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Physicians, however, prefer hemodialysis because of reimbursement trends (Wellbery).
Dietary Changes - Many patients also prefer peritoneal dialysis to hemodialysis because the latter restricts the diet (NKUDICC 2000). Peritoneal dialysis removes body wastes slowly but it always does. In hemodialysis, on the other hand, wastes can build up for two or three days between treatments. In addition, a patient on hemodialysis must observe a restrictive diet. Some clinics help plan the meals of patients undergoing peritoneal dialysis. Their dietitians can give advice on how to prepare more satisfying meals (NKUDICC).
Management and Implications - Managing acute renal failure begins with determining the cause (Agrawal and Swartz 2000). It includes a thorough history and physical examination, blood tests, urine studies and a renal ultrasound examination. Renal failure warrants supportive therapy to maintain fluid and electrolyte balances, reduce the production of nitrogenous wastes, and to sustain nutrition. Death is most frequently the…… [Read More]
Nephrologists are expected to play a role in this determination, but all too often the nephrologist, like other physicians, must be prompted to deal with end-of-life issues. If no one is available to do the prompting, the patient's death may be needlessly prolonged. The amount to which the nephrologist takes on end-of-life care will be reflected in their approach to the patient. At one end of the spectrum, discomfort with dying can lead to passivity, where the nephrologist serves purely passive role, overseeing dialysis and focusing on fluid and electrolyte balance. At the other end, the nephrologist can be seen as taking a leading role in end of life care (Siegler, Del Monte, osati, and von Gunten, 2002).
Chronic diseases are now thought to be the leading causes of death around the world. The World Health Organization (WHO) has reported that there were approximately 58 million deaths worldwide in 2005,…… [Read More]
The cassette has a built-in one-liter bladder to hold urine. The patient should empty the bladder at least every six hours. An alarm will beep if he forgets to do this, or if the bladder becomes full. The device can be used during the day, at night, or both. Unlike CAPD, it is not necessary to connect to and disconnect from the Tenckhoff catheter four times a day, which should reduce the risk of peritonitis. Peritoneal dialysis patients typically lose about 8 grams of proteins and amino acids per day from the treatment. This device will return most of the patient's proteins and amino acids to the dialysate, rather than discard them. If the patient wishes, the device can be powered by plugging it into a wall socket, rather than using a battery pack.
The device's functionality can include the ability to log a wide variety of data, for later…… [Read More]
For-Profit Dialysis Business Plan
Management and Staff
Start-up Costs and Operational Expenses
Strategy and Implementation
Marketing and Communication
The increasing burden of chronic kidney disease (CKD) in Kenya presents a major challenge, with young adults aged 20-50 years being the most affected. CKD is primarily caused by hypertension, diabetes, along with glomerular diseases. HIV-associated CKD is an increasing healthcare concern, and frequently offers late "End-Stage-Renal-Disease" (ESRD) requiring dialysis. In Kenya, dialysis remains out for reach for majority of ESRD patients due to financial constraints, lack of personnel, inadequate renal facilities, as well as lack of national and/or regional registries. Presently, only a few dialysis centres provide service in the country, mainly in a few government hospitals, notably Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital. Nonetheless, the cost of dialysis is high, thereby limiting dialysis to…… [Read More]
Survival in Pediatric Dialysis and Transplant Patients
Children that have to undergo kidney transplantation or dialysis at an early age are at much more risk than the healthier ones. The mortality rate risks have been identified to be around thirty times more. End-stage Renal Diseases (ESRD) can cause either or more of the following consequences in children: cognition and response, lack of muscular coordination, cardiovascular issues, tantamount to quality of life. As a result, science has evolved to assure techniques and methodologies in Kidney transplantation and dialysis for children in the last few decades. The records show improved short-term mortality in patients following the technological advances, in children that have undergone transplantation and dialysis. The allograft outcomes have been positive, too. There is an absence of such affirmation, however in longer-term care as the treated children are required to move out from pediatric care to adult care centers in later…… [Read More]
Diabetes and Pediatric and Dialysis
The objective of this study is to analyze the incidence of diabetes among pediatric patients, with dialysis, by way of analysis of outcomes one year following diagnosis.
Initiatives concerned with investigating pediatric diabetes have previously been associated with varying outcomes. What factors are linked with diabetes, pediatric patients, and dialysis with regards to Glycated hemoglobin (HbA1c) determinants? This forms the groundwork of the paper.
Protection of Human Participants iii. Data collection
Data management and Study Design
Control of blood glucose, as shown by levels of hemoglobin A1c (HbA1c), serves as one of the clearest forecasters of lasting complications in adults as well as children suffering from type 1 diabetes mellitus (T1D). This includes diabetic nephropathy, proliferative retinopathy, age-adjusted mortality, and cardiovascular disease rates.
Hemoglobin A1c is the form of hemoglobin in the blood (red blood cells) that develops when elevated sugars are present. The sugar…… [Read More]
Diabetes and Pediatric and Dialysis
This study's aim was to assess the level of cognition required by nurses to prevent Diabetic Nephropathy (DN). It has been shown that Diabetic affliction leads to build up of DN.
Diabetes Type 1 (T1D) and Type 2 (T2D) complications lead to the micro vascular conditions that progress towards Diabetic Nephropathy; this can become life threatening. The growing incidence of both T1D and T2D especially among children raises concern and fear; prevention is important where possible. Progression of diabetic complications leads to DN. Conditions involved in DN may require dialysis and potentially even kidney transplant(s). Effects include: large costs of treatment, emotional/psychological pain, fatigue, and even loss of life, as well as both patient and family financial and emotional issues. The health care system as a whole needs to focus on this issue through coordinated, patient-centered approaches; the role of the nurse becomes highly significant.…… [Read More]
The company that I have chosen to evaluate is Fresenius, a health care company specializing in dialysis equipment and clinics. They are based on Bad Homburg, Germany, which is just outside of Frankfurt. Fresenius is one of the global leaders in this business, and has an extensive network of dialysis clinics in the United States. The dialysis business is driven by age and overall health of individuals in a society. There are a variety of payers, depending on the country. Most dialysis patients need multiple visits per week to the clinic. This division within the company is Fresenius Medical Care, and accounts for $15.8 billion in revenue and over $1 billion in profits. The company has smaller businesses as well, including Fresensius Kabi, which is IV drugs, clinical nutrition and medical devices. Fresenius Helios operates hospitals, and Fresenius Vamed runs projects and services for hospitals.
The location to be…… [Read More]
prenatal education improves the rate at which newborn infants arrive into this world without undue stress and hardship on the family. Additionally, this review seeks to determine what educational actions can be taken before the newborn arrives to assist the family in acclimating themselves to a change in the family structure, especially if the family structure is affected by the newborn who is born with medical problems. Little Johnny or Little Mary were created out of love (or lust as the case may be) but now that the news has been broadcast throughout the immediate family and friends, reality sets in and the worries begin. Questions such as; will it be a boy or a girl, or will it have any maladies are oftentimes the questions that are at the top of the list. ill it be born without any defects, and how will the rest of the family adapt…… [Read More]
Craig, M.E., Hattersley, A., & Donaghue, K.C. 2009). Definition, epidemiology and classification of diabetes in children and adolescents. Pediatric Diabetes, 10s12), 3-12.
This article is a chapter in the ISPAD Clinical Practice Consensus Guidelines 2009 Compendium. The complete set of guidelines can be found at www.ispad.org. The evidence grading system used in the ISPAD Guidelines is the same as that used by the American Diabetes Association. See page 2 the Introduction in Pediatric Diabetes 2009; 10 Suppl. 12): 1 -- 2).
Delamater, A.M., Patino-Fernandez, A.M., Smith, K.E., & Bubb, J. 2013). Measurement of diabetes stress in older children and adolescents with type 1 diabetes mellitus. Pediatric Diabetes, 141), 50-56.
Abstract: Objective: Studies indicate general psychological stress plays a role in the glycemic control of individuals with type 1 diabetes mellitus T1DM). Disease-specific rather than general measures may be more closely related to measures of health outcomes. Therefore, measurement of diabetes-related…… [Read More]
ecause this is true, it is critically clear that the nursing leadership manager's role is one of a vital nature and that support for nurses in their role is the primary component that must necessarily be integral to leadership in nursing in dialysis units if the turnover of nurses is reduced to the lowest possible level. The nursing leadership manager's role is one that must proactively deal with burnout of these dialysis unit nurses instead of attempting to address these as they occur. Prevention is 'key' toward this end. As the demands grow for quality and competent nursing staff so does the need grow for competency in leadership nursing manager roles. ecause the dialysis unit nurse is very closely involved in their patient's care and because these patients are required to report for treatment several days a week for several hours a day the nurse's mental, physical and emotional state…… [Read More]
Five Forces & Value Chain
NxStage is a medical equipment manufacturer specializing in hemodialysis products for use in the home. Their main flagship, NxStage SystemOne, constitute two-thirds of the company's revenues. The product has been on the market for several years, but NxStage has never been able to turn a profit, nor has it been able to develop a viable second major product. This has created a strategic dilemma for the company as to how best to enhance shareholder value going forward.
The external environment is generally challenging, especially in light of regulatory changes that aim to drive down the cost of medical care, not necessarily good for a company like NxStage that has a differentiated product. There is some demand for the product, but also substitution from dialysis clinics, which can be offered at a lower total…… [Read More]
This information was obtained from the facilities giving dialysis and it was for the first two months only. The study excluded darbepoetin doses as it had only been administered to a few patients. Inpatient EPO doses were not easily determinable as they are not billed differently to Medicare. The use of outpatient EPO only may be underestimating the total use of the medication. The cohort dealt with the biasness by determining the amount of time a patient stayed in hospital. The calculations on the average dose of EPO for every patient per day was by adding the total dose for a whole month then separating it by the number of days of outpatient then multiplying by 30 to get the total of a calendar month. According to the medical reports the study used the right amount of doses. The study was not randomized as it was aimed towards the African-American…… [Read More]
Establishing acceptability regarding this project requires analysis as to whether the project will provide a number of items including; profitability, a viable concern, a needed service and an expanded footprint in the community. Stakeholders include the public which the project will service -- and specifically those in need of dialysis, shareholders in the company who are interested in generating a return on their investment, and employees who will be provided compensation and additional opportunities for a long-term career. As one expert states regarding acceptability of certain projects "Generally there will be more potential projects available than can be undertaken at any time" (Hann, 2011). If what Hann states is true, then analyzing the acceptability of this project from a stakeholder's viewpoint would help to determine whether or not the project should be undertaken.
A recent study demonstrated that health related quality of life "was highest in the healthy general population,…… [Read More]
In an acute care setting, such Veterans Affairs, this objective is executed by educating patients about how to maintain a healthy diet and lifestyle after the leave the facility, while in a long-term care setting-such as Cobble Hill-this objective is executed on a daily basis by providing nutritious meals for elderly residents. And finally, in an ambulatory, out-patient care setting-such as Atlantic -- the clinical nutritionist works to support patients in maintaining a diet that addresses their personal healthcare needs, while still living independently within a larger community. Perhaps the most significant similarity between facilities is the notion of nutrition as merely one component of a comprehensive care program; hence the necessity of a clinical nutritional to work in conjunction with a full medical, administrative, and social support staff. The apparent goal of such an approach is to promote multiple aspects of health and well-being among patients, regardless setting or…… [Read More]
Like all other aspects of business today, security systems often prove to be highly complex and hard (even for the participants) to identify.
The culture of an organization is like the culture of a family, a community, or a nation: Because it surrounds the people in it they often have a great deal of difficulty in recognizing to what extent policies and procedures arise from the constraints of culture and what therefore can be relatively easily changed. Matz (2010) summarizes the ways in which organizational culture both supports an organization and can blind the individuals in it to ways in which their actions may no longer be as effective as they once were:
… the essence of organisational cultures consists of a set of 'unspoken rules' that exist without conscious knowledge of the members of the organisation. Over time the invisibility of the attributes at the deepest level…… [Read More]
Studies conducted over decades have concluded that there is a significant link between diabetes mellitus and cardiovascular disease. For instance, the most common form of diabetes is type 2 diabetes, which involves both the impairment in insulin resistance and the defective secretion of insulin by the pancreas. The development of diabetes often comes with a number of cardiovascular complications including "coronary heart disease (CDC), stroke, peripheral arterial disease, nephropathy, retinopathy, and possibly neuropathy and cardiomyopathy." (Grundy 1999)
Specifically both diabetes type 1 and type 2 are considered to be risk factors for atherosclerotic coronary heart disease. "Moreover, myocardial ischemeal due to coronary atherosclerosis commonly occurs without symptoms in patients with diabetes." (Grundy 1999) In other words, patients with diabetes are more likely to be stricken with congestive heart failure. But it is not only the risk of heart failure that diabetes sufferers are at risk from, another…… [Read More]
Workflow modeling widely types businesses, including health care organizations, visually summarize steps complex processes systems. When constructing a workflow model, important ensure model accurately reflects actual steps a process.
Workflow diagrams: Improving the workflow diagram
"Workflow modeling is basically the process of simplifying reality" (Malhotra, Jordan, & Patel 2005: 1). While the creation of a workflow diagram can never perfectly mirror reality, through this simplicity it is hoped that the tasks delineated can be eased. With a bare-bones presentation, "workflow, role players, devices, protocols and communications" are better understood and problems which can occur in the chain of causal links between these actors are identified and streamlined via a diagram.
Workflow modeling is based upon a systems approach to rectifying organizational problems, versus a patch approach where only the obviously wrong component of the system is addressed while the rest are left intact. While the patch approach might seem to…… [Read More]
Try to identify the following structures in an amoeba (Fig. 4.2):
Nucleus: A single, membrane-bounded oval structure.
Food vacuoles: Membrane-bounded spheres that contain engulfed food. Are these present? Yes.
Contractile vacuoles: Transparent, membrane-bounded spheres used to expel excess water. Are these present? Yes.
Animal Cell Structure
Animal cells contain all the structures in Table 4.1 except they do not have a cell wall and do not have chloroplasts. Can animal cells make their own organic food? No. Why or Why not?
Plants have chloroplasts which allows them to convert solar energy to carbohydrates. The carbohydrates are the organic food that plants then use for energy. Animals do not have chloroplasts and so are not capable of making their own organic food.
Observation: Elodea (Anacharis)
Can you locate the cell nucleus? Yes. It may be hidden by the chloroplasts, but when visible, it appears as a faint, gray lump…… [Read More]
incidence of diabetic nephropathy, its etiology, its comorbidities, and how to control it. The best type of 'cure' is, as always, prevention, and close regulation of the disease which is particularly important since diabetic nephropathy can be fatal.
Diabetic nephropathy is the primary etiology of chronic kidney disease and kidney failure. Unfortunately, type 2 diabetes mellitus is skyrocketing in the United States alone to over 21 million cases, it is imperative for health care professionals to understand the mechanisms of diabetic nephropathy. This is particularly so since early recognition and prevention of the disease as well as tight serum glucose control can help prevent diabetic nephropathy from occurring thereby leading to potentially longer life for its carriers.
The authors describe the characteristics and etiology of diabetic nephropathy explaining how and why it can result in kidney disease and kidney failure.
Understanding these mechanisms can help us prevent kidney failure from…… [Read More]
total I have 13 years in the nursing field. Throughout that combined time I have worked in nursing homes / assisted living facilities, home health, as well as in a hospital setting. During the time that I worked in the hospital I worked in a program called share the care. This entailed me working throughout the entire hospital as a nursing assistant, which gave me experience in various areas, i.e. The emergency room, intensive care, pediatrics, oncology and etc. By being apart of this program it has afforded me the opportunity to do what I truly love, be a part of the whole process of nursing sick patients back to health. This has always been a passion of mine.
A Nurse practitioner is a nurse who has completed a graduate nursing degree and training in providing preventive and medical health care to individuals and families in association with a physician.…… [Read More]
Chronic Liver Disease
With a number of functions -- including detoxification, protein synthesis, and the production of chemicals that are necessary for digestion -- the human liver is vital.
It is reddish brown and has four unequal sized lobes; usually weighs about 3.5 pounds and is the largest gland in the human body. It is located just below the diaphragm in the body's right upper abdominal quadrant.
The liver plays a major role in the body's metabolic processes as well -- glycogen storage, decomposition of red blood cells, some hormone production.
The liver produces bile -- which is an alkaline compound that helps in digestion by changing fat (lipid) molecules to a more digestible format.
The liver's detoxification and synthesis of micronutrients are vital -- short-term liver dialysis is possible, but a person cannot exist without a functioning liver (Virtual Liver, 2008).
Cirrhosis of the Liver
Cirrhosis is the result…… [Read More]
Few hospitals offered both the expertise and the necessary facilities.
Location of the donor and the recipient also impacted availability. Human organs cool and degenerate quickly when removed from the donor. Transportation in the 50s, 60s, and 70s was in the early stages of rapid jet aircraft travel and was too slow for the transportation of organs. The donor needed to be in close proximity to the recipient which was possible with living family members and donors. Research during this time focused on immunosuppressant drugs and on methods to maintain a viable organ outside the host.
In his discussion of justice in respect to the allocation of scarce goods, Jon Elster (1992) identified three levels of scarcity: natural, quasi-natural and artificial. The availability of twins with one needing a kidney transplant and one willing to donate a kidney generates a natural scarcity similar to the availability of natural black pearls.…… [Read More]
Critical Pathway: Chronic enal Failure
egents Online Degree Program
Critical Pathway: Chronic renal failure
Chronic renal failure is often occasioned by chronic kidney disease, immune disorder, trauma among other conditions. It does not have any specific symptoms and might include feeling unwell generally and experiencing a reduced appetite. It is diagnosed following screening of individuals who are identified to be at risk of kidney problems, like individuals with diabetes or high blood pressure and others who have blood relative with chronic kidney disease. It always seems complex when trying to come up with the right diagnosis for a patient.
M.A. is a 60-year-old man who has a stage V chronic kidney disease mainly as a result of diabetic nephropathy and a 12-year of type 2 diabetes. He has symptomatic peripheral vascular insufficiency, and 3 years ago he had undergone coronary artery bypass 3. Within the ten months that…… [Read More]
clinical significance of the problem. Fatigue is one of the most common and serious complaints from patients undergoing dialysis. Dialysis causes fatigue that then may have significant negative impacts on the physical and psychological health of the patient.
What is the research purpose of the study? The specific purpose of the research study is to explore any potential physical performance changes in strength and exertion within the sample study of patients undergoing peritoneal dialysis.
What are the objectives or aims of the study The current research aims to study the extent of fatigue experienced by patients undergoing and the possibility of introducing exercise as an intervention in order to present possible resolutions that could help patients in their everyday lives. The main objectives of the study are to understand the variables that care causing such fatigue in order to combat them so that patients can exercise more and experience a…… [Read More]
Legal Aspects of Health Care
Regulation of Texas ESRD Facilities
An End Stage Renal Disease (ESRD) facility is one that "provides dialysis treatment or dialysis training to individuals" with this disease ("Licensing"). In keeping with its stated goal of ensuring the protection of public health and safety ("Philosophy"), the state of Texas requires such facilities to meet certain regulatory standards concerning design and space, equipment, water treatment and reuse, and sanitary and hygienic conditions; patient care and treatment; and dialysis technicians.
The federal government distinguishes among five types of ESRD facilities: transplant centers, dialysis centers and dialysis facilities (the distinction being that the former is a hosipital unit and the latter a stand-alone site), self-dialysis units, and special purpose renal dialysis centers (which are generally set up for emergency situations). All of these types of facilities in service after September 1, 1996 are subject to Texas licensing requirements.
The standards…… [Read More]
However, many patients suffering with chronic renal disease do not explore this option.
4-6: Increase the proportion of patients with treated chronic kidney failure who receive a transplant within 3 years of registration on the waiting list. Again renal transplantation can improve overall quality of life for patients struggling with this condition.
4-7: educe kidney failure due to diabetes: Type II diabetes is a significant contributor to chronic kidney disease. educing and preventing diabetes can effectively reduce the number of cases of chronic renal failure.
4-8: Increase the proportion of persons with type 1 or type 2 diabetes and proteinuria who receive recommended medical therapy to reduce progression to chronic renal insufficiency. This measure would help improve health outcomes for the patient and reduce the overall impact of the disease on the general population.
elevance of the Objectives and Desired Outcomes
The objective outlined as the principle focus of improving…… [Read More]
Acute renal failure is a serious medical condition. The gravity of the condition is manifested itself in the fact that the survival rate for renal failure has not improved for more than forty years. It occurs in 5% of all hospitalized patients and dialysis treatment is required in approximately .5 of cases. Dialysis is required to sustain "fluid and electrolyte balances, minimize nitrogenous waste production and sustain nutrition Infection accounts for 75% of deaths in patients with acute renal failure, and cardiorespiratory complications are the second most common cause of death" (Agrawal & Swartz 2000). Pathophysiology can vary depending upon the type: "patients who develop AKI can be oliguric or nonoliguric, have a rapid or slow rise in creatinine levels, and may have qualitative differences in urine solute concentrations and cellular content.... Oliguria is defined as a daily urine volume of less than 400 mL/d and has a worse prognosis,…… [Read More]
Hard Economic and Finance Choices in U.S. Healthcare
The United States has recently undergone a financial crisis that has made the government, and the citizens, more conscious of what things cost and have produced debates regarding the costs of items. One debate that has intensified in volume is that over the large, and ballooning cost of healthcare. Although the Affordable Healthcare Act is supposed to take care of a portion of that, evidence shows that costs will remain exorbitant. The main reason for that is the research and development costs of therapies and associated drug treatments. Currently, new therapies have been coming on the market that are able to prolong the lives of cancer patients, but a cost-benefit analysis prove that these therapies are too costly. The debate then is whether a few weeks, months, years of life are worth hundreds of thousands to millions of dollars. This…… [Read More]
Intradialytic weight gain has become a major problem for End Stage enal Disease (ESD) patients who are dependent on hemodialysis. This issue has resulted in more complications and hospitalizations of ESD patients who need effective IDWG management programs that are driven by nurses. This project proposes a project that is geared towards improving IDWG management for these patients by 10% through a 12-week educational program. The paper demonstrates how the project will be implemented in a 19 chair dialysis clinic that functions 6 days every week in order to accommodate 150 hemodialysis patients. The discussion includes a description of the proposed change, rationale for selecting it, implementation methods, and expected results. The author provides evaluation of baseline data collected from patients during implementation and conclusions based on the collected data.
Objectives of CNL Internship Project
The objectives or aim of this CNL Internship Project is to coordinate a plan of…… [Read More]
Above all it has followed the delibeate maketing of health cae (in association with touism) as medical cae has gadually moved away fom the public secto to the pivate secto, ensuing that a gowing majoity of people, especially in the ichest counties, and paticulaly in the United States, must pay -- often consideably -- fo health cae. Finally, gowing inteest in cosmetic sugey, involving such elective pocedues as hinoplasty, liposuction, beast enhancement o eduction, LASIK eye sugey and so on, o moe simply the emoval of tattoos, have ceated new demands. Vaious foms of dental sugey, especially cosmetic dental sugey, ae not coveed by insuance in counties like the UK and Austalia; hence dental touism has become paticulaly common. In Asia these tends ae 'the unlikely child of new global ealities: the fallout of teoism, the Asian economic downtun, intenet access to pice infomation, and the globalisation of health sevices'…… [Read More]
HDF is a strategy that that enables high potential of hydraulic and solute permiabilityof synthetic membranes hence they can be properly exploited. The high cost of the fluids in bags that are commercially prepared as well as the improvement of technology of dialysate preparation and fluid filtration has made it possible in recent years for the development of the novel technique known as online HDF. In this technique a particular amount of freshly prepared ultrapure dialysate is taken daily from daily dialysate inlet line and then processed with several filtration steps before they are used as replacement fluid. With this technique, large amounts of replacement solutions that are relatively inexpensive are made available and HDF can be carried out with a high fluid turnover under the utilization of pre- and post-dilution or even consecutive pre-post dilution in proportions that differ (Yvonne, 2011).
On-line hemodifiltration provides the largest amount…… [Read More]
L.K. Abraham's book Mama Might Be Better off Dead: The Failure of Health Care in Urban America. The critique includes topics such as the book's purpose, the book's scrutiny of the different healthcare aspects with regards to America's poor, and reactions of readers to the work. The focus of the book is on healthcare as of and upto 1994, the publication date; it does not take into consideration and/or discuss the healthcare changes as of the Affordable Care Act, also known as 'Obamacare'.
Topic of Book
This book's main topic is the effectiveness of healthcare in the United States (U.S.) with regards to the poor as of 1994; it also addresses particular formalities of American healthcare. Many of these issues have been addressed with the recent Affordable Care Act.
Purpose of the Book
L.K. Abraham's Mama Might Be Better off Dead offers a profound, unsettling view of the human aspects…… [Read More]
I also assumed that the nurse I was observing would likely support the doctor and try to talk the patient into changing her mind. My assumptions were incorrect. Later I took the time to reflect upon my reaction to the situation.
After thinking through the entire situation, it is my belief that she did make the right choice, she no longer wished to live a life tied to a machine, wheeled about in a chair and unable to enjoy even the smallest of pleasures. As a nurse, my approach would be to comfort the patient, understanding and giving support to the family and friends who are attempting to support the patient. The patient is experiencing enough trauma, and should be fully supported in making whatever decision is best for that particular individual.
Other nurses might disagree. One study determined that even though 80% of newly graduated nurses have developed a…… [Read More]
Renal & ransplant Unit (Renal Directorate)
Mary's NHS rust
I am the Personal Assistant to the Chief of Service, and also act as Administrator for the Renal Directorate, St. Mary's NHS rust. he Directorate is a well established and busy Regional Renal Unit in North-West hames. We offer haemodialysis, continuous ambulatory peritoneal dialysis, and Renal ransplantation / Simultaneous Renal Pancreas ransplantation to patients, in addition to a comprehensive inpatient and outpatient service. We currently have approximately 800 patients on our dialysis programme, 400 transplanted patients, and we see around 1200 patients in outpatient clinic each month. he Service has 5 Consultant Nephrologists, 2 ransplant Surgeons, 1 Service Manager and 1 Business Manager.
here is a Renal Ward, a laboratory to carry out assays, a Haemodialysis Unit, Acute Dialysis eam, a Peritoneal Dialysis Unit, a Renal Outpatients Department, and 3 Satellite dialysis units and outpatient cilnics.
Communication is the backbone of…… [Read More]
In both the case of the dialysis machine sale and the funeral services, a common theme of trust pervades both. These purchasing decisions are completely different than picking out a new car, buying a new iPod, iPad or iPhone, or choosing which new digital camera to buy. These decisions are more driven by how those products contribute to our own sense of who we are and provide us a measure of freedom in defining ourselves while providing enjoyment. All powerful brands, with Apple being one of the most formidable globally, sell not only functionality of their products but the image that goes along with it. This is completely different than choosing a dialysis machine or a funeral home and funeral director. In these instances the uncertainty is far greater, the risk of making a mistake far more intensive, and the level of self-scrutiny is very intense. No one wants to…… [Read More]
Forces of Healthcare
Numerous forces have changed the way healthcare has developed. Rising healthcare costs, service fragmentation, variable access and quality, poor health, high costs for disadvantaged, social and political conflict, infections, chronic diseases, and emotional and behavioral aspects have all been forces in the development of healthcare in the U.S. (Cunningham, 2003). Consumer awareness, high costs of insurance as well as health services, and chronic illness have been major contributors to the way healthcare has developed over time.
Consumer awareness has raised questions to the service quality of healthcare, more especially compared to the rising costs of the services. As a result, healthcare institutions are being challenged with the way healthcare services get delivered to the patient. Consumers are now more aware of healthcare standards and the way illness should be treated, which challenges the healthcare system in the way that service is delivered in treatment settings. This includes…… [Read More]
patient is a 35-year-old (male?), he was diagnosed with diabetes twenty five years ago at the age of ten years old, he claims that this is hereditary in his family. He has one sister who has Type 2 diabetes and a brother who has type 1 diabetes. He manages his diabetes and other illnesses from home and through a medical clinic; for most of his life he has known he has diabetes and manages to regulate it through insulin shots, glucose tablets as well as through the right nutrition, however he claims that this is difficult and there are most days where he experiences draw backs. Many complications have arisen from his diabetes. This patient was selected because of the certain case he has in regards to his diabetes and other complications which had developed from it. His treatment and management also includes an extensive study. At the young age…… [Read More]
(2008). The study measures public opinion concerning two scenarios: one in which the kidney donor is given a fixed financial compensation; and one in which the donor is provided with health insurance coverage for life. According to the findings of the study, "although almost half of the respondents (46%) were reluctant towards introducing a system with fixed compensation to increase the number of living kidney donors, still 25% of the general public reacted positively." (Kranenburg, 1039) This study would conduct a similar comparative discussion, but would expand the number of available options discussed and would use a different sample population, as discussed in the subsequent section.
Subjects and Sampling Technique:
The subjects will be drawn from amongst nursing professionals working in randomly selected renal specialty facilities and wards. Initial contact will be made by phone with a Director of Nursing at selected facilities requesting participation. Those that agree will receive…… [Read More]
During that time, I cannot recall mourning, but I cannot recall feeling much of anything else, either.
My grief returned more intensely than before at the graveside service.
Afterwards, I was exhausted by the emotional flood that I had experienced, but it is equally possible that the relief was more a function of all the energy that it had required not to release during the time between my father's death and his funeral. As powerful as the feelings of outright grief were some of the more unexpected feelings I began to experience in the next few weeks: feelings of anger at my father, anger at myself, shame, totally inexplicable feelings of hurt, and fear, and also relief.
A realized for the fist time, only weeks after my father's death, that I was angry at my father: angry that he'd refused the dialysis which could have prolonged his life; angry at…… [Read More]
Leading and Managing a Change in Clinical Practice: Patient on Ventilator and the Usage of Saline in Performing Suctioning
Organizational direction depends on many factors. Most of them were an integral part of clinical practice for a while, but until the latter part of the 20th century has been so prominent in the organizational structure. This paper will explore the four factors that influence the management of clinic and are characterized by efficient designs. This paper will discuss about the leadership and management in relation to improving quality, change, care management, values and results. We will also present integration and possible implementation concepts, tools and strategies.
Suctioning the patient on ventilator pose a unique challenge in following a clinical pathway or case management model of care. Our patient is on ventilator and we are performing suctioning by the usage of saline solution. Multiple decisions need to be made when…… [Read More]
Size and Temperature on Diffusion
In this experiment is expected that after 30 minutes, the diameter of the diffused dye ring will increase in size when placed at 37°C.
Janus Green at room temperature
Janus Green at 37°C
Potassium Permanganate at room temperature
Potassium Permanganate at 37°C
Measurement of diffusion of Janus Green and Potassium Permanganate at different temperatures.
Consistent with the expectations, potassium permanganate molecules spread further, 1.0 cm at room temperature and 1.1 at 37°C. This was longer compared to those of Janus Green that spread 0.3 cm at room temperature and 0.5cm at 37°C. It is evident that both molecules spread further at 37°C than at room temperature.
Effect of solute concentration on osmosis
Bag Contents (10ml)
Beaker Contents (200ml)
Total Mass Change
10% sucrose dH2O
Figure…… [Read More]
North Dakota: ole of Lpn in IV Therapy
LPN IV Therapy Guidelines
The use of intravenous therapy is not without its risks (David, 2007). A saline bolus, for example, will cause edema as three quarters of the fluid leaves the vascular bed immediately after administration. In contrast to a lay person's expectations, common isotonic solutions, such as Lactated ingers solution, can induce an inflammatory response. The inflammation is caused by neutrophils destroying tissue through apoptosis and the release of reactive oxygen species, possibly triggering respiratory distress.
Kim David (2007) provides an overview of intravenous solutions in common use and their inherent dangers. She also discusses ongoing controversies concerning when to use intravenous fluids to resuscitate trauma patients. For example, most trauma patients will do better if hypotension is left untreated, except for patients who have suffered traumatic brain injury. esearchers have also shown that giving too much fluid perioperatively to…… [Read More]
management of fatigue in patients on peritoneal dialysis and respond to the following critique questions. Do not provide simply yes or no answers to the questions. Provide examples to support your responses. Submit the assignment through the assignment link in Moodle
Identify the study design. Identify the specific type of quasi-experimental design used in the study.
The quasi-experimental design of this research was to implement exercise interventions within a patient population undergoing continuous ambulatory peritoneal dialysis. There was no random sampling because of the very small population that met the inclusion criteria. The independent variable was the level of exercise, while the dependent variable was the reported measures of fatigue experienced by the participants. These measurements were then statistically analyzed using
For the specific design, what are the threats to internal validity? What are the threats to external validity?
There were threats to validity based on the individuals who participated…… [Read More]
Additionally, there may be patients that will be found to have the early symptoms of CKD, and those test results will be passed on to the individual patient.
All participants will be invited to learn more about CKD, and a one-night informational meeting will be conducted in which informational brochures will be passed out to the attendees, and will be discussed in detail. The attendees will also be provided the opportunity to give feedback (positive or negative) concerning their experiences with the early testing and how they view CKD from a current view as compared to their previous perceptions.
After all the data has been gathered and analyzed, a paper will be compiled that presents the results, along with a discussion of those results. It is hoped that the results will provide information to the medical community concerning how early testing and positive reinforcement can be effectively used during the…… [Read More]
Dorothea Orem Nursing Theory
A theory is related concepts, and propositions used to guide a professional practice. Moreover, nursing theory serves as the interrelated concepts, predictive in nature, statement explanatory that assists in understanding the nursing phenomenon, which helps to explain and predict the nursing outcomes. Nursing theory is an organized body of knowledge used to explain the phenomena and supporting the nursing practice. Moreover, the nursing theory is defined as a set of definitions, concepts, assumptions, and relationships or propositions that are derived from the nursing model. However, the nursing theories consist of grand and middle-ranged theory. The middle ranged theory is the testable theory, limited in scope, limited in a variable, and used for the clinical research. More importantly, nursing theory serves as the body of knowledge that assists in carrying out the nursing research.
The objective of this study is to use the Dorothea Orem theory to…… [Read More]
" (AAF, nd)
The Health Maintenance Organization further should "…negotiate with both public and private payers for adequate reimbursement or direct payment to cover the expenses of interpreter services so that they can establish services without burdening physicians…" and the private industry should be "…engaged by medical organizations, including the AAF, and patient advocacy groups to consider innovative ways to provide interpreter services to both employees and the medically underserved." (AAF, nd)
One example of the community healthcare organization is the CCO model is reported as a community cancer screening center model and is stated to be an effective mechanism for facilitating the linkage of investigators and their institutions with the clinical trials network. It is reported that the minority-based CCO was approved initially by the NCI, Division of Cancer revention Board of Scientific Counselors in January 1989. The implementation began in the fall of 1990 and the program was…… [Read More]
However, Harvard Medical School (HMS) reports that in that study of 1,400 patients, 222 "composite events occurred." Those "events" included 65 deaths, 101 "hospitalizations for congestive heart failure, 25 myocardial infarctions and 23 strokes."
In an understatement, the HMS report - written by Dr. Singh - concluded that while improving the lives of patients with CKD is "of paramount importance," this particular study reveals, "...Aiming for a complete correction of anemia is associated with increased risk, increased cost and no quality of life benefits." The study was published in the November 16, 2006 issue of the New England Journal of Medicine.
Meantime, the National Institutes of Health / Medline Plus (www.nim.nih.gov) explains that epoetin alfa is also used with people who have HIV, it is used prior to surgery and after surgery "to decrease the number of blood transfusions needed" in the predicable loss of blood during surgery. It is…… [Read More]
Still others must actually undergo the experience of trying to perform procedures themselves under guidance to learn effectively.
Looking back at some of my clinical experiences, I can recall instances where I took an approach to patient education that was based mainly on my convenience and preference rather than on an assessment of what teaching approach would be most beneficial to patients. More recently, I have tried to incorporate adult learning theory into patient education in connection with post-surgical follow-up self-care and wound care, among other areas. For example, I have recently begun asking patients whether they would prefer to have informational resources in printed form, or whether they would prefer to observe demonstrations. When patients indicate their desire to observe clinical procedures, I also offer them the opportunity to try the procedures under my guidance, taking advantage of the fact that some of them may learn best from experiential…… [Read More]
To that end, patients who opt to pay more are likely to have better access to treatment; meaning, essentially, that patients who choose to go with commercial healthcare providers will have more accessibility and better quality of treatment as opposed to those who depend upon CSM or the government. Patients who go with a commercial healthcare provider such as Fresenius, for example, may be paying considerably more than someone whose costs are financed by CMS or the government. However, that person will certainly be granted treatment (particularly if it involves dialysis), although the expenses will be considerable for medication such as erythropoietin. However, those who opt for CMS or governmental services have to cope with the fact that the former organization is treating fewer and fewer of its population for ESD, while those relying on the government may well see the effects of cost shifting. Those fortunate enough to in…… [Read More]
Mama Might Be Better off Dead
For the past several decades, health care reform has been on the top of the political lip service agenda. Presidential candidates debate heatedly over which types of Medicare or Medicaid reforms should be instated and purport to want "universal health care." They call out for assistance to low-income families and claim that no American citizen should go without health care services. Yet through all their platitudes one thing remains painfully clear: they really just don't care. Not only has little been done to ensure that every American, regardless of race, receives the best health care services available but the situation seems to be getting worse as the income disparity gap widens with every successive year. In her 1993 book Mama Might be Better Off Dead, Laurie Kaye Abraham illustrates the impact of America's failing health care system by focusing on one family. The Banes'…… [Read More]
Surgeons in Canada report that, for heart patients, the danger of dying on the waiting list now exceeds the danger of dying on the operating table. Emergency rooms there are so overcrowded that patients awaiting treatment frequently line the corridors. Not only is there a long wait for care, but care is frequently denied to patients who prognosis is poor. In ritain kidney dialysis is generally denied patients over the age of 55. At least 1,500 ritons die each year because of lack of dialysis.
Countries with national health care systems also lag far behind the U.S. In the availability of modern medical technology. In Canada, high-technology medicine is virtually unavailable. In addition to being biased against new medical technologies, national health care systems generally discriminate against nontraditional practitioners, such as naturopaths and chiropractors.
It is true that Canada spends only about nine percent of its GDP on health care,…… [Read More]
System Analysis of T-SYSTEM
Because of its ability to improve the quality and delivery of health care services, the Electronic Health ecord is becoming a necessity in almost every healthcare organization. The purpose of this paper is to explain the impact of having an electronic health record system in an emergency department. The current computerized system used at Suny Downstate Hospital in Brooklyn is called T-SYSTEM, and has been in operation since 2007. Documentation prior to its implementation was achieved through handwritten notes on various forms as well as through dictation by doctors. Suny Downstate Hospital had to update its system in order to meet state standards and quality core measures. The transition from paper to electronic documentation is major; while it assures many advantages, it also faces many challenges. As the author of this paper, I will be using my workplace as the unit (ED) project observed. I will…… [Read More]
Racism in America -- the Causes - Effects
hy has the ugly social scar of racism -- whites demonstrating racially biased attitudes and actions against African-Americans -- continued in the U.S. through the years? hat causes people to look down on those of another race -- or to otherwise hold people of another ethnicity in contempt? Given the fact that the U.S. Congress passed the Civil Rights Act (1964) and the Voting Rights Act (1965), and that Americans elected and re-elected a bi-racial president (Barack Obama), an objective observer from another country might imagine that racist attitudes have subsided (and in ways things have improved on racial issues).
There is still today -- and may always be -- white racism against blacks, and this paper points to the fact that racism has continued to be a social and moral blemish in the U.S. because it has become institutionalized and carried…… [Read More]
The concern on whether anti-hypertensive's should be withheld in patients who are hypertensive has been debatable in the recent past. Generally, the treatment of hypertension among hospitalized patients is basically an opportunity to enhance the recognition and treatment of blood pressure (Axon, Nietert & Egan, 2011, p.246). This is mainly because hypertension is a basic risk factor for heart diseases, stroke, and death whose impact is widespread to nearly 70 million adults in America. There have been numerous educational initiatives and publication of treatment processes to address this condition in the past few decades. Despite these measures, nearly 39 million Americans are at risk of hypertension because they have not reached their desired or optimal blood pressure.
The concern regarding the use of anti-hypertensive medication as a treatment procedure for hypertension has mainly been centered on the optimal choice of these agents. The other factors include the side…… [Read More]
Billed as "the Daily Journal of the United States Government," the Federal egister was created with the objective of helping "citizens and communities understand the regulatory process, and to participate in government decision-making." The mission of the Federal egister is to inform citizens of their rights and obligations, to document the actions of federal agencies, and to provide a forum for public participation in the democratic process.
There are four types of entries in the Federal egister: Presidential documents, such as executive orders; rules and regulations such as policy statements and interpretations of rules; proposed rules, including petitions for rules, and notices, which include scheduled hearings, grant applications, administrative orders and other announcements
The Office of the Federal egister was created in 1935 under the Federal egister Act, and its mission was enlarged by the Administrative Procedure Act and the Freedom of Information Act. At first, the Federal egister was…… [Read More]
This is the strategy used in Canada, where drug costs have been substantially reduced.
The challenges presented by this law have spilled over into the current health-care reform debate. Many people and many legislators who might have been more open to engage in productive dialogue during the current debate were no doubt made more leery of the process and of the possibility that there could be significant reform that would bring benefits to more people while bringing down the federal deficit.
The fears of opponents of the bill were correct in their fears that the bill would been even more expensive than originally budgeted. The initial estimate for the net cost was $400 billion for the period from 2004-2013. However, only a month after the bill's passage, that estimate was raised to $534 billion. It has since been raised to over $550. The cost over-runs in this bill will no…… [Read More]
Doctors use a fasting plasma glucose test to confirm a diagnosis of type-two diabetes. A patient must fast for 8 hours prior to giving a blood sample (http://diabetes.webmd.com/guide/diagnosing-type-2-diabetes). If it is determine that the patient has diabetes, the doctor will prescribe diet management and exercise. In some cases, insulin shots or pills may also be prescribed.
Unlike type-one diabetes, type-two develops because of lifestyle choices. If you are overweight and get little or no exercise, you have a greater chance of developing type-two diabetes. Other un-controllable factors known to contribute to type-two diabetes include: family history, age, race, ethnicity and a low body weight at birth (https://members.kaiserpermanente.org/kpweb/healthency.do?hwid=hw135189§ionId=ur1000&contextId=hw135189).
COMPLICATIONS AND EFFECTS OF DIABETES
There are many long-term health issues are associated with diabetes. If a patient fails to be diagnosis or a patient does not maintain their insulin schedule, complications may occur. Diabetics have a higher likelihood of developing eye problems…… [Read More]
ESRD patients provide the full fixed cost payment due to the full reimbursement for their care. Long-term care facilities would like to have 100% ESRD patients however, such a patient load does require skilled workers in numbers to care for these especially demanding patients.
ESRD includes the ADL's and care specific to kidney cleaning and functioning, such as dialysis treatment either at home or at an outpatient facility. Additionally, some patients are brought in as in-patients at the hospital for ESRD treatment and some patients are admitted and remain admitted at a hospital until discharged. These patients either receive home care treatment, receive treatment at an outpatient facility, or are admitted to a long-term care facility.
Patient options & trade-offs related to cost, quality, and access to treatment
The patient has somewhat limited options as a function of the cost, quality, and access to health care. Largely, the options are…… [Read More]
This method makes effective use of ability of metals to float on surfaces of leachates on their own. Due to the high proven efficiency of this method, it is widely used for removal of heavy metals such as iron and humic acid from leachates in many parts of the world.
emoval of Plastic from Municipal Waste
Plastic is a non-biodegradable waste that has low recycling margin. Unfortunately, plastic is widely used in everyday products is heavily present in the municipal waste. The environmental threat posed by the presence of plastic in municipal waste is another major issue. Major plastic types that are commonly found in UK municipal waste include PET, high density polyethylene, polyvinyl chloride, low density polyethylene, polypropylene, polystyrene, and other plastics such as melamine. Major source of these types of plastic are fizzy drink bottles, bottles of detergents and washing liquids, plastic plates cups and spoons, bin bags,…… [Read More]