final exam, for advanced practice nursing in the care of older adults

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Question AFTERNOONCost Containment Approaches´Regulation vs. Competition´Note the CON and Health Systems Agencies which were not successful´Fee for service -  inflationary´Nursing considered payment in an aggregate grouping; difficult to assess quality of care provided´Use a CPT coding system linked to diagnoses in ICD-10 for payment level´Prospective Payment Systems´1. )Are they easily identified?2.) What resources do you need to locate them?3.) Which components of the curriculum do you believe has the most impact on the implementation plan?4.) Do you agree or disagree with the principle of faculty control of the curriculum? Support your answer. Replaced FFS system with PPS for Medicare Part A. ´Established care based on Diagnostic Related Groups (DRGs)´Set a payment level for each of the approximately 500 diagnostic groups´*slowed the rate of growth of payment, shortened LOS in hospital thereby increasing the acuity of the patient´Resource - Based Relative Value Scale (RBRVS)´Medicare Part B -  aligned physician service based on work, practice expertise, cost of malpractice, and geographic cost of living.´Has encouraged more procedures to be done in hospitalCost Containment Approaches´Bundled payments/global payments´Hospitals, doctors, providers are paid a flat rate for an episode of care´Being tested by government agencies; ACOs´´Global payments´The insurer is usually paid per member per month´Form of capitationMånga äldre upplever en stor ensamhet. Om man känner sig mycket ensam kan man till slut bli deprimerad. Risken finns också att man börjar känna fysisk smärta. På Väntjänsten jobbar volontärer (frivilliga) för att bryta de äldres ensamhet.  Ta reda på hur Väntjänsten (Röda korset) fungerar i din kommun, eller en annan frivillig organisation, och hur de kan vara till hjälp för den sjuke och deras närstående.   • What factors do you see in practice that influence safe, quality patient-centered care?• Have those factors shifted or changed as your role as an RN has progressed or changed?• Do you think the factors will continue to change?• What factors do you see affecting safe, quality patient-centered in 10 years?• Pathophysiology• risk factors• clinical manifestation• medical management • diagnosis • nursing interventions • complications• nursing diagnosis• laboratory/diagnosis• Have I considered the risk, contraindications and adverse reactions?o What evidence informs my practice? o What are the strategies to minimize the risk of harm?o Are there supports to minimize harm if an adverse event occurs?• Do I need to collaborate or consult with others? For example, the health care team or the client.• Have I provided the client with education?o Is the client informed?o Has the client or substitute decision-maker been involved in the care planning?QUESTION 2. PH =7.45.  PaCO2= 24mmHg.  HCO3= 16mEq/L2. PH= 7.33  PaCO2= 15mmHg  HCO3= 8mEq/L3. PH= 7.51  PaCO2= 25mmHg.  HCO3=19mEq/L4. PH=7.50. PaCO2= 34mmHg  HCO3=26mEq/L5. PH=7.43. PaCO2= 41mmHg.  HCO3= 26mEq/LVitalsTime Temp Pulse Resp BP SPO2 Pain1500 97.3 120 28 173/93 100% RA 10/10 "All over"1530   116 26 168/92 100% RA 9/10 "Chest"1700   108 18 156/88 100% RA 9/10LabsCBC Result Reference RangeWBC 15.3 H 4-11RBC 3.56 L 4.5-5.9Hgb 11.1 L 13.0-17.0Hct 37.3 L 39.0-51.0Platelets 257 150-450Neutrophils (segs) 81.7 H 33-69%Lymphocytes 10.6 L 20-55%Monocytes 6.0 3-8%Eosinophils 0.5 L 1-3%Basophils 1.2 1%Metabolic Result Reference RangeSodium 120 L 135-145Potassium 6.9 H 3.5-5.0Chloride 95 L 98-107CO2 14.5 L 21-32Glucose 1174 H 65-99BUN 40 H 10-20Creatinine 2.86 H 0.5-1.4GFR 19 >60Calcium 8.2 L 8.4-10.2Lipase 11 L 22-51Total Protein 5.6 L 6.2-8.0Albumin 2.1 L 3.2-5.5Arterial Blood Gases + Beta Hydroxybutyrate (BHB) Result Reference RangepH 7.12 L 7.35-7.45paCO2 26 L 35-45paO2 95 75-100HCO3 15 L 22-26spO2 97 94-100%BHB 1.2 H 0.0-0.5 mmol/LWhy was her carbon dioxide low?Why were the sodium and chloride levels low?Why was the potassium elevated?Why were the BUN and creatinine elevated? Nevertheless, humans do generally develop a specific set of physiological features, such as two lungs, one stomach, one pancreas and two eyes. Moreover, having such a bodily architecture is, according to the evidence from genetics, to a significant extent the result of developmental programmes that ground in gene regulatory networks (GRNs). These are stretches of non-coding DNA that regulate gene transcription. GRNs are modular, more or less strongly entrenched structures. The most highly conserved of these tend to be the phylogenetically most archaic (Carroll 2000; Walsh 2006: 436ff.; Willmore 2012: 227ff.). The GRNs responsible for basic physiological features may be taken, in a fairly innocuous sense, to belong to an evolved human nature.Importantly, purely morphological features have generally not been the explananda of accounts that have gone under the rubric "human nature". What has frequently motivated explanatory accounts thus labelled is the search for underlying structures responsible for generally shared psychological features. "Evolutionary Psychologists" have built a research programme around the claim that humans share a psychological architecture that parallels that of their physiology. This, they believe, consists of a structured set of psychological "organs" or modules (Tooby & Cosmides 1990: 29f.; 1992: 38, 113). This architecture is, they claim, in turn the product of developmental programmes inscribed in humans' DNA (1992: 45). Such generally distributed developmental programmes they label "human nature"What was the purpose of the study?List research questions (if available) or Aims Purpose:Research Questions/Aims:Qualitative Research DesignLevel of Evidence What was the qualitative design?Level of Evidence: Describe the sample.How were the participants recruited?Describe how informed consent was obtained. Sample:Recruitment of participants:IRB Approval:   Yes ¬¬¬¬¬____   No ____Informed Consent:Data Collection Describe how data was collected:Data Analysis Describe how data was analyzed:Findings Describe the findings:Strengths & Weaknesses of the Qualitative Study Identify 2 strengths:1.2.Identify 2 weaknesses:1.2.Implications for Future Nursing Practice Describe implications for future nursing practice:Overall critique of the study (describe in a concise paragraph):This conception raises the question of how analogous the characteristic physical and psychological "architectures" are. For one thing, the physical properties that tend to appear in such lists are far more coarse-grained than the candidates for shared psychological properties (D. Wilson 1994: 224ff.): the claim is not just that humans tend to have perceptual, desiderative, doxastic and emotional capacities, but that the mental states that realise these capacities tend to have contents of specific types. Perhaps an architecture of the former kind—of a formal psychology—is a plausible, if relatively unexciting candidate for the mental side of what an evolved human nature should explain. Either way, any such conception needs to adduce criteria for the individuation of such "mental organs" (D. Wilson 1994: 233). Relatedly, if the most strongly entrenched developmental programmes are the most archaic, it follows that, although these will be species-typical, they will not be species-specific. Programmes for the development of body parts have been identified for higher taxa, rather than for species.A further issue that dogs any such attempts to explicate the "human" dimension of human nature in terms of developmental programmes inscribed in human DNA concerns Evolutionary Psychologists' assertion that the programmes are the same in every specimen of the species. This assertion goes hand in hand with the claim that what is explained by such programmes is a deep psychological structure that is common to almost all humans and underlies the surface diversity of behavioural and psychological phenomena (Tooby & Cosmides 1990: 23f.). For Evolutionary Psychologists, the (near-)universality of both developmental programmes and deep psychological structure has an ultimate explanation in evolutionary processes that mark their products as natural in the sense of TP1. Both, they claim, are adaptations. These are features that were selected for because their possession in the past conferred a fitness advantage on their possessors. Evolutionary Psychologists conceive that advantage as conferred by the fulfilment of some specific function. They summarise selection for that function as "design", which they take to have operated equally on all species specimens since the Pleistocene. This move reintroduces the teleological idea of a fully developed form beyond mere statistical normality (TP3).This move has been extensively criticised. First, selection pressures operate at the level of groups and hence need not lead to the same structures in all a group's members (D. Wilson 1994: 227ff.; Griffiths 2011: 325; Sterelny 2018: 120). Second, other evolutionary mechanisms than natural selection might be explanatorily decisive. Genetic drift or mutation and recombination might, for example, also confer "naturalness" in the sense of evolutionary genesis (Buller 2000: 436). Third, as we have every reason to assume that the evolution of human psychology is ongoing, evolutionary biology provides little support for the claim that particular programmes and associated traits evolved to fixity in the Pleistocene (Buller 2000: 477ff.; Downes 2010).1. Describe all the feelings that you (or other PSWs) might have in this situation. Explain how they might be helpful or unhelpful in resolving the problem. (2 marks)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2. List three behaviours of Mrs. Green's that indicate she may be abused. (3 marks)a. _________________________________________________________b. _________________________________________________________c. _________________________________________________________3. In this situation, describe how power is being exerted over another person. (2 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4. What action is appropriate for the PSW to take in this situation? Why? (3 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________       1. Describe all the feelings that you (or other PSWs) might have in this situation. Explain how they might be helpful or unhelpful in resolving the problem. (1 mark)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2. Identify three signs that indicate Sarah is abused. (3 marks)  Health Science Science Nursing Share QuestionEmailCopy link Comments (0)
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