 mg/d, metoprolol succinate 50 mg/d, metformin 500 mg twice daily, spironolactone 25 mg/d, furosemide 40 mg/d, and naproxen 500 mg twice daily.

Vital signs are as follows: blood pressure of 140/80 mm Hg, respiratory rate of 30 bpm, and heart rate of 120 bpm. ECG shows atrial fibrillation with a rapid ventricular response. Echocardiography reveals a moderately dilated left atrium, left ventricular systolic ejection fraction of 35% (unchanged), chronic kidney disease (baseline serum creatinine 1.01 mg/dL), and moderate mitral regurgitation.

Pertinent laboratory values include the following: hemoglobin 12 g/dL, hematocrit 36%, platelets 300,000/microliter, and serum creatinine 1.20 mg/dL (estimated creatinine clearance 39 mL/min). Her weight is 60 kg (increased from 55 kg), and height is 5 ft 3 inches. She does not smoke and does not drink alcohol. Dietary habits include one can of Ensure daily, with other meals provided by a social service agency (Meals on Wheels). Social concerns include the fact she lives alone, but a son visits every 1 to 2 weeks and transports her to physician appointments. She is living on a limited budget. With regard to her medication adherence, her son states that she occasionally forgets to take her afternoon medications, but overall, she is considered to be reasonably adherent with her drug regimens.

Diagnosis: Atrial fibrillation, acute onset

Answer the following questions. Include two references, cited in APA style.

1. List specific goals of treatment for D.G.
2. What drug therapy would you prescribe for stroke prevention in atrial fibrillation? Why?
3. What are the parameters for monitoring success of the anticoagulant therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
6. What would be the choice for the second-line therapy?
7. What OTC or alternative medications would be appropriate for D.G.?
8. What lifestyle changes would you recommend to D.G.?
9. Describe one or two drug–drug or drug–food interactions for the selected agent.

Case Study 6 Acute Renal Injury and Chronic Kidney Disease Will is a 68-year-old male with a history of hypertension. Eight months ago, he started regular dialysis therapy for ESRD. Before that, his p

Case Study 6 

Acute Renal Injury and Chronic Kidney Disease 

Will is a 68-year-old male with a history of hypertension. Eight months ago, he started regular dialysis therapy for ESRD. Before that, his physician was closely monitoring his condition because he had polyuria and nocturia. Soon it became difficult to manage his hypertension. He also lost his appetite, became weak, easily fatigued, and had edema around his ankles. Will debated with his physician about starting dialysis, but she insisted, before the signs and symptoms of uremia increased, the treatment was absolutely necessary. 

1. What is the difference between azotemia and uremia?
2. Two years ago, Will’s physician told him to decrease his protein intake. In spite of what the physician ordered, Will could not stop having chicken, beef, pork, or eggs at least once a day. Why did his physician warn him about his diet? 
3. Will’s feelings of weakness and fatigue are symptoms of anemia. Why is he anemic? 
4. Knowing what you do about Will’s history, why is left ventricular dysfunction a concern for his physician? 

Write a 2-page paper (excluding the separate title and reference pages). Your written assignment must follow APA guidelines 6th edition. Be sure to support your work with specific citations from this

Write a 2-page paper (excluding the separate title and reference pages). Your written assignment must follow APA guidelines 6th edition. Be sure to support your work with specific citations from this week’s Learning Resources and additional scholarly sources as appropriate. Use at least 3 academic sources.  Make sure your citations match your references. Refer to the assignment grading rubric. Submit your assignment to the Dropbox by the end of this Unit.

Read below Case Study and complete assignment:

In 2007 San Francisco began its Healthy San Francisco Plan designed to provide health care for all San Francisco citizens. In 2007, it was estimated that San Francisco had 82,000 uninsured citizens. Under the plan, all uninsured citizens residing in San Francisco can seek care at the city’s public and private clinics and hospitals. The basic coverage includes lab work, x-rays, surgery, and preventative care. The city plans to pay for this $203 million coverage by rerouting the $104 million the city currently spends treating the uninsured in the emergency rooms, mandating business contributions, and requiring income-adjusted enrollment fees. The plan requires all businesses with more than 20 employees to contribute a percentage toward the plan. Many business owners consider this a burden and warn they will not stay in the city. The Mayor sees universal health access a moral obligation for the city.

Take one of the following positions.

• San Francisco has an obligation to provide its citizens with health access.

           -OR-

• San Francisco does not have an obligation to provide its citizens with health access.

Discuss the following in your assignment:

1. What is the government’s role in regulating healthy and unhealthy behavior?
2. Has the balance between personal freedom and the government’s responsibility to provide health and welfare of its citizens been eroded? Why or why not?

Demand, Cost and Price Adaptation” Please respond to the following:Referring to the same novel health care product or service you came up with last week (Week 6 Discussion),(HMO and different insuran

Demand, Cost and Price Adaptation”  Please respond to the following:

• Referring to the same novel health care product or service you came up with last week (Week 6 Discussion),(HMO and different insurances )determine how you would assess demand for and the cost to produce your product or deliver your service and establish a price. Provide a rationale to support your response.
• Describe a situation that would require you to adapt the price of your product or service. Consider the impact of government and private payers on your pricing strategies. Provide specific examples to support your response.
• This week our discussion focuses on cost and demand.  You have been charged to determine how you would assess demand for and the cost to produce your product or deliver your service.  In addition you are to set the price for your product or service.  To supplement our course text reading I have provided a link to interesting article on cost and demand.  Please see http://smallbusiness.chron.com/production-cost-increases-demand-curve-13595.html and feel free to provide comments.

InstructionsAssignment #4 (25 points): Final Project Critical Incident for Bow-Tie AnalysisIn Week 7, the class examined the Joint Commission’s framework for root cause analysis of sentinel Incident

Instructions

Assignment #4 (25 points): Final Project Critical Incident for Bow-Tie Analysis

In Week 7, the class examined the Joint Commission’s framework for root cause analysis of sentinel Incidents in health care organizations. For purposes of this project, a critical incident is a key occurrence, but it is not a sentinel event. A bow-tie analysis places the critical incident at the center of the framework and identifies in graphic format the root cause leading up to the incident on the left side of the critical incident. On the right side of the incident, key preventive measures are graphically represented. In one image, you will capture the incident (at the center), the causes for failure in quality, and (on the right) preventive measures a manager can put in place to stop this failure from happening in the future. The final graphic will appear as a bow-tie. The instructor will provide an example. Each student will select a critical incident for approval by the instructor.

Formatting:

• Title Page
• 1 page (double spaced) Page should clearly articulate what the critical incident is and provide background.
• 1 page Page should include the bow-tie analysis
• Reference Page (2 references minimum)
• Written document should conform to American Psychological Association (APA) 6th  Edition

The grading rubric for this assignment appears below, if you opened the Assignment in the Assignment Folder, or can be opened by clicking on the ‘Written Assignment Rubric’ tab in the lower right corner of the screen, if you opened the Assignment in Content.