2. the symptoms disappeared with rest.
His symptoms were relieved in the emergency department with
medication and he was
transferred to the cardiac floor for catheterization.
The patient’s symptoms were highly debilitating upon his
admission to the emergency
department.
Prior to his admission to the hospital for this event, the patient
was not very active because of his
angina symptoms. The pain that he had was substernal and
crushing and radiated to his neck
and jaw. His symptoms resolve with rest only. He has not
sought any therapeutic maneuvers.
He is currently asymptomatic and is here for a follow-up visit
from his hospitalization to discuss
his risk factors. The patient is still concerned that he may have
other episodes of angina, even
after the stent placement.
PMH
The patient has not sought care for his problems in the past. He
had been treated for
hypertension and high cholesterol in the past but stopped
4. HgbA1c – 7.5
CXR – hyperinflation of the lungs – no infiltrate
EKG – no change from baseline.
Risk Factors:
• High blood pressure
• Hypercholesterolemia
• Type 2 diabetes
• Android obesity
• Cigarette smoker
• Positive family history
Past surgical history of Cholecysectomy, almost 10 years age
without any complications.
ROS
Review of systems is otherwise negative
DISCHARGE MEDICATIONS
Tenormin XL 50 mg QD
Lipitor 10 mg QD
Glucophage – 500mg BID
6. paycheck and cannot afford a vacation. They have three grown-
up children who have left home
and do not live in the area. The patient has lived in the same
city all his life. He does not
participate in sports or any other physical activity. The streets
of his neighborhood are not safe for
exercising; the crime rate is high. There is little community
socialization and most people are at
the poverty level.
He is the sole bread winner in the family. His stress level is
very high because of the impending
bills that he needs to pay while he is not able to work. He
believes that a man should be able to
care for his family and be strong enough not to suffer from any
illnesses himself.
The patient and his wife live in a one-bedroom apartment in an
inner city, quite isolated from their
community. They do not have any relatives living in the area
nor do they socialize with neighbors.
He has little emotional or social support. He is stressed most of
the time and is now suffering from
depressive symptoms such as sleeping excessively and over
eating.
8. Alcohol: Does not drink
Substance Use: Denies street drug use
• WORK HABITS
He’s always been a carpenter; has no hobbies and reads at
home.
• FAMILY HISTORY
He has two older brothers who are being treated for high blood
pressure and type 2 diabetes.
Both brothers were diagnosed with these disorders in their early
forties.
Both parents are deceased; father from heart disease, and
mother from breast cancer.
7. PHYSICAL EXAMINTAION
Vital Signs: BP: 160/92 left are sitting; P:60 ; R: 16; T: 98;
Wt: 220#; Ht:– 70”
HEENT: WNL
Lymph Nodes: None
10. 4 • tellervision • November 2013 Customer Service: 1-800-234-
1660
Sparking Employee
Engagement
Surely you’ve heard CEOs say something to the effect of ‘our
great-
est asset is our people,’ ” says
Denise Federer, founder of FPMG, a
performance management firm. “That
may sound clichéd, but it contains a
good deal of truth, since companies
with engaged employees are more
likely to be successful than those with
the other two employee types: not
engaged and disengaged.”
FPMG believes leaders can have
a significant role in developing and
nurturing employee engagement,
which is defined as “the extent to
which employees commit to some-
thing or someone in their organiza-
tion, how hard they work, and how
long they stay as a result of that
commitment.” No leader wants to see
“loyal” employees leave, especially if
significant time and resources have
been invested in grooming them for
future leadership roles. Those who
11. are shocked when that happens either
aren’t aware of what’s going on,
or they’ve misread cues from these
employees, according to FPMG.
Federer notes that a recent study
by Dale Carnegie and Associates
found seven of 10 employees aren’t
fully engaged, making it even more
imperative to create a culture that
proactively promotes employee
engagement. She says that starts with
ensuring employees understand how
vital their jobs are to the company’s
success, and adhering to the following
three key behaviors:
• Confirm. Ensure the com-
pany mission statement guides
employees with respect to the
behavioral style, work ethic, and
priorities expected from them, and
confirm it’s relevant to current
business goals.
• Assess. Determine what factors
influence employee engagement
by assessing team members, mak-
ing changes to motivate and reen-
ergize those who are no longer
engaged, and ensuring the culture
encourages valued employees to
thrive and achieve their profes-
sional goals.
12. • Communicate. Engage in fre-
quent, transparent communica-
tion with members of the team,
ensuring productive conversa-
tions take place by using the key
behavioral principles of making
no assumptions, managing expec-
tations, and breaking down com-
plex behavior. ■
Professional Pointers
branches. Consumers can now
conduct around 80 percent of
banking transactions through
ATMs and other automated
banking channels without staff
assistance.
Mobile Payments: Young
Adults and Minorities
Take the Lead
A recent report from Mercator Advisory Group reveals that
young adults and minori-
ties lead in use and interest in mobile
payments as they are also the most
likely of customer segments to be
mobile-enabled.
Seventy-five percent of young
adults, 73 percent of Asians, 70 per-
cent of Hispanics, and 64 percent of
African-Americans own smartphones,
compared to an average of 55 per-
13. cent smartphone penetration within
overall US adult households as of
June 2013.
“Greater mobile penetration is
shifting the demographics of smart-
phone users. No longer are mobile
apps the domain only of young adults
who are avid mobile users— minorities
are leading the ranks as well,” said
Karen Augustine, manager of the
CustomerMonitor Survey Series at
Mercator Advisory Group and the
author of the report. “Mobile pay-
ment use and interest is growing, but
there needs to be a compelling reason
to launch a payment app at checkout.
Greater automation in the coupon-
ing and loyalty programs to enable
consumers to get a discount with a
purchase will help move the needle
of consumer adoption of mobile
payments.” ■
Maximizing Retail
Banking Cost Efficiencies
Banks across the world are revis-iting their operational strate-
gies, branch banking models,
distribution channels, and expansion
strategies to achieve cost efficiencies
and increase profits. They are focus-
ing on selling high-margin profitable
products and services and scaling
14. down unprofitable operations, accord-
ing to 2020 Foresight.
These institutions have placed an
increased emphasis on utilizing tech-
nology to improve profitability and
achieve cost efficiencies, and the role
of technology has changed from being
a process driver to a revenue genera-
tor. Retail banks are using technology
to increase profitability by utilizing
customer relationship management
(CRM) systems and consumer analyt-
ics to identify new customer groups
Issues & Tre nds
“
To subscribe: 1-800-638-8437 tellervision • November 2013 • 5
and offer customized products
and services to targeted customers,
according to 2020 Foresight.
In addition, key measures adopted
by retail banks to improve operational
efficiencies include an increase in
information technology (IT) spending
and upgrading IT systems.
Key highlights of the report include:
15. • Global banks are currently seeking
opportunities to enter high-growth
emerging markets to drive revenues.
• Banks are divesting unprofitable busi-
ness segments, product offerings, and
customer groups that are not part of
their core business strategy.
• There will be increased investment
in self-service and digital media
channels to communicate with cus-
tomers promptly and effectively.
• Banks are expected to increase their
spending on integrating distribu-
tion channels to provide a seamless
customer experience across all dis-
tribution channels.
• Use of business intelligence analyt-
ics to develop products and services
that fulfill the unique needs of cus-
tomers is expected to be at the core
of banks’ product-design strategies.
CUNA Offers White
Paper on Branch
Development
T he financial services industry has been conducting a debate
about technology’s effect on
branch development. Some analysts
have forecasted the end of the branch
as we know it. Others say that the
branch will always be with us, but will
16. evolve into a service center for prob-
lem resolution and complex products
such as mortgages, student loans, and
wealth management.
A new white paper from the Credit
Union National Association (CUNA)
entitled “Is Technology Causing
Branches to Close but Service to
Thrive?” addresses this question and
others by interviewing credit union
practitioners and analysts, as well as
examining relevant research.
The research found that consumer
behavior, not technology, is the pri-
mary indicator of branch changes.
There has been a significant decline
both in average monthly transactions
and visits to the branch. Consumers,
however—even those who are tech
savvy—express a need and find com-
fort in a branch that is convenient,
even if they rarely use it. The branch
continues to be a symbol and brand
embodiment for the financial institu-
tion, albeit an increasingly costly one
as branch expenses tend to be higher
than alternative channel costs.
The economics of alternatives to
building a branch are compelling. It
costs an estimated $1 million to $2
million to build a branch. Alternatives
include improving electronic services,
17. especially self-service delivery channels
with employees to help members.
In just two or three years, mobile
banking is predicted to dominate
financial services. Industry profes-
sionals have adhered to the traditional
business model that relationships had
to be built on a face-to-face interac-
tion at a branch. Facebook and other
social media have countered this
dogma with the reality that relation-
ships can be built electronically.
Declining fee income and margins, as
well as regulatory pressures and increas-
ing costs, will cause a rethinking of the
business model and branch development
and will lead to smaller branches, more
self-service, and expanded duties for
staff, according to CUNA’s research.
The paper is available online in
the white-paper section of www.
cunacouncils.org.
The Rise of the
New Bank Account
In the past, bank account relation-ships, combined with payment
cards, have enabled banks to be
the dominant providers of transac-
tion services to their customers. Today
banks’ leadership position in providing
card and payment transaction services
is under threat, primarily from two
18. sources: Regulation and competition.
In a report titled “The Rise of
the New Bank Account? The Quest
for Transactional Account Primacy,”
Celent briefly recaps the threats to the
cards business and examines emerging
threats to the core bank account. The
report also reviews how banks have
been responding to date.
The report poses a crucial ques-
tion. In the not too distant future,
will the “new bank account” need to
have the following capabilities?
• Support for multiple value tokens,
including virtual currencies, miles,
coupons, and loyalty points. The
bank becomes the trusted custo-
dian of value, both monetary and
nonmonetary.
• Full transactional capability: All
types of payment use cases directly
from a bank account.
• Customers fund purchases either
with money or other value tokens,
such as coupons and points, or any
combination of the above.
• Highly contextual services: Making
use of the ubiquitous mobile device
that is always in the consumer’s
hand to deliver highly personal,
19. tailored, and contextual services
such as information, advice, and
merchant offers.
“Banks have to consider many
issues before building these new
capabilities, such as how to manage
tensions between new and old sources
of value, and what would happen
if mobile payments were to lead to
fragmentation and re-emergence of
the domestic payment solutions,” says
Zilvinas Bareisis, Senior Analyst with
Celent’s Banking Group and author
of the report. “However, we strongly
believe that the core bank account
must evolve to maintain its relevance
in the digital world.”
ATM-Mobile Wallet
Partnership Connects
Customers to Cash
Consumers can now use their smartphones instead of their debit
or credit cards
to withdraw cash from automated
teller machines (ATMs). Enabled by
a partnership between Diebold and
mobile wallet provider Paydiant, the
cardless Mobile Cash Access (MCA)
solution gives consumers a more
convenient and secure option to inter-
act with their financial institutions,
while giving banks and credit unions
the opportunity to offer their own
branded mobile wallet solution.
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without the copyright holder's
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individual use.
NSG6001 Advanced Practice Nursing I
Care Plan Template
Patient Initials: ______
Age: _______________
Sex: ___________
Subjective Data:
Client Complaints:
HPI (History of Present Illness):
PMH (Past Medical History—include current medications, any
known allergies, any history of surgery or hospitalizations):
Significant Family History:
Social/Personal History (occupation, lifestyle—diet, exercise,
22. probX1.pdf
hydrology.docx
would you like to take on a Hydrology project? The data is to be
processed in Hec-Hms 4.0.
I will provide the Hec-HMS files HMS.map and CartCreek.basin
and Cannon Ball.pdf (watershed map for problem x-1). I will
also provide Any references used need to be documented.
Detailed instructions will be provide. I will need Problem X-1
by October 2nd and Hec-HMS Part 1 completed by October 13th
2014.
