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You may use either Numeric Rating Scale item (J0600A) or Verbal Descriptor Scale item (J0600B) to diabetes mellitus guidelines malaysia actoplus met 500 mg low cost interview the resident about pain intensity diabetes insipidus or other forms of hypopituitarism discount 500 mg actoplus met amex. If the resident is unable to diabetes mellitus katt purchase actoplus met 500 mg answer using one scale diabetes symptoms in toddlers 500mg actoplus met otc, the other scale should be attempted. Record either the Numeric Rating Scale item (J0600A) or the Verbal Descriptor Scale item (J0600B). While reading, you may show the resident the response options (the Numeric Rating Scale or Verbal Descriptor Scale) clearly printed on a piece of paper, such as a cue card. The resident may provide a verbal response, point to the written response, or both. Numeric Rating Scale (00-10) Enter the two digit number (00-10) indicated by the resident as corresponding to the intensity of his or her worst pain during the 5-day look-back period, where zero is no pain, and 10 is the worst pain imaginable. Verbal Descriptor Scale • Code 1, mild: if resident indicates that his or her pain is “mild. The interviewer would go on to ask about pain intensity using the Verbal Descriptor Scale item (J0600B). Rationale: the resident was unable to select a number or point to a location on the 0-10 scale that represented his level of pain intensity. He looks at the response options presented using a cue card and says his pain is “severe” sometimes, but most of the time it is “mild. The pain interview is successfully completed if the • Persons unable to complete the pain interview may still resident reported no pain have pain. The Staff Assessment for Pain should only be completed if the Pain Assessment Interview (J0200-J0600) was not completed. Item Rationale Health-related Quality of Life • Residents who cannot verbally communicate about their pain are at particularly high risk for underdetection and undertreatment of pain. Planning for Care • Consistent approach to observation improves the accuracy of pain assessment for residents who are unable to verbally communicate their pain. If you observe wrinkled forehead, furrowed additional indicators of pain during the 5-day look-back brow, clenched teeth or jaw, period, code the corresponding items. Coding Tips • Behavior change, depressed mood, rejection of care and decreased activity participation may be related to pain. These behaviors and symptoms are identified in other sections and not reported here as pain screening items. However, the contribution of pain should be considered when following up on those symptoms and behaviors. A note in his medical record documents that he has been awake during the last night crying and rubbing his elbow. Coding: Nonverbal Sounds item (J0800A); Vocal Complaints of Pain item (J0800B); Facial Expressions item (J0800C); and Protective Body Movements or Postures item (J0800D), would be checked. There is no documentation of pain in her medical record during the 5-day look-back period. Coding: Nonverbal Sounds items (J0800A); Facial Expressions item (J0800C); and Protective Body Movements or Postures item (J0800D), would be checked. During the treatment, you observe groaning, facial grimaces, and a wrinkled forehead. Coding: Nonverbal Sounds item (J0800A), and Facial Expressions item (J0800C), would be checked. Rationale: the resident has demonstrated nonverbal sounds (groaning) and facial expression of pain (wrinkled forehead and grimacing). There is no documentation of pain in his medical record during the 5-day look-back period. Coding: None of these Signs Observed or Documented item (J0800Z), would be checked. Rationale: All steps for the assessment have been followed and no pain indicators have been documented, reported or directly observed. J0850: Frequency of Indicator of Pain or Possible Pain (5-Day Look Back) Item Rationale Health-related Quality of Life • Unrelieved pain adversely affects function and mobility contributing to dependence, skin breakdown, contractures, and weight loss. Planning for Care • Assessment of pain frequency provides: — A basis for evaluating treatment need and response to treatment. Review medical record and interview staff and direct caregivers to determine the number of days the resident either complained of pain or showed evidence of pain as described in J0800 over the past 5 days. Rationale: He has demonstrated vocal complaints of pain (“ouch”), facial expression of pain (grimacing) on 2 of the last 5 days. During the 5-day look-back period, the resident was noted on a daily basis to be rubbing her right knee and grimacing. Rationale: the resident was observed with a facial expression of pain (grimacing) and protective body movements (rubbing her knee) every day during the look-back period. J1100: Shortness of Breath (dyspnea) Item Rationale Health-related Quality of Life • Shortness of breath can be an extremely distressing symptom to residents and lead to decreased interaction and quality of life. They sometimes compensate for shortness of breath when lying flat by elevating the head of the bed and do not alert caregivers to the problem. Many residents, including those with mild to moderate dementia, may be able to provide feedback about their own symptoms. If the resident is not experiencing shortness of breath or trouble breathing during the interview, ask the resident if shortness of breath occurs when he or she engages in certain activities. Review the medical record for staff documentation of the presence of shortness of breath or trouble breathing. Interview staff on all shifts, and family/significant other regarding resident history of shortness of breath, allergies or other environmental triggers of shortness of breath. Signs of shortness of breath include: increased respiratory rate, pursed lip breathing, a prolonged expiratory phase, audible respirations and gasping for air at rest, interrupted speech pattern (only able to say a few words before taking a breath) and use of shoulder and other accessory muscles to breathe. If shortness of breath or trouble breathing is observed, note whether it occurs with certain positions or activities. Any evidence of the presence of a symptom of shortness of breath should be captured in this item. Shortness of breath could be present during activity as limited as turning or moving in bed during daily care or with more strenuous activity such as transferring, walking, or bathing. If the resident avoids activity or is unable to engage in activity because of shortness of breath, then code this as present. Also code this as present if the resident avoids lying flat because of shortness of breath. She reports feeling “winded” when going on outings that require walking one or more blocks and has been observed having to stop to rest several times under such circumstances. Three days ago, during a respiratory illness, he had mild trouble with his breathing, even when sitting in bed. J1300: Current Tobacco Use Item Rationale Health-related Quality of Life • the negative effects of smoking can shorten life expectancy and create health problems that interfere with daily activities and adversely affect quality of life. Planning for Care • this item opens the door to negotiation of a plan of care with the resident that includes support for smoking cessation. Ask the resident if he or she used tobacco in any form during the 7-day look-back period. If the resident states that he or she used tobacco in some Includes tobacco used in any form during the 7-day look-back period, code 1, yes. If the resident is unable to answer or indicates that he or she did not use tobacco of any kind during the look-back period, review the medical record and interview staff for any indication of tobacco use by the resident during the look-back period. Coding Instructions • Code 0, no: if there are no indications that the resident used any form of tobacco. Review the medical record for documentation by the average resident with that level of illness would not be physician that the resident’s condition or chronic disease expected to survive more may result in a life expectancy of less than 6 months, or than 6 months. If the physician states that the resident’s life expectancy this judgment should be may be less than 6 months, request that he or she document substantiated by a physician note. Do not code until there is pinpoint the exact life documentation in the medical record. Under the hospice months, she has had three hospital admissions for acute program benefit regulations, heart failure. Her heart has become significantly weaker a physician is required to despite maximum treatment with medications and oxygen.

Syndromes

  • Disorientation
  • Electrocardiogram (ECG)
  • Breathing problems
  • Nasal decongestants
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  • Infection (a slight risk any time the skin is broken)
  • Burning skin

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These items can transmit microorganisms to diabetes medications for free actoplus met 500mg mastercard other clients/patients/residents and must be taken with the client/resident/patient on discharge/transfer or discarded diabetes symptoms when blood sugar is high buy actoplus met 500mg line. Once these tasks are completed diabetes type 2 tingling feet cheap actoplus met 500 mg free shipping, cleaners can then conduct a discharge/transfer clean of the room blood sugar solution actoplus met 500 mg line, following the steps outlined in Appendix 6. In all cases, cleaning should be performed immediately if contamination or gross soil is identified and sufficiently frequently to maintain a clean, dirt and dust free environment. The appropriate frequency for changing privacy curtains (or other solutions that minimize the need for laundering privacy curtains) is discussed in 1. For the other tasks listed, facilities should determine the minimum frequency required to maintain a clean, dirt and dust free environment. As a minimum, high dusting and baseboard cleaning should occur weekly; window blinds should be dusted monthly; and window curtains and coverings should be cleaned at least annually. These are minimum frequencies and more frequent cleaning may be required to maintain appropriate levels of cleanliness. High dusting involves dusting all horizontal surfaces and fixtures above shoulder height, including vents. When performing high dusting: fi Dust when the patient/resident is out of the room to minimize exposure to spores. Bathrooms for patients in a private room should be cleaned daily, at the time of routine daily room cleaning. For shared bathrooms in semi-private or ward rooms, daily cleaning of the bathroom is a minimum and consideration should be given to twice daily cleaning, particularly for ward rooms housing more than two patients/residents. Additional, immediate cleaning is required when there are spills or gross contamination of room surfaces is identified. Emergency room/urgent care centre bathrooms are located in high traffic areas and are used frequently by ill patients who may contaminate the environment with microorganisms including enteric viruses 497-500 such as norovirus, and C. However, because bathrooms are at high risk of microbial contamination, they still require a health care clean. It is important to review the manufacturer’s recommendations for cleaning a particular type of flooring before developing cleaning protocols. Floors are low-touch surfaces that rarely come in contact with the hands of patients/residents or health care providers; under normal circumstances, the use of a disinfectant is 152,502-505 not required. Dry mopping may be done with microfibre mops or pads to reduce dispersal of dust and debris. For facilities that have not yet removed all carpeting from care areas, there should be a plan for permanent removal of carpeting. The manufacturer’s recommended 16,85,158,159 contact time for the product being used must be closely followed. Increasingly, electronic equipment used in health care settings also includes mobile phones, tablets, laptops and a variety of items that may be purchased by the facility or may be owned by staff. Inappropriate use of liquids on electronic medical equipment may result in fires and other damage, equipment malfunctions and health care provider burns. Equipment malfunctions could result in life-threatening events to patients such as over-infusion of medications and 506 loss of life-supporting interventions. To avoid hazards: fi Obtain the manufacturer’s labelling which may include instructions for cleaning and disinfection; information may be available on the manufacturer’s website. Electronic equipment that cannot be adequately cleaned, disinfected or covered should not enter the immediate care environment. Plastic coverings may be an effective means to protect keyboards and other devices from contamination, but must be cleaned and maintained appropriately (see 1. In addition, no-touch disinfection systems may offer a means for disinfecting 507-510 electronic devices but efficacy of this approach has not yet been widely validated. Electronic equipment should be cleaned on a regular basis, depending upon its use and the risk for patient-to-patient transmission of microorganisms, as follows: fi Electronic equipment that goes from client/resident/patient to client/resident/patient within the care environment must be cleaned and disinfected between patients. These recommendations apply not only to products purchased by the health care facility. Microorganisms in ice can contaminate clinical specimens and medical solutions that require ice for 366 transport or holding. Ice may become contaminated if the water source for the ice is contaminated 511,512 and from contaminated hands touching the ice. To minimize contamination, ice machines that dispense ice directly into a container are 366 recommended. If older machines have not yet been replaced: 366 fi Provide a scoop for dispensing the ice. Ice machines and ice chests should be cleaned at least quarterly, including cleaning, de-scaling and disinfection. Transmission of influenza and other respiratory pathogens may occur in pediatric waiting rooms and 523 contamination of toys with insufficient cleaning and disinfection may contribute to this problem. Playrooms or play areas that are used by more than one child should have an area for segregation of used toys. Toy storage boxes/cupboards should be emptied and cleaned weekly or when visibly soiled. Toys, books, magazines and puzzles should be dedicated to children on Additional Precautions and discarded afterwards or sent home with the child if the article cannot be cleaned. Responsibility for cleaning toys should be assigned and written procedures regarding frequency and methods of cleaning are required. Toys should be removed from general waiting rooms if an adequate process cannot be established to ensure their daily inspection, cleaning and disinfection. During outbreaks it may be prudent to remove, and not replace, the toys until the outbreak is over. There should be a plan in place to replace cloth furnishings with cleanable furnishings. If cloth furnishings are present, 3 these should be vacuumed regularly and steam cleaned as necessary when stained or visibly soiled. Skin and wound infections may result from direct contact of intact skin or wounds to contaminated water. Inhalation of microorganisms in aerosolized water has resulted in respiratory 92 infections. Cleaning and disinfection should be scheduled 92 and the schedule strictly adhered to regardless of whether tub liners are used. When replacing or purchasing hydrotherapy equipment, health care facilities should consider designs with improved 532 cleanability and that are meant for use in the health care setting. Transport equipment such as wheelchairs that may have padded areas should be carefully inspected for damage prior to cleaning. In addition, all transport equipment should be cleaned according to a written schedule. Transport equipment that is clean should be stored in an appropriate clean area and/or covered to prevent recontamination between uses. Ambulances (vehicles that transport patients on stretchers) should be cleaned, disinfected and restocked after each patient transport; a thorough cleaning should also be completed when required for 542 heavy contamination and on a regular, scheduled basis. Contaminated hand hygiene sinks, and other sinks within the health care environment, have been associated with outbreaks, including outbreaks of antibiotic resistant organisms. Outbreaks occurred due 368,543-548 366-369,549 to poor sink design, use of a hand hygiene sink for purposes other than hand hygiene, or 368 suboptimal sink cleaning practices. If sinks drains become contaminated, decontamination of the sink can be difficult, likely due to the 368,369,550-554 presence of biofilm. Some facilities have reported success in terminating their outbreaks by 546 545,554,555 556 disinfecting the sinks with acetic acid, chlorine-based disinfectants, heat, or some self- 557-559 decontaminating drain systems. In many cases, facilities have reported that their outbreaks were 369,543,544,550,552,553,559-562 not controlled until the implicated sinks (and parts) were replaced. Given these concerns it is important that hand hygiene sinks, and other sinks located within the health care environment, are cleaned and disinfected regularly. After cleaning a sink, the cloths used 563 should not be used to clean another sink. Consideration may also be given to using three different 365 cloths to clean the tap, the sink and the area around the tap and sink. It is also critically important that hand hygiene sinks not be used for disposing body fluids and other 80,366,369,544,545,551,552,556,561,563 waste. Prolonged contamination of sink drains with microorganism can result from this practice.

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The tumour must require surgical or radiation treatment or cause irreversible objective neurological deficit(s) diabetes symptoms skin rash buy cheap actoplus met 500 mg line. An example of an excluded cancer is cancer-in-situ of the cervix diabetes signs of pregnancy buy actoplus met 500mg otc, which is No benefit will be payable for cancer if blood sugar 20 proven actoplus met 500mg, within the first usually identified and treated before the malignant cells 90 days following the later of: have invaded adjacent tissues diabetes signs and symptoms in adults generic actoplus met 500 mg line. Coma Deafness Coma means a definite diagnosis of a state of Deafness is defined as a definite diagnosis of the total unconsciousness with no reaction to external stimuli or and irreversible loss of hearing in both ears, with an response to internal needs for a continuous period of at auditory threshold of 90 decibels or greater within the least 96 hours, and for which period the Glasgow coma speech threshold of 500 to 3,000 hertz. The diagnosis of a recent heart attack therefore, is confirmed by the detection of > agnosia (difficulty recognizing objects), or abnormal electrical activity over the surface of the heart, > disturbance in executive functioning. If the insured person has a loss of independent existence before the policy anniversary nearest their 18th birthday, you must wait to send us a claim for this illness. These new symptoms and deficits must be Severe burns corroborated by diagnostic imaging testing. The full critical illness benefit amount will not be reduced and the coverage will be available for any future claims. Cancer – Stage 1A Cancer Grade 1 malignant melanoma neuroendocrine tumours Stage 1A malignant melanoma is a melanoma confirmed by (carcinoid) biopsy to be less than or equal to 1. The diagnosis of grade 1 neuroendocrine tumours the diagnosis of stage 1A malignant melanoma must (carcinoid) must be made by a specialist and confirmed be made by a specialist and confirmed by pathological by pathological examination of the tissue. The diagnosis of papillary thyroid cancer or follicular thyroid cancer must be made by a specialist and confirmed by pathological examination of the tissue. If the child is diagnosed with and survives one of these critical illnesses, you’ll receive a lump sum payment of your coverage amount and the policy will end. Cerebral palsy means a definite diagnosis of a non Congenital heart disease also covers specific conditions progressive neurological defect affecting muscle described below for which open heart surgery is control. Muscular dystrophy Muscular dystrophy means a definite diagnosis of muscular dystrophy where the insured person has well defined neurological abnormalities, confirmed by electromyography and either muscle biopsy or other testing acceptable to us that confirms the diagnosis. These forms may be useful for recording information in the medical record and for communicating information from physicians to the cancer registrar. Cervical Lymph Nodes and Unknown Primary Tumors of the Head and Neck 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Note: A designation of “U” or “L” may be used for any N category to indicate metastasis above the lower border of the cricoid (U) or below the lower border of the cricoid (L). Tobacco use and pack-year: fi Never fi fi 10 pack-years fi > 10 but fi 20 pack-years fi > 20 pack-years 9. Major Salivary Glands 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Depression diagnosis: fi Previously diagnosed fi Currently diagnosed this form continues on the next page. Major Salivary Glands 7 Histologic Grade (G) There is no uniform grading system for salivary gland. Schematic indicating the location of the lymph node submandibular, and sublingual glands. Nasopharynx 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Schematic indicating the location of the lymph node oropharynx, hypopharynx, and esophagus. Oropharynx (p16fi) and Hypopharynx Oropharynx (p16fi) and Hypopharynx each have different sections for Definition of Primary Tumor (T). Oropharynx (p16-) 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. U Metastasis above the lower border of the cricoid L Metastasis below the lower border of the cricoid 4. Hypopharynx 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. U Metastasis above the lower border of the cricoid L Metastasis below the lower border of the cricoid this form continues on the next page. Lymphovascular invasion: fi Intratumoral: fi Focal fi Multifocal fi Extratumoral: fi Focal fi Multifocal 8. Tobacco use and pack-year: fi Never fi fi 10 pack-years fi > 10 but fi 20 pack-years fi > 20 pack-years 10. Alcohol use: Number of days drinking per week: Number of drinks per day: 11. Nasal Cavity and Paranasal Sinuses Maxillary Sinus, Nasal Cavity and Ethmoid Sinus each have different sections for Definition of Primary Tumor (T). Alcohol use: Number of days drinking per week: Number of drinks per day: 9. Larynx: Supraglottis 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Tobacco use and pack-year: fi Never fi fi 10 pack-years fi > 10 but fi 20 pack-years fi > 20 pack-years 8. Larynx: Glottis 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Schematic indicating the location of the lymph node the larynx: supraglottis, glottis, and subglottis. Mucosal Melanoma of the Head and Neck 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Mucosal Melanoma of the Head and Neck 6 Registry Data Collection Variables See chapter for more information on these variables. Involvement of the lateral wall nasal cavity, inferior turbinate is illustrated, as well as septum, hard palate, ethmoid, and nasal vestibule. Primary site location: fi temple fi cheek fi ear fi lip, hair-bearing fi lip, vermilion border 7. Esophagus and Esophagogastric Junction: Squamous Cell Carcinoma 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Esophagus and Esophagogastric Junction: Squamous Cell Carcinoma 7 Registry Data Collection Variables See chapter for more details on these variables. Anatomy of esophageal cancer primary site, including typical endoscopic measurements of each region measured from the incisors. Esophagus and Esophagogastric Junction: Adenocarcinoma 5 Prognostic Factors Required for Stage Grouping 5. Whereas location of tumor is not a prognostic variable in adenocarcinoma of the esophagus, grade significantly affects outcome and therefore staging. Esophagus and Esophagogastric Junction: Other Histologies 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. If there is perforation of the visceral peritoneum covering the gastric ligaments or the omentum, the tumor should be classified as T4. Stomach 6 Registry Data Collection Variables See chapter for more details on these variables. Small Intestine: Other Histologies 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. T1 Tumor invades the submucosa (through the muscularis mucosa but not into the muscularis propria) T2 Tumor invades the muscularis propria T3 Tumor invades through the muscularis propria into the subserosa or the mesoappendix T4 Tumor invades the visceral peritoneum, including the acellular mucin or mucinous epithelium involving the serosa of the appendix or mesoappendix, and/or directly invades adjacent organs or structures T4a Tumor invades through the visceral peritoneum, including the acellular mucin or mucinous epithelium involving the serosa of the appendix or serosa of the mesoappendix T4b Tumor directly invades or adheres to adjacent organs or structures fi T Suffix Definition (m) Select if synchronous primary tumors are found in single organ. Anus 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Anal cancer (A–C), perianal cancer (D), and skin cancer (E) as visualized with gentle traction placed on the buttocks. Liver 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. The liver is divided into two hemilivers and eight segments according to the portal venous ramification pattern. Intrahepatic Bile Duct 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up. Intrahepatic Bile Duct 6 Registry Data Collection Variables See chapter for more details on these variables. Right liver tumors drain to right portal (A) and then portocaval (C) nodal basins, while left liver tumors drain to left gastric and celiac (B) nodal basins. Gallbladder 1 Terms of Use the cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting treatment plans or follow-up.

Diseases

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