Risk Management And The Role Of Managed Care

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Addressing the knowledge you have gained, and building on that knowledge to add your evaluation of the role that the managed care organization (MCO) plays in today’s health care environment, develop a 500 word reflection to incorporate the following:

  1. What is a health care organization’s administrative role regarding oversight of risk management      policies and ensuring compliance with managed care organization (MCOs)      standards?
  2. What is your assessment of the value provided to an organization that stems from the regulatory statutes      of a typical MCO? Consider the establishment of conflict resolution and risk management strategies within the health care organization from the employer/employee perspective as well as in regards to patient conflict circumstances Risk Management And The Role Of Managed Care.
  3. What MCO responsibilities pertain to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?

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Examine the importance of professional associations in nursing. Choose a professional nursing organization that relates to your specialty area, or a specialty area in which you are interested. In a 750-1,000 word paper, provide a detailed overview the organization and its advantages for members. Include the following:

  1. Describe the organization and its significance to nurses in the specialty area. Include its purpose, mission, and vision. Describe the overall benefits, or “perks,” of being a member.
  2. Explain why it is important for a nurse in this specialty field to network. Discuss how this organization creates networking opportunities for nurses.
  3. Discuss how the organization keeps its members informed of health care changes and changes to practice that affect the specialty area.
  4.  Discuss opportunities for continuing education and professional development.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion Risk Management And The Role Of Managed Care

Nursing Practice Problem Of Interest.

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The first step of the EBP process is to develop a question from the nursing practice problem of interest.

Select a practice problem of interest to use as the focus of your research.

Start with the patient and identify the clinical problems or issues that arise from clinical care.

Following the PICOT format, write a PICOT statement in your selected practice problem area of interest, which is applicable to your proposed capstone project Nursing Practice Problem Of Interest..

The PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Conduct a literature search to locate research articles focused on your selected practice problem of interest. This literature search should include both quantitative and qualitative peer-reviewed research articles to support your practice problem.

Select six peer-reviewed research articles which will be utilized through the next 5 weeks as reference sources. Be sure that some of the articles use qualitative research and that some use quantitative research. Create a reference list in which the six articles are listed. Beneath each reference include the article’s abstract. The completed assignment should have a title page and a reference list with abstracts.

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Suggestions for locating qualitative and quantitative research articles from credible sources:

  1. Use a library database such as CINAHL Complete for your search.
  2. Using the advanced search page check the box beside “Research Article” in the “Limit Your Results” section.
  3. When setting up the search you can type your topic in the top box, then add quantitative or qualitative as a search term in one of the lower boxes. Research articles often are described as qualitative or quantitative.

To narrow/broaden your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Diabetes and pediatric and dialysis. To determine what research design was used, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion Nursing Practice Problem Of Interest. .

Pharmacotherapy for Respiratory Disorders

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To the untrained ear, most coughs sound the same. However, as you might recall from past clinical experiences, a simple cough can lead to a patient diagnosis of a common cold, pneumonia, or even a chronic obstructive pulmonary disease (COPD). Although it can sometimes be challenging to diagnose a patient based on common respiratory symptoms such as congestion, coughing, and wheezing, it is important to be able to distinguish minor differences as even mild symptoms might require intervention with drug treatments. When recommending potential treatment options, advanced practice nurses must consider how individual patient factors might impact the effects of prescribed drugs Pharmacotherapy for Respiratory Disorders.

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To prepare:
  • -Review Chapter 26 and Chapter 27 of the Arcangelo and Peterson text.
  • -Select and research one of the following respiratory disorders: the common cold, pneumonia, or a chronic obstructive —-pulmonary disease (COPD) such as emphysema or chronic bronchitis. Consider types of drugs that would be prescribed to patients to treat symptoms associated with this disorder.
  • -Select one of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how this factor might impact effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.
  • With these thoughts in mind:
  • Post a description of the respiratory disorder you selected including types of drugs that would be prescribed to patients to treat associated symptoms. Then, explain how the factor you selected might impact effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects. Pharmacotherapy for Respiratory Disorders
  •  

Obstetrics Comprehensive Patient Assessment

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When completing practicum requirements in clinical settings, you and your Preceptor might complete several patient assessments in the course of a day or even just a few hours. This schedule does not always allow for a thorough discussion or reflection on every patient you have seen. As a future advanced practice nurse, it is important that you take the time to reflect on a comprehensive patient assessment that includes everything from patient medical history to evaluations and follow-up care. For this Assignment, you begin to plan and write a comprehensive assessment that focuses on one female patient from your current practicum setting Obstetrics Comprehensive Patient Assessment.

To prepare

  • Reflect on your Practicum Experience and select a female patient whom you have examined with the support and guidance of your Preceptor.
  • Think about the details of the patient’s background, medical history, physical exam, labs and diagnostics, diagnosis, treatment and management plan, as well as education strategies and follow-up care.

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To complete

Write an 8- to 10-page comprehensive assessment that addresses the following:

  • Age, race and ethnicity, and partner status of the patient
  • Current health status, including chief concern or complaint of the patient
  • Contraception method (if any)
  • Patient history, including medical history, family medical history, gynecologic history, obstetric history, and personal social history (as appropriate to current problem)
  • Review of systems
  • Physical exam
  • Labs, tests, and other diagnostics
  • Differential diagnoses
  • Management plan, including diagnosis, treatment, patient education, and follow-up care  Obstetrics Comprehensive Patient Assessment

EFFECTS OF LEGISLATIVE PROCESS ON NURSING

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To prepare:

  • Review Chapter 3 of Milstead, J. A. (2016). Health policy and politics: A nurse’s guide (5th ed.). Burlington, MA: Jones and Bartlett Publishers.
  • In the first assignment, you reflected on whether the policy you would like to promote could best be achieved through the development of new legislation, or a change in an existing law or regulation. Refine as necessary using any feedback from your first paper.
  • Contemplate how existing laws or regulations may affect how you proceed in advocating for your proposed policy.
  • Consider how you could influence legislators or other policymakers to enact the policy you propose.
  • Think about the obstacles of the legislative process that may prevent your proposed policy from being implemented as intended EFFECTS OF LEGISLATIVE PROCESS ON NURSING.

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To complete:

Part Two will have approximately 3–4 pages of content plus a title page and references. Part Two will address the following:

  • Explain whether your proposed policy could be enacted through a modification of existing law or regulation or the creation of new legislation/regulation.
  • Explain how existing laws or regulations could affect your advocacy efforts. Be sure to cite and reference the laws and regulations using primary sources.
  • Provide an analysis of the methods you could use to influence legislators or other policymakers to support your policy. In particular, explain how you would use the “three legs” of lobbying in your advocacy efforts.

Descriptive Statistics

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To prepare:

Review the Statistics and Data Analysis for Nursing Research chapters assigned in this week’s Learning Resources. Pay close attention to the examples presented, as they provide information that will be useful when you complete the software exercise this week. You may also wish to review the Research Methods for Evidence-Based Practice video resources to familiarize yourself with the software.

Refer to the Week 4 Descriptive Statistics Assignment page and follow the directions to calculate descriptive statistics for the data provided using SPSS software. Download and save the Polit2SetA.sav data set. You will open the data file in SPSS. Descriptive Statistics

Compare your data output against the tables presented in the Week 4 Descriptive Statistics SPSS Output document. This will enable you to become comfortable with defining variables, entering data, and creating tables and graphs.

Formulate an initial interpretation of the meaning or implication of your calculations.

To complete:

Complete the Part I, Part II, and Part III steps and Assignment as outlined in the Week 4 Descriptive Statistics Assignment page.

Part I

Using the Polit2SetA data set, run descriptive statistics on the following variables: respondent’s age (age) and highest school grade completed (higrade). Create a frequency distribution for the variables: race and ethnicity (racethn) and currently employed (worknow). Create a table (in APA format) summarizing the results, using the below table shell as a model. Write a paragraph summarizing the information in the table. 

Table 1. Demographic Data (N = 30)

n % M (SD)

Age (in years)     30  15(2.4)

Highest School Grade Completed  29  11(1.2)

Race and Ethnicity

   Black, Not Hispanic    14 (46.67)

   Hispanic       8 (26.67)

   White, Not Hispanic      6 (20.0)

   Other        2 (6.66)

Currently Employed

   Yes      27 (90)

   No        3 (10)

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Note. Differences in sample size are due to missing data. 

Follow these steps when using SPSS:

1. Open Polit2SetA data set. 

2. Click on Analyze, then click on Descriptives Statistics, then Descriptives.

3. Click on the first continuous variable you wish to obtain descriptives for (respondent’s age), and then click on the arrow button and move it into the Variables box. Then click on highest school grade completed and then click on the arrow button and move it into the Variables box.

4. Click on the Options button in the upper-right corner. Click on mean, standard deviation, minimum, maximum, and skewness. 

5. Click on Continue and then click on OK. 

To run the frequency distribution in SPSS, do the following:

1. Click on Analyze, then click on Descriptive Statistics, then Frequencies.

2. Click on the first categorical variable you wish to obtain a frequency for (race and ethnicity), and then click on the arrow button and move it into the Variables box. Then click on currently employed, and then click on the arrow button and move it into the Variables box. Click on the Statistics button in the upper-right corner, then in the Dispersion box click on Minimum and Maximum Descriptive Statistics. 

3. Click on Continue and then click on OK.

Assignment: Create a table (in APA format) summarizing the results, using the below table shell as a model. Write a paragraph summarizing the information in the table.

Part II 

For the variables respondent’s age (age) and highest school grade completed (higrade) create a histogram with a normal curve displayed over the histogram.  

To create a histogram for respondent’s age in SPSS, do the following:

1. Click on Graphs, then on Legacy Dialogs, then Histogram.

2. Click on the variable respondent’s age and then click on the arrow button and move it into the Variables box. Click on the Display Normal Curve button, which is right below the Variables box. 

3. Click on OK. 

To create a histogram for highest school grade completed in SPSS, do the following:

1. Click on Graphs, then on Legacy Dialogs, then Histogram.

2. Click on respondent’s age in the Variable box and click the arrow to move it back to the box on the left that contains all the variables. 

3. Click on the variable highest school grade completed and then click the arrow button and move it into the Variables box. The Display Normal Curve button should alredy be on.

4. Click on OK. 

Assignment: Using the data obtained when you ran the descriptives and the histograms, determine whether the data skewed. If so, is it a positive or negative skew?

Part III

Using the Polit2SetA data set, run descriptive statistics on the variable “Family Income Prior Month, all sources” (Income).  

Follow these steps when using SPSS:

1. Click on Analyze, then click on Descriptives Statistics, then Descriptives.

2. Click on Family Income Prior Month, all sources, and then click on the arrow button and move it into the Variables box. 

3. Click on the Options button in the upper-right corner. Click on mean, standard deviation, minimum, maximum, S.E. Mean (standard error of the mean), and skewness. 

4. Click on Continue and then click on OK. 

Assignment: Using the descriptive statistics for Family Income Prior Month, all sources (Income), answer the following questions: Descriptive Statistics

1. What is the mean income in this sample?

2. What is the standard deviation?

3. What is the standard error of the mean?

4. Compute a 95% confidence interval around the mean. (Use 1.96 for the 95% CI and get the standard error from the descriptive statistics table). The formula is as follows:

95% CI = [mean ± (1.96 ´ SE)]

5. Compute a 99% confidence interval around the mean. (Use 2.58 for the 99% CI and get the standard error from the descriptive statistics table). The formula is as follows:

99% CI = [mean ± (2.58 ´ SE)]

6. Which interval is wider? Explain.

Review the corresponding Week 4 Descriptive Statistics Exercises SPSS Output document that has the SPSS output for the above problems. Compare your output with the output in the file.  

HISTORY AND PHYSICAL HEALTH EXAMINATION

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This Assignment will help develop skills to perform an integrated history and physical examination for individuals across the lifespan.

Considerations of lifestyle practices, cultural/ethnic differences, and developmental variations will be incorporated into the plan of care.

  1. Use critical thinking and diagnostic reasoning skills to formulate differential diagnoses, medical diagnoses, and an evidence-based action plan.
  2. Include sections 1 and 2 of the SOAP note with recommendations (incorrect or omitted data) based on feedback provided for the previous sections of the SOAP note HISTORY AND PHYSICAL HEALTH EXAMINATION.

WRITE A PARAGRAPH ON EACH QUESTION.

1.  Discuss the example of Harry Truman dropping nuclear weapons on  Hiroshima and Nagasaki in the context of the Utilitarian and Kantian  principles. Also include a discussion of Elizabeth Anscombe’s critic of  Truman.

2.  Describe the Categorical Imperative. Be sure to include a description  of how Kant derives the principle from an understanding that Morality is  a matter of reason not emotion.

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3.  What is Kant’s argument against lying? What is problematic about it,  and what happens when it comes into conflict with other absolute rules?

4. How do Kant’s core values cause him to embrace retribution, and reject rehabilitation?

5. What are the Utilitarian arguments for the implementation of retribution?

6.  Discuss Kolberg’s six stages of moral development. Include in your  discussion the examples of Amy and Jake, and how their different  approaches to a moral dilemma would be understood in the context of  Kohlberg’s theory.

7.  Discuss Giligan’s Objection to Kolberg’s labeling of Amy and Jake. What  are the differences between the way men and women approach moral  dilemma’s according to Giligan?

8.  Discuss the ethics of care. How does it differ from the pre-dominantly  male oriented approaches to morality that have been discussed? HISTORY AND PHYSICAL HEALTH EXAMINATION

Promoting Health Care

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Quality Measurement and Assessment

This week you continue working on Section 3 of your Course Project, which was introduced in Week 6. Through your work in previous weeks of this course, you have likely gained critical insights into the organization that serves as the focus for your quality improvement plan. Integrating this knowledge of the organization into your plan for addressing a quality improvement issue is essential for successfully facilitating change.

As you deepen your analysis of your selected organization, consider how the information presented in this week’s Learning Resources relates to strategic priorities as well as to the uniquely collaborative and competitive dynamic that binds organizations in health care Promoting Health Care.

To prepare:

  • Think about the quality improvement issue that you are addressing and the associated plan that you are developing. Consider the following:
    • What is the overall purpose, or aim, of doing this work?
    • What would you hope to achieve for the organization by undertaking this project? What are the objectives of this initiative?
    • What value would this work add to the organization?
    • How would this work improve practice and create outcomes with impact?
  • Review Chapter 7 of the Sadeghi, Barzi, Mikhail, and Shabot course text. Consider how addressing this quality improvement issue would align with the organization’s mission, vision, values, and strategic goals and objectives. How does it relate to regulatory issues, and other matters that are significant for the organization? If you notice a misalignment, use this as an opportunity to refine your focus.
  • With this in mind, continue to hone your development of this Assignment, integrating the concepts addressed here into Section 3.

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To complete:

Write a 3- to 5-page paper that includes:

  • An introduction to your quality improvement plan, including the overarching aim of this initiative and an explanation of how it aligns with the mission, vision, values, and strategic goals and objectives of the organization, as well as regulatory issues and other matters that are significant for the organization
  • An overview of the current situation with regard to this quality improvement issue in the organization
  • A description of measures and indicators Promoting Health Care
  • A presentation on data related to this issue, including:
    • Actual historical and current data and/or a description of the methods that you would use to collect and analyze the data
    • Methods for collecting and analyzing data in the future, including when you would do this
  • A description of realistic, evidence-based targets

Be sure to cite evidence from the literature to justify your selection of the measures and indicators, as well as the performance targets. This section of the Course Project serves as the Portfolio Assignment for this course.

THE HUMAN BODY

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Question 1. You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism?

Moist and smooth

Moist and rough

Dry and smooth

Dry and rough

Question 2. Question : You are assessing a patient with joint pain and are trying to decide whether it is inflammatory or noninflammatory in nature. Which one of the following symptoms is consistent with an inflammatory process?

Tenderness THE HUMAN BODY

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Cool temperature

Ecchymosis

Nodul

Question 3. Question : A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis?

Actinic keratosis

Seborrheic keratosis

Basal cell carcinoma

Squamous cell carcinoma

Question 4. Question : A 28-year-old graduate student comes to your clinic for evaluation of pain “all over.” With further questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and knees. She denies swelling in her joints. She states that the pain is worse in the morning. There is no limitation in her range of motion. On physical examination, she has several points on the muscles of the neck, shoulders, and back that are tender to palpation. Muscle strength and range of motion are normal. Which one of the following is likely the cause of her pain?

Rheumatoid arthritis

Osteoarthritis

Fibromyalgia

Polymyalgia rheumatica THE HUMAN BODY

 

HUMAN HEALTH CARE

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Question 1. A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about three days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, three days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over fifty years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination, he appears his stated age and is in no acute distress. His temperature is 100.9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative.His prostate is slightly enlarged but his testicular, penile, and inguinal  examinations are all normal. Blood work is pending.

What diagnosis for abdominal pain best describes his symptoms and signs?

Acute diverticulitis

Acute cholecystitis

Acute appendicitis

Mesenteric ischemia

Question 2. Question : Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for two days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?

Bleeding from a diverticulum

Bleeding from a peptic ulcer

Bleeding from a colon cancer

Bleeding from cholecystitis

Question 3. Question : A 26-year-old sports store manager comes to your clinic, complaining of severe right-sided abdominal pain for twelve hours. He began having a stomachache yesterday, with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was the night before and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination, he appears ill and is lying on his right side. His temperature is 100.4 degrees and his heart rate is 110. His bowel sounds are decreased and he has rebound and involuntary guarding, one-third of the way between the anterior superior iliac spine and the umbilicus in the right lower quadrant (RLQ). His rectal, inguinal, prostate, penile, and testicular examinations are normal.

What is the most likely cause of his pain?

Acute appendicitis

Acute mechanical intestinal obstruction

Acute cholecystitis

Mesenteric ischemia

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Question 4. Question : Josh is a 14-year-old boy who presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate?

His spleen is definitely enlarged and further workup is warranted.

His spleen is possibly enlarged and close attention should be paid to further examination.

His spleen is possibly enlarged and further workup is warranted.

His spleen is definitely normal.

Question 5. Question : Diminished radial pulses may be seen in patients with which of the following?

Aortic insufficiency

Hyperthyroidism

Arterial emboli

Early “warm” septic shock

Question 6. Question : A 42-year-old florist comes to your office, complaining of chronic constipation for the last six months. She has had no nausea, vomiting, or diarrhea, and no abdominal pain or cramping. She denies any recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new medications. During the review of systems (ROS), you note that she has felt fatigued, had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary artery disease. There is no family history of cancers. On examination, she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the Achilles tendons.

What is the best choice for the cause of her constipation?

Large bowel obstruction

Irritable bowel syndrome

Rectal cancer

Hypothyroidism

Question 7. Question : A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of sixteen, but is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system?

Intermittent claudication

Chest pressure with exertion

Shortness of breath

Knee pain

Question 8. Question : You are assessing a 59-year-old gas station owner for atherosclerosis in the lower extremities. In which of the following locations would the patient’s pain make you concerned for this disease process?

Thigh

Knee

Calf

Ankle

Question 9. Question : A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension comes to your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms?

Femoral pulse, popliteal pulse

Dorsalis pedis pulse, posterior tibial pulse

Carotid pulse

Radial pulse, brachial pulse

Question 10. Question : Cody is a teenager with a history of leukemia and an enlarged spleen. Today he presents with fairly significant left upper quadrant (LUQ) pain. On examination of this area, a rough grating noise is heard. What is this sound?

It is a splenic rub.

It is a variant of bowel noise.

It represents borborygmi.

It is a vascular noise.