Prompt 1 M1A2
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Apr 3, 2024
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Module 1 Assignment 2 – A. Westfall, School of EMS Paramedic Program Prompt 1
: Research and describe Health Literacy in your own words and describe a situation when you had to be sensitive to a patient's health literacy - do not confuse this concept with a language barrier! If you do not have a personal experience, then describe a situation in which you might find yourself as a paramedic.
Health Literacy is defined as the ability to obtain, read, understand, and use healthcare information to make appropriate health decisions and follow instructions for treatment. There are multiple definitions of health literacy, in part, because health literacy involves both the context (or setting)
in which health literacy demands are made (e.g., health care, media, internet
or fitness facility) and the skills that people bring to that situation.
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(Wikipedia, n.d.)
The above writing prompt asks that we provide a situation where health literacy may present when providing care as a paramedic. This prompt
immediately makes me think of my own personal situation that I often see patients facing. We all know someone that has been faced with the dreaded diagnosis of cancer. At 17 years old, I found myself sitting in a doctor’s office awaiting diagnostic test results. Those results showed cancer. I’m 17 years old and 1
https://en.wikipedia.org/wiki/Health_literacy
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Module 1 Assignment 2 – A. Westfall, School of EMS Paramedic Program getting ready to graduate high school when Dr. Charles Rosen, MD informed me that I had brain cancer. Fast forward several years and many surgeries, chemotherapy, and radiation treatments later; I am now 38. That is a long time to live with brain cancer or any cancer diagnosis. Since my initial diagnosis, I have had 2 brain surgeries. I’ve also developed 2 other masses. Currently, I am living with a mass in the frontal lobe near the anterior falx. This mass is growing between the two hemispheres of the brain. Unfortunately, it is inoperable and at some point, will lead to my demise. This is part of my “why” of being a paramedic but, I also feel as though
this helps when dealing with a patient and their health literacy. Health literacy is understanding your health, your diagnosis, and what treatments are available to you. To be a paramedic gives you a position of trust. Often the information we give and the advice we provide is taken in high regard. Being able to provide a patient with information about what to expect, pointers on what worked for me and what didn’t, and understanding the feelings they are feeling gives me an advantage in assisting with their health
literacy. 2
Module 1 Assignment 2 – A. Westfall, School of EMS Paramedic Program Prompt 2:
You have just completed resuscitating a diabetic patient using IV Dextrose. The patient is adamantly refusing to go to the hospital because they do not have insurance.
Ambulance services respond to diabetic service calls very regularly. Depending on what the protocol that your service sets forth will dictate how these calls for service play out. The current service that I work for allows paramedics to initiate IV access, give dextrose, and stabilize the patients’ blood sugar and obtain a refusal if the patient wishes to refuse transport to the ED. My previous service, I was unable to do this and if we initiated treatment or started an IV, we were required to transport. For the sake of this
writing prompt, we will assume that the protocol is we are allowed to treat and obtain a refusal. When obtaining a refusal, first and foremost, we need to make sure the patients mental status affords them the ability to refuse service. Since they are diabetic and just suffered a hypoglycemic incident; checking their mental
status is crucial. 3
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Module 1 Assignment 2 – A. Westfall, School of EMS Paramedic Program Once we obtain that the patient’s mental status by asking if they can identify themselves, their location, the date, and I like to follow up with an additional question such as “how many quarters are in 1 dollar” we can proceed with completing the refusal document. The cost associated with ambulance transport is a real concern for almost everyone we transport. Most ambulance bills are $500.00 or more and with the current economic situation, that is a hefty bill. Often, there are charity care programs available to patients. There are also options that your services billing department can setup for the patient if they request to do so.
Being cognizant of the costs for your service and your billing practices will only help you be a better provider. The costs associated with ambulance transport is a frequent question that will arise. Once the patient has been stabilized and they have voiced they do not wish to be transported; be sure to inform the patient that they have the right
to refuse and if they do so, you will need them to sign a document stating they are refusing ambulance transport. It is best to inform them of the risks – in this case, they may have another hypoglycemic situation and lose consciousness. You also need to inform the patient that our treatment is a temporary fix and that they need 4
Module 1 Assignment 2 – A. Westfall, School of EMS Paramedic Program to eat an appropriate meal to keep their sugar from dropping again. Lastly, inform the patient that they can always call us back at any point
.
Your narrative should be very descriptive of the situation including times you started treatment and discontinued treatment. What their blood sugar was upon arrival, during treatment, and prior to leaving scene. Your narrative should include the reason they did not want to be transported – due to not having insurance and what you informed them of about the options for financial help. In the narrative, make sure you refer to obtaining their signature and that their mental status was intact, and they understood the risks associated with refusing transport. Prompt 3:
Dr. Jones, a pulmonologist, tells you that the patient, James Smith, has severe cardiomegaly as a result of a long history of pulmonary hypertension from arteriosclerosis and heart valve dysfunction. He tells you Mr. Smith developed a cardiac dysrhythmia while doing some pulmonary tests in the office. Mr. Smith also has NIDDM.
Based on your knowledge of medical terminology, what kind of doctor is a pulmonologist, and what does the history of pulmonary hypertension tell you?
What is cardiomegaly, arteriosclerosis, and NIDDM?
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Module 1 Assignment 2 – A. Westfall, School of EMS Paramedic Program You turn on the cardiac monitor and open a package of patches to prepare for an ECG. You note that the patient has supraventricular tachycardia but for
now is stable. Because of the sudden onset, you decide it probably is PSVT.
What does ECG stand for?
What do supraventricular tachycardia and PSVT mean?
The patient’s heart rate is 130 beats/min and regular, his respirations are 20 breaths/min, and his blood pressure is 156/94 mm Hg. The pulse oximeter shows a SpO2 of 90%. You decide to start treating the patient’s hypoxia with an NC at 4 LPM. You notice that the patient has some cyanosis of his fingers and is otherwise pale. You remember the doctor telling you that the patient has a low erythrocyte count, and that he has had episodes of hemoptysis.
What do oximeter, hypoxia, and SpO2 mean? What does oxygen by NC at 4 LPM mean?
What is cyanosis? What does the doctor mean by a low erythrocyte count and hemoptysis?
You start an intravenous line of NS in the left AC at KVO, in case the patient’s
condition worsens. You decide to give him adenosine, an antiarrhythmic drug, IVP, which breaks the SVT.
What is an IV, where did you place it on this patient, what solution did you use, and at what rate did you run the IV?
What did it mean when you gave the drug IVP?
Before you leave the office, the nurse hands you some paperwork to bring to the hospital with the patient. Included in this paperwork are reports from the 6
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Module 1 Assignment 2 – A. Westfall, School of EMS Paramedic Program patient’s nephrologist and cardiologist, as well as a copy of his most recent echocardiogram, which indicated he has a significant MVP. You also note in the chart that the patient has had some recent blood work done, which included a CBC, BGL, and PTT, as well as a U/A.
What type of doctors are cardiologists and nephrologists?
What is an echocardiogram and what does the finding of MVP mean?
What kind of lab test is each of the following: CBC, BGL, PTT, and U/A?
You and your partner prepare the patient for transport and place him in high-
Fowler position as he has less dyspnea in this position. Fortunately, the oxygen helps, the SVT does not return, and the patient does not need additional treatment. After dropping the patient at the hospital, you include the following abbreviations on your PCR: PMH, HTN, SVT, ASHD, and DOE.
What do these abbreviations and the term dyspnea mean?
In our first mock narrative, we meet James Smith. Mr. Smith is seeing his pulmonologist when we get called for service. A pulmonologist is a specialist physician who has a focus in treating the lungs and disorders associated with
the lungs. We are told that Mr. Smith has a history of pulmonary hypertension. Pulmonary hypertension is a disorder of the lung that often causes the heart to weaken and work harder. Pulmonary Hypertension is secondary to left sided heart failure. Although 50% of cases have no known origin. 2
2
https://www.nhlbi.nih.gov/health/pulmonary-hypertension
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Module 1 Assignment 2 – A. Westfall, School of EMS Paramedic Program We are also informed that Mr. Smith has a history of cardiomegaly – otherwise known as an enlarged heart. Arteriosclerosis -- Arteriosclerosis is a type of vascular disease where the blood vessels carrying oxygen away from the heart (arteries) become damaged from factors such as high cholesterol, high blood pressure, diabetes, and certain genetic influences. The arteries thicken and become stiff which can sometimes restrict blood flow to other organs and tissue.
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NIDDM is also in Mr. Smiths history. NIDDM is an abbreviation for Non-
Insulin Dependent Diabetes or otherwise referred to as Type 2 diabetes. In our assessment of Mr. Smith, we use the cardiac monitor to assess Mr. Smith’s heart. An ECG or Electrocardiogram is obtained. An Electrocardiogram is a visual representation and print out of the electrical function of ones heart. The ECG we obtained of Mr. Smiths heart revealed a dysrhythmia known as SVT or Supraventricular Tachycardia. Supraventricular tachycardia (SVT) is as an irregularly fast or erratic heartbeat (arrhythmia) that affects 3
https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-
treated-a-to-z/arteriosclerosis#:~:text=Arteriosclerosis%20is%20a%20type%20of,diabetes
%20and%20certain%20genetic%20influences.
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Module 1 Assignment 2 – A. Westfall, School of EMS Paramedic Program the heart's upper chambers. SVT is also called paroxysmal supraventricular tachycardia 4
which is also known as PSVT. During our assessment, we used a pulse ox or pulse oximeter which is a medical diagnostic tool used to measure the oxygen saturation levels of the blood. This is done noninvasively and is painless. This tool helps us to assess hypoxia. Hypoxia is a state in which oxygen is not available in sufficient amounts at the tissue level to maintain adequate homeostasis; this
can result from inadequate oxygen delivery to the tissues either due to low blood supply or low oxygen content in the blood (hypoxemia).
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Our treatment
to help correct hypoxia in this case was O2 @ 4LPM via NC or oxygen delivered by a nasal cannula at a rate of 4 liters per minute. It was noted that Mr. Smith’s fingertips appeared to be cyanotic. Cyanosis is when the skin has a blue/grey hue from the lack of oxygen rich blood flow. It was also noted that Mr. Smith had a low erythrocyte count which is a low red blood cell count that is usually secondary to Anemia. Mr. Smith was also noted to have hemoptysis. H
emoptysis refers to coughing up blood from some part of the lungs (respiratory tract).
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4
https://www.mayoclinic.org/diseases-conditions/supraventricular-tachycardia/symptoms-
causes/syc-20355243
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https://www.ncbi.nlm.nih.gov/books/NBK482316/#:~:text=Hypoxia%20is%20a%20state
%20in,in%20the%20blood%20(hypoxemia).
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https://www.mayoclinic.org/symptoms/coughing-up-blood/basics/causes/sym-
20050934#:~:text=Hemoptysis%20refers%20to%20coughing%20up,you%27re
%20coughing%20up%20blood.
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Module 1 Assignment 2 – A. Westfall, School of EMS Paramedic Program As part of our treatment, an IV or intravenous access which is obtained by placing a small catheter using a needle inside Mr. Smith’s AC or antecubital fossa. The antecubital is in either the right or left bend of the arm. He was given a common fluid referred to a NS or Normal Saline. Normal Saline was delivered at a rate of KVO. KVO refers to “keep vein open” which is a maintenance rate. We administered Adenosine IVP meaning the medication was given iv push. The nursing staff provided a copy of Mr. Smith’s chart which contained notes from
his Nephrologist. A nephrologist is a specialized physician who specializes in the treatment of the kidneys. There were also notes from the cardiologist. A cardiologist is a physician who specializes in treatments of the heart. Accompanying the chart were lab reports and values. Among the reports were a CBC or Complete Blood Count which looks at the 7 types of cells found within the blood.
They are red blood cells, neutrophil, eosinophil, basophil, lymphocyte, monocyte, and platelet counts. BGL or Blood Glucose Level measures the amount of glucose or sugar found within the blood. Partial thromboplastin time (PTT) is a blood test that
looks at how long it takes for blood to clot. It can help tell if you have a bleeding problem or if your blood does not clot properly.
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Finally, we saw a report for a UA. A urinalysis is a 7
https://www.ucsfhealth.org/medical-tests/partial-thromboplastin-time-
(ptt)#:~:text=Definition,the%20coagulation%20(clotting)%20system.
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Module 1 Assignment 2 – A. Westfall, School of EMS Paramedic Program test of your urine. It's used to detect and manage a wide range of disorders, such as urinary tract infections, kidney disease and diabetes.
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Echocardiogram results were also contained in Mr. Smiths report. An echocardiogram
uses sound waves to show how blood flows through the heart and heart valves. Sensors attached to the chest and sometimes the legs check the heart rhythm during the test. The test can help a health care provider diagnose heart conditions.
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Results of the echocardiogram showed MVP. Mitral Valve Prolapse is defined as
mitral valve displacement more than 2 mm above the mitral annulus in a long-axis view (parasternal or apical three chambers)
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Finishing up our PCR or Patient Care Report before handing over a copy to the receiving hospital we want to make sure all of our abbreviations are accurate and concise. PMH was used and stands for Past Medical History. HTN refers to Hypertension. SVT as we stated above stands for Supraventricular Tachycardia. ASHD refers to atherosclerotic heart disease. DOE refers to dyspnea on exertion and finally we
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https://www.mayoclinic.org/tests-procedures/urinalysis/about/pac-20384907
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https://www.mayoclinic.org/tests-procedures/echocardiogram/about/pac-
20393856#:~:text=An%20echocardiogram%20uses%20sound%20waves,care%20provider
%20diagnose%20heart%20conditions.
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https://www.ncbi.nlm.nih.gov/books/NBK470288/#:~:text=Mitral%20Valve%20Prolapse
%20is%20defined,of%20the%20mitral%20valve%20leaflets.
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Module 1 Assignment 2 – A. Westfall, School of EMS Paramedic Program have dyspnea or shortness of breath, which is often described as an intense tightening in the chest, air hunger, difficulty breathing, breathlessness or a feeling of suffocation.
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https://www.mayoclinic.org/symptoms/shortness-of-breath/basics/definition/sym-
20050890#:~:text=Shortness%20of%20breath%20—%20known%20medically,or%20a
%20feeling%20of%20suffocation.
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