To better the rural community it serves, XYZ Hospital has instituted a remote patient monitoring system for patients with pacemakers. Patients use a smart phone app to download the information collected by the pacemaker that is then sent to their physicians on a more frequent basis than a regularly scheduled doctor's appointment. Because the data is collected more frequently, the doctor's can identify cardiac issues before they become a real problem requiring the patient to be admitted. Benefits to telehealth include:

A. Access to patient information

B. Reducing hospitalization

C. Providing information to healthcare providers

D. Population health

Apply the ICD-10-CM Official Guidelines for Coding and Reporting of the Principal Diagnosis for Inpatient Care (Guidelines I A- J) to identify the principal diagnosis in the following scenario.

The patient was admitted to the hospital for a total right knee replacement for osteoarthritis of the knee. During the patient's preoperative preparation, the patient began having chest pain. The patient's knee surgery was canceled, and the patient had extensive testing to determine the source of the chest pain, which was determined to be due to hypertensive heart disease.

Apply the ICD-10-CM Official Guidelines for Coding and Reporting of the Principal Diagnosis for Inpatient Care (Guidelines II A-J) to identify the principal diagnosis in the following scenarios.

Patient was admitted to the hospital with acute pyelonephritis and acute cystitis. Both infections were evaluated and treated with IV antibiotic therapy. THe patient was discharged home to continue taking oral medications.

1. The nurse working in a long-term care facility incorporates a focused assessment of
the immune system for all newly admitted patients over the age of 65. Older adults

are more likely to develop problems related to immune function than are middle-
aged people. The focused immune assessment includes a systemic approach based

on age-related changes in immunologic function. (Learning Objective 4)
a. What changes in the immune system in the older adult increase the incidence of
infection and cancer in this population?
b. Explain why older adults may have decreased inflammatory responses.
c. Why are older adults at increased risk of gastroenteritis and diarrhea secondary
to proliferation of intestinal organisms?

2. The nurse educator for an oncology unit is preparing an in-service presentation for
new nurses about the care of patients with immunodeficiencies. Patients with cancer
who are receiving chemotherapy, as well as those with bone marrow transplants, are
immunocompromised and require special attention to assess for signs of infection.
The nurse educator focuses on special care needs of this patient population.
a. What is the rationale for assessing the pulse and respiratory rates for 1 full
minute in a patient with immunodeficiency?
b. What special precautions about dietary restrictions and food preparation should
be included in the teaching for a patient with immunodeficiency?
c. What nursing actions should be implemented to decrease the risk of infection in
the patient with immunodeficiency?
3. Molly Baker, a 22-year-old patient, presents to the clinic with the diagnosis of
allergic rhinitis. She states that she develops paroxysmal sneezing, clear nasal
drainage and congestion, watery, red eyes, and nasal itching from the late spring
until the first frost in the fall. She states that she has a dry cough and voice
hoarseness. She complains of feeling extremely tired, unable to sleep at night, and
having difficulty concentrating on her collegiate course work.
a. What further assessment should the nurse provide?

1. Ellie Long, a 55-year-old patient, presents to the pain clinic with the diagnosis of
   fibromyalgia syndrome. The nurse at the clinic obtains a history and physical
   assessment of the patient. (Learning Objective 2)
   a. On what areas should the nurse concentrate when interviewing the patient
   during the history process?
   b. On what areas should the nurse concentrate when assessing the patient?
   c. What diagnostic tests are used with fibromyalgia syndrome?