Assignment: HIM FPX 4610 Capella Discharge Summary The Cardiorespiratory System Template
Translate into medical terms or abbreviations common terms contained in a patient’s discharge summary. Identify 5 drugs appearing in the discharge summary and specify the usage reason for each drug on the provided template. Record yourself reading the patient’s discharge summary (1-2 single spaced pages).Assessment 5 continues the exploration of medical terminology related to various body systems and the general structure and functions of the human body. In this assessment, you will focus your attention on the cardiorespiratory system, a specialized area of medicine. The cardiorespiratory system refers to the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity. You will have an opportunity to demonstrate your knowledge of this system’s purpose, various parts, and importance to overall body functioning. In addition, you will demonstrate your knowledge of cardiorespiratory diseases, diagnostic studies, and treatments, including pharmacology. In the assessment you will review a discharge summary for a patient with cardiorespiratory disease and demonstrate your command of medical terminology, including your pronunciation of the terms through an audio recording.
DEMONSTRATION OF PROFICIENCY
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Competency 1: Use medical terminology and abbreviations related to pharmacology.
Identify drugs correctly.
Specify the correct reason for the drug’s use.
Competency 2: Use medical terminology and abbreviations related to general structures and functions of the human body.
Identify common terms related to general structures and functions of the human body correctly.
Translate common terms related to general structures and functions of the human body into medical terms or abbreviations correctly.
Competency 3: Use medical terminology and abbreviations related to body systems.
Identify common terms related to body systems correctly.
Translate common terms related to body systems into medical terms or abbreviations correctly.
Competency 4: Use medical terminology and abbreviations related to specialized areas of medicine.
Identify common terms related to specialized areas of medicine correctly.
Translate common terms related to specialized areas of medicine into medical terms or abbreviations correctly.
Competency 6: Spell and pronounce basic medical terms.
Spell common and medical terms or abbreviations correctly.
Pronounce medical terms correctly.
Competency 7: Communicate in a professional manner.
Use volume, tone, and clarity reflective of professional communication in a health care setting.
Provide citations and references in APA style.
To prepare for your audio recording of the discharge summary:
Set up and test your microphone or headset, using the installation instructions provided by the manufacturer.
Practice using the equipment to ensure the audio quality is sufficient.
Consult the Using Kaltura [PDF] for guidance in how to record your discharge summary and upload it in the courseroom.
Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact Disability Services to request accommodations.
Review the patient’s discharge summary below. Next, download the Discharge Summary Template [DOCX] and complete all of the following:
Identify 10 common terms contained in the discharge summary and correctly translate them into medical terms or abbreviations. Remember, you must spell the common and medical terms or abbreviations correctly.
Identify 5 drugs that appear in the discharge summary and specify the reason each drug is used.
Cite in correct APA style the references you used to perform your translation.
The final step in this assessment is to record yourself reading the discharge summary with the correct medical terms. In your recording, you need to correctly pronounce all the medical terms. In addition, be sure to use appropriate tone, volume, and clarity for professional communication in the health care field. Submit your Discharge Summary Template and your audio recording of the discharge summary to the appropriate area in the courseroom.
Discharge Summary: Cardiorespiratory
Non-ST-elevation myocardial infarction.
Moderate coronary artery disease.
High blood pressure.
An abnormally high concentration of lipids in the blood.
Chronic obstructive pulmonary disease.
Chronic systolic congestive heart failure.
ProceduresLeft heart catheterization, medical imaging test to determine cardiac function in the left ventricle, medical imaging used to visualize coronary arteries with stent placement, computed tomography scan, magnetic resonance imaging scan, posterior artery in the brain repair with stent placement.Brief HistoryThis 72-year-old male presented to the emergency room with chest pain, shortness of breath, and left arm numbness. Patient has a history of high blood pressure, an abnormally high concentration of lipids in the blood, chronic obstructive pulmonary disease, and congestive heart failure. In the emergency room, troponin levels and EKG results came back positive for Non-ST-elevation myocardial infarction. Patient was taken directly to the cardiac catheterization lab.Past Medical HistoryHigh blood pressure, an abnormally high concentration of lipids in the blood, chronic obstructive pulmonary disease, and congestive heart failure, asthma as a child, previous right total knee replacement.MedicationsNorvasc, Lipitor, Lasix, Cozaar, oxygen dependent.Family HistoryPatient is adopted and does not know family history; all children are healthy.Social HistoryFormer smoker, no alcohol or illegal drugs.AllergiesPenicillin, Sulfa.Physical ExamGENERAL: Alert and oriented X3.HEENT: Normocephalic and atraumatic, blindness over half the field of vision.LUNGS: Few rales in lower lobes.HEART: RRR without murmur.ABDOMEN: Soft, non-tender, without swelling or masses.EXTREMITIES: 2+ edema in lower extremities, no cyanosis.Hospital CourseThis is a 72-year-old male who was taken directly to the cardiac catheterization lab from the emergency department due to an evolving Non-ST-elevation myocardial infarction. A 98% close to the center right coronary artery lesion was treated with a Cypher 3.5 x 13 mm stent. The left descending artery showed 35% stenosis, and the left circumflex artery showed 25% stenosis. The image of the left ventricle demonstrated an ejection fraction of 40%. Following the procedure, the patient was admitted to the telemetry unit for observation. He remained in stable condition without chest pain but developed an irregular, rapid heartbeat. The next day, the patient complained of a severe headache in the back of his head with double vision and only being able to see from half of his eye. The patient was taken for a computed tomography scan and magnetic resonance imaging scan which showed a blood clot blocking the posterior artery in the brain. The patient was take back to the catheterization room where a catheterization of the head artery was performed to remove the blood clot and to place a stent to keep the vessel open. Patient is being discharged home on routine meds to follow up with primary care physician within 7 days.
Format: Be sure to complete all columns on the Discharge Summary Template.
Submission: Be sure to submit to all of the following to the appropriate area in the courseroom:
The Discharge Summary Template.
Your audio recording of the discharge summary.
Scoring Guide: Be sure to read this assessment’s scoring guide, so you understand how your faculty member will evaluate your Discharge Summary Template and your audio recording.
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.