Discussion Week 1: Introduction to Health Care Delivery, Part 1

Is health care a right or a privilege? Well, in my honest opinion it should be a right to all but it looks like it’s becoming a privilege because not everyone can afford it these days. There are plenty of people, poor people, who can’t afford health care. Being a health care professional, I have noticed that upper class and upper-middle classes are the ones who stay in good health for the most part. Poor people don’t get to the hospital until its too late sometimes. That is partly because poor people cannot afford routine yearly examinations or tests. Also, it is getting tougher to locate doctors who take Medicare or Medicaid since they get compensated pennies to dollars. Many physicians don’t want to deal with that. Whereas, upper class or the upper-middle class go to the doctor for anything that makes them seek medical attention. (Knickman and Kovner, 2015, p5) states that, adequate family incomes, high-quality education opportunities, and being socially connected are all key factors that predict the health of a given person. Nurs 6050 Week 1 Discussion: Policy and Advocacy

What role does the government play in U.S health care? I believe that the U.S government plays a major role in the delivery of health care to its population. We have come a long ways from the early days. Most 19^th century Americans received health care in their homes, often from family members who relied on traditional healing techniques (Knickman and Kovner, 2015, p31). As the population grew so did new ways of delivering health care to the population. The government had to come up with programs like Medicare, Medicaid, and CHIP. However, as I stated in the earlier paragraph, it can get challenging to locate physicians who honor those programs. On another note, the government should make an effort to change the way we pay for health care services: The idea is to encourage value-based purchasing and pay for performance rather than traditional models that provide a preset fee for each service provided Knickman and Kovner, 2015, p49).  Health care is a complex subject in today’s politics. I think it will take quite some time to reshape health care in United States.

There is also a major ethical issue how health care is being delivered in this country. Insurance companies have too much power.  They don’t want to pay or insure for pre existing conditions. Which I think is very unethical in my opinion. Even if one is insured, I have seen instances as a health care professional where insurance companies don’t want to pay for certain diagnostictests just because of the cost, which to me is not ethical. Even when physicians have an appropriate amount of autonomy in their practice, pressure from administrators and insurance companies leads to a conflict of interest in which the physician is forced to weigh the costs of going against the administration with their own duty to help their patients (Castlen et al., 2017). Physicians should be free to work according to their own professional ethics without financial incentives or fear of damage to their career, as stated in the American Medical Association Code of Medical Ethics (Castlen et al., 2017). Nurs 6050 Week 1 Discussion: Policy and Advocacy

Reference:

Knickman, J.R., &Kovner A.R. (2015). The Challenge of Health Care Delivery and Health Policy. In J. Steven (Ed.), Health Care Delivery in the United States. New York , NY : Springer

Joseph P. Castlen., David J. Cote., Wouter A. Moojen., Pierre A. Robe., NaciBalak., JannickBrennum.,…Marike L.D. Broekman. (2017). The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice. Retrieved from http://ac.els-cdn.com.ezp.waldenulibrary.org/S1878875017303960/1-s2.0-S1878875017303960-main.pdf?_tid=1d64111a-4651-11e7-8b53-00000aacb35d&acdnat=1496270166_290dd482603d9a6f98d4bbf807cfbc9b

NURS 6050 week 1 discussion

Patient Scenario

A 30-year-old, Caucasian female presented to the emergency room complaining of severe epigastric and right upper quadrant (RUQ) pain, nausea, vomiting, and fever. Her medical history is only significant for irritable bowel syndrome and endometriosis. The only medication the patient takes is a birth control pill daily. The patient stated that the pain started about four hours ago, but has steadily increased. She denies any significant changes in her diet or recent abdominal injuries but says she has eaten a lot more over the past week because of the Thanksgiving holiday. The patient says she is very busy between working and taking her kids to after school activities, so they often eat fast food and she requires a lot of caffeine throughout the day, so she doesn’t drink much water. Upon physical examination, bowel sounds present in all four quadrants, RUQ guarding, tenderness noted to entire abdomen upon palpation, no rebound tenderness, but Murphy’s sign was positive.

Impacting Factors

This patient is suffering from cholelithiasis (gallstones) with an influencing factor of behavior, specifically because of dietary habits. Cholelithiasis is the process of gallstones forming (Pak & Lindseth, 2016). “Gallstones are hardened deposits of digestive fluid that can form in your gallbladder” (Mayo Clinic, 2013). Some impacting factors to this disorder are: being female, eating a high-fat, high cholesterol, low-fiber diet, and taking medications that contain estrogen (Mayo Clinic, 2013). The patient admits to eating fast food frequently which typically means the food she is eating is high in fat, high in cholesterol, and low in fiber. She also said she took a birth control pill daily. A majority of birth control pills contain estrogen and progesterone to prevent pregnancy. NURS 6050 week 1 discussion

Pathophysiology and Associated Alterations

There are two common types of gallstones: cholesterol and pigmented. “Most are composed largely of cholesterol with or without calcium deposits” (Hammer & McPhee, 2014). Cholesterol gallstones form when the cholesterol concentration in the bile is greater than its solubility percentage (Hammer & McPhee, 2014). Having a higher percentage of cholesterol causes cholesterol crystals to form called “microstones” (Huether & McCance, 2012). More crystals collect on the microstones, growing “macrostones” (Huether & McCance, 2012). This process occurs in the gallbladder because of decreased motility. “The stones may lie dormant or become lodged in the cystic or common duct, causing pain when the gallbladder contracts and cholecystitis” (Huether & McCance, 2012). If cholecystitis occurs and is left untreated, it can progress to acute pancreatitis “if a stone travels down the common bile duct but fails to clear the sphincter of Oddi, thereby blocking the pancreatic duct” (Hammer & McPhee, 2014). An infection and necrosis may also occur if the gallbladder is left untreated, putting the patient at risk of becoming septic (Hammer & McPhee, 2014). NURS 6050 week 1 discussion

References

Hammer, G. D., & McPhee, S. J. (2014). Pathophysiology of Disease: An Introduction to Clinical Medicine (Seventh ed.). New York, NY: McGraw Hill Education.

Huether, S. E., & McCance, K. L. (2012). Understanding Pathophysiology (Fifth ed.). St. Louis, Missouri: Elsevier.

Mayo Clinic. (2013, July 23). Diseases and Conditions: Gallstones. Retrieved from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/gallstones/basics/definition/con-20020461

Pak, M., & Lindseth, G. (2016). Risk Factors for Cholelithiasis. Gastroenterology Nursing, 39(4), 297-309.