Below is a summary of Maya’s EHR activity during her four hours in the ED. As her ED physician, you are responsible for examining Maya, ordering tests and procedures and diagnosing her condition. Using her EHR, Virtual Physical Exam (VPE) and Internet research, answer the questions and be prepared to discuss the responses with the rest of Maya’s healthcare team.

1. Review Maya’s VPE: You assess Maya’s condition and review her vitals listed in her EHR. Maya’s blood pressure and pulse rate are high and you are concerned that Maya is having a stroke. You immediately begin performing the National Institute of Health’s Stroke Scale (NIHSS). Maya’s results show her score as a 24, which indicates that she has suffered a severe stroke. After reviewing her NIHSS score in VPE, which areas are of moderate and high concern?


2. Internet Research: There are three types of strokes. Your first task is to determine what type of stroke Maya is having.
   1. What are the three types of strokes? Provide a brief description of each.
   2. Which is the most common?
   3. Why is it critical for you to determine the correct one?


3. Internet Research: You write orders for an immediate CT scan of Maya’s brain as well as an angiography. Both of these tests provide different information that may be helpful in determining Maya’s diagnosis. Explain what information each of the procedures will provide in diagnosing a stroke.
   • CT Scan:
   • Angiography:


4. Review Maya’s ED EHR: What do the results of Maya’s CT Scan with Angiography indicate?


5. Internet Research: You determine that Maya is having an ischemic stroke and you will provide her an intravenous injection (IV) of tissue plasminogen activator (tPA). Why?

Below is a summary of Maya’s EHR activity during her four hours in the ED. As an ED nurse, in addition to preparing Maya for tests and procedures ordered by the physician, you are responsible for obtaining, reading and monitoring her vital signs. Using her EHR, Virtual Physical Exam (VPE) and Internet research, answer the questions and be prepared to discuss the responses with the rest of Maya’s healthcare team.

1. Review Maya’s ED EHR: As an ED nurse, you are responsible for collecting Maya’s vital signs (heart rate, blood pressure, temperature and respiration/breathing rate). Which of Maya’s vitals indicate a cause for concern?
   
   Internet Research: What are normal results / ranges for these vital signs?


2. Review Maya’s VPE: You prepare Maya for a CT scan and angiography. What are these tests and what will the results tell the physician?



3. Internet Research: The ED physician believes that Maya is suffering from an ischemic stroke. Why is quick treatment important for Maya?



4. Internet Research: You greet Maya’s daughter when she arrives. As a nurse you are required by law to follow HIPPA; which only allows for certain information to be shared. What can you legally tell Maya’s daughter about Maya’s health?

Below is a summary of Maya’s EHR activity during her four hours in the ED. As a laboratory or radiology technologist, you are responsible for obtaining and providing test results to assist the physician in diagnosing Maya’s condition. Using her EHR, Virtual Physical Exam (VPE) and Internet research, answer the questions and be prepared to discuss the responses with the rest of Maya’s healthcare team.

1. Review Maya’s VPE: Maya’s results must be obtained quickly. The physician orders a CT scan and an angiography. Explain what information these procedures will provide.



2. Internet Research: The physician has ordered several laboratory tests. Among the tests are: coagulation, lipid panel, complete blood count (CBC) and basic metabolic panel (BMP). How do these tests help determine if a stroke has occurred?
   • Coagulation
   • Lipid panel
   • CBC
   • BMP


3. Review Maya’s ED EHR: What results are abnormal (as indicated in blue or red)?

Below is a summary of Maya’s EHR activity during her four hours in the ED. As a pharmacist, you are responsible for ensuring that Maya receives the proper medications and dosages ordered by the physician. You are also responsible for reviewing any adverse interactions Maya might have with her current medications. Using her EHR, Virtual Physical Exam (VPE) and Internet research, answer the questions and be prepared to discuss the responses with the rest of Maya’s healthcare team.

1. Review Maya’s ED EHR: You are responsible for ensuring that the medications prescribed by Maya’s physician do not interfere with her current medications or allergies. What is Maya’s allergy?
   
   Internet Research: Why is it important that you are aware of Maya’s allergy?



2. Internet Research: Maya’s EHR indicates (in Home Medications) that she was taking Altace, Zaroxolyn and Toprol-XL prior to admittance. What type of medication is each drug and what is its use?
   • Zaroxolyn:
   • Altace:
   • Toprol-XL:


3. Review Maya’s VPE: The physician orders a tissue plasminogen activator (tPA). Using information from VPE, what does a tPA do?

Below is a summary of Maya’s electronic health record (EHR) activity during the four hours she is in the ED. As a medical and health services manager, you are responsible for ensuring that she receives excellent care. You will also figure Maya’s bills, consisting of her tests, procedures, room charges, supplies and medications. Using her EHRs, Virtual Physical Exam (VPE) and Internet research, fill out the billing statements and be prepared to share this information with the rest of Maya’s healthcare team.

• MHSM – Bill (which includes both an PCP and Outpatient statement)
• MHSM – Bill Reference
• Maya’s EHR – ED Chart (link below)
• Virtual Physical Exam (VPE) (link below)
• Maya’s EHR – Inpatient Chart

1. Use the blank copy of Maya’s ED and Inpatient bills and the Bill Reference to calculate her costs. In her EHRs, look for the number of times a test is administered, number of days a cost is incurred or the units per day a medication is administered. You may need to do additional Internet research. Some helpful sites are www.healthcarebluebook.com, www.fairhealthconsumer.org and www.pharmacychecker.com

Below is a summary of Maya’s EHR activity during her four hours in the ED. As a health coach, your job is to recommend lifestyle changes to alleviate symptoms, prevent symptoms from recurring and decrease the need for future emergency care or hospitalization. You will also provide the education she needs to understand her diagnosis and the risk factors that may have caused her condition. Using Maya’s EHR, Virtual Physical Exam (VPE) and Internet research, answer the questions and be prepared to discuss the responses with the rest Maya’s of healthcare team.

1. Internet Research: As a health coach, you want everyone to know the warning signs of a stroke. What are they?



2. Review Maya’s VPE: As Maya is being cared for in the ED, you begin to plan for her recovery. You review her National Institute of Health Stroke Scale (NIHSS) in VPE and notice several issues that are of concern. What are those areas?
   
   Internet Research: What are some of the challenges a stroke survivor with these issues might hope to overcome?



3. Review Maya’s ED EHR: In reviewing Maya’s EHR and medical history, you discover several areas Maya can improve to decrease her risk of having another stroke. In what areas can she improve?