Written communication and mail

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Question Answered step-by-step Written communication and mail Written communication and mail Image transcription textCRITICAL THINKING ACTIVITIES A. Parts of a Letter Refer to the letter in Figure 44.2. Identify the followingparts of that letter. 1. Inside address 2. Salutation… Show more Health Science Science Nursing Share QuestionEmailCopy link Comments (0)

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Question Answered step-by-step Diane: Ending of One Life, Beginning of Another Diane is a... Diane:  Ending of One Life, Beginning of Another Diane is a 26-year-old woman who gave birth three days ago to a healthy 9 pounds 2-ounce baby girl. The vaginal delivery was uneventful. Two hours after the birth, Diane began to complain of an "excruciating headache." Within 1 hour of receiving acetaminophen for her headache, Diane became unconscious and suffered from a respiratory arrest. She was coded, placed on a ventilator, and sent to the ICU. A CT scan revealed that she had suffered from a massive cerebral hemorrhage. After it was determined that the damage to the brain was irreversible and that Diane would be unable to breathe on her own, her husband, Brett, made the decision that his wife should be removed from life support. "Our neighbor had Lou Gehrig's disease and Diane would go visit with him and his wife. She always said she would never want to live like that," stated Brett.  However, Brett was not quite ready to have the ventilator removed. The Palliative Care team was called to visit with Brett and also Diane's parents. It was decided that Diane would be moved from the ICU down to one of the two new palliative care suites and have the ventilator removed there.Upon arriving at the palliative care suite, Brett and Diane's parents were introduced to Nancy, the nurse that would be taking care of Diane and her family. Nancy was sensitive in talking with the family and had a great desire to find out what they wanted. The family agreed that the ventilator would be removed at noon the next day, to give family and friends an opportunity to say goodbye. Throughout the rest of the day, evening, and the next morning, over 75 people came to say goodbye to Diane.Brett's mother requested to stay with the new baby in the newborn nursery. Brett was so torn between spending time with his new baby girl and his wife. Nancy agreed that it was a good plan to have Brett's mother care for the baby, while Brett concentrated on making decisions regarding Diane. Per Brett's request, his mother brought the baby to the palliative care suite two times.Diane's pastor came by to spend time with Brett. He supported Brett in this very difficult decision. The hospital chaplain was also present. Nancy suggested some memory-making rituals such as taking a clipping of Jennifer's hair so her baby girl would have that later on. Footprints and handprints were made of Diane, per her parent's request. A hand mold of the baby's hand in her mother's hand was made. Both Diane and the baby's hospital name bands would be removed and placed in a memory box.  Diane's mother requested to bathe her.  Brett brought in Diane's favorite college sweatshirt to put on her. CDs of some of Diane's favorite music was brought in and played.The next day, as per the request of the family, the palliative care team reviewed with Diane's family how they would extubate her. They talked about possible symptoms and how they would treat those. Brett, Diane's parents, 2 brothers, and 12 other close friends were all together with Diane in the palliative care suite. The nurse from the newborn nursery brought down the baby and laid her on Diane's abdomen, per the family's request. They were all reminiscing and telling Diane how much they loved her and how much she had meant to all of them. The palliative care nurse, physician, and chaplain were all present in the room and encouraged the family to take as much time as they needed. At 2 pm, the family reluctantly requested that the ventilator be removed. When Diane was extubated, she turned cyanotic and began gasping for air. The team administered supplemental oxygen and morphine. Diane continued to gasp for air, and the morphine was doubled. This was repeated one last time until Jennifer was no longer dyspneic. Unfortunately, Diane remained cyanotic. Diane died 15 minutes after she had been extubated. The palliative care team stayed with the family during the entire process. The palliative care nurse made arrangements for Diane's body to be picked up by the funeral home directly from the palliative care suite. The family had requested that she not be taken to the hospital morgue. The team remained with the family until the funeral home came. Once Diane's body was removed by the funeral home, Brett left the palliative care suite to visit his new daughter in the newborn nursery. "One life so precious is gone and yet God has blessed me with another new life." Discussion Questions:Would you consider this a "good death?"  Why or why not?How did the nurse and other members of the interdisciplinary team assess and manage this family?How could you use evidence-based research to establish practice standards for withdrawing ventilator support?What kind of bereavement services would you want to offer this family?Are there additional memory-making rituals that could have been used?   Health Science Science Nursing NURSING MISC Share QuestionEmailCopy link Comments (0)
Question Answered step-by-step Use your lecture materials to determine what CPT E&M Codeand ICD-10 diagnosis code to utilize for this 'new patient' encounter using the medical decision-making (complexity) approach. Provide justification for the code you assigned by including the following information in your discussion: Case:This patient presents to a local health center.  As the provider, you must conduct a full physical on the patient as well as a psychiatric intake. Liam is a 22-year-old who reports to you that he feels depressed and is experiencing a significant amount of stress about school, noting that he'll "probably flunk out." He spends much of his day in his dorm room playing video games and has a hard time identifying what, if anything, is enjoyable in a typical day. He states once he leaves the room he begins sweating and feels as if he has heart palpations. He rarely attends class and has avoided reaching out to his professors to try to salvage his grades this semester. Liam has always been a self-described shy person and has had a very small and cohesive group of friends from elementary through high school. Notably, his level of stress significantly amplified when he began college. You learn that when meeting new people, he has a hard time concentrating on the interaction because he is busy worrying about what they will think of him - he assumes they will find him "dumb," "boring," or a "loser." When he loses his concentration, he stutters, is at a loss for words, and starts to sweat, which only serves to make him feel more uneasy. After the interaction, he replays the conversation over and over again, focusing on the "stupid" things he said. Similarly, he has a long-standing history of being uncomfortable with authority figures and has had a hard time raising his hand in class and approaching teachers. Since starting college, he has been isolating more, turning down invitations from his roommate to go eat or hang out, ignoring his cell phone when it rings, and habitually skipping class. His concerns about how others view him are what drive him to engage in these avoidance behaviors. After conducting your assessment, you give the patient feedback that you believe he has social anxiety disorder, which should be the primary treatment target. You explain that you see his fear of negative evaluation, and his thoughts and behaviors surrounding social situations, as driving his increasing sense of hopelessness, isolation, and worthlessness. Significant Symptoms:  -Anxiety -Depression -Ruminations -Social Anxiety -Physical symptoms; sweating, heart palpationsVitals: 127/80 98 18 60 90% BMI 30 225 lbs 72" Physical exam: General: Well appearing, well-nourished, in no distress. Oriented x 3, normal mood and affect. Ambulating without difficulty.  Skin: Good turgor, no rash, unusual bruising, or prominent lesions  Hair: Normal texture and distribution.  Nails: Normal color, no deformities  HEENT: Head: Normocephalic, atraumatic, no visible or palpable masses, depressions, or scaring. Eyes: Visual acuity intact, conjunctiva clear, sclera non-icteric, EOM intact, PERRL, fundi have normal optic discs and vessels, no exudates or hemorrhages  Ears: EACs clear, TMs translucent & mobile, ossicles nl appearance, hearing intact.  Nose: No external lesions, mucosa non-inflamed, septum, and turbinates normal  Mouth: Mucous membranes moist, no mucosal lesions.  Teeth/Gums: No obvious caries or periodontal disease. No gingival inflammation or significant resorption. Pharynx: Mucosa non-inflamed, no tonsillar hypertrophy or exudate  Neck: Supple, without lesions, bruits, or adenopathy, thyroid non-enlarged and non-tender  Heart: No cardiomegaly or thrills; regular rate and rhythm, no murmur or gallop  Lungs: Clear to auscultation and percussion  Abdomen: Bowel sounds normal, no tenderness, organomegaly, masses, or hernia  Back: Spine normal without deformity or tenderness, no CVA tenderness  Rectal: Normal sphincter tone, no hemorrhoids or masses palpable  Extremities: No amputations or deformities, cyanosis, edema or varicosities, peripheral pulses intact  Musculoskeletal: Normal gait and station. No misalignment, asymmetry, crepitation, defects, tenderness, masses, effusions, decreased range of motion, instability, atrophy or abnormal strength or tone in the head, neck, spine, ribs, pelvis or extremities.  Neurologic: CN 2-12 normal. Sensation to pain, touch, and proprioception normal. DTRs normal in upper and lower extremities. No pathologic reflexes.  Psychiatric: Oriented X3, intact recent and remote memory, judgment and insight, anxious mood and affect.  Breast: No nipple abnormality, dominant masses, tenderness to palpation, axillary or supraclavicular adenopathy.  G/U: Penis circumcised without lesions, urethral meatus normal location without discharge, testes and epididymides normal size without masses, scrotum without lesions.  -The level of medical complexity encompassed by including the number of points for the diagnoses/management options and the amount/complexity of data reviewed; then identify the level of risk for complications, morbidity, mortality -In the discussion explore how the ICD-10 Codes that you assigned impact third-party payor reimbursement for this visit. Health Science Science Nursing NU 673 Share QuestionEmailCopy link Comments (0)
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