The nurse administers cimetidine to a 75-year-old client diagnosed with a Gastric ulcer the nurse should monitor the client for the following adverse reactions Headache, Sleepiness, Confusion, Dizziness, Nausea which contribute for the change in Metal status.
- Cimetidine is a H
Receptor Antagonist. - Gastric partial cells contains receptors for Histamine.
- Histamine is released from the Enterochromaffin cells upon the stimulation from food intake or from Vagus nerve stimulation.
- Thus Histamine released from Enterochromaffin cells binds to H receptors on the parietal cells and increases the secretion of HCl.
- Cimetidine has totally opposite effect and decreases the secretion of HCl from the parietal cells.
- Not only on gastric cells H receptors are also present in CNS where they stimulate brain cells.
- The above point justifies the adverse effects of Cimetidine.
- Patients over the age of 50 or those who are severely ill may experience transient confusion while taking H
blockers, particularly cimetidine.
Hence from these points we can conclude that patients who are above 50 years and receiving Cimetidine medication for gastric ulcer should be monitored for the above mentioned adverse reactions.
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A Drug Trend report published in 2009 had predicted continued price increase among traditional branded and biotech drugs that lack generic competition. Now, further, CMS has reduced its Average Sales price (ASP) margin from 6 percent to 4 percent for non-pass-thorough. This has affected pharmacy reimbursement. However, there are certain other aspects of Pharmacy Billing that can affect reimbursement and thereby the Revenue Cycle Management (RCM) process if not well implemented.
1. Data Workflow:
Recognizing how the revenue cycle works in pharmacy is very essential. Procurement to Inventory, billing and reimbursement involves purchase of medications, their storage, and method of dispensing, how they are administered, way they are coded & billed, and finally reimbursed. If the drug is covered as a pharmacy benefit, or the payer needs that to be obtained via a specialty pharmacy as identified through patient-specific benefit verification, then here both the provider and the pharmacy are part of the reimbursement process. The physician writes a prescription and orders the drug. This is followed by the pharmacy that fills the order and issues the drug to the physician, CMHC, or hospital outpatient department. Here the pharmacy bills the insurance company for the drug. If any information is entered incorrectly into the pharmacy system in the initial phase of the cycle, errors can prove to be costly, impacting aspects of clinical and revenue cycle.
2. Procurement:
During this phase information is converted from purchased quantities and pricing to storage units of measure (UOM) and inventory costs. Manually entering the data is followed in most cases. UOM conversions, when data is uploaded from the wholesale distributor to the pharmacy system, are also checked and verified manually. Here too mistakes can lead to breakdown in the revenue cycle management (RCM) process.
3. The Charge master:
Critical & substantial revenue leakage can occur when separately reimbursable medications are either missing from or miscoded in the charge master. Conversion of pharmaceutical quantities is a must from purchased amounts to patient-administered amounts, and only then made billable. There is often a difference between dosage amounts required for patient use as from that purchased. Besides inventory, the clinician and pharmacist should convert dosage, strength, and delivery mechanism for each drug. Drug data must be correctly converted from the quantities residing in clinical systems into the payer-billable quantities appropriate for the financial system or charge master. The UOMs must be reconciled to avoid any under- or over-payments. More than often, missing or incorrect data in the charge master can result in negative financial consequences – denied claims, partial reimbursement, and compliance risks.
4. Linkages between Purchases & Billing:
Most hospitals have separate processes to order drugs, administer them, and process reimbursement. Without linkage between pharmacy expenditures for medications (i.e., spend data) and the charge master, ensuring proper charge capture and optimal reimbursement is a challenge. Besides hospitals should have automated tools to identify charge capture errors precisely, so as to pinpoint when and where their occurrence to decreasing revenue loss.
Certain contraindications exist for laparoscopic appendectomy, including extensive adhesions, radiation, or immunosuppressive therapy, severe portal hypertension coagulopathies. Laparoscopic appendectomy is contraindicated in the first trimester of pregnancy. Hope this answers/helps
A head drape is used for procedures of the nose and throat. It protects the eyes during surgery and prevents hair from entering the surgical field.
A head drape is the procedure of covering the patient's non-sterile region from one that is going to be operated. The process id performed to minimize the risk of unwanted objects and the infections during the surgery.
Surgical field is the sterile, microorganisms free area where the surgery is to be performed. It consists of the draped patients, the tools and equipment that are necessary to perform the operation. Even the doctors are a part of surgery field. They must be completely covered with masks on and the hands and forearms scrubbed.
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