Fluent Essays

Instructions for Discussion Replies to 6 DQS DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION. 1- Each reply should be at least 200 words. 2- Minimum One Peer reviewed/scholarly reference ( NO MAYO CLINIC/ AHA) 3- APA 7th edition style needs to be followed. 4- Each response should have reference at the end of each reply 5- Reference should be within last 4 yearsQ-1 Overall the differences between acute rehab, skilled care, long-term care, and hospice patients depend on the category of the facility and their services offered (Alina Health, n.d.); (Differences Between LTACHs, IRFs and SNFs, 2021); (Smith, Kulhari, Wolfram, & Furlan, 2017). Some examples include the complexity of medical care in which intensive care needs to be provided continuously so an LTACH would be most appropriate such as long-term weaning from a trach or a ventilatior (Differences Between LTACHs, IRFs and SNFs, 2021). Another example would be the level of therapy offered,  and an LTACH may offer some, but not as intense or as skilled as an Inpatient Rehab Facility for those who need aggressive rehab to get back to a prior level of functioning (Differences Between LTACHs, IRFs and SNFs, 2021). A skilled nursing facility tends to be the middle ground for patients who dont qualify for inpatient rehab due to medical conditions holding them back, but those medical conditions dont require intensive care so they dont qualify for an LTACH (Differences Between LTACHs, IRFs, and SNFs, 2021). In the question of dialysis, both LTACHs and SNFs can provide either onsite dialysis or transportation to dialysis centers depending on the facility capabilities, but rehab facilities usually do not thus renders the patient unable to be placed (Differences Between LTACHs, IRFs and SNFs, 2021). However, in my career I have seen people be admitted to rehab facilities, but then have additional arrangements for transportation to a dialysis center, but their medical requirements were extremely low on discharge.  Hospice is unique from the others in the fact that the admission criteria include a terminal diagnosis (Matthews & Daigle, 2020). Notably, the most major difference between hospice and the others is that the goal of hospice is not to restore the patient to the prior level of functioning or to decrease their therapies, but to provide a comfortable, dignified experience while the patient passes on (Matthews & Daigle, 2020). An example of an intermediate care facility that helps to precipitate progression to an independent living facility would be that if someone had an acute stroke (Smith, Kulhari, Wolfram, & Furlan, 2017). There are several factors that play into the placement of an acute stroke patient, such as the severity of the stroke, neurological deficits, and hours of therapy that are estimated to either get the patient back to their baseline, or to a point of which they can care for themselves (Smith, Kulhari, Wolfram, & Furlan, 2017). This is also dependent on the ability of the patient to be involved in and participate in set hours of rehabilitation therapy or days of rehabilitation therapy (Smith, Kulhari, Wolfram, & Furlan, 2017). Most acute strokes usually are able to be placed in a short or intermediate-length acute care facility depending on the factors mentioned previously (Smith, Kulhari, Wolfram, & Furlan, 2017). These patients are Discussion Replies Week 2 Name of Student Course Title & Course Code Institute Name (Department + Affiliation) Instructor Name Date Q-1 Sepsis characterized by unresponsive hypotension and lactic acidosis (serum lactate >2 mmol/L) requiring vasopressor therapy to maintain MAP> 65 mmm of Hg despite adequate fluid resuscitation. It is a condition of infection with acute organ dysfunction which is associated with high mortality, long term morbidity for those who survive. Approximately 19 million people develop sepsis every year and only 14 million survives to hospital discharge with varying prognosis (Prescott, & Angus, 2018). The survival depends on pre-sepsis health status, the severity of acute sepsis episode, quality of hospital treatments. The resuscitation and management initiated immediately within 1 hour. The interventions were measuring lactate level, re-measuring if initial lactate is >2 mmol/L, obtain cultures prior to administration of antibiotics, administer broad-spectrum antibiotics, begin rapid administration of 30 ml/kg crystalloids for hypotension or lactate >4 and apply vasopressors if the patient is hypotensive during and after fluid resuscitation to maintain MAP>65 (Levy, Evans, & Rhodes, 2018). Sequential Organ Failure Assessment (SOFA) score equal to or > 2 points are the diagnostic criteria. SIRS-Systemic inflammatory response syndrome is a condition of the excessive inflammatory response of the body to an infectious or non-infectious process such as burns, pancreatitis, autoimmune disorders, ischemia, and trauma. The diagnostic criteria based on the presence of two out of five categories which were temperature above 100.4 or below 98.6, Heart rate over 90 beats per minute, resp. rate over 20, PaCO2 less than 32 mmHg, WBC over 12000 or less than 4000. Severe sepsis/ septic shock- Severe sepsis is a condition of prolonged sepsis leading to multi-organ failure. The patient will be presented with positive signs and symptoms of septic shock which are persistent hypotension even after fluid resuscitation and while being on vasopressors with signs of poor perfusion such as low urinary output, cold/clammy/cyanotic extremities/digits, and altered mental status. The sepsis protocol used in the Ascension facility (Ascension library services, 2021), is based on recognizing the signs and symptoms using the tools and automated EHR alerting the staff for screening the patients and use clinical judgments and notify MD for concern of sepsis even if the screening tool is negative. The criteria were any hypotension with MAP <65 mm of Hg, SBP <90, or decrease > 40 mm of Hg. Our hospital follows a 3-hour bundle goal which is measuring serum lactate, draw blood cultures prior to antibiotics administration, and starting of broad-spectrum antibiotics within 1 hour if possible, at least within 3 hours, and fluid replacement for any hypotension or lactate >4 with 30 ml/kg of crystalloids. 6-hour bundle includes re-measuring lactate if initiaQ-1 Opioid dependence must be identified when patients come in for medication reviews or by a drug search. It is reasonable to assume a patient who has been on the maximum or exceeded the maximum recommended dose of an opioid analgesic continuously should be assessed further. A patient assessment can be carried out by any of the practice clinical staff: GPs, advanced nurse practitioners, mental health practitioners, clinical pharmacists, and practice nurses with relatively little additional training. However many providers do not feel confident, trained, or experienced in managing drug dependence. Opioid dependence is suggested by the factors such as overt drug-seeking behavior, lost or misplaced prescriptions, frequent requests for additional medication, use of additional over-the-counter medication, requests for medication for out-of-hours medical services, walk-in centers, or other surgeries and a previous history of drug or alcohol dependence (Becker & Liebschutz, 2018). Thus my response would be to ask how often is he taking his OxyContin, review the prescribed dosage, emphasis how long the prescription should last him, and ask how history of previous addiction. I would then offer non-narcotic alternatives, assist to find alternative ways to cope with chronic pain and stress which may be contributing to his pain and refer to pain clinic if needed. Becker, W. C., & Liebschutz, J. M. (2018). Managing Concerning Behaviors in Patients Prescribed Opioids for Chronic Pain: A Delphi Study. Journal of general internal medicine, 33(2), 166–176. https://doi.org/10.1007/s11606-017-4211-y Q-2 In this scenario, the patient’s appropriate treatment involved a multitude of therapies to appropriately treat the underlying cause (Azadfard, Heucker & Learming, 2020); (Wolfe, 2021); (Shah & Heucker, 2021). With this patient presentation I believe he is currently withdrawing from his recent abuse of opioids, and would need to have that addressed appropriately prior to entering a post-acute facility rehabilitation center (Azadfard, Heucker & Learming, 2020); (Wolfe, 2021); (Shah & Heucker, 2021). With this being said I would like to admit him to the hospital for investigation of his abdominal pain and withdrawl symptoms (Azadfard, Heucker & Learming, 2020); (Wolfe, 2021); (Shah & Heucker, 2021). I would also order Zofran 4mg IV Q6 PRN nausea, but also an EKG to check his QT prolongation due to his other home medications as well as combining it with methadone (Shah & Heucker, 2021). I would also want to order a non-contrast CT Scan of his abdomen due to his intractable abdominal pain as it may be an ileus due to the recent abuse of opiates (Beach & De Jesus, 2021). I would like to consult Neurosurgery to see if there is anything they can provide from a surgical standpoint or treatment management. I would also like to consult psychiatry for the patient’s admittance of opioid addiction and abuse and an appropriate treatment plan (Azadfard, Heucker & Learming, 2020)