Throughout this course, you’ve examined the importance of anticipating financial fluctuations that may impact your organization’s ability to provide services. While financial managers have no time machines or crystal balls, they do have expense forecasts. Expense forecasting is one of the preeminent tools that financial managers can use to prepare their organizations for future fiscal turbulence. In this Assignment, you will examine a scenario and generate a corresponding expense forecast in Excel.
Before pursuing an opportunity or making a major purchase, financial decision makers must first ascertain if the expenditures are justified. Determining whether a new process, system, or purchase will yield worthwhile returns is no easy task. However, managers have a variety of tools to help them decide whether the new expenditure is warranted. Analyzing a venture’s benefit/cost ratio, marginal profit and loss statement, and break-even points enable nurse managers to make educated decisions about how they choose to commit their funds.
Note: For those Assignments in this course that require you to perform calculations you must:Use the Excel spreadsheet template for the Week 3 assignment
Show all your calculations and formulas in the spreadsheet.
Answer any questions included with the problems (as text in the Excel spreadsheet).
Expense Forecasting
In this Application Assignment you calculate scenarios focusing on benefit/cost ratio analysis, marginal profit and loss statements, and break-even analysis. For these scenarios, you will utilize the provided figures to perform calculations and then make recommendations about the viability of the investment opportunities
Expense Forecasting Scenario
Your department has performed 20,000 procedures during the first six months (January–June) of 20X1. Spending during that period of time was $210,000 for fixed expense items and $1,200,000 for variable expense items. Of those amounts, $50,000 of fixed expense money was spent on preparing for a Joint Commission survey. Volume is anticipated to be 10% higher in the second half of the year. On November 1st, two new procedure technicians will begin work. The salary and fringe benefit costs for each are $96,000/year. Based on the information provided, prepare an expense forecast for 20X1.
Annualization for Fixed: (Adjusted Total for Year to Date Expense/6) * 12 =Total Annualized Amounts
Annualization for Variable (Adjusted Total for Year to Date Expense/ 20,000) * 40,000 =Total Annualized Amounts.
Financial Analysis Cycle
Marginal Profit and Loss Statement Scenario
You are examining a proposal for a new business opportunity – a new procedure for which demand is expected to be 1,400 units the first year, growing by 600 units a year thereafter. The price charged per procedure is $1,000. The collection rate is anticipated to be 80%. Each procedure consumes $300 of supplies. Salary cost is estimated to cost $540,000 each year, fringe benefits are 25% of salaries, rent for the facility is $55,000/yr and operating cost are $120,000/yr.
Questions:
- Develop a marginal profit and loss statement for this business opportunity.Based on that analysis, should this opportunity be pursued?
Break-Even Analysis Scenario
You can charge $1,075 for a new service. Demand is anticipated to be 8,000 units a year. Your business is able to handle up to 16,500 units annually, so capacity should not be a problem. The average collection rate is 80%. The new service has annual fixed costs of $4,700,000. Variable cost per unit of service is $420.
Question: Use break-even analysis to determine if this new service is financially viable. If the business is not financially viable, what steps could you take to make a case to proceed with implementation? Explain your decision.
Benefit/Cost Ratio Analysis Scenario
You are considering the acquisition of a new piece of equipment with a useful life of five years. This new technology will make your clinical operation more efficient and allow for a reduction of 10 FTEs. The equipment purchase price is $4,500,000 plus 10% installation fee. The purchase price includes service for the first year, an item that has an annual cost of $10,000. There is a potential for additional volume of 150,000 units in the first year, growing by 30,000 each year thereafter. The price charged per unit is $15.00 with a 50% collection rate. The staff being eliminated are paid $12.50 per hour. The fringe benefits rate is 20%. The hurdle rate is 7.5%.
Questions: After reviewing Dr. Ward’s Video and the calculations below, please answer the following questions:
- What is meant by benefit/cost ratio, average payback period and ROI and why are the all important to understand when purchasing new equipment?
- Based on this information, would you pursue this opportunity?
- Explain your decision in 250-500 words in the text box below.
References:
Baker, J. J., Baker, R. W., & Dworkin, N. R. (2018). Health care finance: Basic tools for nonfinancial managers (5th ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 14, “Trend Analysis, Common Sizing, and Forecasted Data” (pp. 149-160)
The focus of this chapter is the use of trend analysis and forecasting to develop future budgets and make financial decisions about capital purchases, programs, and personnel.
Chapter 15, “Using Comparative Data” (pp. 161-173)
In this chapter, you are introduced to the criteria for identifying other health care organizations that are comparable to your own. Data from these organizations can then be used to evaluate your own organizational performance.
Chapter 19, “Estimates, Benchmarking, and Other Measurement Tools” (pp. 223-231)
In this chapter, you continue exploring the concept of financial benchmarking. The chapter focuses on the importance of benchmarking for identifying performance gaps.
Zelman, W., McCue, M., & Glick, N. (2009). Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications (3rd ed.). Hoboken, NJ: Jossey-Bass.
Retrieved from the Walden Library databases.
Chapter 5, “Working Capital Management” (pp. 187–231)
This chapter examines the concept of working capital. The authors explore the specifics of current assets and the management of the working capital cycle.
Chapter 11, “Responsibility Accounting” (pp. 468–497)
Review: This chapter explores the trend toward the decentralization of health care organizations and the challenges this presents. This chapter also describes responsibility centers, or organizational units intended to achieve specific tasks.
Mulva, S., & Dai, J. (2009) Health care facility benchmarking. HERD, 3(1), 28–37.
Reprinted by permission of Sage Publications via the Copyright Clearance Center.
This article describes a national health care facility’s benchmarking program. It is designed to compare measures of capital project performance.
Agency for Healthcare Research and Quality. (2013). Measuring and benchmarking clinical performance. Retrieved from www.ahrq.gov
Ettorchi-Tardy, A., Levif, M., & Michel, P. (2012). Benchmarking: A Method for Continuous Quality Improvement in Health. Healthcare Policy, e101-e119. Retrieved fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359088/
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Nursing Finances
/in Uncategorized /by JosephThroughout this course, you’ve examined the importance of anticipating financial fluctuations that may impact your organization’s ability to provide services. While financial managers have no time machines or crystal balls, they do have expense forecasts. Expense forecasting is one of the preeminent tools that financial managers can use to prepare their organizations for future fiscal turbulence. In this Assignment, you will examine a scenario and generate a corresponding expense forecast in Excel.
Before pursuing an opportunity or making a major purchase, financial decision makers must first ascertain if the expenditures are justified. Determining whether a new process, system, or purchase will yield worthwhile returns is no easy task. However, managers have a variety of tools to help them decide whether the new expenditure is warranted. Analyzing a venture’s benefit/cost ratio, marginal profit and loss statement, and break-even points enable nurse managers to make educated decisions about how they choose to commit their funds.
Expense Forecasting
In this Application Assignment you calculate scenarios focusing on benefit/cost ratio analysis, marginal profit and loss statements, and break-even analysis. For these scenarios, you will utilize the provided figures to perform calculations and then make recommendations about the viability of the investment opportunities
Expense Forecasting Scenario
Your department has performed 20,000 procedures during the first six months (January–June) of 20X1. Spending during that period of time was $210,000 for fixed expense items and $1,200,000 for variable expense items. Of those amounts, $50,000 of fixed expense money was spent on preparing for a Joint Commission survey. Volume is anticipated to be 10% higher in the second half of the year. On November 1st, two new procedure technicians will begin work. The salary and fringe benefit costs for each are $96,000/year. Based on the information provided, prepare an expense forecast for 20X1.
Annualization for Fixed: (Adjusted Total for Year to Date Expense/6) * 12 =Total Annualized Amounts
Annualization for Variable (Adjusted Total for Year to Date Expense/ 20,000) * 40,000 =Total Annualized Amounts.
Financial Analysis Cycle
Marginal Profit and Loss Statement Scenario
You are examining a proposal for a new business opportunity – a new procedure for which demand is expected to be 1,400 units the first year, growing by 600 units a year thereafter. The price charged per procedure is $1,000. The collection rate is anticipated to be 80%. Each procedure consumes $300 of supplies. Salary cost is estimated to cost $540,000 each year, fringe benefits are 25% of salaries, rent for the facility is $55,000/yr and operating cost are $120,000/yr.
Questions:
Break-Even Analysis Scenario
You can charge $1,075 for a new service. Demand is anticipated to be 8,000 units a year. Your business is able to handle up to 16,500 units annually, so capacity should not be a problem. The average collection rate is 80%. The new service has annual fixed costs of $4,700,000. Variable cost per unit of service is $420.
Question: Use break-even analysis to determine if this new service is financially viable. If the business is not financially viable, what steps could you take to make a case to proceed with implementation? Explain your decision.
Benefit/Cost Ratio Analysis Scenario
You are considering the acquisition of a new piece of equipment with a useful life of five years. This new technology will make your clinical operation more efficient and allow for a reduction of 10 FTEs. The equipment purchase price is $4,500,000 plus 10% installation fee. The purchase price includes service for the first year, an item that has an annual cost of $10,000. There is a potential for additional volume of 150,000 units in the first year, growing by 30,000 each year thereafter. The price charged per unit is $15.00 with a 50% collection rate. The staff being eliminated are paid $12.50 per hour. The fringe benefits rate is 20%. The hurdle rate is 7.5%.
Questions: After reviewing Dr. Ward’s Video and the calculations below, please answer the following questions:
References:
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Medical Case Study (Operative Report)
/in Uncategorized /by JosephI NEED THIS DONE WITHIN THE NEXT 20 MINUTES. IT IS JUST ONE CASE STUDY QUESTION NOT A WHOLE ASSIGNMENT.
After reading the operative report below, provide a complete response and codes to the questions that follow.
Findings: The patient had a superficial wound dehiscence with exposure of his leads. He had a small area of lead fraying on lead one. After the leads were freed up from the scar and the pocket, that showed one area of lead dropout on interrogation.
The patient was taken to the operating room and placed in the supine position. General endotracheal anesthesia was obtained. The patient had the usual monitors placed. The patient was then rolled prone onto the Jackson OSI table. All of the soft tissue areas were well padded. The patient had the usual monitors placed. He then had the chest wound for the new generator site identified with the incision identified using C-arm fluoroscopy in the AP plane and the course of the lead was followed and the lead was planned to be explanted at a new level and then reconnected to the generator, which would be disconnected from the lead to the present location pocket. The patient had a timeout done per protocol confirming the correct patient, correct procedure, and all equipment that was necessary from the Boston Scientific pacemaker rep. The patient then had the incisions injected with local and the initial incision was made over the area where the generator was. Sharp dissection was used to get down to the generator layer, and bipolar cautery was used for hemostasis. The leads were dissected free from the superficial aspect of the incision and then the area of the generator was exposed, and the generator was explanted and then it was disconnected from the leads, and the temporary stoppers were placed in the lead holes on the generator and secured and then the generator was placed in antibiotic solution. The area of the leads was then inspected and noted to be markedly scarred in the pocket where they had been positioned behind the generator. These were dissected free using the Bovie cautery on cutting mode and, once the leads had been freed up from all the scar, the new pocket was made hemostatic and was irrigated out. The leads were then exposed through the other incision for the new generator site. This was placed approximately 5 in. above the present site and then, once the leads had been identified in the depth of the new incision, they were mobilized and dissected free and then mobilized up to the new incision and then wrapped in an antibiotic soaked lap. The new pocket was created using a Bovie cautery and the Army-Navy retractors and, once hemostasis was obtained using the suction cautery, the area was irrigated out and then the old generator site was irrigated out. Then the generator was brought up after we had changed our gloves on the field and then the generator had the stoppers removed and the leads were then placed in their usual positions. The generator was placed halfway in the pocket and then interrogated by the Boston Scientific rep, and the #1 lead was noted to have one area of dropout but otherwise was functioning well. This was consistent with a small area of fraying of the lead with the bulk of the lead intact. The leads were then tightened and then reinterrogated with otherwise good function noted, normal impedances, and then the excess lead was placed behind the generator in the pocket. Then the pocket was irrigated out again with Vancomycin antibiotic solution and, once both pockets had been irrigated out, the wound was closed in multiple layers and the skin was ultimately closed with staples at both sites. The patient then had the wounds cleaned off and dressed and the patient was then rolled supine and extubated and brought back to the recovery room alert and moving all extremities.
Questions
• Based on your review of the operative report, what is the objective of the procedures performed today?
• Based on your review of the operative report, what two approaches are used for this report?
• Based on your review of the operative report, identify the two codes needed to reflect the work performed on the leads.
• Identify the code that would be used to report the insertion of the pulse generator.
• Identify the code for the interrogation of the pacemaker.
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Practice Issue And Evidence Summary Worksheet
/in Uncategorized /by JosephCapstone Project Milestone 1: Practice Issue and Evidence Summary Guidelines
Purpose
Clear identification of the practice issue is the first step in evidence-based nursing. Next, the evidence is reviewed to determine the best intervention to change practice outcomes. Completion of the milestone will include identification of the practice issue using the ACE Star Model of Knowledge Transformation and a review of the evidence that will support an intervention that will change outcomes. The evidence summary will be conducted through the ‘breaking down’ of a systematic review on your topic for your change project.
Course Outcomes
This assignment enables the student to meet the following course outcomes:
Due Dates
Milestone 1 consists of the completion of ONE form with two worksheets called the Practice Issue and Evidence Summary Worksheets. (Links to an external site.)Links to an external site. Complete both worksheets
Practice Issue Worksheet Directions
Evidence Summary Worksheet Directions
**Academic Integrity Reminder**
Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.
By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately
References
Krogstad, J. M. (2015). Reflecting a racial shift, 78 counties turned majority-minority since 2000. Pew Research Center. Retrieved from http://www.pewresearch.org/fact-tank/2015/04/08/reflecting-a-racial-shift-78-counties-turned-majority-minority-since-2000/
O’Daniel, M., & Rosenstein, A. H. (2008). Professional communication and team collaboration. In R. G. Hughes (Ed.). Patient safety and quality: An evidence-based handbook for nurses. Rockville: MD: Agency for Healthcare Research and Quality.
Rogers, E. M. (1995). Diffusion of innovations (4th ed.). New York, NY: Free Press.
Sanson-Fisher, R. W. (2004). Diffusion of innovation theory for clinical change. Medical Journal of Australia, 180, 55-56.
The Joint Commission. (2009). The Joint Commission guide to improving staff communication(2nd ed.). Oakbrook Terrace, IL: Joint Commission Resources.
The Joint Commission. (2015). Quick safety: Overcoming the challenges of providing care to LEP patients. Retrieved from https://www.jointcommission.org/issues/article.aspx?Article=07L7HYJFF9ixfyUPFpDzwohKEfieQSJZAT2%2bhFsYXm0%3d
Vardaman, J. M., Cornell, P., Gondo, M. B., Amis, J. M., Townsend-Gervis, M., & Thetford, C. (2012). Beyond communication: The role of standardized protocols in a changing health care environment. Health Care Management Review, 37(1), 8897. doi:10.1097/HMR.0b013e31821fa503
Rubric
NR451_Milestone1NR451_Milestone1
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Surgery: Iturralde V. Hilo Medical Center USA
/in Uncategorized /by JosephOverview: The final case study for this course will require you to analyze a court decision in which a physician was found liable for medical malpractice. You will focus on facts pertaining to the medical standard of care, breach of care, and causation, and you will explain how they were applied to law. You will then use the facts of the case to identify an ethics issue and determine an ethical theory that would help provide a safe, quality healthcare experience for the patient. Next, you will apply a clinician–patient shared decision-making model to describe how the ethics issue could be resolved. You will also include a discussion about possible violations of the code of ethics in your given field. Lastly, you will augment or vary the facts of the case to create a hypothetical scenario that changes the outcome so that the physician is no longer liable for medical malpractice.
Prompt: In this project, you will analyze a court case involving medical malpractice. For this milestone, you will use the facts from the original case to identify an ethics issue, determine an ethical theory that would help provide a safe and quality healthcare experience for the patient, and apply a clinician–patient shared decision-making model.
III. Ethical Component: In this section, you will evaluate the case to identify the specific ethical issues and determine ethical theories and shared decision- making models that would help resolve the issue and provide a safe, quality healthcare experience. Then, you will propose and defend ethical guidelines for healthcare providers to follow in order to avoid future incidents. A. Describe the ethical issues that led to the malpractice case and explain why the issues are credited with causing the incident. Support your response with research and relevant examples from the case. B. Describe an ethical theory that would help resolve the issue and provide a safe, quality healthcare experience for the patient. Support your response with research and relevant examples from the case. C. Select a physician–patient shared decision-making model and explain how it would provide a safe, quality healthcare experience for the patient D. Propose ethical guidelines that would have helped prevent the incident and would help the organization prevent future incidents. E. Defend how your proposed ethical guidelines will hold healthcare providers accountable to themselves, their profession, their patients, and the public.
Rubric Guidelines for Submission: Your paper should be a 2- to 3-page Microsoft Word document with double spacing, 12-point Times New Roman font, one-inch margins, and at least three sources cited in APA format
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create an informal committee to review the issues surrounding the CPOE implementation
/in Uncategorized /by JosephPerform the following tasks:
· Complete the reading assignment and the interactive lesson before attempting this assignment.
· To complete this assignment:
o Review the case study and select one of the committee roles.
o Download the provided PowerPoint template to create a presentation that includes:
§ Your selection as a member on the committee
§ Identification one or more issues, related to your role on the committee
§ Identification of probable cause(s) of identified issue(s)
§ Proposed recommendations to resolve the identified issues
§ Reference slide – list of academic references, using APA style
Ø Case Study
Read the following case study
A good friend of yours is director of nursing at a 220-bed community hospital. Last year the hospital merged with a much larger medical center. One of the upsides, as well as one of the challenges, resulting from this change has been the rapid introduction of new computer systems. The goal is to bring the hospital “up to speed” within 3 years. At present, the Computerized Physician Order Entry (CPOE) is being implemented. The general medical and surgical units went live last month. The ICU, pediatrics, and obstetrics units are scheduled to go live next month. The plan is to work out any kinks or problems on the general units and then go live in the specialty units. Most of the physicians, nurse practitioners, and physician assistants initially complained but are now becoming more comfortable with the computers and are beginning to integrate the CPOE process into their daily routines. Several physicians are now requesting the ability to enter orders from their offices and others are looking into this option. However, three physicians have not commented during this process but are clearly resisting. For example, after performing rounds and returning to their offices they called the unit with verbal orders. After being counseled on this behavior, they began to write the orders on scraps of paper and put these in the patient’s charts or leave them at the nurses’ station. When they were informed that these were not “legal orders,” they began smuggling in order sheets from the non-activated units. In addition, they have been coercing the staff nurses on the units to enter the orders for them. This has taken two forms. Sometimes they sign in and then ask the nurses to enter the orders. Other times they ask the nurses to put the orders in verbally and then they confirm the orders. The nurses feel caught between the hospital’s goals and the need to maintain a good working relationship with these physicians.
You suggest to your friend (director of nursing) to create an informal committee to review the issues surrounding the CPOE implementation. The committee would determine methods to address these issues, prior to implementing CPOE within the ICU, pediatrics, and obstetrics units. Your friend appreciates the suggestion and forms a small committee with the following members:
· Taylor Terrific, RN – a nurse practitioner
· Dr. Dudley Do-Right – a physician who uses the CPOE system routinely and correctly
· Dr. Frank Burns – a physician who rarely, if ever, uses the CPOE system
The director of nursing asks each committee member to create a short PowerPoint presentation for the committee. The presentation would identify issues that occurred during CPOE implementation, identify potential causes of such issues, and list specific recommendations, based on strong rationale and research, to resolve the identified issues prior to the next CPOE implementation. Each committee member will have a unique perspective, based on their position (i.e., nurse, physician).
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Developmental Assessment And The School-Aged Child
/in Uncategorized /by JosephDetails:
The needs of the pediatric patient differ depending on age, as do the stages of development and the expected assessment findings for each stage. In a 500-750-word paper, examine the needs of a school-aged child between the ages of 5 and 12 years old and discuss the following:
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.
Developmental Assessment and the School-Aged Child
1
Unsatisfactory
0.00%2
Less than Satisfactory
75.00%3
Satisfactory
79.00%4
Good
89.00%5
Excellent
100.00%80.0 %Content 25.0 %Comparison of Physical Assessment Among School-Aged ChildrenA comparison of physical assessments among different school-aged children is omitted.An incomplete comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is omitted or contains significant inaccuracies.A general comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is generally described. More information or support is needed for clarity or accuracy.A comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is described. Some information is needed for clarity.A detailed comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is thoroughly described. Insight is demonstrated into the physical assessment of school age children.25.0 %Typical Assessment for a Child of a Specific AgeThe typical developmental stage of a child between the ages 5 and 12 is not described. The typical developmental stage of a child between the ages 5 and 12 is summarized. The summary contains significant inaccuracies for the age of the child. The typical developmental stage of a child between the ages 5 and 12 is generally described. The description contains some inaccuracies for the age of the child.The typical developmental stage of a child between the ages 5 and 12 is described. The overall description is accurate. Some information is needed for clarity.The typical developmental stage of a child between the ages 5 and 12 is accurately and thoroughly described. 30.0 %Developmental Assessment of a Child Using a Developmental Theory (Erickson, Piaget, Kohlberg)A child assessment based on a developmental theory is omitted.A child assessment based on a developmental theory is partially summarized. Partial strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are omitted or are incorrect. There are significant inaccuracies.A child assessment based on a developmental theory is generally described. General strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are summarized. There are minor inaccuracies.A child assessment based on a developmental theory is described. Appropriate strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are described. Some information is needed for clarity.A child assessment based on a developmental theory is thoroughly described. Well-developed strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are all accurate and described in detail.15.0 %Organization and Effectiveness 5.0 %Thesis Development and PurposePaper lacks any discernible overall purpose or organizing claim.Thesis is insufficiently developed or vague. Purpose is not clear.Thesis is apparent and appropriate to purpose.Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.15.0 %Organization and Effectiveness 5.0 %Argument Logic and ConstructionStatement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.15.0 %Organization and Effectiveness 5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.5.0 %Format 2.0 %Paper Format (use of appropriate style for the major and assignment)Template is not used appropriately or documentation format is rarely followed correctly.Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.Template is used, and formatting is correct, although some minor errors may be present. Template is fully used; There are virtually no errors in formatting style.All format elements are correct. 5.0 %Format 3.0 %Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)Sources are not documented.Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.100 %Total Weightage
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Research the different nursing care facilities in your community
/in Uncategorized /by JosephResearch the different nursing care facilities in your community. Discuss the pros and cons of the facility in terms of what they offer. Provide a brief report with the following questions:
• What is the basic rate for room, board, and services (it’s a good idea to get this information in writing)?
• What services are covered by this rate?
• Are there other services available and how much do they cost?
• What are the payment policies?
• What is the refund policy if someone leaves before the end of a month?
• What is the policy for rate increases?
• How long has the current administration been in place?
• Is there enough staff available to meet my needs?
• Is there frequent staff turnover?
• Is some level of nursing care provided (RN, LPN, Nursing
• Assistant)? How often is it available?
• Who will help me with medications if I need it (e.g. reminding me to take them, opening the bottle)?
• Can someone administer medications to me if I can’t take them myself (e.g. applying medication to my skin, putting a pill in my mouth)?
• Can someone help me if I need special care (e.g. caring for a wound)?
• What happens if I have an emergency? Can I get help right away?
• Are staffs suitably dressed, personable, and outgoing?
• Do the staff members treat residents with respect and dignity?
• Do staff members treat each other in a professional manner?
• What language does most of the staff speak?
• What type of help with personal care is available (e.g. bathing, dressing)?
• How flexible is the schedule for receiving help with personal care?
• What, if any, transportation services are available? (e.g. medical appointments, shopping, religious services).
• Will staff arrange for activities (e.g. hair appointment, concert)?
• How does the home support and accommodate personal hobbies?
• Are there regularly planned activities that I will enjoy?
• Will I be able to attend religious services of my choice?
• Can I bring my pet with me when I move?
• When can I have visitors?
• Are there shops, a library, a park, or other amenities within walking distance?
• Is the home close to activities I enjoy?
• Is the home on a bus line?
• Is there an outside area to sit, walk, or garden?
• Are there shops, a library, a park, or other amenities within walking distance?
• Is the home close to activities I enjoy?
• Is the home on a bus line?
• Is there an outside area to sit, walk, or garden?
• Is the floor plan easy to follow?
• Are doorways, hallways, and rooms accommodating to wheelchairs and walkers?
• Are there hand rails to help with walking and in the bathroom?
• Are cupboards and shelves easy to reach?
• Are there nonskid floors and firm carpets to assist walking?
• Does the home have good natural and artificial lighting?
• Is the home clean, free of odors, and well heated and cooled?
• Does the home meet my standards of cleanliness?
• Is the home free from obvious environmental hazards?
• Are the home’s rooms clean, safe, and adequate for my needs?
• Will I have free use of common areas, such as the kitchen, activity rooms, toilet facilities, dining room, or grounds?
• Can I smoke in my room or in common areas?
• What furniture is provided?
• Can I bring along some of my furniture or other personal items?
• Can I adjust the temperature of my room?
• Is there a sit-down shower?
• Can I have my own personal phone line or internet connection?
• Are emergency procedures clearly posted?
• Am I able to lock my room and/or are there locked areas in each room for personal valuables?
• Is the food pleasing, nutritious, adequate, and attractively served?
• What if I don’t like what is being served?
• Can I cook in my room?
• Are snacks available?
• Are there specific meal times or are they flexible?
• Is there a refrigerator available to store my personal food?
• Will the home meet my dietary or cultural food preferences?
• Can I request special foods?
• Do other residents socialize with each other and appear happy and comfortable?
• Do residents speak favorably of the facility?
• Do the residents look like people I want to live with?
• How are room changes and roommate concerns addressed?
• Is there a resident group that meets?
• Do any of the other residents have a history of violent or other problem behaviors? How are these situations handled by staff?
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annotated bibliography
/in Uncategorized /by JosephInstructions
This course requires you to write an argumentative paper. You will submit a topic and outline. Also, you will submit an annotated bibliography and source evaluation.
Use the Source Evaluation Worksheet to submit an annotated bibliography of 5 sources that you intend to use in your paper. Prepare a citation, annotation, and evaluation for each source.
You may collect the worksheets together as one document or you may submit a separate worksheet for each source.
Click on the following link for an example of an annotation.
For this assignment, address the following:
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Case STudy
/in Uncategorized /by JosephCASE STUDY- TYPE 2 DIABETES
INITIAL HISTORY
• 52-year old black female.
• Diagnosed with type 2 diabetes 6 years ago but did to follow up with recommendations for care.
• Now complaining of weakness in her right foot and itching rash in her groin area.
Question 1: What questions would you like to ask her about her symptoms?
ADDITIONAL HISTORY
• Patient says her foot has been weak for about a month and is difficult to dorsiflex; feels numb.
• Denies any other weakness, numbness, difficulty speaking or walking, syncope, or seizures. She finds that watching television particularly in the evening, is becoming a problem because her eyes “are tired” more.
• Has had some increased thirst and gets up more often at night to urinate, sometimes excessively.
• Says she has a rash on and off for many years. It is worse when the weather is warm. It also occurs in her armpits. She gets some relief from salt baths. She occasionally gets a boil in these areas.
• Denies any chest pain, shortness of breath, edema, change in bowel habits, or skin ulcers.
Question 2: What other personal and family-related questions would you like to ask her about her diabetes?
DIABETES HISTORY
• Patient remembers being told her blood sugar was “around 200” when she was first diagnosed. She had gone for a work physical and felt fine at the time and saw no need for expensive drugs.
• Her mother and sister have diabetes. Both of them were diagnosed in their 40’s and are on pills and injections.
• Has been completely asymptomatic, except for rash, until the foot weakness.
• Has gained 18 pounds over the past year and eats a diet high in fats and refined sugars.
• Employed as banking executive and gets little exercise.
Question 3: What would you like to ask about her about her medical history?
PHYSICAL EXAMINATION
• Obese female in no acute distress.
• T= 37 C orally; P=80 and regular; RR=15 and unlabored; BP= 162/98 right arm (sitting); weight 84 kg.
Skin
• Erythematous moist rash in both inguinal areas, beneath both breasts, and in the axillae.
• No petechiae or eccymoses.
• Many dime-sized hyper pigmented spots located on the anterior shins
HEENT, Neck
• Pupils equal and round, fundi with mild arteriolar narrowing.
• Nares and tympanic membranes clear.
• Pharynx clear.
• Neck without bruits or thyromegaly.
Lungs, Cardiac
• Lungs clear to auscultation and percussion.
• Cardiac examination with distant heart tones, a regular rate and rhythm without murmurs or gallops.
Abdomen, Extremities
• Abdomen moderately obese with bowel sounds heard in all four quadrants; no abdominal bruits, tenderness, masses or organomegaly.
• Extremities without edema; arterial pulses are diminished in volume but palpable in both feet.
Neurologic
• Alert and oriented.
• Cranial nerves II through XII intact (including normal vision acuity with glasses).
• Limb strength 5/5 throughout except 2/5 on dorsiflexion of the right foot.
• Sensory perception to light touch diminished on the soles of both feet along the metatarsal bar
• Deep tendon reflexes 1+ and symmetric throughout.
• Gait normal except for accommodation to a right foot drop; negative Romberg test.
Question 4. What are the pertinent positives and negatives on the physical examination?
Question 5. What laboratory tests would you order now?
INITIAL LABORATORY RESULTS
• Serum electrolytes, including BUN and creatinine, calcium, and magnesium all within normal limits.
• Random glucose=253mg/dL (taken at 11 am).
• HgbA1c=9.1%
• Urine dipstick positive for glucose, negative for protein; microscopic without significant cellular or infectious findings.
• Wet prep of smear from skin rash consistent with fungal spores and mycelia.
• Electrocardiogram with evidence of early left ventricular hypertrophy (LVH) by voltage.
Please answer the case study questions.
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Nursing Research
/in Uncategorized /by Josephthe first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.
For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.
Use the “Literature Evaluation Table” to complete this assignment.
Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles. Therefore, they should not be included in this assignment.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
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