Quadruple AIm

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Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs.

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions.

 

  • Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
  • Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.

To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

  • Patient experience
  • Population health
  • Costs
  • Work life of healthcare providers

 References include:

unit 1 dq

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see attached

Nutrition & Hydration

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Nutrition & Hydration/Persistent Vegetative State (PVS)

After studying the course materials located on 

Module 7: Lecture Materials & Resources
 page, answer the following:

1. Cure / care: compare and contrast.

2. Basic care: Nutrition, hydration, shelter, human interaction.

· Are we morally obliged to this? Why? Example

3. Swallow test, describe; when is it indicated?

4. When is medically assisted N/H indicated?

· Briefly describe Enteral Nutrition (EN), including:

· NJ tube

· NG tube

· PEG

· Briefly describe Parenteral Nutrition (PN), including:

· a. Total parenteral nutrition

· b. Partial parenteral nutrition

5. Bioethical analysis of N/H; state the basic principle and briefly describe the two exceptions.

6. Case Study: Terry Schiavo (EXCEL FILE on 

Module 7: Lecture Materials & Resources
 page). Provide a bioethical analysis of her case; should we continue with the PEG or not? Why yes or why not?

7. Read and summarize ERD paragraphs #:  32, 33, 34, 56, 57, 58.

PN1

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Case Study #1

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 A 72-year-old woman presents to her regular primary care physician (PCP) with a 2-day history of fatigue, malaise 

Reflection

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Please read attachment for instructions. Thank you

Discussion Post-Prevention of Shock

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Your patient is a 42-year-old female that arrives in the ED with complaints of fever and not feeling well. She is currently undergoing chemotherapy for bladder cancer. She has an indwelling urinary catheter with scant amount of dark, foul smelling urine. She has a temperature of 102.2F, HR 136, BP 110/50 and RR 28. She is allergic to penicillin and Sulfa.

  • What type of shock is she experiencing?
  • What interventions do you anticipate the doctor will order?
  • What can you teach this patient about prevention of infection?
  • The doctor orders Bactrim. What should you be concern about? Why?

Minimum of 250 words. 

Genetics

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Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.  Three (3) resources after 2008 are required along with APA format. 

Jane and Jackie, 30 year old twin sisters, adopted when they were two years old, lived mirrored lives to this point. They do everything together, from having a double wedding, living next door to each other, and making any appointments, medical or social together.

Today they made an appointment with their OB/GYN. Information was as follows:

Jane Information: Jackie’s Information:

BP 115/70 BP 165/96

HR 70 HR 96

Resp. 20 Resp, 22

Temp 98.6 Temp 99.2

N/A Normal U/A + Hematuria

+ Proteinuria

Weight No gain Weight +15 pounds

C/O Intermittent Headache C/O Has lower back and stomach

at times relieved with pain at times and is relieved also

Tylenol by Tylenol.

Other: This individual is noted to have

some loss of muscle mass in her

arms and legs and less subcutaneous

tissue overall.

1. At this point, what do your think is the problem with Jackie? Why is this problem co common in women? What test would you request to confirm your diagnosis?

The physician uses the ultrasound to assess Jackie’s back and abdomen. He finds that her kidneys are about 4 times larger than normal and appear to have numerous fluid filled cysts noted. At this point he asks BOTH sisters to see a nephrologist and to be scheduled for MRI’s of the kidneys. The MRI showed that Jackie’s kidneys were indeed larger and filled with cysts. Jane’s kidneys were somewhat larger than normal, and no cysts were present at this time.

2. What problem do you anticipate that Jackie has now? How was it acquired?

3. Why did Jackie gain so much weight over the last year?

4. Why does Jackie have high blood pressure and the UTI?

5. Why were both sisters requested to have this test.

The sisters went to see the nephrologists who requested that they have MRI’s of the brain and an echocardiogram. Jane’s MRI and echocardiogram were normal. Jackie’s brain MRI and echocardiogram were not. Jackie had a cerebral angiogram that followed which confirmed complications of her disease process, an Intracranial aneurysm and Mitral regurgitation. Jackie undergoes a procedure called Coil Embolization Therapy to resolve the aneurysm.

6. What is an Intracranial aneurysm? How does Coil Embolization Therapy resolve the problem.? Please be specific of the procedure.

7. What is Mitral Valve Prolapse and how will it affect Jackie’s health care needs before procedures in the future?

8. What education is needed to be shared with these sisters related to their children having this condition in the future?

Neafsey. P. (2010).Sisters for life:
Case Mysteries in Pathophysiology. Englewood:

Morton Publishing Company

gmt/2015

Module 1: Indigenous Religions Overview

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Module 1: Indigenous Religions Overview

  

Explain how economic factors have influenced the development of indigenous religious traditions. Include at least one specific example in your response.

Replace this text with your response to the item in 1–2 paragraphs.

Explain why oral traditions are a common influence on indigenous religious traditions. In your response, include a comparison of the influence of an oral tradition to the influence of a sacred text.

Replace this text with your response to the item in 2–3 paragraphs.

Explain the significance of ancestors for indigenous religions. Provide at least one specific example of this significance to support your response.

Replace this text with your response to the item in 1–2 paragraphs.

Identify key characteristics of leadership in indigenous regions and how this understanding of leadership differs from Western religions.

Discussion questions

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1. Because the patient’s reported hallucinations are not persecutory, as a clinician, what medications would you start with?

2. What treatments (pharmacological and non-pharmacological) are most effective for patients with extensive trauma history?

3. What symptoms could be co-occurring in relation to PTSD vs schizophrenia for this patient?