CASE #1

 

List of possible differential diagnoses.

Low back pain is a “common symptoms and not a disease condition accounting for 15% to 20% of the U.S. population, and approximately 50% of working-age adults” (Bartleson, 2001). Differential diagnoses for low back pain include back strain, acute disc herniation, osteoarthritis, ankylosing spondylitis, infection, malignancy, etc.

Evidence needed to rule in or rule out each differential.

Comprehensive general physical examination, with attention to specific areas as indicated by the history, can be helpful to rule out or rule in any differential diagnosis. However, there are some signs and symptoms that may be specific. Therefore, a detailed initial assessment of the patient that includes musculoskeletal and neurological examination to assess bones, joints, muscle strength, and flexibility must be performed to elicit diagnosis. Review of system and questions about the onset of pain (e.g., time of day, activity), location of pain (specific site, radiation of pain), type and character of pain (sharp, dull, etc.), aggravating and relieving factors is also important in diagnosing back pain. For example, “back strain has an ache or spasm pain quality that increases with activity or bending with local tenderness and limited spinal motion at the low back, buttock and posterior thigh which is different from symptoms of acute disc herniation which come with a sharp shooting or burning pain in the lower back or lower leg and paresthesia in the leg and decreases with standing and increases with bending or sitting” (Patel and Ogle, 2000). Likewise, the presentation of “ankylosis that presents with ache and morning stiffness in the sacroiliac joint or lumbar spine with decreased back motion and tenderness over these joints is different from osteoarthritis or spinal stenosis that presents with a low back to lower leg shooting pain, pin and needled like sensation which is often bilateral and increases with walking especially up an incline and decreases with sitting with mild decrease in spine extension and reflexes” (Patel and Ogle, 2000). The presenting complaint of the patient that highlights that onset, location, and quality of pain as well as aggravating or relieving factor can be helpful to make a clinical diagnosis.

Additional aspects of the history and physical examination could provide relevant information to help in the diagnosis.

Apart from the onset, location, and quality of pain as well as aggravating or relieving factor mentions above, age of the patient, work, and medical history including previous injuries or surgeries, etc. and examination of the entire spine, stance, deep tendon reflexes, sensation, posture, and gait can be an additional aspect of history and physical examination that can provide a relevant clue to the diagnosis. Also, questions about “constitutional symptoms, presence of night pain, bone pain, morning stiffness and, the occurrence of visceral pain or symptoms of claudication and neurologic symptoms such as numbness, weakness, radiating pain, and bowel and bladder dysfunction can be helpful” (Patel and Ogle, 2000).

 

The Individual EBP Assignment requires the learner to find an EPB article that relates to the topic and group project problem. below you find documents to help you with this assignment:

EBP Article Analysis Guideline.docx
Exemplar.EBP.docx

TOPIC: PATIENTFAMILY-CENTERED CARE

• First review the group project problem and title.
• Use keywords from your problem for your lookup inquiry. i.e. infection control, nurse, retention, etc. 
• Use EBP articles no more than 5 years old. 
• Make sure you put your name at the top and include your article citation in 7th ed. APA format of your assignment – see exemplar. 
• There are prompts in the left column to assist you. 
• Do not give research terms on your assignment i.e. this is a cross-sectional study or has validity unless you’re ready to explain how this will help you solve your problem. These terms are used so that you know if an article is valid and reliable. OK, so now that you found this, your job is to find out how this project will help you solve your problem. 
  • The paper is set up to determine the strength, weaknesses, opportunities, and threats of the project itself. 
  • By answering these questions, you will help guide and collaborate with your peers with constructive feedback on how to solve your problem collectively as a team.
    • Strength – Example: Did they have the support of the peers, manager, CEO. Did this project improve patient satisfaction, quality, efficiency? Usually found in the literature review and results.
    • Weakness – Example: This is the opposite. Why was this plan weak: Not enough education, no support, not enough money because of the expense? Usually found in the problem of the literature review, results, and limitations.
    • Opportunity – Example: If there wasn’t enough education, is this an opportunity? A better survey or tool? Usually found in results or limitations and future implications.
    • Threat – Example: Increased infection, possible death, etc. Usually found in the literature review. 
  • It is your job to know your article and have the ability to articulate what your article is about with your peers and with your instructor. 
  • During the virtual class, you may be asked to elaborate on your article. So know your article! 
• Please note that the exemplar provided received maximum points. 
• Submit both the Assignment and Article in the BrightSpace Assignment submission folder. 

 

• Read the initial comments posted by your classmates and reflect upon them.
• Formulate one new comment of your own. It must be a logical and thoughtful response that synthesizes the comments of at least 3 classmates into one comment. Be sure to synthesize; do not simply reply to each of the 3 classmates or restate their comments.
• If the class is small, the discussion will be with your professor.
• NOTE: You are not required to cite sources and include a reference list for the second post if it is simply your opinion. However, if your opinion is based on facts (as it should be), it is good practice to strengthen your position by citing sources.

post 1: 

Kelsey Adams posted May 27, 2021 10:23 AMSubscribe

According to The Medicare Resource Center, “ancillary services are medical services provided in a hospital while a patient is an inpatient, but paid by Medicare Part B (outpatient care) when the Part A (hospitalization) claim is denied because Medicare believes that it was unreasonable or unnecessary for the person to be admitted as an inpatient” (2021). Some examples of these services are but not limited to; diagnostic ancillary services, therapeutic ancillary services and custodial ancillary services. Diagnostic ancillary services include radiology and lab. Therapeutic ancillary services can include physical, speech and occupational therapy. Custodial ancillary services is usually in home health care. There are many services within these services but these are the main ones available to most people.

From my knowledge a rural area differs from an urban area because an urban area is largely populated and a rural area is smaller in comparison. I grew up in a rural area where the hospitals were about a 45 minutes from my house. There was a little specialized clinic about 30 minutes away but the main hospitals and urgent care offices were quite a bit away from my house so when we needed medical attention we had to travel. Living in an urban area you have a much quicker and easier access point to care. As for ancillary services, sometimes these services are not in the same location where patients are seen for medical care. Depending on the insurance carrier or recommendation from the documentation it could cause a burden.  For example, when I was in high school I was playing basketball and broke my ankle, I was rushed to the emergency room and once I was taken care of referred to 6 months of physical therapy after heeling. My hospital was in an urban area but because I lived so far away from everything I had to endure the travel. For major procedures or specialties it was more of a 4 hour drive which in some instances could hurt someone. A lot of employment doesn’t pay for time off for appointments so it could limit the duration of time a patient could have to get the treatment they need.

Some recommendations I would provide as a health care leader to lessen the disadvantages living in a rural area would be the delivery methods, access to care, and teleworking/telehealth.  I would of course canvas the area I am working and learn what works best for my facility/region. After some realignment and hard thought as a leader I would suggest the area consider “Community Paramedicine, a model of care where paramedics and emergency medicine technicians (EMTs) operate in expanded roles to assist with healthcare services for those in need without duplicating available services existing within the community” (Rural Health Information Hub, 2021). Having this throughout the community would vastly help the access to care. I also thinking having a line of communication like a hot line or a teleconference line for patients to be able to call a nurse with symptoms. There are many factors that need to be determined when considering adding certain things to a rural area and one of the main factors is money. There are many rural areas that have a lower income rate and this could cause a potential problem. Understanding the wants and needs of each area could be different depending on what is needed and where the focus is. Every area is different.

Rural Health Information Hub. Healthcare Access in Rural Communities Introduction. (2002-2021). https://www.ruralhealthinfo.org/topics/healthcare-access. 

What are ancillary services? medicareresources.org. (2021, March 11). https://www.medicareresources.org/glossary/ancillary-services/. 

Post 2:

Mateo Alba posted May 25, 2021 7:58 PMSubscribe

Ancillary services are the important services that completes the patient treatment or the provider’s diagnosis. There are three types of ancillary services, treatment, diagnosis and custodial. Some examples of ancillary services are Pharmacy, Laboratory and Radiology (x-ray). Treatment services provide the necessary modalities prescribed by the provider. Without it, the patient will remain sick or injured and possibly get worst. The diagnostic services are essential to confirm the provider’s diagnosis. It provides the treatment team a clear picture of what the best course of action or treatment plan for the patient.

Urban area ancillary services

Ancillary services in urban areas can be a very profitable business. Due to the demographics, cultural background, high tempo and social norms in an urban environment patients will always pay for the convenience of the location. As an example, services like Optometry, Pharmacy and Physical Therapy, can be found in or around the same parking lot of a big grocery store like Fred Myers, Super Walmart or Costco. It gives the patient the convenience of multitasking which in an urban environment is essential. Ancillary services that can be found in an urban area not only provides the basic services but also the convenience. If the patient requires special treatment or diagnostic modality, they can go to a hospital or treatment facility in their network within their local area. Additionally, Urgent care centers or clinics provides the majority of the ancillary services the patients needs. Again, it is a one-stop shopping and prevents the patient from sitting around for hours in the hospital. Majority of these services accepts most medical insurance which is great for the patient and good business for the services.

Rural area ancillary services

Ancillary services in a rural community can be isolated and austere. They are normally very limited, operating with bare essentials and sometimes none existent. These services are normally collocated within the medical clinic and with limited hours of operations. Since the services are limited, patients tend not to use them or just make do of what they have. For example, patients will travel long distance just to get their medicine.

Disadvantages of patients living in rural areas

It is a challenge for the patients and the providers. From the patient side, it can be frustrating because the time and distance it takes to travel to the medical facility. Limited hours of operations and services they offer, sometimes it is better making the effort of traveling to the urban community just to get the services they need. That means spending time and money which can be hard for the families. From the provider side, it is also a challenge. The issue are volume and cost to operations. Even though the rural providers would like to get the state-of-the-art diagnostic or therapeutic machines and the highly trained staff to operate it is not cost-effective. Rural areas normally do not have the patient load compared to the urban areas. Therefor, the providers must balance on what type and volume of patients they normally have, what modalities or treatment they can perform and the cost to business operations.

Recommendations to providers in rural areas

One recommendation which has been validated during the current COVID 19 pandemic is the use of telemedicine (Weisgrau. 1995). From the basic primary care patient visit to specialty appointments like allergy, dermatology appointments. Also, it is currently being used effectively by the military and the Veterans Healthcare system for mental health services. It was initially used in the Philippines and Iraq (Chen. 2016).

Invest in basic diagnostic equipment that is portable, easy to use, can conduct multiple test and cost-effective like the i-STAT-1 Handheld Blood analyzer (Abbott. n.d.). It will save lives and good for business.

Lastly, keep it simple and basic. Always remember to goal of healthcare (even in the most austere environment) is the same…save lives (U.S. Army. 2020).

References

Abbott. (n.d.). i-STAT-1 Point of care Blood analyser. Retrieved May 25, 2021, from https://www.pointofcare.abbott/us/en/offerings/istat/istat-handheld

Chen, M. (2016, November 7). Lessons on Bringing Surgical Care and Telemedicine to Iraq Kurdistan. Linkedin. Retrieved May 25, 2021, from https://www.linkedin.com/pulse/lessons-bringing-surgical-care-telemedicine-iraq-kurdistan-chen

U.S. Army. (2020). Army Health System FM 4-02 [PDF].

Post 3 :

Jaydin Davis posted May 28, 2021 7:39 PMSubscribe

Ancillary services are medical support services offered to primary physicians. They are the services offered by hospitals and medical institutions, other medical and nursing services. Ancillary services are divided into three categories: diagnostic services like laboratory tests, therapeutic services like hospice care services, and custodial services.

Access to medical services is the main problem facing the rural population. The same applies to ancillary services, where the main difference between rural and urban is access. The services are usually provided in different areas in rural areas. Rural hospitals are usually smaller in size than urban hospitals (Hatten & Connerton, 1986). The size leads to the geographical disbursement of ancillary services. Patients have to travel for distances to obtain ancillary services. Spasojevic et al., (2015) articulated that rural folks are more likely to travel more than 15 minutes to obtain medical services.

Rural consumers of medical services living in rural areas are at a disadvantage when receiving ancillary services. The services are disbursed in different places making access to the services a problem. The charges for ancillary service in rural areas are higher than in urban areas. Ancillary services follow a pattern where medical services are charged higher (Hatten & Connerton, 1986). This increases the cost of medical care for the patients in rural areas.

One way of improving access to health care services and ancillary services in rural areas is through better remuneration of physicians and providers of ancillary services. This will make the services in rural areas more attractive, attracting more professionals, and improving access. Medicare payments to rural physicians should be increased. Studies have shown that lower payments to physicians in rural areas may be why rural areas are not attractive to professionals.

References

Hatten, J. M., & Connerton, R. E. (1986). Urban and rural hospitals: how do they differ? Health care financing review, 8(2), 77–85.

Spasojevic N, Vasilj I, Hrabac B, Celik D. (2015). Rural – Urban Differences In Health Care Quality Assessment. Mater Sociomed. 2015 Dec;27(6):409-11. Doi: 10.5455/Msm.2015.27.409-411. Pmid: 26937222; Pmcid: Pmc4753384.

Post a brief description of the website you visited.

Explain how you might support Veronica and other human trafficking victims incorporating the information you have found.

Explain how you can begin to increase your awareness of this issue and teach others about human trafficking victims.

Describe opportunities to get involved and become an ally to those who have been trafficked.

Identify steps you can take to begin to support this group.

References (use at least 2)

Adams, M., Blumenfeld, W. J., Castaneda, C., Hackman, H. W., Peters, M. L., & Zuniga, X. (Eds.). (2013). Readings for diversity and social justice. (3rd ed.). New York: Routledge Press.

Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). (2014). Social work case studies: Foundation year. Baltimore, MD: Walden International Universities Publishing. [Vital Source e-Reader].

• “Working With Survivors of Human Trafficking: The Case of Veronica”

Working With Survivors of Human Trafficking: The Case of Veronica

Veronica is a 13-year-old, heterosexual, Hispanic female. She attends high school and is in the ninth grade. She currently lives in an apartment with her biological mother and her sister, age 9. She came to this country 7 months ago from Guatemala. Veronica is a sex trafficking survivor and was referred to me for individual therapy by a human trafficking agency in the United States.

Veronica’s biological mother and father separated when Veronica was 3 years old. She lived with her maternal aunt and biological mother until she was 6 years old, and her mother left Guatemala to come to the United States. At that time, Veronica stayed in the care of her maternal aunt and kept in touch with her biological mother via phone and through the visits that her mother made to Guatemala. Veronica would visit with her father, who lived nearby, on occasion, although she stated they did not have much of a connection. When Veronica was 12 years old, her maternal aunt forced her into prostitution, using the money from the sex acts as her main source of income. Veronica reported that her maternal aunt began treating her “like a slave” and would make her smoke an unknown substance before obligating her to perform sexual acts on countless men for money. This took place for close to a year before Veronica was able to sneak a phone call to her mother and explain what had been happening to her. Her mother quickly arranged for Veronica to be picked up by a “coyote” (a person who smuggles people into the United States). The coyote successfully smuggled Veronica into the United States within 2 months of that phone call. However, while crossing the border from Mexico to the United States, Veronica once again became the victim of sex trafficking crimes. The coyote was also a pimp who arranged for men crossing the border in the same truck as Veronica to engage in sexual acts with her for which the coyote collected money. U.S. immigration officers caught most of the people traveling in the truck, including Veronica, and placed them in a detention center. However, the coyote got away. Three weeks after Veronica was detained, after much questioning and investigation, she was reunited with her mother.

I met with Veronica weekly for individual therapy in my role as a social worker at an agency serving individuals who have experienced human trafficking. Veronica reported having occasional flashbacks and fear that “it will all happen again,” and she was diagnosed with post-traumatic stress disorder (PTSD). The goals agreed upon in therapy included building Veronica’s support system, building her self-esteem, and managing her symptoms of trauma. Building rapport with Veronica in therapy took several weeks as she reported not trusting anyone and not wanting to think about what happened to her. After about 9 weeks of relationship building and safety planning, I was able to engage her through education on the dynamics of human trafficking. She reported that it was especially hard for her to trust men and that she often had a hard time speaking up. I worked with her on these issues by teaching her how to be more assertive and by modeling assertive behaviors. We worked on self-affirmations to help build her self-esteem. Because Veronica is very self-conscious, practicing self-affirmations was challenging for her. I often utilized a trauma-informed curriculum for adolescents called S.E.L.F. (Safety, Emotions, Loss, and Future) to facilitate healing and trauma reduction. Veronica reported that grounding techniques taught via this curriculum helped take her out of her thoughts and bring her back to the present moment. Some of the grounding techniques she continues to engage in on a daily basis include tapping her feet, stretching, writing, walking, and washing her face when she feels she is becoming numb or getting lost in thoughts of what happened to her.

Veronica has demonstrated great resiliency. She is attending a church close to her home and reports having faith in God. She recently enrolled in swimming and volleyball and has made several friends in the community. I continue to meet with Veronica on a weekly basis and will be stepping down with her to biweekly sessions now that she is stable and connected to her community. Because Veronica does not speak English and is a child, there are no support groups available in her area for human trafficking survivors. I am presently working on connecting her with a mentor.

Veronica is currently working with the human trafficking agency that referred her, Immigrations and Customs Enforcement (ICE), and an attorney to obtain a visa specific to human trafficking (T-Visa). A T-Visa grants survivors of human trafficking a visa in the United States. In 2000, Congress passed the Victims of Trafficking and Violence Protection Act (VTVPA), which strengthens the ability of law enforcement agencies to investigate and prosecute human trafficking and also offers protection to victims via a T-Visa. The T-Visa is for those who are or have been victims of human trafficking. It protects victims of human trafficking and allows victims to remain in the United States to assist in an investigation or prosecution of human trafficking.

Veronica’s mother is also attending weekly individual therapy. She has been working through the heavy guilt and trauma of this experience. Veronica and her mother continue to heal, and with each passing day, they grow stronger.

Reply1( to the professor)       

Marial,

Thanks for sharing how to be a better listener. Great discussion regarding the role of feelings. Body language is another way to show you are being an active listener and it also is one way to read how well others are listening to us. In terms of listening for content, what are some specific strategies from the book that you can use? Which do you prefer? For instance, do you prefer open ended questions or maybe affirmations? How about the other strategies?

Explain.

Reply2

When engaging in a difficult conversation for the purpose of reaching a resolution for a conflict, it is important to use listening techniques. The use of appropriate and effective listening techniques shows the other party that one has an interest and concern in the conversation. Active listening is a must as it helps to receive important information that is needed to understand meaning of the conversation (Weger Jr., Castle Bell, Minei, & Robinson, 2014). If one is actively listening, one can paraphrase what the other party said. This demonstrates that one is paying attention as one can summarize what was said. This technique should also be in conjunction with emotional labeling (EL). EL can be used to label the other party’s feeling that are expressed.