Reply to two other student posts with a reflection of their response.  Please make sure to provide citations and references (in APA, 7th ed. format) for your work. (300 words minimum)

Unit 3 Discussion – ICD-10 Codes. Due 7-25-23. 1000words. 4 references

1. Why is accurate coding using the ICD-10-CM important?

2. Use your lecture materials to determine what ICD-10 Codes to assign for this patient encounter.

3. In paragraph form, construct a discussion that supports the Codes you identified. 

4. In the discussion explore how the ICD-10 Codes that you assigned impact third party payor reimbursement for this visit.

5. Summarize an article that pertains to ICD-10-CM

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.

Please review the rubric to ensure that your response meets the criteria.

Chief Complaint:

Older sister reports – “Our mother died three weeks ago and we lost our father several months ago. I think that my sister was depressed and just wanted to be with them.”

History of Present Illness:

31-year-old female who was brought to the hospital by ambulance. She was found slumped over in her car in front of the funeral home where memorial services for both her father and mother had recently been held. On the seat beside her were two empty bottles of sleeping pills, a Bible opened to Psalm 23, and a note that read
: “I am going to be with mom and dad. It is just too sad being here anymore without them. I love you all and you will be in my prayers.” When she was found by the funeral home director her hair was oily and unkempt and she smelled as if she had not bathed in a long time. She was wearing a dirty orange T-shirt and jeans.

PMH:

Depression when she was a junior in HS which led to psychiatric admissions at 15 and 19 years of age. For these admissions she was treated with antidepressants and psychotherapy. Length of stay for both admissions was approximately 5 weeks. At age 19, following a suicide attempt, she met her first husband in the psych ward of the hospital. Diagnosed with bipolar disorder 6 years ago.

Information from Sister:

Older sister reports ‘hard life’. Reports both parents were alcoholics. Parents would go to bars almost every night and leave the 8 children in the care. The children were eventually removed from the home. Some of the children went to the Catholic girls’ home others were placed in “horrible” foster homes where they were subjected to physical and sexual abuse.

Reports numerous siblings, including the patient, have been through several detoxification centers for alcohol abuse.

Patient is in her second marriage with 3 daughters – 2 from the first marriage and 1 from the current marriage.

Reports that after having her third baby the patient went into a ‘terrible depression’. The patient was under the care of a psychiatrist for this depression and was placed on an anti-depressant after about 3 months of being under the psychiatrist’s care. After 3 weeks of being on this anti-depressant the patient is reported as having gotten ‘really weird’; patient was staying up all night pacing around her house and talking to people on the phone, she would go on shopping sprees for 2-3 days at a time and max out all her credit cards. The patient finally crashed and was taken to the hospital by her family and it was during this admission, 6 years ago, that the patient was diagnosed with bipolar disorder. Sister reports the patient has been on Lithium since being diagnosed with bipolar disorder.

Reports their father had been sick for a while so his death was not unexpected. However, their mother went downhill fast and the patient is reported to not cope well with the mother’s illness/death.

Reports the patient hadn’t been eating lately with noted weight loss. Additionally, the sister reports the patient had been smoking and drinking ‘more than usual’ lately.

Family Hx:

Paternal grandmother – depression

Two maternal aunts – bipolar disorder

Mother and father – alcohol abuse

Father died from pancreatic cancer

Mother died from heart failure

3 living brothers, 3 living sisters, one deceased brother who had an AMI at age 34

Social Hx:

Divorced and remarried

Worked as a nurse’s aid and health insurance claims adjuster

Attends church regularly

Smoked 1ppd for 15 years

History of alcohol abuse with several DWI violations

History of IV drug use, not in the last 10 years

ROS:

Information from sister:

Neuro – history of migraine headaches since late teens, takes Imitrex prn

SIGECAPS:

Sister reports: at times the patient is up all night – particularly when bipolar symptoms not well controlled, the patient seemed to be more depressed since the loss of their mother, does not believe the patient felt guilty surviving parents, patient has been not been attentive to her personal hygiene, the patient appeared to be obsessing on parental loss, patient appeared to be losing weight and therefore suspect she was not eating well, patient seemed to not be engaging in typical daily activities; patient had not expressed having suicidal ideations, had not expressed homicidal ideations

Medications:

Lithium 600mg po Q AM and 600mg po Q HS

Sumatriptan 50-200mg po PRN

Allergies:

ASA – swelling of face

Physical Examination:

General – lethargic and slow to respond to questions; BP 110/72, P 66, RR 12, T 97.0, SpO2 on RA 95%, Ht 66 in, Wt 135 lbs, BMI 21.8

Integument – skin pale, warm, dry; good turgor; several cystic lesions on chin; no rashes, ecchymoses or petechiae noted

HEENT – Head is normocephalic and atraumatic, pupils dilated with sluggish reaction to light, TMs gray and shiny bilateral, nares patent without discharge noted, no tonsillar enlargement, moist mucous membranes

Neck – supple without adenopathy, no thyromegaly

Lungs – CTA

Breasts – deferred

Cardiovascular – heart with RRR without murmur/gallop, multiple varicosities noted bilateral lower extremities

Abdomen – soft, non-distended, active bowel sounds, non-tender, no organomegaly

Genitalia/Rectum – deferred

Musculoskeletal – no major limitations of ROM or gross abnormalities noted

Neurologic – oriented to person, DTRs 2+ and equal bilateral, no localizing signs, CN II- XII grossly intact

Diagnostics – Na 139 meq/L, K 3.7 meq/L, Cl 108 meq/L, HCO3 23 meq/L, Bun 10 mg/dL, Cr 0.7 mg/dL, fasting Glu 102 mg/dL, Ca 8.7 mg/dL, PO4 3.2 mg/dL, Protein 4.8 g/dL, Mg 2.0 mg/dL, AST 33 IU/L, ALT 20 IU/L, GGT 82 IU/L, Alb 2.9 g/dL, TSH 4.1, Vit B12 203 pg/mL, Hgb 12.2 g/dL, HCT 36.8 %;

Lithium 0.08meq/L

Urine dipstick – 6.3 pH, SG 1.021, all other parameters negative

Assessment:

You will be evaluating the subjective and objective data sets to determine the diagnoses for this patient encounter.

Plan:

The plan cannot be developed until the diagnoses are assigned.

Implementation, critical reflection and evaluation of an educational event

For this assessment, you will develop a Word document or an online resource repository of at least 12 annotated professional or scholarly resources that you consider critical for the audience of your safety improvement plan to understand or implement to ensure the success of the plan

Introduction

Communication in the health care environment consists of an information-sharing experience whether through oral or written messages (Chard & Makary, 2015). As health care organizations and nurses strive to create a culture of safety and quality care, the importance of interprofessional collaboration, the development of tool kits, and the use of wikis become more relevant and vital. In addition to the dissemination of information and evidence-based findings and the development of tool kits, continuous support for and availability of such resources are critical. Among the most popular methods to promote ongoing dialogue and information sharing are blogs, wikis, websites, and social media. Nurses know how to support people in time of need or crisis and how to support one another in the workplace; wikis in particular enable nurses to continue that support beyond the work environment. Here they can be free to share their unique perspectives, educate others, and promote health care wellness at local and global levels (Kaminski, 2016).You are encouraged to complete the Determining the Relevance and Usefulness of Resources activity prior to developing the repository. This activity will help you determine which resources or research will be most relevant to address a particular need. This may be useful as you consider how to explain the purpose and relevance of the resources you are assembling for your tool kit. The activity is for your own practice and self-assessment, and demonstrates course engagement.

References

Chard, R., & Makary, M. A. (2015). Transfer-of-care communication: Nursing best practices.AORN Journal, 102(4), 329–342.Kaminski, J. (2016). Why all nurses can/should be authors. Canadian Journal of Nursing Informatics, 11(4), 1–7.

Professional Context

Nurses are often asked to implement processes, concepts, or practices—sometimes with little preparatory communication or education. One way to encourage sustainability of quality and process improvements is to assemble an accessible, user-friendly tool kit for knowledge and process documentation. Creating a resource repository or tool kit is also an excellent way to follow up an educational or in-service session, as it can help to reinforce attendees’ new knowledge as well as the understanding of its value. By practicing creating a simple online tool kit, you can develop valuable technology skills to improve your competence and efficacy. This technology is easy to use, and resources are available to guide you.

Scenario

For this assessment, build on the work done in your first three assessments and create an online tool kit or resource repository that will help the audience of your in-service understand the research behind your safety improvement plan pertaining to a specific patient safety issue and put the plan into action.

instructions

Using Google Sites, assemble an online resource tool kit containing at least 12 annotated resources that you consider critical to the success of your safety improvement initiative. These resources should enable nurses and others to implement and maintain the safety improvement you have developed.It is recommended that you focus on the 3 or 4 most critical categories or themes with respect to your safety improvement initiative. For example, for an initiative that concerns improving workplace safety for practitioners, you might choose broad themes such as general organizational safety and quality best practices; environmental safety and quality risks; individual strategies to improve personal and team safety; and process best practices for reporting and improving environmental safety issues.Following the recommended scheme, you would collect 3 resources on average for each of the 4 categories focusing on a specific patient safety issue. Each resource listing should include the following:

• An APA-formatted citation of the resource with a working link.
• A description of the information, skills, or tools provided by the resource.
• A brief explanation of how the resource can help nurses better understand or implement the safety improvement initiative pertaining to a specific patient safety issue.
• A description of how nurses can use this resource and when its use may be appropriate.

Remember that you must make your site “public” so that your faculty can access it. Check out the Google Sites resources for more information.Here is an example entry:

• Merret, A., Thomas, P., Stephens, A., Moghabghab, R., & Gruneir, M. (2011). A collaborative approach to fall prevention. Canadian Nurse, 107(8), 24–29.
  • This article presents the Geriatric Emergency Management-Falls Intervention Team (GEM-FIT) project. It shows how a collaborative nurse lead project can be implemented and used to improve collaboration and interdisciplinary teamwork, as well as improve the delivery of health care services. This resource is likely more useful to nurses as a resource for strategies and models for assembling and participating in an interdisciplinary team than for specific fall-prevention strategies. It is suggested that this resource be reviewed prior to creating an interdisciplinary team for a collaborative project in a health care setting.

  Additionally, be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.

• Identify necessary resources to support the implementation and continued sustainability of a safety improvement initiative pertaining to a specific patient safety issue.
• Analyze the usefulness of resources to the role group responsible for implementing quality and safety improvements focusing on a specific patient safety issue.
• Analyze the value of resources to reduce patient safety risk related to a specific patient safety issue.
• Present reasons and relevant situations for use of resource tool kit by its target audience.
• Communicate in a clear, logically structured, and professional manner that applies current APA style and formatting.

Example Assessment: You may use the following example to give you an idea of what a Proficient or higher rating on the scoring guide would look like but keep in mind that your tool kit will focus on promoting safety with medication administration. Note that you do not have to submit your bibliography in addition to the Google Site; the example bibliography is merely for your reference.

• Assessment 4 Example [PDF] Download Assessment 4 Example [PDF].

To submit your online tool kit assessment, paste the link to your Google Site in the assessment submission box.Example Google Site: You may use the example found on the Assessment 4: Google Sitesreading list, Resources for Improved Heparin Infusion Safety, to give you an idea of what a Proficient or higher rating on the scoring guide would look like for this assessment but keep in mind that your tool kit will focus on promoting safety with medication administration.Note: If you experience technical or other challenges in completing this assessment, please contact your faculty member.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

• Competency 1: Analyze the elements of a successful quality improvement initiative.
  • Analyze the usefulness of resources to the role group responsible for implementing quality and safety improvements focusing on a specific patient safety issue.
• Competency 2: Analyze factors that lead to patient safety risks.
  • Analyze the value of resources to reduce patient safety risk related to a specific patient safety issue.
• Competency 3: Identify organizational interventions to promote patient safety.
  • Identify necessary resources to support the implementation and continued sustainability of a safety improvement initiative pertaining to a specific patient safety issue.
• Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.
  • Present reasons and relevant situations for resource tool kit to be used by its target audience.
  • Communicate resource tool kit in a clear, logically structured, and professional manner that applies current APA style and formatting.

Tom Lee

he/him/his

10/26/23, 9:26 PM NEW

Maintaining appropriate nutrition levels is crucial for older adults as it promotes overall health and well-being. However, there are various dietary concerns and barriers that older adults may encounter, which can lead to inadequate nutrition. Reduced physical mobility can make grocery shopping and meal preparation challenging. Older adults live longer, which means ailing health status and increased immobility as they try to maintain their autonomy and self-sufficiency. Access to nutritious foods may be limited, leading to reliance on convenience or processed foods, which are often less healthy. Loneliness or living alone can contribute to poor dietary choices and meal skipping. Eating alone can also reduce the enjoyment of meals. Limited income may lead to difficulty affording nutritious foods, forcing older adults to make compromises on food quality.

Educate the older adult and their caregivers about meal planning and preparation. Encourage them to plan balanced meals and provide assistance or resources for grocery shopping. Meal planning can mitigate some of the limiting factors associated with decreased mobility. Connect the older adult with community resources such as Meals on Wheels or senior meal programs that provide adequate meals. Encourage older adults to increase their social circle if possible. Integrating peers can reduce loneliness and encourage physical and mental activity. Provide them with resources to community centers and assist with activity searches. These teachings and collaborative efforts from the client can improve nutritional health.

Angela Antonczak

10/24/23, 11:24 PM

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Nutrition is essential for the body so when older adults have dietary problems and barriers it is very difficult to maintain a healthy diet. The dietary concerns and barriers for an older adult to maintain appropriate nutrition levels are physical difficulties and medical conditions are two examples that are extremely difficult for older adults. Elderly people age and so does the immune system so when it weakens they get more prone to health issues. Obesity is a big problem for elderly people with diabetes type 2 because they are overweight. They might have to limit their sugar intake so they don’t have to take insulin shots. Another is osteoporosis when an older person has calcium deficiency or low calcium levels in their diet. My aunt had this disease and it hurt when she walked. She was told to take a calcium supplement, but she refused to take anything. Maintaining an healthy diet in general is extremely difficult for elderly people because they might be set in their own ways of eating which is a difficult thing like my family was. If older patients do not take consideration for their health and nutrition then they are at risk for many health related complications like heart disease from high fat content consumption. The two client teaching and nursing interventions for prevention of nutritional deficits as well as the consequences of inadequate nutrition and hydration are for nurses to teach the patient about their nutritional needs as far as a strict diet if they are suffering high blood pressure or eating way too much sugar. They should promote physical activity in their ADLs or some form of exercise to help maintain a healthy weight balance. The fluid intake should be limited if a person is suffering from pneumonia or edema which can result to more fluid intake especially if they are having renal failure. The kidneys are at risk because they can’t function normally and filter the blood properly and maintain normal urine. Staying hydrated is essential for the body but for some elderly they must reduce their fluids due to complications. When an older person has inadequate food they are can be at risk for malnutrition which is harmful for the body since an elderly can find it difficult to eat food properly or skip meals due to lack of appetite or no flavor in their meals. 

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