...research and development, described the pros and cons of the project, a proposal to develop a new portable electrocardiograph machine (EKG) specifically for the Indian market. Cherian believed the time was right to tackle the tough, but fast-growing Indian market. The key question was whether Bella India’s local R&D team, under Manning’s direction, was ready to lead the product development: My goal has always been to develop products that serve emerging markets and make healthcare more accessible. I think medical device companies are learning that this can be done most effectively by those who know these markets best. We should develop our affordable EKG in India, for India. Bella India has proven itself in manufacturing and cost- engineering; this is the next logical step. The endeavor was not without risk. The costly failure of Project Baton, a global product development effort, was fresh on everyone’s mind. Failure with Project TKO would not only hurt Bella Healthcare’s overall profitability, it would undermine Cherian’s case that the India operation was ready for more challenging product development undertakings. Industry Background: Electrocardiogram Equipment Electrocardiography, commonly referred to as EKG or ECG, is the measurement and interpretation of the electrical activity of the heart as it contracts. An EKG enables physicians to assess cardiac health—the regularity of heartbeats, the size and position of the chambers, the identification...
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...Case Studies on Cardiac Function This is the first case study that is required for the class. Please submit a paper (doesn’t have to be long; you could even give me bullet-point answers to the questions listed below) that answers all of the questions posed after Case Study 1. I have included an easy second case study which, if you complete it, will be worth extra credit. Answers to the first Case Study are worth 25 points and responding to Case Study 1 is required work for the course. The extra credit, which is not required, will be worth a total of 10 points. Case 1 A.O. is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl, and sublingual nitroglycerin. Discussion Questions 1. Which type of heart failure (left or right sided) is usually associated with dyspnea? Left-sided heart failure is usually associated with dyspnea. What other clinical findings are likely to be present with left-sided heart failure? Other clinical findings that are likely to be present with left-sided heart failure include radiographic cardiomegaly, abnormal apical pulse and...
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...If the QRS is present and the pattern is sever, it is a sign of atrial flutter. Also, a sine wave shows ventricular flutter, and the absence of P waves with wide QRS complexes is ventricular tachycardia. Therefore, it is very important to consider the rate and rhythm of the heart beat in ECG recording. Moreover, axis is another factor that we can study from the ECG recording for clinical diagnosis. The QRS axis shows the direction of the ventricular depolarization in heart beat. A normal QRS axis should be in the range of −30° to 105°. If this value is more than +105°, right axis deviation, it shows right ventricular hypertrophy or left posterior fascicular block. If this value is less than −30°, left axis deviation, it shows a left ventricular hypertrophy or left anterior fascicular block. Also, the waves and the distance between them have a normal range of time duration and the amplitudes (voltages). P wave larger than 80ms represents atrial enlargement, PR wave larger than 200ms indicates first degree atrioventricular block, tall QRS complex indicates left ventricular hypertrophy,...
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...Should Bella Healthcare India take on Project TKO and develop an EKG specifically for the local market? Why or why not? TKO, “Technical Knockout”, is single channel EKG, Bella Healthcare India is planning to launch in Indian market. As per my opinion, Bella has many reasons to take up this opportunity. I will categorise these reasons in two broad categories, External and Internal factors. First external factor that affects decision of Bella to take TKO is large population of India with insufficient health care services. India’s population is large and growing but healthcare facilities are not growing with the same rate. Also most of the medical facilities of the country are concentrated in urban areas, leaving rural area with insufficient healthcare facilities. Unfortunately, most of the Indian population stays in small towns and villages. Another fact, in line with this, is availability of less no of physicians and specialists in the field of heart diseases. This has created room for medical services and devices sellers to expand their businesses in the country. The EKG global revenue chart shows that between 2010 and 2015, 9% – 12% of the global revenue will come from Asia-Pacific. As one of the second highest population country in Asia-Pacific, India will definitely contribute major portion of the revenue. The figures in the chart substantiate the fact that Bella has good scope to expand its services in the country. Second factor that helps Bella to take go ahead decision...
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...had previously implemented two different approaches to cutting physician-driven costs; however both approaches failed. After analyzing the previous failures, Hammer felt that reducing physician-driven costs must be done one physician at a time. Hammer believed by producing short-term wins employees will realize that change is necessary and can be done successfully, therefore generating buy-ins from employees who were otherwise opposed to the change process. Hammer brought in Marge Harding, COO of General Hospital, to help with the change process. Harding was given the task of finding areas where cost-reduction was necessary. (Hellriegel & Slocum, 2011) Marge Harding decided after reviewing each candidate’s pros and cons that the EKG readings cost the hospital well over $100,000 each year (Hellriegel & Slocum, 2011). EKG’s were interpreted by Dr. James Boyer, an attending cardiologist. Dr. Boyer provided on-time and accurate results for the past 15 years at General Hospital. Harding believed by eliminating...
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...DIFFERENCE IN COMPETENCIES BETWEEN NURSES WITH ASSOCIATE DEGREE AND BACCALAUREATE DEGREES Kelly Matthews Grand Canyon University: RN to BSN NRS 430 V – PROFESSIOANL DYNAMICS 06/14/12 Abstract This is an attempt to analyze the differences in competencies between the nurses with Associate Degree (ADN) and Bachelor’s degree (BSN) in Nursing. The contemporary nursing career demands critical thinking, effective communication skills and comprehensive knowledge. To be equipped with these attributes, a Nurse must pursue at least the BSN degree program. The salient points considered for this analysis and finding are: • A comparison of curricula of both programs. • Increasing requirement of Educators, Researchers and Administrators in Nursing. • Patient safety, quality of care, sync with technological advancements. • A patient care situation. DIFFRENCES IN COMPETENCIES OF NURSES WITH ASSOCIATE DEGREE AND BACCALAUREATE DEGREE Education is an infinite process. Everyday, new developments emerge and new deceases and remedies discovered. The overall outlook of healthcare professions has dramatically changed in the past few decades. Nursing plays a very critical and important part in efficient care and patient safety. Nurses work shoulder to shoulder with physicians in treatment planning and management. Legal and ethical responsibility of the care provided is also increasingly shared by the Nurses. Nursing profession thus calls for better qualified and well groomed...
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...Case Study of DKA Patient Anonymous Student Name College or University Name Your Nursing Class # Instructor’s Name November 18, 2011 R.C. is a 42 year old Native-American male that presents to the ER today generally looking ill and, appears to be 10 years older than his stated age. He is dehydrated, and has had Type 1 diabetes, which was diagnosed ten years ago. He has been sick for the last 2 days; as stated by his wife, “I brought him in today (ER) because he is just not getting any better.” Mrs. C. also said that her husband has vomited, over the last 2 days. R.’s chief complaint (c/c) is abdominal pain, voiding frequently, and hasn’t been taking insulin due to nausea. Vital signs (RR) 32, and oxygen saturation (SAO2) 95%. He is alert & orientated (A&O) A&O x 1 (oriented only to person), and his mouth and mucous membranes are very dry. Doctor’s Orders: After seeing Mr. C. the doctor orders: CBC, Chem Panel, Electrolytes, UA with ketones, ABG, 12 lead EKG, and sliding scale insulin to be given IVP, oxygen at 2L/min per nasal cannula, and IV bolus of 500 cc/NS. After initiating a peripheral IV catheter, blood samples are drawn for labs and the nurse administers the 500 cc/NS and rechecked VS: Temperature (T) 100.3, P-106, BP-92/56, and RR-28. Labs The labs return with blood glucose of 625, K+5.3, bicarb (HCO3) 8 mEq/l, large amounts of ketones in urine and serum. ABG of pH-7.19, PO2-89, CO2-25, and HCO3-15. EKG The EKG is noted for...
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...Case Study James Morasco College of Southern Nevada – Nursing 211 Clinical Professor Judith Alewel, MSN, RN October 15, 2012 Introduction AV is a 57 year old male whom presented to the Emergency Department of Valley Hospital Medical Center in Las Vegas, NV on September 7, 2012 with the classic signs and symptoms of a left-sided middle cerebral artery (MCA) infarct and was admitted to the medical intensive care unit (MICU). These signs included left sided facial drooping, non-reactive left pupil, right sided weakness in the upper and lower extremities, and the inability to speak. Along with the signs and symptoms of the stroke, a 12-lead EKG revealed that he also has atrial fibrillation. The initial computerized tomography (CT) scan of his brain revealed nothing, but a subsequent MRA (magnetic resonance angiogram) concluded that he did, in fact, have an occluded branch of the left MCA that eventually converted to become hemorrhagic and he was admitted to the MICU. The MRA also found a persistent left trigeminal artery, which is insignificant to his presenting disease process. Along with all of this, a two dimensional echocardiogram revealed some significant hearts problems that will be discussed later. I cared for this patient during the clinical shift on September 18, 2012. History and Physical The only history and physical that was available in this patient’s chart was some narrative comments from his daughter notated by the physician, and this is most likely due to...
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...Case Study: Coronary Disease Laura Kwan Past Medical History: - tonsils removed as a child - no regular medication - takes reloads occasionally Family Medical History: - father died of myocardial infarction at age 52 - mother is 73 and in good health Social History: - moderately heavy social drinker - 2-3 beers after work - 5-6 beers per day on weekends - smokes a pack of cigarettes a day - married with two children - finances are stable History of Present Illness: - woke up at 4am with pressure in his chest, described as “worst indigestion I ever had” - sweaty and slightly short of breath - achy, heavy feeling in his right arm - ate pizza before bed (unhealthy) - took four Rolaids initially - didn't bring any relief - sitting made the pressure settle down - he was clammy - pressure on his chest persistently for approximately two hours - put on oxygen mask - nurses concerned about his EKG - EKG showed 1 cm ST elevation on leads V2,3,4,5 with slight ST depression on leads 2,3 and AVF Physical Examination: - heart rate was 110 (high heart rate) - respiratory rate was 22 (high respiratory rate. Should be 16-20) - blood pressure was 160/100 (high bp) - sweaty, pale, and had no obvious jugular venous distention - chest was clear on auscultation - abdomen was unremarkable - skin was slightly sweaty - chest x-ray was normal with normal heart size - lab work was normal Research: Heart Problems - closely linked to diet and lifestyle choices ...
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...Introduction Nursing is a dynamic and diverse profession. One of the most debated issues regarding nursing is the standardization of entry level requirement, such that, all Registered Nurses should have a minimum education level of a Baccalaureate degree. “Differentiation of practice debates that have plagued nursing for the past 50 years started in the early 1960’s when a preliminary report by the Surgeon General’s Consultant Group on Nursing stated nurses in leadership positions should have a minimum of BSN preparation” (Orsolini-Hain, 2009, pp.266-271). By comparing the competencies of both the ADN nurse and the BSN nurse, one may begin to understand why there is such an ongoing debate about the educational qualifications of each of these nursing types and how they relate to entry level practice. “Ironically, though, nursing continues to allow many pathways into practice and has yet to reach a consensus about the educational qualifications needed by entry-level practicing nurses” (Creasia, 2011, pp.11-25). Associates Degree The Associates Degree nurse is required to complete a minimum average of 70 credit hours. These credits can take up to 4 years to complete depending on the school and the educational aptitude of the student. The ADN program was designed to be only 2 years in length and was created to help quickly increase the quantity of nurses available to offset the nursing shortage. “Associate degree nursing programs are designed to be 2 years in length and consist...
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...IT’S MY BIKE Debbie Martin was overjoyed when she was selected the new Supplier Quantity Manager for the commercial product division of Cold Air Corporation. In this role, she was responsible for monitoring the quality of component parts for twelve production lines scattered throughout the large manufacturing plant. When she started the new position, Debbie knew she would be faced with many opportunities and conflicts. Her immediate supervisor, the manager of shipping and receiving, was not known as an easy person to work for. He expected his subordinates to have a take charge attitude and to avoid bothering him with trivial issues. What Debbie had not envisioned was just how trivial and non-productive some of the conflicts in her new position would be. She certainly had not expected to be on the verge of a fistfight. Debbie was just starting her shift when she received a telephone call from Ronnie, one of her subordinates. Ronnie was a purchasing parts inspector, and was responsible for inspecting certain incoming parts for all production lines in the plant. He was complaining that the Airhandler Quality team had borrowed “the bike” for a special project and would not return it. He reminded Debbie of his current project and how covering the entire 15-acre plant on foot would only delay completion of the project. Debbie rolled her eyes as she thought about the logistics of inspecting component past’s three separate buildings. She also realized that Ronnie had a...
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...19 CASE The Case for Open Heart Surgery at Cabarrus Memorial Hospital Situation It was a clear, crisp October morning in Concord, North Carolina. The board of trustees of Cabarrus Memorial Hospital gathered in the windowless, walnut paneled boardroom for its monthly meet- ing (see Exhibit 19/1 for board members). Board chairman George Batte opened the meeting saying, “Because we do not have an open heart surgery program, patients needing open heart surgery or coronary angioplasty have to be transferred to another hospi- tal, causing inconvenience to the patient’s families and risks from delayed treatment. There are several questions we have to answer in addressing this issue. Should we add open heart surgery to the mix of cardiac services we offer? Does the hospital’s existing service area provide adequate patient volumes to support the program? What This case was written by Fred H. Campbell, The University of North Carolina at Charlotte, and Darise D. Caldwell, Executive Vice President and Chief Operating Officer, Northeast Medical Center. It is intended as a basis for classroom discussion rather than to illustrate either effective or ineffective handling of an administrative situation. Used with permission from Fred Campbell. 804 Exhibit 19/1: CMH Board of Trustees Mr. George A. Batte, Jr., Chairman (Retired Manufacturing Executive) Mr. L. D. Coltrane, III, Vice Chairman (Telephone Company President) Mr. Robert L. Wall (President, Cabarrus...
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...Performance With concentration in Sport Administration April 2013 Abstract The purpose of this study is to determine if college athletes that are predisposed to heart defects develop a heart defect during their athletic career. The researcher will conduct a causal comparative study to prove that college athletes that are predisposed to heart defects develop one during their athletic career. The study will examine college athletes that are predisposed to heart defects and do not realize they are at risk for possible development of a heart defect during their athletic career. Knowing an athlete’s family and medical history could help prevent a great deal of possible health conditions. Athletes have a higher risk of developing a higher risk if they are predisposed. There are athletes that do not realize that they are predisposed to heart defects and that they could develop one. Table of Contents Introduction 5 Background 5 Theoretical Framework 6 Statement of the problem. 6 Research question. 6 Purpose for the study. 7 Significance 7 Limitations of the Study 7 Definitions of Terms 8 Arrhythmias 8 Athletic Career 8 Electrocardiogram 8 Hypertrophic cardiomyopathy: 8 Sudden Cardiac Death: 8 Review of Related Literature 9 What is causing the sudden death of young athletes? 9 Successful Prevention 10 Role of NCAA 11 Summary 12 Methodology 13 Design 13 Setting and Participants 13 Data Collection 14 Treatment of the Data...
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...Chapter 51. Enhancing Patient Safety in Nursing Education Through Patient Simulation Carol Fowler Durham, Kathryn R. Alden Background The alarming rise in morbidity and mortality among hospitalized patients throughout the United States heightens concerns about professional competency.1 Nurses and other health care professionals are under increased scrutiny to provide safe, effective care. Likewise, nursing education programs are faced with increased pressure to produce graduates who are capable of providing safe patient care. Toward that end, nursing education programs develop curricula, hire qualified faculty, and select learning experiences for students in an effort to train and graduate competent, effective nurses. The instructional strategies utilized in both didactic and clinical components of nursing education courses are highly influential in determining critical thinking and clinical decisionmaking ability as well as in developing the psychomotor skill performance of new graduates. Of course, it is unrealistic to think that graduates of nursing education programs have received all the training they need when they depart the doors of academia. Orientation programs for new graduates and continuing education for nurses are essential tools to help practitioners improve their knowledge, skills, and expertise so that quality patient care is provided and outcomes are optimized while errors are minimized. Ongoing evaluation of nursing competence is necessary...
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...Cardiovascular Case Study Mr. Smith is a 56-year-old Caucasian man who is being evaluated in the emergency room with progressively worsening chest pain that began 2 hours ago. The patient describes the pain as pressure in the center of his chest. He rates his pain 7/10. He reports the pain is now radiating down his left arm and through to his back, he is diaphoretic, and complaining of shortness of breath. He denies nausea or vomiting. Mr. Smith reports no previous history of chest pain or pressure. He smoked one pack of cigarettes daily for 13 years but quit smoking last year. He denies a family history of heart disease. Upon initial examination he did not have jugular venous distension, no carotid bruits, normal S1 and S2 with an S3 present. No S4 or murmurs auscultated. Lung sounds clear to auscultation bilaterally, bowel sounds normal, all pulses palpable 2+/4, no edema present. Diagnostic data: BP: 165/98 mmHG HR: 96 bpm RR: 30 breaths/min Temp: 37 C SaO2: 96% with 2L/min O2 per nasal cannula Wt:100 kg A 12-lead ECG was performed in the emergency room showed: Normal Sinus Rhythm (NSR) with frequent premature ventricular contractions. ST segment elevation in Leads 1, aVL, and V2 through V6 (3mm). ST segment depression in Leads III and aVF. Q waves in V2 through V4. The chest X-ray revealed slight cardiomegaly with mild congestive heart failure. An echocardiogram reveals an ejection fraction of 30% and mild mitral valve regurgitation. Mr. Smith’s...
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