Reply to these works with a reflection of their response.  200 words each ones

Please make sure to provide citations and references (in APA, 7th ed. format)  

1.My name is Ceria Mok Yam, I came from Venezuela 8 years ago and currently living in Miami with my husband and 2 little kids. I am a foreign medical doctor and as part of my goals to continue working in the healthcare field I became a registered nurse last year and decided to continue my path through the family nurse practitioner program. Right now, I am fully dedicated to my classes and family. My hobbies usually include a pleasant restaurant and playgrounds or kids’ friendly activities. And my long term goals include working as a PCP in a medical office once I complete my FNP.

During this first week, I am going to discuss the use of the paradigms of health, by linking between health and behavior, and describing how this relationship affects social determinants of health.

As part of the paradigms of health, John Travis, a medical practitioner, developed a model of wellbeing called The Illness-Wellness Continuum, which explain the constant dynamic between different degrees of wellness and illness, starting from a neutral point in the center of the graphic, from which a patient can move to the left showing a progressively worsening level of health, or moving to the right, indicating an increase state of health, and wellbeing (Lothes & Kantor, 2021). This model tries to explain that in the healthcare field, the absent of a disease does not necessarily mean that a person is healthy, it describes how a patient with physical injuries, symptoms, and disabilities can be treated in a way to achieve the neutral point. However, the wellness paradigms explain that additional progression to the right side of the model is necessary to ensure not only physical but emotional and mental wellness.

In order to achieve a higher level of wellness, it is essential to determine the effect of medical treatments, behavior, and socioeconomic status in the patient’s health condition; acquiring a more holistic approach can help nursing professionals better understand the importance of a individualized plan of care specific to each patient.

Some of the elements that might influence the paradigms of health include the education level (Solanki, Shankar Rath, Silan, & Singh, 2020). It is known that those with higher education levels and literacy usually engage in healthy behaviors, compared with individuals with lower education preparation and less access to information about healthy habits. Socioeconomic status has a significant impact on health conducts and conditions (Solanki, Shankar Rath, Silan, & Singh, 2020). Patients with financial challenges and reduced access to resources can have difficulties fulfilling their health goals. Also, patients with chronic disease can lead to job loss, worsening his or her resources and status.

Cultural and social support, family, close relatives, and friends, as well as community members may influence in the patient’s capacity to engage in healthy behaviors, which includes physical activities preferences, cultural habits, food options, emotional states, capacity to express themselves, and others.

In conclusion, the comprehension of the paradigms of health can help nursing professional and healthcare providers in general, to assess the individual health status and address social determinants of health in order to create interventions that provide adequate resources and promote healthier conducts, which consequently improve their overall status.

2. My name is Anny Morales Souquett, I am a foreign doctor, specialist in Gynecology and Obstetrics. I arrived in the EEUU in 2018.  I live in Miami. In 2020 I started nursing school and finish in December 2022. I did the Nclex in February 2023. I currently work as a Care Coordinator, taking care of the needs of patients with Highly Complex, High Risk, and High Utilizer. In my spare time, I enjoy walking in the parks, going to the beach, and traveling with my family. My favorite movies are Start Wars and Disney movies. In 5 years, I visualize myself as a Nurse Practitioner of a Gynecological medical office, providing the best care to my patients, doing prevention, and teaching them to provide their lifestyle. I am sure that the class will help me understand this topic much better.

Understanding how societal and personal variables affect well-being requires using the paradigms of health to investigate the connection between health and behavior. Social determinants of health, which are the circumstances under which people are born, develop, live, work, and age and which affect health outcomes, are significantly impacted by this relationship. Three references who are no older than five years old provide the following overview of this relationship:

The biomedical perspective has a history of emphasizing the physical components of health and frequently views disorders as distinct entities. Modern biological research does, however, recognize the significant influence that behavior has on health consequences. According to research, lifestyle factors like food, exercise, and drug use significantly affect how chronic diseases start and advance (Danaei et al., 2019). Healthcare professionals can better meet the needs of each patient by customizing therapies and prevention measures by understanding these linkages.

The biopsychosocial paradigm takes a comprehensive approach to health, considering biological, psychological, and social variables. Health is understood to be both a result of behavior and its primary cause. Stress-related harmful behaviors, such as smoking or binge eating, can have an impact on one’s physical health (Taylor et al., 2017). A holistic approach to healthcare must consider how these aspects interact.

Social Determinants of Health: Social determinants of health are closely related to the connection between behavior and health. Individual behaviors and health outcomes are significantly influenced by social, economic, and environmental factors. For instance, socioeconomic gaps might prevent disadvantaged groups from having access to nutritious food options and secure spaces for physical activity, which can result in harmful habits and worsened health (Braveman et al., 2017). The significance of tackling social determinants to lessen health disparities is highlighted by the recognition of these relationships.

It is crucial to comprehend how behavior and health interact within the framework of these paradigms to create public health strategies and policies that are efficient. Policymakers and healthcare practitioners can create treatments that target both individual behaviors and the larger societal contexts that drive such behaviors by considering the complex web of variables that affect health outcomes.

How would you anticipate this life changing diagnosis is going to affect your patient according to his age and sex? 

Choose one of the following to respond to in Week 1 Discussion Board;

·
Chapter 1, Exercise 1.5 or

·
Chapter 2, Exercise 2.1 or

·
Chapter 2, Exercise 2.4

Respond with a minimum of two (2) paragraphs of 4-5 sentences each.

1.
You should address each bullet point in the exercise you select.

2.
Your work should have in-text citations integrating at a minimum one scholarly article from this week's readings and course textbook.

3.
APA format should be utilized to include a reference list.

4.
Correct grammar, spelling, and APA should be adhered to when writing, work should be scholarly without personalization or first person use.

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

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

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

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

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

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

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

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

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

Chief Complaint:

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

History of Present Illness:

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

PMH:

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

Information from Sister:

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

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

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

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

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

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

Family Hx:

Paternal grandmother – depression

Two maternal aunts – bipolar disorder

Mother and father – alcohol abuse

Father died from pancreatic cancer

Mother died from heart failure

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

Social Hx:

Divorced and remarried

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

Attends church regularly

Smoked 1ppd for 15 years

History of alcohol abuse with several DWI violations

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

ROS:

Information from sister:

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

SIGECAPS:

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

Medications:

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

Sumatriptan 50-200mg po PRN

Allergies:

ASA – swelling of face

Physical Examination:

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

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

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

Neck – supple without adenopathy, no thyromegaly

Lungs – CTA

Breasts – deferred

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

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

Genitalia/Rectum – deferred

Musculoskeletal – no major limitations of ROM or gross abnormalities noted

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

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

Lithium 0.08meq/L

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

Assessment:

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

Plan:

The plan cannot be developed until the diagnoses are assigned.

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