All About Nursing · CNE self study · Hospice & Palliative Care

The Four Different Levels of Hospice Care

The Medicare Hospice Benefit provides for four different levels of hospice care, depending on the needs of the terminally ill patient.

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CNE self study · Hospice & Palliative Care

What is POLST?

POLST is a physician order for life-sustaining treatment, which is called a medical order for life-sustaining treatment in some states. This form is created during a conversation with a medical provider and lays out the patient’s end-of-life wishes. It is considered a medical order, and is most useful in times of emergency. Typically, POLST or MOLST forms are intended for patients who have a life expectancy of 1 year or less, and the POLST is a doctor’s order for the specific instructions the patient has given the physician about what to do in possible future situations.

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Atopic dermatitis (Reading & Sharing)

Atopic dermatitis is a common inflammatory skin disease that mostly occurs in children and E (IgE) is secreted in response to environmental or food allergens. Typically dermatitis and eczema are used interchangeably when the patient has an acute flare-up. The condition is non-contagious and is characterized by dry, itchy skin, but in chronic or severe cases it can cause thick plaques, slightly raised, watery exudate to form or become infected which can affect the patient’s quality of life. So, therefore, because eczema is a common skin disorder seen in primary care the discussion will include the incidence, prevalence of the disease and pathophysiology from the primary provider perspective. As well as the physical assessment and exam, treatment plan, patient education, follow up and evaluation.

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Cough (Reading and Sharing)

A cough is the natural reflex response of the body to clear the airways, to the stimuli that may irritate the respiratory system, which consists mainly the nasopharynx, larynx, trachea, and large bronchi. It is acute when it is less than 3 weeks, and chronic if beyond 8 weeks.  Cough can also be generated by issues in the upper and lower airways, psychological issues, cardiovascular system pathophysiologic disturbances, and the side effects of certain medications like the ACE inhibitors. Cough is the fifth most common symptom that prompts the patients to see their health care provider in the primary care setting (Rhoads & Jensen, 2015). Mainly, the pathogenic triad of cough, that is responsible for 92% to 100% of cough, is due to upper airway cough syndrome which is commonly known as post nasal drip syndrome; asthma, and gastroesophageal reflux disease (GERD). The other associated signs and symptoms of cough are: fatigue, rhinitis, epistaxis, tickle in the throat, pharyngitis, night sweats, dyspnea, fever, sputum production, hoarseness and post nasal drip.  As cough interferes with the activities of daily living and sleeping, there is a decrease in quality of life (QOL).  Therefore, patients seek treatment in the health care settings (Cash & Glass, 2017).

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Differential Diagnosis: Interstitial Cystitis, Urethritis, and Pelvic Inflammatory Disease

  • Interstitial cystitis (painful bladder syndrome), due to pain associated with bladder filling as well as urinary urgency and frequency. Urethritis due to typical symptoms of urinary tract infection (UTI) such as frequency and dysuria. Pelvic inflammatory disease (PID) due to abdominal or suprapubic pain.

On physical examination of a patient with a urinary tract infection, you may notice fevers, pelvic pain or tenderness on palpation, costovertebral angle tenderness (CVA) if pyelonephritis is considered, pain on urination, burning on urination, back pain or hematuria.  Patients may also present with shaking and chills, nausea, and vomiting (Ferri, 2018).

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