your resource. This may be a Word document using a chart or table, an Excel sheet, Power Point slide or other application of your choice.Ø  Create a list of 15 to 20 key reference terms or abbreviations and provide the meanings of your selections.Ø  Share how this resource will be beneficial for you on the job as a new medical coder or reimbursement specialist.

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Question Ø  Determine which application and layout will work best to createyour resource. This may be a Word document using a chart or table, an Excel sheet, Power Point slide or other application of your choice.Ø  Create a list of 15 to 20 key reference terms or abbreviations and provide the meanings of your selections.Ø  Share how this resource will be beneficial for you on the job as a new medical coder or reimbursement specialist. Health Science Science Nursing HIM 3674 Share QuestionEmailCopy link Comments (0)

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Question Scenario D.W. is a 29-year-old married woman with three children... ScenarioD.W. is a 29-year-old married woman with three children under 5 years of age. She saw her provider 7 months ago with intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss. Her provider noted small, patchy areas of vitiligo and a scaly rash across her nose, cheeks, back, and chest at that time. Laboratory studies showed D.W. had a positive antinuclear antibody (ANA) titer, positive anti-dsDNA test, positive anti-Sm test, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and decreased C3 and C4 serum complement. Joint x-ray films showed joint swelling without joint erosion. D.W. was diagnosed with systemic lupus erythematosus (SLE). Initial treatment consisted of hydroxychloroquine (Plaquenil), prednisone, and naproxen sodium, and ice packs. D.W. responded well and the steroid was tapered and stopped. She was told she could follow up every 6 months unless her symptoms became acute. D.W. resumed her job in medical billing at a large geriatric facility.1. What is the significance of each of D.W.'s laboratory findings?2. Using the mnemonic SOAP BRAIN MD, how is SLE diagnosed?3. What priority problems would be addressed in D.W.'s care plan at the time of diagnosis?  CASE STUDY PROGRESSTwenty-eight months after diagnosis, D.W. seeks out her provider, saying that she has increased fatigue and puffy hands and feet. D.W. reports that she has been working longer hours because of the absence of two co-workers who are on maternity leave.Chart ViewLaboratory Test ResultsSodium 129 meq/L (129 mmol/L)Potassium 4.2 meq/L (4.2 mmol/L)Chloride 119 meq/L (119 mmol/L)Total CO2 21 meq/L (21 mmol/L)Blood urea nitrogen (BUN) 34 mg/dL (12.1 mmol/L)Creatinine 2.6 mg/dL (230 mcmol/L)Glucose 123 mg/dL (6.8 mmol/L)Urinalysis 2+ protein, 2+ hematuria4. Which laboratory findings concern you, and why?5. The goal of therapy in lupus nephritis is to normalize or prevent the loss of renal function. To reach this goal, what additions to D.W.'s care can you anticipate?6. The provider orders cyclophosphamide 100 mg/m2/day orally in two divided doses. D.W. weighs 140 pounds (63.5 kg) and is 5 feet, 4 inches (163 cm) tall. How much will she receive with each dose?7. What key points should you include in a teaching plan about cyclophosphamide therapy? CASE STUDY PROGRESSD.W. is seen in the immunology clinic twice monthly during the next 3 months. Although her condition does not worsen, her BUN and creatinine remain elevated. While at work one afternoon, D.W. begins to feel dizzy and develops a severe headache. She reports to her supervisor, who has her lie down. When D.W. starts to become disoriented, her supervisor calls 911, and D.W. is taken to the hospital. D.W. is admitted for probable lupus cerebritis related to acute exacerbation of her disease.8. What other findings indicative of central nervous system involvement should you assess for in D.W.?9. What protective measures need to be instituted at this time?10. In caring for D.W., which care activities can be delegated to the UAP? Select all that apply.a. Monitoring D.W.'s BUN and creatinine levelsb. Counseling D.W. on seizure safety precautionsc. Assisting D.W. with personal hygiene measuresd. Assessing D.W.'s neurologic status every 2 hourse. Measuring D.W.'s blood pressure (BP) every 2 hoursf. Emptying the urine collection device and measuring the outputCASE STUDY PROGRESSThe provider orders pulse therapy with methylprednisolone 125 mg IV every 6 hours and plasmapheresis once daily.11. What major complications associated with immunosuppression therapy will D.W. have to be monitored for?12. D.W. asks about what plasmapheresis does and why it might help her feel better. How you would respond?Chart ViewVital SignsBP 80/43 mm HgPulse rate 118 beats/minRespiratory rate 18 breaths/minTemperature 97.2° F (36.2° C)13. D.W. returns to the floor after the plasmapheresis. The UAP reports D.W.'s vital signs to you. Based solely on her vital signs, what could be happening with D.W. and why?14. You go to assess D.W. What do you need to include in your assessment?15. D.W. is complaining of dizziness and is slightly diaphoretic but denies any headache, nausea, or paresthesia. What do you immediately suspect is occurring and why?16. You need to call the provider regarding D.W.'s status. Using SBAR, what would you report to the provider?17. What do you expect your care of D.W. will include over the next 2 to 3 hours?18. What outcome criteria would support that D.W.'s condition is stabilizing?19. You note that D.W.'s husband is visiting her. You enter the room to ask whether they have any questions. D.W.'s husband states, "I have tried to tell her that she cannot go back to work. Sure, we need the money, but the kids and I need her more. I'm afraid that this lupus has weakened her whole body and it will kill her if she goes back to work. Is that right?" How should you respond to his concerns?  Health Science Science Nursing NURS 2320 Share QuestionEmailCopy link Comments (0)
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