Case Studies 1–3

Respiratory disorders such as pneumonia and asthma are among the leading causes of hospitalization in pediatric patients (U.S. Department of Health and Human Services, 2011). With such severe implications associated with many respiratory disorders, advanced practice nurses must be able to quickly identify symptoms, diagnose patients, and recommend appropriate treatment. For this Discussion, consider potential diagnoses and treatments for the patients in the following three case studies. RESPIRATORY DISORDERS

Case Study 1:

A 14-month-old female presents with a 4-day history of nasal congestion and congested cough. This morning, the mother noted that her daughter was breathing quickly and “it sounds like she has rice cereal popping in her throat.” Oral intake is decreased.

Physical examination reveals the following: respiratory rate is 58, lung sounds are diminished in the bases, she has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields, and her tympanic membranes are normal.

There is moderate, thick, clear rhinorrhea and postnasal drip. Her capillary refill is less than 3 seconds, and she is alert and smiling. Her RSV rapid antigen test is positive.

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Case Study 2:

Brian is a 14-year-old known asthmatic with a 2-day history of worsening cough and shortness of breath. He reports using a short-acting beta agonist every 3 hours over the previous 24 hours. He has a long-acting inhaled corticosteroid, but the prescription ran out, and he forgot to get it refilled.

He says he came today because he woke up at 2 a.m. coughing and couldn’t stop, thus preventing him from going back to sleep. Over-the-counter cough suppressants don’t help.

He denies cigarette smoking, but his clothing smells like smoke. His respiratory rate is 18 and he has prolonged expiration and expiratory wheezes in all lung fields. There are no signs of dyspnea. All other exam findings are normal. RESPIRATORY DISORDERS

Case Study 3:

A father presents his 9-year-old with a 3-day history of cough. Dad states that his son is coughing up yellow mucus. The boy is afebrile and is sleeping through the night, but the father’s sleep is disturbed listening to his son coughing.

Dad says he thinks his son has bronchitis and is requesting treatment. Physical examination reveals the following: respiratory rate is 18, lungs are clear to auscultation, patient is able to take deep breaths without coughing, there is no cervical adenopathy, nasal turbinates are slightly enlarged, and there is moderate clear rhinorrhea.

Case Studies 4–6

Assessing, diagnosing, and treating pediatric patients for many cardiovascular and genetic disorders can be challenging.

As an advanced practice nurse who facilitates care for patients presenting with these types of disorders, you must be familiar with current evidence-based clinical guidelines. Because of the clinical implications, you have to know when to treat patients with these disorders and when to refer them for specialized care.

In this Discussion, you examine the following case studies and consider appropriate treatment and management plans.

Case Study 4:

Miguel is a 15-year-old male who presents for a sports physical. He is a healthy adolescent with no complaints. He plays basketball. He is 6 feet 5 inches tall and weighs 198 pounds. You note long arms and long thin fingers. He has joint laxity in his wrists, shoulders, and elbows.

Case Study 5:

Trina is a 9-year-old female who weighs 110 pounds. Vital signs are as follows: BP 122/79, P 98, R 20.

Her mother reports she is a picky eater and refuses to eat fruits and vegetables. Her physical activity includes soccer practice for 1 hour a week with one game each weekend from September through November.

Family history is negative for myocardial infarction, but both parents take medication for dyslipidemia.

Case Study 6:

You see a 2-month-old for a well-child visit. She is breastfed and nurses every 2 to 3 hours during the day, but her mother reports she is not nursing as vigorously as before.

She sleeps one 4-hour block at night. Birth weight was 7 pounds 5 ounces. Weight gain over the last 2 weeks reveals gain of 5 ounces per week. RESPIRATORY DISORDERS

Physical examination reveals the following: HEENT exam is benign, lung sounds are clear, a new III/VI systolic ejection murmur is noted along the left lower sternal border, cap refill is brisk, skin is pink and moist, and abdominal exam is benign.

To prepare:

• Review “Respiratory Disorders,” “Cardiovascular Disorders,” and “Genetic Disorders” in the Burns et al. text.
• Review and select one of the six provided case studies. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
• Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis.

Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the respiratory, cardiovascular, and/or genetic disorder. RESPIRATORY DISORDERS

Details:

 

In addition to the topic study materials, use the chart you completed and questions you answered in the Topic 3 about “Case Study: Healing and Autonomy” as the basis for your responses in this assignment.

Answer the following questions about a patient’s spiritual needs in light of the Christian worldview.

1. In 200-250 words, respond to the following: Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James, or would that mean a disrespect of a patient’s autonomy? Explain your rationale SPIRITUAL DECISION MAKING IN HEALTH CARE.

2. In 400-500 words, respond to the following: How ought the Christian think about sickness and health? How should a Christian think about medical intervention? What should Mike as a Christian do? How should he reason about trusting God and treating James in relation to what is truly honoring the principles of beneficence and nonmaleficence in James’s care?

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3. In 200-250 words, respond to the following: How would a spiritual needs assessment help the physician assist Mike determine appropriate interventions for James and for his family or others involved in his care?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance SPIRITUAL DECISION MAKING IN HEALTH CARE.

No one can predict the future, but accountants and financial managers must try and do exactly that!  By examining net revenue, costs, and cash flow, you can get a clearer picture of what to expect in your organization’s (or one with which you are familiar) fiscal future. Using these metrics to look forward will enable you to more effectively plan budgets that accomplish organizational goals.

When developing a budget, what variables do you have to take into account? In health care organizations, two of the largest groups of factors that you must consider are first, volume, and second, staffing and supply. The number of patients and tests performed each day, as well as employees and their pay rates are all crucial pieces of information when determining a budget Net Revenue and Budgeting.

In this Assignment, you address five scenarios: net revenue, fixed and variable costs, cash flow, volume budget, and staffing and supplies budget.

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Note: For those Assignments in this course that require you to perform calculations you must:

• Use the Excel spreadsheet template for the Week 5 assignment.
• Show all your calculations and formulas in the spreadsheet.
• Answer any questions included with the problems (as text in the Excel spreadsheet).

A title and reference page are NOT needed in this assignment.  Put your name and assignment at the top of the Excel spreadsheet.

For those not comfortable with the use of Microsoft Excel, this week’s Optional Resources suggest several tutorials.

To prepare:

• Review the information in this week’s Learning Resources regarding net revenue, fixed and variable costs, and cash flow, and how they are used in financial decision making. 
• Review the budgeting information in Week 5 Learning Resources dealing with volume, staffing, and supplies budget.
• View the following tutorial videos, provided in this week’s Learning Resources.
  • Week 5 Application Assignment Tutorial: Cash Flow Scenario
  • Week 5 Application Assignment Tutorial: Fixed Variable Scenario
  • Week 5 Application Assignment Tutorial: Net Revenue Scenario
  • Week 5 Application Assignment Tutorial: Staffing and Supply Budget Scenario
  • Week 5 Application Assignment Tutorial: Volume Budget Scenario
• Use the Week 5 Application Assignment Template, provided in this week’s Learning Resources, to complete this assignment. Carefully examine the information in each of the scenarios and provide the necessary calculations. Using this information will help you answer the questions.

Note: All the scenarios will be submitted as one document.  Each scenario will be on a different tab in the spreadsheet.

Scenario 1: Net Revenue Scenario

Your clinic provides four kinds of services: Net Revenue and Budgeting

• Comprehensive initial medical consultation is priced at $250
• Established patient limited visit is priced at $75
• Established patient intermediate visit is priced at $125
• Established patient comprehensive visit is priced at $250

Question: The profile of your patients is such that the average collection rate is 75%. Assuming you have 100 visits of each type each month, what amount of new revenue will you generate in the next 12 months?

Scenario 2: Fixed/Variable Cost Scenario

You have performed a cost analysis of your health care organization and have determined the following: based on the latest three years of information, your annual cost of operations is $1,600,000 with annual volume of 10,000 procedures. You have determined that certain of your supply items are fixed in nature (those marked with an F) while others are variable (marked with a V).

Question: An insurance company that is considering directing its 1,000 units per year of procedure business to your organization has approached you. For the last three years, you have been charging a price of $165 per procedure (with a 100% collection rate).

Your board has mandated that you make $5 of profit from each of the procedures. You obviously want the highest possible price, but as you enter the negotiations, what is the lowest possible price you would be willing to accept from this payer?

Hint: Calculate the variable cost.

Scenario 3: Cash Flow Scenario

Your new business venture will begin operation on July 1, 20X2. You will hire staff effective January 1, 20X2 with a cost of $40,000 per month. You know from experience that collections lag billing by 3 months (in other words, once you bill for a service, you must wait 90 days for the payment to be received.) Your business volume is projected to be as follows:

Question: If you have $380,000 of cash on hand on January 1, 20X2, how much cash will you have at the end of June 20X3?  Assume a 100% collection rate Net Revenue and Budgeting.

Scenario 4: Volume Budget Scenario

You manage lab services in a large hospital. You have the following data on both the hospital’s budgeted patient days and visits for budget year 20XX along with the ratio of lab tests to patient days or visits.

Question: Based on this raw data provided , how many lab tests would you anticipate for the coming budget year? If each test is priced at $20.00, how much gross revenue would you budget? Assuming each full-time lab technician (FTE) can perform 200,000 tests each year, how many full-time lab technicians would you plan for?

Example on Template: 2 North Bldg calculated.  You will need to complete 2 South Bldg, ICU and OPD

Scenario 5: Staffing and Supply Budget Scenario

Calculate the supplies budget necessary to operate your unit for the fiscal year beginning January 1, 20X8. It is your expectation that you will perform 24,820 procedures in the budget year. The following spending data is available for the period January 1 to March 31, 20X7 during which time procedure volume amounted to 3,240. Items marked (F) are considered fixed, those marked (V) are considered variable. Inflation is planned at 4%.

In reviewing performance to date, you note that in January, you purchased $150,000 of D5W fluid replacement charged to IV solutions, which represents an entire year’s supply. In addition, you returned $2,800 of office supplies for credit from the vendor in Febuary. These supplies were purchased in a previous fiscal year.

You also need to prepare the salary budget for the same fiscal year. You have determined that staff needs are for 6.5 FTEs.

A pay raise will be given to all staff on October 1st of each year at a rate of 8 percent. In making your calculations, always round to the nearest whole dollar for annual salary amounts, but keep pennies in the hourly pay rates. New staff begins the new fiscal year at $16.00 per hour.

This Assignment will be due by Day 7 of Week 5. Be sure and include all of your calculations Net Revenue and Budgeting.

This week your Discussion will focus on interprofessional practice. This Discussion is an opportunity for you to examine your perspective and experiences with interprofessional collaborative practice and to apply your knowledge to managing patient care.

To prepare:

Identify a professional nursing organization and review their position on interprofessional practice

Review the following case study: INTERPROFESSION PRACTICE

Case Study:

Ms. Tuckerno has been diagnosed with multiple sclerosis (MS). The patient receives care at an internal medicine clinic. Her internist is not in the office today and she is being treated by the nurse practitioner. The patient is on two medications for her MS, three different blood pressure medications, one medication for thyroid disease, one diabetic pill daily, insulin injections twice a day, she uses medical cannabis, and uses eye drops for glaucoma. Upon assessing the patient, the nurse practitioner (NP) decides her treatment plan should be adjusted. The NP discontinues some of the patient’s meds and discontinues medical cannabis. She orders the patient to follow up in two weeks.

The patient returns and is seen by her internist. The internist speaks with the patient and reviews her medical chart. The internist states to the patient, “I am dissatisfied with the care you received from the nurse practitioner.” The internist places the patient back on originally prescribed medications and medical cannabis.

Post  2 pages on : An explanation of your understanding of interprofessional practice.

 Also, explain the position on interprofessional practice for a professional nursing organization that you are a member of or of which you plan to become a member.

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 Then, explain what you think is the best collaborative approach to manage Ms. Tuckerno’s care.

References

Required Readings

Altman, S. H., Butler, A. S., Shern, L. (Eds.). (2015). Assessing Progress on the IOM Report The Future of Nursing. Washington, DC: The National Academies Press. Retrieved from http://www.nationalacademies.org/hmd/Reports/2015/Assessing-Progress-on-the-IOM-Report-The-Future-of-Nursing.aspx doi: 10.17226/21838

Bankston, K., & Glazer, G., (2013) Legislative: Interprofessional collaboration: What’s taking so long? OJIN: The Online Journal of Issues in Nursing, 19(1).

Buppert, C. (2015). Appendix 11-D: Sample Professional Services Agreement. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.) (417-422). Burlington, MA: Jones & Bartlett.

Buppert, C. (2015). Legal Scope of Nurse Practitioner Practice. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.) (37-78). Burlington, MA: Jones & Bartlett.

 Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).

Note: Retrieved from the Walden Library databases.

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Collaboration. In Advanced Practice Nursing: An Integrative Approach (5th ed.) (299-327). St. Louis, MO: Elsevier Saunders INTERPROFESSION PRACTICE.

To prepare:

· Select a client family that you have observed or counseled at your practicum site.

· Review pages 137–142 of Wheeler (2014) and the Hernandez Family Genogram 

  video in this week’s Learning Resources. (SEE ATTACHED VIDEO TRANSCRIPT)

· Reflect on elements of writing a comprehensive client assessment and creating a  

  genogram for the client you selected ACCESSING CLIENT FAMILIES.

                                                                         The Assignment

                                          Part 1: Comprehensive Client Family Assessment

Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) the following:

· Demographic information

· Presenting problem

· History or present illness

· Past psychiatric history

· Medical history

· Substance use history

· Developmental history

· Family psychiatric history

· Psychosocial history

· History of abuse and/or trauma

· Review of systems

· Physical assessment

· Mental status exam

· Differential diagnosis

· Case formulation

· Treatment plan

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                                                Part 2: Family Genogram

Develop a genogram for the client family you selected. The genogram should extend back at least three generations (parents, grandparents, and great grandparents).

N:B. (1)PLEASE THIS ASSIGNMENT HAS 2 PARTS, AND I HAVE ATTACHED A SAMPLE OF THE ASSIGNMENT, BUT THE SAMPLE TALKS ONLY ABOUT HERNANDEZ, BUT THIS ASSIGNMENT IS FOCUS ON HERNANDEZ FAMILY. 

(2). HERNANDEZ FAMILY GENOGRAM VIDEO TRANSCRIPT IS ATTACHED INCASE YOU CAN NOT VIEW THE VIDEO ACCESSING CLIENT FAMILIES

                                                      Learning Resources

Required Readings

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

• Chapter 8, “Experiential      Family Therapy” (pp. 129–147)
• Chapter 13, “Narrative Therapy” (pp. 243–258)

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

• “Genograms” pp. 137-142

Cohn, A. S. (2014). Romeo and Julius: A narrative therapy intervention for sexual-minority couples. Journal of Family Psychotherapy, 25(1), 73–77. doi:10.1080/08975353.2014.881696

Escudero, V., Boogmans, E., Loots, G., & Friedlander, M. L. (2012). Alliance rupture and repair in conjoint family therapy: An exploratory study. Psychotherapy, 49(1), 26–37. doi:10.1037/a0026747

Freedman, J. (2014). Witnessing and positioning: Structuring narrative therapy with families and couples. Australian & New Zealand Journal of Family Therapy, 35(1), 20–30. doi:10.1002/anzf.1043

Phipps, W. D., & Vorster, C. (2011). Narrative therapy: A return to the intrapsychic perspective. Journal of Family Psychotherapy, 22(2), 128–147. doi:10.1080/08975353.2011.578036

Saltzman, W. R., Pynoos, R. S., Lester, P., Layne, C. M., & Beardslee, W. R. (2013). Enhancing family resilience through family narrative co-construction. Clinical Child and Family Psychology Review, 16(3), 294–310. doi:10.1007/s10567-013-0142-2

                                                    Required Media

Governors State University (Producer). (2009). Emotionally focused couples therapy [Video file]. Chicago, IL: Author.

Laureate Education (Producer). (2013b). Hernandez family genogram [Video file]. Baltimore, MD: Author. (SEE ATTACHED VIDEO TRANSCRIPT)

Psychotherapy.net (Producer). (1998). Narrative family therapy [Video file]. San Francisco, CA: Author. ACCESSING CLIENT FAMILIES