Cost analysis paper

This is a little assignment that I did for class recently..
Treatment decisions made by healthcare professionals affect the outcomes of patients and the costs to the healthcare system tremendously. It is important for Nurse Practitioners to be up to date with research relating to different admission diagnoses.
Scenario: Pt is admitted with generalized abdominal pain. Pt complains of heartburn, upset stomach and one case of diarrhea. WBC count is slightly elevated and low-grade temperature of 100.0 is present. Stool studies for WBC, C-Diff toxin, occult blood, ova and parasites are sent. This patient has never been diagnosed with GERD prior to admission. Clinical treatment decision issue involves whether or not to place this patient on a proton pump inhibitor to treat for GERD due to request for “something for this horrible heartburn”.
Option 1: Give patient Mylanta PRN for heartburn. Stool studies continue to be negative. GI specialist recommends EGD as outpatient to rule out hiatal hernia and GERD. Pt discharged to home after temperature resolves and is scheduled for EGD.
Option 2: Stool studies negative for C-diff, and O&P. Treat patient with Nexium 40mg PO daily. Heartburn is resolved but with concurrent use of antibiotics, this patient develops diarrhea with a foul odor and is now positive for C-difficile resulting in 5 days of hospital stay and use of private room and contact precaution equipment.
It is estimated that C. difficile infections cost over 1.1 billion healthcare dollars (U.S.) each year and significantly extend the length of hospital stay by an average of three days when compared to patients whose hospital course was not complicated by C. difficile infection. Research as shown that use of proton pump inhibitors on patients with no known reason for heartburn (hiatal hernia, GERD) increases the chances that C-difficile infections will occur due to the reduction of natural acids that may inhibit it’s growth. Furthermore, in the cohort study, patients at greatest risk were those who received multiple antibiotics in addition to a PPI. A case-control study, in which patients were matched based on antibiotic therapy, number of antibiotics and renal dysfunction, also showed a positive association between PPI use and C. difficile infection. (Yam, 2005)
Therefore based on current data, I would not arbitrarily prescribe PPIs to patients in the hospital with no known GERD diagnosis in order to reduce the potential for C-difficile infection. The costs of extended hospital stays which insurance will no longer pay for due to DRGs and the risk of cross contamination to other patients of the C-difficile infection, I would choose Option 1 as a treatment base.

Good advice from Azygos!

I was poking around on Azygos's site and found some excellent advice for Nurse Practitioner Students.. You can bet I will be following his advice. It is very important to network and ask other NPs what kinds of experiences that they have had and LEARN from them early.

Nursing Theory

Regarding my opinion on "nursing theory", I'm going out on a limb, and am a little controversial maybe when I say that I have found that most theories just repeat what others have already said. While it is interesting to explore the past and understand the framework of nursing theory, I am more interested in where nursing is going. As nurse practitioners, we must learn to blend the nursing theory with medical theory because we are now stepping into the "diagnostic" mode as well. That blend is what makes nurse practitioners unique. We combine the best of both worlds to better care for our patients. We learn, we watch, and we apply what we see. Nurses take "care" of the patient mind, body, and sometimes soul.
This is what makes nursing different from any other profession.

Patients that touch your heart

While talking to the current group of nursing students, one asked if I had a particular patient that stuck in my mind. I told her that I had many patients that have touched me in some way, but the first as a new nurse was a 70's year old female who had suffered an aphasic stroke. She couldn't speak at all and could only smile or nod. During the three days I took care of her, the tech and I would do her daily care and the assessment would commence. All the while, I would talk to her constantly even though she couldn't respond. On the third day, she was to be sent back to the nursing home. Right before transport arrived, I went over to her and leaned in and said that it was nice to meet her but I hoped not to see her again her in the hospital. Slowly, she raised her good hand and stroked my face and smiled. Tears ran down my face as I gave report to the transport personnel and I knew that they must have thought that I lost my mind.. I never did see her in the hospital again because she passed a few weeks later at the nursing home. I like to think that she felt that she was cared for while I had her..
Remember what we are here for!!!

Quit bitching and get out of the way!

I have just signed up for the summer classes. (Advanced Patho, Legal and Ethical Issues, and another Theory class) There were a grand total of nine days off in between semesters and it's not nearly enough. I have been in school for the last two years completing my BSN and jumped right into the NP track.
"Why do you do this?" "Aren't you satisfied to be a RN?" "Don't you want to just spend time with your family without worrying about all that?" These are questions I get on a daily basis at work. I am surprised by the negativity I get from other nurses when I tell them that I am pursuing my NP, let alone when I went back for my BSN. Often we hear of nurses eating their young, but we often will try to sabatoge others when they try to educate themselves as well. The usual comments include "Who does she think she is?, "I've been a nurse longer than she has." This is sad because we should be lifting each other up and giving encouragement whenever possible. No one is going to look out for us, but ourselves. I'm truly sorry that nurses have felt stuck in a rut and are so burned out that they work only for the money. After offering to help, one can only go on and leave them bitching behind in the mud.

I was thinking of reasons why "I do this to myself" to keep me motivated. So here's my list, so far..
1. I am a human knowledge sponge. I like to learn new things, especially medical...
2. I want to make a difference in my patient's outcomes. I believe that only by educating myself and keeping up with standards of practice can I do this.
3. I am working toward a higher level of income so that I can give my family things they need and some they just want for a change.
4. To prove to those that have told me my whole life that I would never amount to anything, that I did! (You can all bite my ass!!) Sorry for the diatribe..
5. Because I can.. Some people don't have the opportunity to further their educations, especially in other countries of the world.

My advice to other nurses who are thinking of furthering their educations is this.. If you truly want to, do it!!! Make a list of reasons for yourself and do some research and you will find a way. And for those that don't, quit bitching and get out of the way!!!