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Health care delivery systems in the United States
Health care delivery systems in the United States
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On 3/5/2016 SO EMT Perez was dispatched to FC-518 regaurding a Vitals Check. SO EMT Perez knoacked and announced his presence at the door. SO EMT Perez was greeted by the resident a Mrs. Cynthia Cohen. Mrs. Cohen stated that she had been feeling shaky and uneasy for the past 3 days and wanted to go to the hospital to get checked out. Mrs. Cohen also stated that she had not had a bowel movement in 2 days and her last Blood Presure she took was 203/112 about 15 minutes to SO EMT Perez's arrival. Mrs. Cohen stated that she has hypertension and she had taken her BP Medication 15 minutes prior as well. SO EMT Perez performed an assesment which revealed the following; Blood Pressure 180/100, Pulse 86 bpm and Sp02 94%. Mrs. Cohen stated that she had
Professor Burns found that the worker's hypertension was secondary to the stroke, rather than a consequence of it, unlike Dr Ellice-Flint. Professor Burns based this opinion on the lack of history of hypertension and no evidence of an enlarged heart or changes suggestive of longstanding hypertension, having had regard to a normal echocardiogram undertaken in 2011.
El Camino Hospital is a 300-bed, state-of-the-art, nonprofit, multi-specialty acute care facility in Mountain View, California with a smaller branch in Los Gatos, California. Located in the heart of Silicon Valley, approximately 15 miles north of San Jose, and 45 miles south of San Francisco, the hospital is considered one of the most technologically advanced hospitals in the nation. Since the hospital is located in a relatively affluent community, it typically only serves a small number of indigent, and Medi-Cal (California's insurance program for low-income residents) patients. This is because most indigent, and Medi-Cal patients in the area are served by Santa Clara Valley Medical Center, which is a county hospital. Meanwhile, nearly 50 percent of El Camino Hospital's patients are covered by private insurance such as Blue Shield Blue Cross, United Healthcare, Aetna, and Cigna while roughly 45 percent are covered by either MediCare or a Medicare HMO. Since the opening of its doors in 1961, El Camino Hospital has valued, and embraced the important role of technological advancements in healthcare. In 1971, the hospital partnered with Lockheed to launch the original computerized medical information system. More importantly, due to its geographical advantage, the hospital is not only able to obtain the technology but to obtain the newest version of it because the company is down the street.
On completion, the ECG was checked by a doctor and instructions were given to rush the patient to the resuscitation department of the Emergency department. This incident was chosen for discussion as the consequences could have been great if not dealt with correctly.
High blood pressure is called the “silent killer” because it often has no warning signs or symptoms, and many people don’t know they have it. For most patients, high blood pressure is found when they visit their health care provider or have it checked elsewhere. Because there are no symptoms, people can develop heart disease and kidney problems without knowing they have high blood pressure. Some people may experience: bad headache, mild dizziness, and blurry vision. Traditionally, diagnosis of high blood pressure (BP) has relied on consecutive checks of clinic BP over a 2 to 3 month period, with hypertension confirmed if BP remains persistently raised over 140/90 mmHg. This method of diagnosis has significant limitations because the BP measured for an individual patient in a clinic setting may not reflect their BP in day-to-day life. The main concern is that as a result of the “white coat syndrome”, hypertension may be over-diagnosed when checked in the clinic setting; resulting ...
On my third day of clinical course I had an African America patient age 72, female, a retired high school teacher who was admitted for an Acute Diverticulitis with Perforation. She is diabetic and had a medical and surgical history of diverticulitis, High Cholesterol, Non-Insulin-Dependent Diabetes Mellitus (NIDDM), Hysterectomy, and Scoliosis. She has been on clear liquid diet since she was admitted then she was Nothing by Mouth NPO for the CT scan for that day. When I got the assignment that I was going to be taking care of a patient with an acute diverticulitis, the first thing on my mind was that she will be in a severe abdominal pain, high fever due to infection because my aunty had same disease. To my surprise, she claimed a 0 /10 on a 0-10 pain scale. Her blood sugar and vital signs were normal except for respiratory that was 22. All her laboratory test results were normal including WBC. Patient concern was that she couldn’t have a bowel movement. She was medicated on Colace- a stool softener, morphine for pain, sulfran for nausea, and azactam an antibiotics.
On the 7th of March in 2018, I attended the Community experience with the EMS team at Fire station of area one. This station is located at the northeastern corner of nine mile road. Upon arrival I introduce myself to the team. Every member of the team was presented in a professional manner that included: one’s skills, education, and the years of experience. During the meeting, several subjects were discussed such as: nursing student’s objective from this experience, Clarifying tasks and tactics, protocols and daily operations. All the tasks were executed with each member of the team with integrity, honesty and beneficence to the warren community. During the twelve hours shift, there
Hypertension is viewed as a critical condition because it places a lot of effort on the heart to pump blood to the body. According to Mastalerz-Migasthoug, & Kilis-Pstrusinska (2015), "hypertension (HT) is known as one of the most significant risk factors of atherosclerosis and cardiovascular diseases" (p. 1). It is an effortless task to examine blood pressure. While examining the blood pressure, two numbers will be displayed.
Dr. Murray, the chief resident who arrived around 8:00pm, charted Lewis’ heart rate as normal and noteds a probable ileus; however, nursing documentation at the same time recorded a heart rate of 126 beats per minute (Monk, 2002). Subsequent heart rates at midnight and 4:00am arewere charted as 142 and 140 beats per minute respectively without documented intervention (Monk, 2002 ). On Monday morning Lewis noted that his pain suddenly stopped after being very constant and staff charted that they were unable to get a blood pressure recording in either arm or leg from 8:30-10:15am despite trying multiple machines (Monk, 2002; Solidline Media, 2010).
Everyday there are hundreds of ambulances, fire engines and police cars being called to the scene of emergencies. I’m sure you hear the roar of their sirens, but you don’t think twice about them and are able to tune them out. The only time most people even think about the sirens is if they are forced to wait at a light or move over to the right shoulder and let them pass. When you look back and think about those sirens, where do you suppose they are going? Most people probably think that they are going to a car accident with entrapment, or a person with crushing chest pain to try and intervene and get them to the hospital.
Treatment for the client presenting to the APN diagnosed with hypertension, the first efforts should be focused on education. The patient should be informed of what current JNC 8 guidelines for the diagnosis of hypertension are. This will help the patient identify that he or she in fact has a problem and his blood pressure is abnormal. Further education should also include anticipated progression of the disease and complications from prolonged hypertension to help the patient understand the effects hypertension have on the body and risk of development of end-organ damage. Since hypertension is a silent disease, often void of symptoms, the patient must understand fully the implications of the disease and necessity to control the blood pressure.
I escorted her to a room, and helped her change into a gown. I understand that a 22-year old is capable of changing her own clothes, but I wanted to spend more time with her for further investigation. Auscultation of the lungs revealed bilateral clear and equal breath sounds, and heart tones were audible and regular. No peripheral edema was noted upon examination of her lower extremities, and she denied a history of similar symptoms or any medical issues in the past. Again, my nursing experience was challenged. Everything looked great, except this feeling remained that something was wrong. ER was busy that day, so I put in on order for a chest x-ray, and then told the doctor why she wanted to be seen. I told him that I ordered an x-ray, but something was not right about her skin color, not jaundiced, swallow, or cyanotic just not right, and I asked for basic lab work. The doctor felt lab work was not needed at that time, and I did not push the issue. I just thought to myself, “maybe he is right, and I have worked too many days in a row”. When the patient returned from the x-ray department, I met her at the room. I asked how
My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to protect her safety and dignity, whilst also trying to ascertain what was going on. During the unresponsive episodes we returned the patient to the stretcher where she spontaneously recovered and refused hospital treatment. I completed my patient report form to reflect the patient's decision and highlighted my concerns. The patient’s intoxicated husband then carried his wife back into the house.
The morning started slowly, with a 63 year old woman with a history of hypertension, back in the office four months after her pills ran out. Her blood pressure, not surprisingly, was high. The doctor reminded her, wearily, to call the office for refills. She nodded. "Compliance," he told me, as we left the exam room, "is our biggest problem."
Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital.
Mary is a 52-year-old woman with poorly controlled hypertension who came into the office today because she has become increasing inactive over the past 8 years as a result of work and life stresses, including chaperoning 2 teenage daughters to clubs and dance classes. Mary complains of persistent fatigue and a vague feeling of malaise. She denies having shortness of breath or chest pains but states that she "barely does anything more physical than starting the car." She has put on 42 pounds over the past 6 years. She reports taking her antihypertensive medication as prescribed.