Health Care

Funding Preventive Care in America Preventive care is an element that is becoming important to not only those in the healthcare field but America as a whole. Preventive care helps to not only prevent but in some cases stop from increasing illness such as obesity, hypertension, and heart disease. Many healthcare officials feel that preventative care is important to the health care field while the government does not share their sentiments and thus funds are not distributed equally to areas which assist with preventative care.

Many critics feel that if the government would work with funding preventive care programs, the cost of health insurance would decrease and many Americans would be more apt to take a healthier approach to living. Preventive health care is measures taken by an individual to prevent illness or diseases that may or may not arise in the future. The American government does not equally fund preventive health care measures as it does the war. With this being said, many health care officials believe that it is important for individuals to receive preventive care.

The whole idea would be to help keep costs down yet there has not been sufficient enough studies that shows that preventive care actually keeps rising health care costs down. Preventive health care measures include services such as screening (ie cancer, cholesterol), vaccines, and other wellness benefits. Currently the government is making adjustments in order to allocate more money into the preventive health care sector and this is partially due to the Health Care Reform Act created by President Obama.

However, as good as this sound, this act has been met with much criticism. The government is still quite hesitant to allocate funds for several reasons: the estimated costs of spending is different based upon the type of preventive care that is provided, lack of evidence to show the effects of a decrease in rising health care costs due to preventive measures, and the evidence shows that the actual cost to implement preventive measures is more costly. For example, a simple medical test such as one that is given for cholesterol can detect if a person has cholesterol.

The idea behind early detection would be to provide patient education in hopes that the patient would not have to get on medication and this condition could be able to control this by eating healthy and exercising. With early detection, the physician is able to assist the patient in monitoring their behavior. This action is presented two-fold: the patient is empowered to take charge of his health and the cost that was involved in the test is minimal thus keeping costs down by ensuring the patient is monitored and does not have to get on medication.

One of the downfalls with funding preventive care is that neither the government or the physician knows if the illness(es) that is being prevented will be costly or not. It has been noted that prevented care is beneficial when a certain group of people suffer from a particular problem, yet it is difficult to target such a group because medical care cannot be predicted and often times many of the patients are asymptomatic. Preventive health care measures can be costly especially when physicians tend to test for everything and this added cost exceeds the savings which is what they are trying to do.

Therefore, this is a catch 22 situation. Preventive care is meant to save money while the government does not see it in that way. Therefore, they restrict the amount of money that is allocated for preventive care. Interestingly enough, the idea that preventive care is beneficial; however, when you look at costs in the long run, preventive care may not be that beneficial. An interesting point to notate is that regardless of how the government is not allocating funds equally into the preventive health sector, many physicians have implemented preventive care services and started educating their patients.

Most of this is done through a regular office visit; therefore, it does not look like the patient is coming in for preventive measures. Wellness Services Physicians are not the only one that is not relying on government funds to help with preventive measures. Large corporations are equally involved in wellness (Aldana, 2005). Many corporations are offering incentives to their employees. For example, Blue Cross Blue Shield offers wellness benefits to their employees that maintain a healthy lifestyle to include not smoking, weight management, hypertension and high cholesterol management.

This company has even gone as far as to offer financial incentives offset the costs for health insurance. The employees have access to a gym that resembles at a rate of approximately $10 per month. The employees have access to a personal trainer to help them with their weight management. BCBS have a health care team which visits the site and gives blood tests to determine their cholesterol level, hypertension, and smoking. This incentive allows employees to be seen for free and receive the proper treatment for free.

To add more to this plan, the company gives the employee that meet the requirements for “a healthy lifestyle”, the gives the employee money titled “Wellness” each pay period. This is incentive enough to some people to continue to live a healthy lifestyle. Government interaction Great Britain’s Health Committee believes that the government should fund preventive care yet incorporate clear guidelines. The group feels as though the government should fund those with fluctuating needs.

This seems to be an answer to those that are uninsured or underinsured. This committee; however, does agree with the US government that prevention even though is better than treating the symptoms is quite expensive (Great Britain, 2009). According to Masters 2005, even though prevention is costly, it is recommended because the government is wasting money on illness that could have been prevented through the use of prevention and these illnesses can result in lifestyle and environmental risk factor changes.

It is believed that high quality can cost the government more money it is the level of quality care that is provided to the patient that prevents future costs and this is the whole intent of preventive care (Masters, 2005). Currently the government is offering incentives for health care physicians that use electronic health records. The first incentive was for $144,000; however, the government fails to incorporate some form of incentive for healthy living. It is unlike that many physicians will take the government up on the incentives before it is mandated in 2013 for all physicians to use some form of electronic health record.

Many critics of this feel that incentives such as this should be going to help fund some form of preventive services. In an effort to answer the need for preventive measures in America’s health care system, the department of Health and Human Services (DHHS) is investing $750 million into prevention and public health (hhs. gov). The funds are distributed into tobacco use, obesity, heart disease, stroke, cancer, immunizations, and patient education. The idea is to be able to target individuals that are faced with these conditions and educate them so that history will not repeat itself.

In order to assure that the funds are allocated correctly, DHHS has decided to disburse accordingly: • 298 million for community prevention • 198 million for clinical prevention • 137 million for public health (health departments) • 133 million for research and tracking (quality assurance). The general idea is to work as a unit to ensure that once the funds are allocated to the stated department that the organizations are able to utilize the funds accordingly. Apart from the government not allocating enough funds to go into the preventive care sector, the individual is responsible for their appropriate level of care.

Conclusion Regardless if the government is willing to pay for war or for health; it is up to the individual to make sure that they are living in a healthy manner. Many people feel that to live a healthy lifestyle is costly, this may be true; however, by taking small measures, they are able to prevent many of the diseases and illnesses that occur. For example, if obesity is a problem and this is a medical burden which accounts for over 10% of medial spending (Finkelstein, E. A. et al, 2009).

People that have this condition are able to eat smaller amounts, start to exercise, and monitor the intake of junk foods. By making these small adjustments, the individual is able to help combat obesity and not rely on the government to fund preventive health measures. The same thing that a physician would say to someone that is obese is the same thing that the individual can find online.

References

1. Aldana, S. G. “Financial Impact of a Comprehensive Multisite Workplace Health Promotion Program,” Preventive Medicine, vol. 40 (2005), pp. 31–137.
2. Finkelstein, E. A. et al (2009). “Annual Medical Spending Attributable to Obesity: Payer- and Service-Specific Estimates,” Health Affairs, Web Exclusive (2009), pp. w822–w831.
3. Great Britain: Parliament: House of Commons: Health Committee. (2009). Social Care. United Kingdom: The Stationary Office HHS Press office. (2011, February 9). Retrieved from http://www. hhs. gov/news/press/2011pres/02/20110209b. html
4. Masters, K. (2005). Role development in professional nursing practice. Burlington: MA, Jones Bartlett Learning.

Check these details with the people you care for and stick to them. Rights We all have rights and just because we can no longer kick after our selves this goes not mean all our rights disappear, the right to go to bed when we want. The right to decide what to wear and which room we want to sit in. Choice If you were unable to choose anything for yourself ask yourself would you be happy if these choices were taken away from you! The answer I’m sure is no! Then why would the people you are caring for be any different. Rivalry If everyone just walked into your house without asking would you be happy, NO. Knock on the door before entering a room; make sure the door is closed when carrying out personal hygiene. Protect the private information Of the people you care for as if it was yours. Independence Allow the people you care for to do things for themselves, you are there to support them to be independent Dignity To treat someone with dignity is to treat them as being of importance, in a way that is considerate of their diversity, as valued individuals.

When dignity is present people feel in control, valued, confident, comfortable and able to make decisions for themselves. Respect Respect involves valuing the people you care for, acknowledging their value. This will express itself in certain behaviors for example extending common oratories, expressing concern for others and their well-being taking their feelings and experiences seriously. The Guidance and standards that is relevant to your role – Human Rights Act There are 16 basic rights in the Human Rights Act. Each one is called an Article.

They are all taken from the European Convention on Human Rights. They affect everybody. They are also about your rights in everyday life. What you can say and do. Your beliefs. The right to life Freedom from being tortured or killed The right to marry and a family life The right to liberty and security Freedom of expression Protection from discrimination in respect of these rights and freedoms UN Convention on the Rights of the Child Protects the rights of all children to an education, to be healthy, to a childhood, to be treated fairly and to be heard.

These included the ‘Right to life The right to family life It forbids capital punishment General Social Care Council Code of Practice Provides a clear guide, for those who work, in health and social care. Setting out the standards of practice, responsibilities and conduct for employees and their employers to follow. Employee should- Protect the rights of the service user

Respect the rights of the service user Promote the independence of the service user Establish and maintain Be accountable and take responsibility for your actions Employers should- Ensure that the people they employ are suitable and understand their role and responsibility Provide appropriate training and development for their employees to strengthen their skills Have policies and procedures in place to cover any dangerous or discriminatory behavior Nursing and Midwifery Council code of Practice You must make the care of the person you care for your primary concern.

You have a duty of care always to them. You are personally accountable for your actions or inactions in your work life always. Valuing and Respecting Service Users Values guide the way we live our lives and the decisions we make. A value is defined as something that we hold dear, those characters or behaviors which we consider to be of importance. Everyone has the right to be valued and respected for their own individuality. We should take the service user’s feelings, needs, thoughts, ideas, wishes and preferences into consideration. It means taking all of these seriously and giving them worth and value.

Giving money respect seems similar to valuing them and their thoughts, feelings, etc. It also includes acknowledging them, listening to them, being truthful with them, and accepting their individuality and differences. Treat others how you would want yourself or a relative to be treated. Valuing Adults Listen to the service user, ask them what they want and how they want to do it, then help them to achieve it. Do not automatically do things for the service user; allow them to do things for themselves and aide when required Be flexible allow service user to decide when they want to do things such as eating, going to bed, getting up.

Valuing children Acknowledge them When you communicate with a child come down to their level Treat them as equals Encourage them to do things for themselves Be patient The importance of a person-centered approach is to ensure the service user is thought of first before anyone else. Also it makes sure that the knowledge that a service user has about what they want and need, then provides information about what is the best thing to do. As a career you should focus on the wants, wishes and needs of the service user.

Connecting Toward a Healthier Future Social technologies are affecting the way our world operates as they become more and more established and interconnected. Individuals are using Faceable, Twitter, Linked, and a wide variety of other forms of social media to communicate, connect, and share. The way many communicate with their family, friends, employers, and strangers has changed as social media has as well. Individuals can have closer contacts with those who live far away and stay up to date with those who they many not see everyday.

As well as individuals ability to communicate more than they ever have before, the way they do things is changed due to social media and mobile technologies. More specifically, social technologies are affecting health care, connecting and collaborating to a healthier future. People worldwide are sharing information that can be accessed from any place, at any time. Not only is social media changing the nature of the way we access information, but it’s also changing the speed of which we retrieve the information.

Patients, doctors, and health care organizations can connect quicker and easier then they once could, roving important information to mass amounts of people at one time when needed, and sharing information creating a interconnected approach to health services. Individuals no longer have to wait in a doctors office for hours to find out the answer to a question they have as they can rely on social media; they can check their symptoms or type their question in on a website, such as www. WebMD. Com, and get instant answers from doctors without leaving their home.

At the same time, individuals can post a question on a social media site and get answers and opinions from a large group of people including family, friends, doctors, and any one else who may stumble across the post. Social media has changed the way our world, and more specifically health care, connects to create a healthier future. Health care has gone through tremendous amounts of changes since social media has emerged. At one time, patients were passive recipients of knowledge, relying solely on the information that one doctor has given them at any specific time.

Results were not discusses and people would not go to others for advice or answers to medical questions or concerns they had. Today, however, through the use of social media, individuals are sharing more than they ever have, relying on the information from others, connecting and communicating for knowledge. After visiting a new doctor, having a procedure, or going for surgery, individuals can easily tell others about the experiences they had, sharing reviews of the doctor, and updates but posting and commenting on social media sites.

Medications and treatments can also receive reviews by consumers, informing others of potential risks, benefits, and other concerns they may have. Patients can share health-related images ND videos and providers post quizzes to provide users with important information in an engaging way. PWS shares snapshots of recent activity, demonstrating how through social media users are asking questions such as, “when do you deliver your baby? – early, late, or on time? ” receiving 61 likes and 766 comments (Anally, 2012. . This is a perfect example of how individuals today are using social media to get answers to the questions they have. Support groups for medical issues and health-related causes are being created, with awareness being spread through social media. As awareness is extending, so is the support received: information and input is shared and obtained through a mass number of people, called scrounging (courseware, n. D. ). When many people come together, great success is achieved.

Websites such as The Foundation for Parade-Will Research is an example of a non-profit organization that has created a Faceable page made to bring individuals with Parade-Will, family members, and friends together to learn and share knowledge (Howard, J. , Strong, T. , Johnson, S. , Viral, A, & porter, J. , 2014). This page delivers information, advice, suggestions, and arsenal stories about Parade-Will and how individuals are dealing with this medical disability. Different medications and treatment options along with the outcomes are shared, as well as school adaptations and success stories are shared among the group.

The Faceable page creates awareness worldwide and receives support and pledges from many for research development. When someone joins a group where others experience similar issues a sense of community is built, sharing supporting, and helping others creating a healthier and happier population. Not only is there a Faceable page for Parade-Will, but there are also a wide variety of pages and sites through all forms of social media that offer support for those with medical exceptionalness and loved ones.

There are also other ways to retrieve medical health care information through social media and mobile devices, such as Telepathy Ontario. Telepathy is ministry of health and long-term care program, that is a free telephone service where you have access to a registered nurse 24 hours a day, 7 days a week. With mobile devices we have today, this means you can talk to a registered nurse at any time of any day, no matter where you are as Eng as you have a mobile device. The health professional will help you determine your first step in what to do when medical issues arise.

After asking a series of questions, the nurse can help individuals determine whether self care is advised or if it’s recommended you make a doctors appointment, visit a clinic, or go to a hospital emergency room. One will also be given numbers of community resources nearest to them, and answers to questions they may have. Telepathy is just one example Of a service provided due to the emergence of social media and mobile devices. Due to the rapid expansion of social media and mobile devices, there are many services emerging that connect us to create a healthier future. As application software has become very popular, so has the term “app. APS have appeared on smart phones, pods, pads, tablets, and computers. “App” was even coined the 201 0 word of the year by the American Dialect Society (Metcalf, A. 201 1). This comes no surprise as you can see the emergence of technology has even shaped the way society talks. If we look back to 1990, society begins talking about technology, with the “most likely word to succeed” being notebook PC, followed by the 1993 ‘ rod of the year” being information superhighway. The 1994 word of the year was cyber and 1 995 “word of the year,” as well as “most likely to succeed and most useful word’s was World Wide Web.

In 1998 the ‘rod of the yea’ and “most useful word” was the prefix e- as in e-mail and e-commerce, with 1 ass’s “most useful word” being dot-com. In 2002 the “most likely to succeed” word was blob and the most useful word was Google, as a verb, as it to Google someone. By 2009 the “word of the year” was tweet and 201 g’s word of the year, app (Metcalf, A. 201 1). APS are available in nearly every subject, with the saying ‘there’s an app to that,” applying to nearly anything today. This includes health, with a wide variety of health APS to help individuals get and stay healthy.

For those with a child, loved one, or oneself who has a food allergy or restrictive diet, there are APS such as Foddering which allows them to check the ingredients and additives in each product (Hobbles, 2012). For keeping your body at a healthy weight there are a wide variety of diet APS, as well as fitness APS. Many diet APS allow you to input the food you eat and based off your body it ill tell you how much you should be having of each thing and how it is going to affect you. There are also a variety of fitness APS, with fitness plans, calorie counters, and exercises for you to do.

Calorie Counter and Diet Tracker by “My Fitness Pal” is an example of a combination of the TVВ»’0, as they affect each other. A healthy mind is also important when it comes to an individuals overall health, and for that there are APS such as Stress Check which tells you how you rate on the stress chart, and what to do to help reduce anxiety so you can have a healthier mind. Summary is an example of n app that can be used to help individuals of all ages, by letting you know when you do and do not need sun protection, such as sunscreen, hats, and light clothing, before going outside to help prevent skin cancer.

To help prevent and detect another common form of cancer, birdwatchers and other similar APS have been created to help reduce the risk and provide early detection of breast cancer. This app provides a video on how to do a breast check, as well as sets up reminders in a calendar as to when to do it. For men there are similar APS for prostate exams and symptoms of when to visit the doctor. On top of all the more specific health APS, there is also an app called WebMD Mobile where individuals can check symptoms, get first-aid advice, or some medical advice all right from their phone (Hobbles, 2012).

As we can see, there are APS for virtually anything, including health, that you have access to nearly every moment of everyday, creating a healthier, more connected population. On top of that, not only are all these APS helpful in keeping us healthy, but you can often find many of them (or similar APS with the same function) for free. This leaves us to see that individuals enjoy accessing information from home as well as connecting with others around the globe for answers. From here, a wide range of APS have been emerging, and continue to emerge based off the demands of society.

We can see that individuals are using social media and mobile technologies to become a healthier, potentially happier population, but who specifically is using these new technologies? Is it everyone, or just one group? Well, we can see that the longer technologies have been out and the more they advance, the more people are pursuing the use of them. However, the problem remains that not all of the population is. Seeing as the younger population has grown up with the advances in technology they are much more inclined to use and stay up to date with the technology we have today.

As we look at the older population though, it seems as the older the individual is, the less likely they are to use technology as much as they could, however, it really depends on the lifestyle of which someone has had. An example of this is an 80 year old who has worked in a profession that relied on the advances of technology might be much more up to date and involved than a 55 year old who has never needed to use a computer or cell phone for their job, even Hough on average most 55 year olds are more engaged and aware than 80 year olds.

This poses a problem when not all parties are involved in social media when trying to communicate, as some individuals may miss out on important information and don’t have the opportunity to put their input in, which becomes a large challenge when trying to follow an inclusive model. Not only are individuals using social media though; patients, doctors, hospitals, health insurance companies, drug companies, pharmacies, and work places are all using social media. We can see how this affects them by joking at PWS Global Network Chairman, Anally explains how “an insurer gained new member by hosting a contest to 5,10th-page like.

The contest posted 321 likes, 5 shares, 16 comments,” and how a “pharmacy manufacturer alerted members about a product recall which resulted in 12 likes, 47 shares, 12 comments. ” (2012) Everyone not on the bandwagon for social media is not the main disadvantage, however. The main problems have to do with the users who are engaged in these technologies. One problem is that not all information found on the internet, and more specifically through social media, is accurate. With everyone having the ability to post, we have a large portion of inaccurate information, that users have to watch out for.

It can be nearly impossible at times to determine whether or not you are accessing information from a trustworthy source. At the same time, many post information about themselves on social media sites without realizing how dangerous it could be, and how virtually anyone can find out tremendous amount of information without ever meeting them. Once information has been put online, it no longer is your property, it becomes the social media site’s property. For health care specifically, there is a struggle for patient confidentiality.

Keeping confidential information private can be hard when on social media sites. At the same time, there is a struggle between relationships health care practitioners build with patients, to make patients feel more secure, but also have the confidentiality for these professionals to maintain their professionalism and not mix their work and their home life. The main problem with social media site is that individuals now share personal information with many across the world, which can make others feel purported, but it comes with risks of individuals using that personal information in dangerous ways.

The emergence and growth of social technologies and mobile devices has changed health care worldwide, connecting and collaborating for a healthier future. The quality of medical care has been improved as there is more communication between patients and medical professionals, as well as communication and support between individuals. Important messages can be delivered quicker and easier than they once were, and information is much more accessible than it once was as well. There a a wide range of APS to help individuals get and stay healthy, as well as share their progress with others.

However, as with anything, there are disadvantages to social health care. Privacy and confidentiality is very hard to be kept when using social media, as is professionalism while still providing patients with friendly, secure relationships. Also, it can be hard to determine what information is accurate and what sources are trustworthy. Overall, social media is changing health care, creating many opportunities to build off of and engage all to create a healthier population connecting and collaborating to a healthier future.

Skeletal survey is a consistently apply series of radiographic images that include the entire skeleton or those anatomical areas suitable for clinical indicators (The Americana College of radiography, 2014). Moreover, it using x-ray beam that pass through the patient electromagnetically to capture and take many x-ray images of body from the skull to feet (Adam ,2017).

In addition, radiography skeletal survey are necessary in many clinical conditions such as , Skeletal dysplasia’s, disseminated infections, metastatic bone disease, multiple myeloma, suspected child abuse and many other pathologies in pediatric. The most common indication of it is child abuse. According to centers for disease control and prevention (2009), child abuse is any act or series of act or neglect from the parent or other care provider that harm the child.

Child abuse is one of the common problem which can find in the social and ethnic borders. For instant, in 1993, US the third National Incidence Study of Child Abused shown that approximately 1,553,800 children in United States were abused. Therefore skeletal surveys are applied to determine the physical injuries in children according to specific guidelines.

Furthermore, the skeletal survey performed on suspected abuse to provide enough anatomic detailed to image the skeleton of them or any young patients. However, there are special stander that published by American college of radiology that mention there were special film cassettes and intensifying screens to reduce the radiation exposure and they mention that low dose enough for chest and abdomen however its insufficient in some part like rib, metaphysical and other high specific injuries.

Also it should provide without an anti scatter grid and faster general for especially thicker part. Nowadays, digital or computed radiography are used in most hospitals for pediatric imaging. DR and CR produce high quality image as it replace the traditional film/screen imaging. DR produce high quality image because it is lower in spatial resolution tan traditional film/screen imaging.

Also the ability of doing post processing provide the ability to modify the image to avoid repeating the examinations and provide the ability to compare in diagnostic performance for skeletal imaging. Moreover, it provides the ability to select low exposure value to reduce dosage with producing high quality diagnostic image.

Postpartum Endometritis Evidence Based Paper March 13, 2012 Endometritis is the inflammation or irritation of the uterus, which is a common post partum complication that occurs in more than 15% of all pregnancies and is currently the leading cause of maternal mortality (Scott & Hasik, 2001). When endometritis is not related to pregnancy, it is referred to as pelvic inflammatory disease (PID).

The Centers for Disease Control and Prevention (CDC) 2010 sexually transmitted diseases treatment guideline defines PID as any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. From a pathologic perspective, endometritis can be classified as acute versus chronic. Acute endometritis is distinguished by the presence of neutrophils within the endometrial glands. Chronic endometritis is characterized by the presence of plasma cells and lymphocytes within the endometrial stroma.

Chronic endometritis in the postpartum or post abortion patient is usually associated with retained products of conception after delivery or abortion. In the nonobstetric population, chronic endometritis has been associated with infections such as chlamydia, tuberculosis, bacterial vaginosis, and the presence of intrauterine devices (Rivlin, 2011). Early-onset postpartum endometritis occurs within two days of delivery, and the late-onset of the disease can occur up to six weeks postpartum.

This condition will usually start as a local infection at the placental attachment site and if left untreated, can spread to the entire uterine endometrium (French & Smaill, 2004). There are numerous risks associated with this condition, and diagnosis relies heavily on the clinical judgment of the practitioner. The contamination of the uterine cavity with vaginal organisms during labor and delivery causes the disease. Both bacterial and viral infections may initiate endometritis and many of the agents that cause the infection are naturally present in the vagina.

This condition arises commonly after delivery because delivery results in tears, rips or incisions in the vagina, cervix or uterus that allow these agents to enter the uterine lining. The infection can have several species of causative agents that can be aerobic or anaerobic flora (French & Smaill, 2004). The method of delivery will determine which causative agents prognosticate the possibility of endometritis. For vaginal deliveries, the presence of the organisms associated with bacterial vaginosis or genital cultures positive for aerobic gram-negative organisms can indicate endometritis.

In cesarean births, the occurrence of certain bacteria such as group A hemolytic streptococci, staphylococci B, Neisseria gonorrhoeae, or Mycoplasma hominis in amniotic fluid cultures will put the patient at an increased risk for this infection (French & Smaill, 2004). With the increasing number of people opting for natural birth methods, including water births, the danger only multiplies. This is because disinfecting procedures as they are carried out before major surgery is usually not practiced in a home environment.

Prompt treatment is essential to prevent the spread of the infection through other areas of the body, including the blood. Prolonged infection can be fatal. The immediate postpartum period following birth is a time of increased risk for all women for infection. Microorganisms entering the reproductive tract and migrating into the blood and other parts of the body could result in life threatening septicemia (French & Smaill, 2004). Timely diagnosis and aggressive treatment is essential to prevent these complications.

Complications of endometritis include infertility, extension of infection to involve the peritoneal cavity with peritonitis, intra-abdominal abscess, and septic pelvic thrombophelbitis. Septic pelvic thrombophelbitis is a condition in which blood clots in one of the pelvic vessels become infected. If untreated it could progress to septic pulmonary emboli, in which the infected blood clots travel to the lungs and lead to death (French & Smaill, 2004).

Septic shock is a life-threatening systemic infection usually caused by bacteria and on rare occasions follows postpartum endometritis. The bacteria that invade the bloodstream release a substance known as endotoxin, which causes decreased blood pressure, clot formation, major tissue injury, and leakage of fluids. Accordingly, organs may fail because they are not receiving enough blood and nutrients. Fortunately, this condition during pregnancy or in the postpartum period is a rare clinical event (Mazzeffi and Chen, 2010).

Major risk factors for obstetric endometritis include the following: Cesarean delivery (especially if before 28 weeks’ gestation), rupture of membranes lasting more than 24 hours, excessively long labors, severely meconium-stained amniotic fluid, manual placental removal, and extremes of patient age. Other threatening factors have been identified in additional studies, including no prior cesarean delivery, preterm or postterm gestation, low infant Apgar scores, antepartum infections, preeclampsia, amnioinfusion, postpartum anemia, the presence of internal monitors, and steroid medications (Olsen, Butler, Willers ;amp; Gilad, 2010).

Acute endometritis is typified by the existence of neutrophil cells in the endometrium. Neutrophils are white blood cells with cytoplasmic granules that consume harmful bacteria, fungi, and other foreign materials. Characteristic symptoms of endometritis include abdominal distention or swelling, abnormal vaginal bleeding, abnormal vaginal discharge, fever (100 to 104 degrees Fahrenheit), general discomfort, uneasiness, or ill feeling (malaise), and lower abdominal or pelvic pain (uterine pain). Anemia occurs when a patient’s red blood cell count is lower than 4. -6. 0 million red blood cells per micro liter of blood. Losing large amounts of blood during delivery or prior to delivery may be a contributing factor for a low red blood count, anemia and potentially endometritis. Red blood counts (RBC) are needed to indicate anemia and the sedimentation rate (ESR). The sedimentation rate measures the rate at which red blood cells sediment in a period of 1 hour. It is a common hematology test that is a non-specific measure of inflammation, which is evident in endometritis.

The diagnosis of postpartum endometritis is based on the presence of fever in the absence of any other cause. Uterine tenderness, purulent or foul-smelling lochia and leukocytosis are common clinical findings used to support the diagnosis of endometritis. Leukocytosis is a raised white blood cell count (the leukocyte count) above the normal range in the blood. The standard definition for puerperal fever used for reporting rates of puerperal morbidity is an oral temperature of 100. 4 degrees centigrade or more on any two of the first ten days postpartum or 101. degrees or higher during the first 24 hours postpartum (French ;amp; Smaill, 2004). Additionally, when the above symptoms occur, urinalysis and urine culture may be done. However, endometrial cultures are rarely indicated because specimens collected through the cervix are usually contaminated by vaginal and cervical flora. A sterile technique with a speculum is used to avoid vaginal contamination, and the sample is sent for aerobic and anaerobic cultures. If fever persists for 48 hours (Some clinicians use a 72-hour cutoff) after endometritis is adequately treated, ther causes such as pelvic abscess and pelvic thrombophlebitis should be considered. Abdominal and pelvic imaging, usually done by CT, is sensitive for abscess but detects pelvic thrombophlebitis only if the clots are large. If the results of the imaging are negative, a trial of heparin is typically begun to treat presumed pelvic thrombophlebitis as a diagnosis of exclusion (Moldenhauer, 2008). Before the advent of the antibiotic era, puerperal fever was an important cause of maternal death.

With the use of antibiotics, a sharp decrease in maternal acute postpartum infections has been observed, and it is now accepted that antibiotic treatment for postpartum endometritis is warranted. Intravenous broad-spectrum therapy (cephalsporins, penicillins, or clindamycin and genatmicin) is appropriate for the treatment of endometritis. Regimens with activity against penicillin-resistant anaerobic bacteria are better than those without. There is no evidence that any one regimen is associated with fewer side effects.

Once uncomplicated, endometritis has clinically improved with intravenous therapy, and oral therapy is not needed (French, 2003). Furthermore, it is essential that the patient receive supportive care including hydration, rest and pain relief. Antibiotics should be discontinued 24 hours after the patient is asymptomatic. Assessments should be taken of the lochia, vital signs, and changes in the women’s condition continue during treatment (Perry, Hockenberry ;amp; Lowdermilk, 2010). Treatment is usually considered successful after the woman is afebrile for 24 to 48 hours.

If the initial antibiotic regimen does not result in resolution of fever and other symptoms within three days, the antibiotic regimen is usually changed. Consideration is also given to the possibility that the woman may have complications requiring specific treatment. The most effective treatment and least expensive treatment of postpartum infection is prevention. Preventative measures include good prenatal nutrition to control anemia and intrapartal hemorrhage. Good maternal perineal hygiene with through hand hygiene is emphasized.

Strict adherence to aseptic techniques by all healthcare professionals during childbirth and the postpartum period is very important (Perry, Hockenberry ;amp; Lowdermilk, 2010). Endometritis is usually caused, in the postpartum scenario, because of a deficient care taken to avoid streptococcus and staphylococcus infections in the delivery area. These two bacteria are present on every inch of our skin, and considering that delivery is the one time when the mother’s insides are most exposed, precautionary measures to maintain a sterile environment in the delivery or birthing room should be taken.

The benefit of antibiotic therapy for laboring women has been unquestionably established. Intravaginal metronidazole as surgical preparation and oral methylergometrine after delivery are two interventions that show promise as additional prophylactic interventions (French, 2003). Having a baby by Caesarean section is becoming increasingly common, despite the higher risks associated with the surgery compared to a vaginal birth. One important concern is the risk of infection, which is between five and 20 times greater for women who undergo scheduled or emergency Caesarean section.

According to the Cochrane Review, “the single most important risk factor for postpartum maternal infection is Caesarean section. ” The review further cited that antibiotics to women undergoing Caesarean section reduced the incidence of fever by 45 percent, wound infection by 39 percent, inflammation of the uterine lining by 38 percent and serious infectious complications for the mother by 31 percent (Nelson, 2010). This approach can significantly lower the risk of endometritis, particularly in women having surgery after extended labor and ruptured membranes.

To prevent future infection, most doctors prescribe Cefazolin, which is administered intravenously immediately after the baby’s umbilical cord is clamped. If you are at high risk, a second dose may be given eight hours later (French ;amp; Smaill, 2004). The overall goal for the postpartum client with endometritis is, “The patient will be free from infection. ” Nursing management and general interventions of the patient would include the collection of vaginal and blood cultures, education on handy hygiene, the administration IV antibiotics and analgesics as prescribed.

Non-pharmacological interventions include distraction, imagery, relaxation, and application of hot and cold. Non-pharmacological interventions can restore the client’s sense of self-control, personal efficacy, and active participation in her care. It is essential that the information and method of delivery of information be tailored to the specific client and family (French ;amp; Smaill, 2004). Secondary to free from infection, an accurate nursing care plan for a postpartum patient with an with endometritis would include: 1.

The patient will follow a specific, mutually agreed upon, healthcare maintenance plan. (The nurse should assume that first-time mothers lack sufficient knowledge regarding condition and treatment diagnosis, and therefore, needs education and specific instructions during the postpartum recovery period). If a mother has given birth to more than one child a review of proper heath care regimens is also justifiable. The new mother should receive instruction pertaining to hygienic care for her perineal area. This care would include changing her perineal pad frequently and washing her hands afterwards.

The presence of a wet pad against sutures is an excellent medium for the development of an infection that could potentially spread to the uterus. The use tampons should be prohibited for six weeks after delivery, since tampon use can cause infection or even toxic shock syndrome. It is the nurse’s responsibility to promote adequate rest and encourage a generous intake of nutrients and fluids. The patient will report that pain management regimens achieves comfort function goal without adverse effects (Ackley ;amp; Ladwig, 2011).

The nurse should administer comfort measures to ease pain and teach the patient proper understanding of the condition as well as taking measures to correct the complications of endometritis (Perry, Hockenberry ;amp; Lowdermilk, 2010). 2. The patient will maintain oral temperature within adaptive levels (less than 100. 4 degrees). Evaluate the woman’s temperature at the end of the first hour postpartum and then every four hours for the first 22 hours postpartum. Clients with endometritis typically have a fever, chills, general malaise, and may exhibit tachycardia.

Oral temperature measurement provides a more accurate temperature than tympanic measurement, auxiliary, or use of a chemical dot thermometer. Use the same site and method device for temperature measurement for a given client so that temperature trends are assessed accurately (Ackley & Ladwig, 2011). 3. The patient will report that pain management regimens achieves comfort function goal without adverse effects (Ackley & Ladwig, 2011). The importance of prompt reporting of unrelieved pain is the patient’s responsibility.

An important step toward improved control of pain is a better client understanding of the nature of pain, its treatment, and the role the client needs to play in pain control (Ackley & Ladwig, 2011). Despite the normalcy of childbirth, complications may arise that will have detrimental effects on the postpartum client. These include postpartum hemorrhage, thrombophlebitis, and infections such as endometritis. Healthcare providers working with postpartum clients must have a clear understanding of these complications, including the symptoms, nursing interventions, and treatment.

A cognizant nurse would carefully review the results of laboratory tests for signs of anemia, infection, and electrolyte imbalance. Blood cultures to identify the causative agents of potential infections are typically done, and white blood cell (WBC) counts are monitored. However, it is important to remember that the white blood cell count is normally elevated after delivery for a short period; continued monitoring of the WBC count is required in identifying endometritis (French, L. , & Smaill, F. M, 2004).

Nearly 90% of women treated with an approved regimen note improvement in 48-72 hours. Delay in initiation of antibiotic therapy can result in systemic toxicity. Endometritis is associated with increased maternal mortality due to septic shock. However, mortality is rare in the United States because of aggressive antimicrobial management. Most cases of endometritis, including those following cesarean delivery, should be treated in an inpatient setting. For mild cases following vaginal delivery, oral antibiotics in an outpatient setting may be adequate (French, L. & Smaill, F. M, 2004). References Ackley, B. J. , & Ladwig, G. B. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care. (9th ed. , pp. 47,426-429,446-449,600-604). St. Louis, Missouri: Mosby Elsevier. French, L. (2003). Prevention and treatment of postpartum endometritis. Current Women’s Health Reports, 3(4), 274-279. Retrieved from http://www. ncbi. nlm. nih. gov/pubmed/12844449 French, L. , & Smaill, F. M. (2004). Antibiotic regimens for endometritis after delivery. Cochrane Database of Systematic Reviews, Retrieved from http://www. rw. interscience. wiley. com/Cochrane/clsysrev /articles/CD001067/frame. html Mazzeffi, M. A. (2010). Severe postpartum sepsis with prolonged myocardial dysfunction: A case report by michael a. mazzeffi and katherine t. chen. Journal of Medical Case Reports, (4), 318. Retrieved from http://www. jmedicalcasereports. com/content/4/1/318 Moldenhauer, J. S. (2008, November). Puerperal endometritis. Retrieved from http://www. merckmanuals. com/professional/gynecology_and_obstetrics/postpartum_care_and_associated_disorders/puerperal_endometritis. tml Nelson, C. B. (2010, January 22). Routine antibiotic use reduces mothers’ infection risk from c- section. Health Behavior News Service. Retrieved from http://www. physorg. com/news183387263. html Olsen, M. A. , Butler, A. M. , Willers, D. M. , & Gilad, A. G. (2010). Risk factors for endometritis after low transverse cesarean delivery. Infection Control and Hospital Epidemiology, 31(1), 69-77. Retrieved from http://www. jstor. org. proxy. li. suu. edu:2048/stable/10. 1086/649018 Perry, S. E. , Hockenberry, M. J. & Lowdermilk, D. L. (2010). Maternal child nursing care. (4th ed. , pp. 586-587). Maryland Heights, MO: Mosby. Pillitteri, A. (1999) Maternal & Child Health Nursing, (3rd ed. pp. 789-792). Philadelphia: PA: Lippincott. Rivlin, M. E. (2011, June 14) Endometritis. Retrieved from http://emedicine. medscape. com/article/254169-overview Scott, L. D. , & Hasik, K. J. (2001). The similarities and differences of endometritis and pelvic inflammatory disease. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 30(3), 332-41.

Desai pinky HSC601:-Healthcare Policy and Medical Ethics Date: – 10/06/2009 Question 2: What moral theories are the most important in the healthcare reform debate? The four moral theories which have been refereed in the book satisfy one or the other aspect of the ethical analysis and also keep the foundation for further analysis. However no theory satisfies all the relevant criteria. All the four theories have pointed out their ways and means to reach a decision which is correct and ethically considered.

All the theories have reached some of the goals in the common like autonomy, privacy, beneficence yet with different perspectives. The utilitarian mainly focuses on the value of the well being, which is analyzed in the terms of the pleasures, happiness welfare, preference satisfaction whereas the Kantianism believes that the morality is grounded in reason, duty rather than the sympathy, emotions. This indicates that the person have to act not only in an accordance with but for the sake of the obligation. Utilitarianism is divided into two: – the rule utilitarianism and act utilitarianism.

The rule utilitarian considers the consequences of adopting certain rules whereas the act utilitarian disregards the level of the rules and sticks only to the principle of the utility. Thus the advantage of the rule utilitarianism is that it considers the parameters like justice, beneficence and laws and legal rights which lacks in the act utilitarianism. Kantianism mainly rotates around the following objectives. According to Kant “maxim” is the moral worth of an individual’s action that depends exclusively on the moral acceptability if the rule on which the person acts.

Since the maxim applies to every individual that performs the similar act in the similar condition it has been declared as an universal law. The second objective of the Kantianism is the “categorical imperative”, which stresses the importance of the what must be done irrespective of our desires and the final objective of the Kant theory is the autonomy which typically refers to the judgments and actions one can take with their own will. However the importance of the autonomy is that if and only if the individual knowingly act in accordance with the universally valid moral principles that pass the requirements of the categorical imperative.

In the utilitarian theory the major flaw is immoral preference and actions. Even if the individual performs the act to produce the overall utility for everyone but if accidental the greatest possible utility is not achieved then the action will be wrong and it will be considered against the act. According to this theory the individual should perform the act in such way that it provides benefit to the most of the people regardless of their feelings and preference of their opinion.

This has led a question that an individual should have to consider every action and their consequence before implementing this theory. Additionally one has to take into account the proposed alternatives before performing the action as any unexpected results would prove utilitarian theory wrong and unethical as it was not able to provide the benefit to the society. Another major flaw with this theory is that difficulty in defining the line between morally obligatory actions and supererogatory action. The heroic donation of the bodily parts such as an kidney to save another person life is unethical.

Whereas with Kantianism the main flaw is the duty is given prime importance neglecting virtue, emotion. But these motives do count morally. Another major flaw is the conflicting obligation. It generally arises from a single moral rule rather than from two different rules, since it fails to take into account the consequence of the one situation, it becomes even more difficult when a conflicting condition arises at the same time. Both the theory attempts to explain the moral principles but have different viewpoints to guide the individual towards ethical analysis.

The utilitarian’s considers the act to be morally valid if the results produced provide maximal values in terms of happiness or pleasure. It holds that actions are right or wrong according to the balance of their good and bad consequence. If the actions have more good consequences then it is morally appropriate and if the actions have more bad consequences then it morally inappropriate. Since this is based on the individual context, this theory cannot be universally accepted and merely depends on the situational analysis.

As the utilitarian lacks the universal set of rules which defines morality, hence one has to analyze the situation individually. In outweighing the benefits of the good or bad consequences to attain the maximum utility and also considering the alternative consequences makes this theory bit complex, tedious and time consuming. Whereas Kantianism is based on the autonomous and maxim. One has to perform the duty at his will without considering the whether the consequences are favorable as he is imbibed to perform the duty which is otally contradictory to the utilitarian theory. From the analysis it seems that it is more logical theory and has a set of universal rules which has been widely used in the health care reforms and in the healthcare industry. From the above analysis , Kantianism theory seems to be more appealing to me but when the healthcare reforms are involved I feel every theory has their positives and negatives and should be included in the healthcare reform debates as every pieces of theory has a lot to provide to the health care reforms.

The Complete Lives System The allocation of healthcare has always been a huge issue in our society and the principles to allocate this resource also has come under fire. In the past it has always been “first come first serve” basis. Whether or not this approach is ethical is another question, but is it practical. The authors of “Principles for allocation of scarce medical interventions” have discussed a new approach called the Complete Lives System.

The complete lives system posses five principles for allocation that Include: ingest first, prognosis, save the most lives, lottery, and Instrumental value (Principles 6). The priority of this system Is to lad those who have not yet lived a complete life and will not be able to do so unless they get the aid necessary. This idea also considers many ethical factors such as saving the most lives possible, as well as a lottery, which takes into account the little information needed for recipients.

While this system is not practical for an entire economy at this point, it is a step closer to determining an appropriate approach to our health care system. The Complete Lives System is an ethically Justified and practical approach to health care because; it takes into account various practical approaches to healthcare, and it focuses on those able and capable to live a complete life with the public resources that they have used in the past. The Complete Lives system takes into account a variety of different principles used around the world.

As stated before, the core principle Is youngest first. The system focuses on “youngest first” by giving the priority to those between the ages of 15 and 40. The mall reason why this first approach Is ethically Justified Is that adolescents eve received substantial education and parental care, and these investments would be wasted without a chance at a complete life (Principles 6). These resources primarily schooling would be a waste if without aid necessary. Infants have not received this benefit so they should not be considered a factor for instrumental value.

They are also unable and incapable forming long term plans and values that some have already received before they turn 18. While alone this principle is impractical, the combination of prognosis and instrumental values makes this model ethically sound. Demand will always be larger than supply In the healthcare system it is almost an Inevitable factor when determining a correct model. The argument of which healthcare model should be used Is focused around who will receive the appropriate care, and who will be left out.

The abandonment of the “sickest first” Is ethically Justified based on the principle of prognosis. Factoring prognosis Into the model takes into account that large amounts of resources will not be use the majority of resources to those that can benefit the most? I believe so, and the tutors of this article also agree. If the care given to those terminally ill only give benefits of a couple of weeks or a few months compared to multiple years for those that are better off, it is hard to not see this as an ethically Justified model.

As I said before not every person is able to reap equal benefits of the healthcare system, no country possesses the resources capable of achieving this utopia. The most practical method is providing aid to those that can reap the most benefit from the care. Objections to the Complete Lives System is said to discriminate against older people. Everyone was once the age of 25 and able to seek the benefits of the system but why now that they are 65 that they cannot? Some tend to say that this is discrimination and “ageist”.

The system was designed to give each person an equal responsibility of living a complete life, which has been accomplished at the age of 65. They have already had the chance to live a complete life and reap the benefits designed by society such as education e. T. C. When the system is maximized, it is designed to offer the greatest benefit to those that need it. An adolescent offers more infinite to society in the future then an elderly one would. As an economics major I have always thought to look at decisions based on the opportunity cost, or the cost associated with an alternative decision that is forgone.

What would be the opportunity cost of choosing to extend an elder life potentially 10 years, over an adolescent for maybe 50-60? Obviously it depends on the specific person but the benefit to society by one living another 50 years triumphs one that only has a few left. If the United States would switch to the Complete Lives system then my current enervation would benefit greatly from this change. We would be able to look forward to the high possibly of benefiting from a “complete” life.

It gives a sense of relief knowing that if I were to develop an ailment in the near future that I would be able to get the care I need to regain of life. In contrast those that are past the age to be prioritize will not feel the same way about the system. One quote I found particularly interesting was the rule of rescue, “our moral response to the imminence of death demands that we rescue the doomed” (Principles 2). The Complete Lives System does not factor the sickest first, which usually is the elder generation.

Its hard to agree with the principle knowing that when I get older and my quality of life decreases, that I will not receive the same treatment as I once did. This is the only flaw of this system it does make you question whether or not it could be effective when it is put into action. Even with this flaw in the system it is still nice to know that the priority is given to those that have not lived a complete quality filled life. Recently I had a close family member of mine pass away at the age of 87. He had been dealing with various health problems the last 5 years or so and had been receiving pretty extensive medical care.

I definitely believe that under this system that he would not have received the same amount of care and most likely would not have lived as long. When the time came for my family and him to decide what the future plan of action would be, they decided he did not want to continue the treatment to only be in pain for maybe a couple extra months. When he passed it was very hard for all of us to accept the news and the decision but in the end it was to receiving the treatment he needed years ago under the Complete Lives System and looking at it now I probably would not want the system to apply.

I believe that this system is a step forward in the right direction for our healthcare system but any person is selfish in dealing with one of his or her own friends or family members. While I wouldn’t have wanted the system to apply to my family member I could accept the fact knowing that the resources necessary too keep him alive could be better used on someone else to increase their quality of life. The Complete Lives System uses a variety of different principles to try and have a concise system in place to designate who receives the appropriate care.

At this time it would be hard to put a system like this into place in somewhere such as the United States, but if used appropriately for the correct system it could be considered as an ethical approach to this big question. Some of the opposing viewpoints accurately generate questions about various aspects of the Complete Lives, but I believe that it is a legitimate policy that factors in all aspects of morality.