Research the delivery, finance, management, and sustainability methods of the U.S. health care system.

Part 1: 

Research the delivery, finance, management, and sustainability methods of the U.S. health care system. 

1. Evaluate the effectiveness of one or more of these areas on quality patient care and health outcomes. 

2. Propose a potential health care reform solution to improve effectiveness in the area you evaluated and predict the expected effect. 

3. Describe the effect of health care reform on the U.S. health care system and its respective stakeholders. 

Part 2: 

The Affordable Care Act was signed into law by President Barack Obama in March 2010. Many of the provisions of the law directly affect health care providers. 

Review the following topic materials

“About the Affordable Care Act”

“Health Care Transformation: The Affordable Care Act and More”

1. What are the most important elements of the Affordable Care Act in relation to community and public health? 

2. What is the role of the nurse in implementing this law?

Part 3: ( INFECTION CONTROL AND PREVENTION )

1. Discuss one personal strength and one weakness you have regarding professional presentations (project capstone about  INFECTION CONTROL AND PREVENTION  ). 

2. Name one method for improvement for each of these 

3. Discuss why it is important for you to work on these skills if you want to present your findings in a more formal setting.

Part 4:  ( INFECTION CONTROL AND PREVENTION)

Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of EBP is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time. 

1. Name two potential barriers that may prevent your EBP change proposal from continuing to obtain the same desired results 6 months to a year from now, and your strategies for overcoming these barriers.

Part 5:

Fifty-four-year-old Fred is complaining of a headache that started about 2 weeks ago. For the past 2 days, the headache has increased in severity, and he is photophobic and has uncial rigidity and projectile vomiting. CT scan results show an arteriovenous malformation in the basal artery and a small hemorrhagic bleed in the middle meningeal artery.

1. How is the concept of “disorders of brain function” related to Fred’s presenting symptoms?

2. What aspects of cerebral circulation would come into play in Fred’s case?

Part 6:

Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan:

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1.    According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.    Does he need medication(s) given his history of MI?

3.   Considering that you have a case study, you only need 2 posts for this discussion board, 1 initial and 1 reply. As usual, all posts must be supported by at least 2 peer reviewed references and all paragraphs must be cited.

Part 7: Community Nursing

There is a planned community health project to decrease the incidence of human papilloma virus (HPV).

1.  Who is/are the target population? Why?

2. What are some key factors to consider when planning an HPV prevention program?

Part 8:

 1. What is meditation? 

      a. Discuss the benefits of meditation? (mention at least 3).

2. Indicate any research study that support the benefits  of meditation 

3. Have you ever practiced meditation? (Yes)

      a . Discuss your experience? 

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