HIT 1550 MOD 4 DB

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Instructions:

This discussion will be completed in two parts and will give you an opportunity to reflect upon this week’s content and to interact with your classmates.

  • Part 1 – Post your initial response to the discussion questions by Thursday at 11:59 pm
  • Part 2 – Post substantive feedback to two (2) classmates by Sunday at 11:59 pm

Create a scenario that includes a procedure from the measurement and monitoring section of the ICD-10-PCS book. Then provide the procedure code that would be used for the procedure and describe the process for finding the code in the ICD-10-PCS book.

HIT 2000 MOD 4 DB

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Instructions: This discussion will be completed in two parts and will give you an opportunity to reflect upon this week’s content and to interact with your classmates.

  • Part 1 – Post your initial response to the discussion questions by Thursday at 11:59 pm
  • Part 2 – Post substantive feedback to two (2) classmates by Sunday at 11:59 pm

Part 1 Initial Post: Contribute a substantive initial posting that demonstrates critical thinking and understanding of the subject matter presented. Health Information technology is in a rapid and constant state of evolution. This means that the working environment is changing at the same pace that the technology evolves. Change can have a dramatic impact on people and process, and therefore we refer to the HIM professionals as being agents of change. For your initial response, discuss the impact that this rapid and constant state of change can have on a healthcare organization and it employees. Furthermore, discuss what it means to be an agent of change and the importance of being able to manage and drive change in the industry.

HIT 2000 MOD 4 ASSN

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For this assignment, you will complete an EHR Go activity. Specifically, this week’s assignment will include:

  • Retrieval of Data

Please follow the instructions below, and reach out to your professor if you have any questions.

  1. Click on the Retrieval of Data Assignment Link Links to an external site.and enter your EHR Go credentials to begin. 
    • If you have not yet set up your EHR Go account, you will need to do so before you can begin. Please follow the instructions below.
  2. Download the “Retrieval of Data” activity pdf from the “Overview & Resources” tab in EHR Go..
  3. Click on the 2nd tab “Launch EHR” to review the chart and begin completing the activity.
  4. Use the activity sheet to work through the assignment and formulate your answers
  5. Complete the attached “Retrieval of Data Answer Sheet” and submit as an attachment to this assignment link

Couse Outcomes and Professional Growth

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Reflection Discussion Prompt: Reflecting on Course Outcomes and Professional Growth

Overview: This course has provided you with the opportunity to strengthen your nursing practice by integrating nursing science with leadership strategies to deliver high-quality care across diverse healthcare settings. For this discussion, reflect on how this course has helped you achieve the following outcomes:

1. Integrate nursing and related sciences into the delivery of care to clients across diverse healthcare settings.

2. Create effective interdisciplinary organizational and systems leadership in the care of the client in diverse healthcare settings.

Instructions:

1. Reflect on Outcome 1:

o Discuss how the course content, assignments, or activities helped you integrate nursing and related sciences (e.g., evidence-based practice, pathophysiology, or health informatics) into client care.

o Provide a specific example of how this knowledge can be applied to diverse healthcare settings, such as acute care, community health, or primary care.

2. Reflect on Outcome 2:

o Describe how this course enhanced your understanding of interdisciplinary organizational and systems leadership.

o Share an example of how you can apply this leadership knowledge to improve collaboration, care coordination, and patient outcomes in diverse healthcare environments.

3. Link to Practice:

o Explain how these outcomes align with your current or future nursing role.

o Discuss any new insights or changes in perspective regarding client care and leadership in healthcare systems.

4. Support Your Reflection:

o Include at least one scholarly source to support your reflection. Use APA format for in-text citations and the reference list. 

4k25 research 4

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Asssigment

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Similarituy less than 20 %

Discussion P W6 Reply to peer 1

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GFR is a key indicator of kidney function, reflecting how well the kidneys filter blood. The most accurate method of measuring GFR involves using exogenous markers such as inulin clearance, which is freely filtered by the glomerulus and neither reabsorbed nor secreted by renal tubules (Levey et al., 2020). However, inulin clearance is time-consuming and not practical for routine clinical use. Instead, creatinine clearance is commonly used, though it has limitations since creatinine undergoes some tubular secretion, leading to an overestimation of GFR. Serum creatinine-based equations, such as the CKD-EPI or MDRD formulas, provide a more practical estimation, adjusting for variables like age, sex, and body surface area (Inker et al., 2021). Another alternative is cystatin C, a protein filtered by the glomerulus, offering a more reliable marker in certain populations, such as children and those with fluctuating muscle mass (Sharma et al., 2022).

     Vesicoureteral reflux is a congenital or acquired condition where urine flows retrograde from the bladder into the ureters due to an incompetent vesicoureteral junction. Normally, the ureter enters the bladder at an oblique angle, forming a functional one-way valve that prevents backflow. In VUR, this angle is disrupted due to congenital abnormalities in the ureter’s insertion or bladder wall, resulting in urine reflux during bladder contraction (Shapiro et al., 2021). VUR increases the risk of urinary tract infections and renal scarring due to recurrent pyelonephritis (infection gets so bad it migrates to the kidney, resulting in kidney infection, which is a more serious infection). Higher-grade VUR can lead to progressive kidney damage and hypertension if untreated. Management varies based on severity, ranging from antibiotic prophylaxis to surgical intervention for persistent or high-grade cases.

References

Inker, L. A., Schmid, C. H., Tighiouart, H., et al. (2021). Estimating glomerular filtration rate using serum creatinine and cystatin C. The New England Journal of Medicine, 385(19), 1737-1749.

Levey, A. S., Stevens, L. A., Schmid, C. H., et al. (2020). A new equation to estimate glomerular filtration rate. Annals of Internal Medicine, 150(9), 604-612.

Sharma, A., Menon, S., Ghosh, A., et al. (2022). Cystatin C-based estimation of glomerular filtration rate in children: A systematic review. Pediatric Nephrology, 37(4), 829-840.

Shapiro, E., Tejwani, R., & Franco, I. (2021). Vesicoureteral reflux in children: Pathophysiology, diagnosis, and management. The Journal of Urology, 206(2), 265-274.

Discussion P W6 Reply to peer 2

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Assessment of glomerular filtration rate (GFR) is fundamental to clinical practice, public health, and research. The kidney has several critical functions; GFR is used as an overall assessment of these kidney functions. GFR is used to diagnose, stage, and manage chronic kidney disease (CKD) (Inker & Titan, 2021). GFR is most commonly assed through markers and creatinine levels. Strengths: GFR is a well-established clinical laboratory practice, particularly in the neonatal population. It is a property of the kidney, has a large range, and is affected by physiological, pharmacologic, and pathologic conditions. Limitations: Methods to measure GFR are laborious, expensive, and not broadly available (Bjornstad et al, 2018).  A major challenge to diagnose early kidney disease is the lack of individuals that participate in yearly doctor visits as well as those who live with hypertension unknowingly will result in kidney failure. Creatinine and/or cystatin C are most accurate once GFR is <60ml/min/1.73m2, a point at which half of renal function is already lost. Accurate measurement of GFR is also important to stratify renal injuries, monitor nephrotoxicity and guide medication dosing (Bjornstad et al, 2018). Often certain medication drugs that are nephrotoxic can lead to acute renal failure (AKI), creatinine levels, BMP as well as GFR levels must be monitor on a weekly basis to be able to treat the patient accordingly.

About 1-3% of all infants and children have a condition called vesicoureteral reflux (VUR), which means some of their urine flows in the wrong direction after entering the bladder. Some of the urine flows back up toward the kidneys and can increase the chance of developing a urinary tract infection (UTI) (2024). Most pediatric UTIs are caused by Gram negative coliform bacteria arising from fecal flora colonizing the perineum, which enter and ascend the urinary tract. Escherichia coli (E. coli) is the most common uropathogen, responsible for approximately 80% of pediatric UTIs (Tallus, 2019). Other common uropathogens include Klebsiella, Proteus, Enterobacter and Enterococcus species (Kaufman et al., 2019). Refluxing ureteral endings show structural and functional anomalies: previous studies have shown a significant decrease in alfa actin, miosin and desmin contents as well as a high rate of atrophy and muscular degeneration with disorganized muscular fibres (Arena et al., 2016). VRU can also be caused by an abnormal embryological development occurring during the early stage of fetal life. VRU occurs on both sexes however females are prone to have more UTIs due to their anatomy and a shorter urethra, in males a circumcision will favor in the prevention of UTIs.

References

Inker, L. A., & Titan, S. (2021, November). Measurement and estimation of GFR for use in clinical practice: Core curriculum 2021 – American journal of kidney diseases. National Kidney Foundation. https://www.ajkd.org/article/S0272-6386(21)00707-1/fulltext

Bjornstad, P., Karger, A. B., & Maahs, D. M. (2018). Measured GFR in Routine Clinical Practice-The Promise of Dried Blood Spots. Advances in chronic kidney disease, 25(1), 76–83. https://doi.org/10.1053/j.ackd.2017.09.003

Vesicoureteral reflux (VUR) in Infants & Children. National Kidney Foundation. (2024, October 26). https://www.kidney.org/kidney-topics/vesicoureteral-reflux-vur-infants-children

Kaufman, J., Temple-Smith, M., & Sanci, L. (2019, September 24). Urinary tract infections in children: An overview of diagnosis and management. BMJ pediatrics open. https://pmc.ncbi.nlm.nih.gov/articles/PMC6782125/

Tullus K. Fifteen-minute consultation: why and how do children get urinary tract infections? Arch Dis Child Educ Pract Ed (2019. 10.11)36/archdischild-2018-315023.

Arena, S., Iacona, R., Impellizzeri, P., Russo, T., Marseglia, L., Gitto, E., & Romeo, C. (2016, November 29). Physiopathology of vesico-ureteral reflux. Italian journal of pediatrics. https://pmc.ncbi.nlm.nih.gov/articles/PMC5129198/ 

Discussion NT W6 Reply to Peer 1

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Middel range theories have been applied to nursing and psychology fields, for example in Nursing: A middle-range theory like Leininger’s Cultural Care Theory could be used to explore how cultural factors impact patient care and in In Psychology: Bandura’s Social Cognitive Theory might be used to study how individuals learn behaviors through observing others, which could be applied to phenomena like aggression or educational achievement. Middle-range theories in nursing and physiology connect big ideas with real-world use, helping nurses understand patient behavior and improve care (Smith et al., 2024). Liehr and Smith’s concept building process is a 10-phase process which allows one to reflect on and delineate an area of interest, formulate abstract ideas through reflection, then formulate a concrete concept with its conceptual definition. Children and adolescents are faced with multiple stressors that will lead to insecurities and fears, often both groups will recover from such stressors through resilience that promotes positive outcomes and positive mental health outcomes.

           The purpose of building the concept of nurturing resilience is to clarify the meaning of this concept in children and adolescents, develop a conceptual definition of nurturing resilience, and provide a conceptual model of nurturing resilience based on the building process. The concept was formulated utilizing Liehr and Smith’s practice-based approach to concept building (Martinez, & Opalinski, 2019). It is imperative that nurses use the resilience theory to promote balance and a positive outcome. Resilience is a protective mechanism which keeps youth balanced while promoting positive mental health when faced with adversities by allowing one to bounce back after adversity to an original, fundamental state (Martinez & Opalinski, 2019). Nurses need to be able to be resilient in order to promote it and achieve positive outcomes in children and adolescents. Nurturing resilience provides adolescents and children the ability to change in response to difficult circumstances; in turn, mental distress is reduced, and mental health of youth are optimized.

References

Smith, M. J., Liehr, P. R., & Carpenter, R. (2024). Middle range theory for nursing. Springer Publishing.

S; M. W. (2020, July 8). Taking on enduring distress: Building a concept to lead a program of Research. Nursing forum. https://pubmed.ncbi.nlm.nih.gov/32643164/

Martinez, L. A., & Opalinski, A. S. (2019). Home Page: Journal of Pediatric Nursing: Nursing Care of children and families. Building the Concept of Nurturing Resilience. https://www.pediatricnursing.org/

Discussion NT W6 Reply to Peer 2

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Two middle-range theories that could be used to analyze a phenomenon of interest in nursing are Merle Mishel’s Theory of Uncertainty in Illness and Barbara Riegel’s Theory of Self-Care in Chronic Illness. Both offer complementary perspectives to address phenomena related to the patient’s experience of chronic or uncertain conditions.

The Theory of Uncertainty in Illness focuses on how patients perceive and manage uncertainty associated with events related to their illness. It proposes that uncertainty arises when individuals cannot adequately structure or categorize events due to a lack of information or ambiguous cues (FAAN et al., 2023). This theory is particularly useful for exploring emotional and cognitive aspects, such as stress or coping strategies, and how these influence patient adaptation. For example, in patients with chronic diseases, this theory could analyze how uncertainty about the course of the disease affects their psychological well-being and their ability to make informed decisions.

On the other hand, the Theory of Self-Care in Chronic Illness addresses the process by which patients maintain their health and manage their illness through self-care. Its key concepts include self-care maintenance, self-care monitoring, and self-care management (Curcio et al., 2024). This theory emphasizes the practical skills and behaviors needed to manage symptoms, adhere to treatments, and respond to changes in their condition. It is particularly valuable in assessing how factors such as motivation, social support, or personal skills influence health outcomes.

When comparing the two theories, it is observed that while Mishel’s Theory focuses more on the psychological and emotional aspects related to the perception of uncertainty, Riegel’s Theory emphasizes the concrete actions and practical processes that patients use to manage their illness. However, the two can complement each other: for example, a patient experiencing high levels of uncertainty (according to Mishel) may have difficulty implementing effective self-care strategies (according to Riegel). Taken together, these theories allow for a holistic understanding of the phenomenon by integrating both the emotional and behavioral dimensions of chronic disease management.

References

Curcio, F., Lommi, M., Zambrano Bermeo, R. N., Esteban-Burgos, A. A., Pucciarelli, G., & Avilés González, C. I. (2024). Identifying and Exploring Jean Watson’s Theory of Human Caring in Nursing Approaches for Patients with Psychoactive Substance Dependence in Medical and Surgical Acute Wards. Nursing Reports, 14(3), Article 3. https://doi.org/10.3390/nursrep14030162

FAAN, M. J. S., PhD, RN, RN, P. R. L., PhD, & CNE, R. D. C., PhD, RN, NE-BC. (2023). Middle Range Theory for Nursing. Springer Publishing Company.