Below is a summary of Pam’s electronic health record (EHR) activity while she is in the hospital. As a pulmonologist, you are responsible for examining Pam, ordering tests and procedures and diagnosing her condition. Using her EHR, Virtual Physical Exam (VPE) and Internet research, answer the questions and be prepared to discuss the responses with the rest of Pam’s healthcare team.

1. Internet Research: You review Pam’s EHR and initial spirometry results, which indicate * FEV₁/FVC < 0.7; * 50% ≤ FEV₁ < 80% predicted. Using the Global Initiative for Obstructive Lung Disease (GOLD) staging system, determine what these results signify.



2. Review Pam’s Outpatient EHR: You also notice that Pam’s oxygen saturation (SpO₂) is low (as indicated in blue). What is Pam’s SpO₂?
   
   Internet Research: How is oxygen saturation (SpO₂) measured?
   
   Internet Research: What causes low SpO2 (also referred to as hypoxemia)?



3. Review Pam’s VPE: You ask Pam to use her bronchodilator and then perform another spirometry test—the results are similar. You decide to have her complete the remaining pulmonary function tests and order a pulmonary plethysmography and diffusing capacity (DLCO) test. Using VPE, explain these tests.
   
   Review Pam’s VPE: What do Pam’s results indicate?



4. Internet Research: You order an arterial blood gas test (ABG). What is the purpose of this test?

Below is a summary of Pam’s electronic health record (EHR) activity while she is in the hospital. As a nurse, in addition to getting Pam prepared for the tests and procedures ordered by the physician, you are responsible for obtaining, reading and monitoring her vital signs. Using her EHR, Virtual Physical Exam (VPE) and Internet research, answer the questions and be prepared to discuss the responses with the rest of Pam’s healthcare team.

1. Review Pam’s Outpatient EHR: You are responsible for taking Pam’s vital signs, including determining her oxygen saturation (SpO₂), which you note on her EHR. Pam’s SpO₂ is low, as indicated in blue. What is Pam’s SpO2?
   
   Internet Research: How is oxygen saturation (SpO₂) measured?
   
   Internet Research: What causes low SpO2 (also referred to as hypoxemia)?



2. Review Pam’s VPE: The pulmonologist orders another spirometry test after Pam uses her bronchodilator, and the results are similar. Based on the results, the pulmonologist orders a pulmonary plethysmography and a diffusing capacity (DLCO) test. Using VPE, explain these tests.
   
   Review Pam’s VPE: What do Pam’s results indicate?



3. Internet Research: You help prepare Pam for an arterial blood gas (ABG) test, which was also ordered by the pulmonologist. Explain the purpose of this test to Pam.
   
   Internet Research: How is an ABG test administered?

Below is a summary of Pam’s electronic health record (EHR) while she is in the hospital. As a laboratory or radiology technologist, you are responsible for obtaining and providing test results to assist the physician in diagnosing Pam’s condition. Using her EHR, Virtual Physical Exam (VPE) and Internet research, answer the questions and be prepared to discuss the responses with the rest of Pam’s healthcare team.

1. Internet Research: After using her bronchodilator, Pam completes another spirometry test and the results are similar, so the pulmonologist orders a pulmonary plethysmography and a diffusing capacity (DLCO) test. Explain these tests to Pam.
   
   Internet Research: How are these tests performed?
   
   Review Pam’s Outpatient EHR: What do the results indicate?



2. Review Pam’s VPE: The pulmonologist orders an arterial blood gas test (ABG). Using VPE, explain the purpose of this test.
   
   Review Pam’s VPE: What do Pam’s results indicate?



3. Internet Research: A sputum analysis has also been ordered. What is this test?
   
   Internet Research: Why is the sputum analysis ordered?



4. Internet Research: You prepare Pam for the chest X-ray that was ordered. What type of information can be learned from a chest x-ray?

Below is a summary of Pam’s electronic health record (EHR) activity while she is in the hospital. As a pharmacist, you are responsible for ensuring that Pam receives the proper medications ordered by the physician. You are also responsible for reviewing any adverse interactions Pam might have with her current medications. Using her EHR, Virtual Physical Exam (VPE) and Internet research, answer the questions and be prepared to discuss the responses with the rest of Pam’s healthcare team.

1. Review Pam’s Outpatient EHR: According to Pam’s EHR, she is allergic to penicillin and codeine. What type of reaction could she experience if she is given any form of these medications?
   
   Internet Research: As Pam’s pharmacist, why is it important for you to be aware of drug allergies?
   
   Internet Research: Are there other forms of Penicillin that Pam cannot take?



2. Internet Research: Pam’s PCP physician, Dr. Jamison, prescribed albuterol (Ventolin HFA), a short-term bronchodilator. What is a bronchodilator?
   
   Review Pam’s VPE: Using VPE, explain how a bronchodilator with a metered-dose inhaler is administered.



3. Internet Research: The pulmonologist prescribes fluticasone and salmeterol (Advair HFA), a long-term bronchodilator, in addition to the short-term medication. How does a long-term bronchodilator differ from a short-term bronchodilator?



4. Internet Research: As part of a nicotine replacement therapy, the pulmonologist prescribes varenicline (Chantix). Explain the purpose of this medication.

Below is a summary of Pam’s electronic health record (EHR) activity while she is in the hospital. As a medical and health services manager, you are ultimately responsible for ensuring that Pam receives the best overall care possible. Your team will also compile Pam’s bills, consisting of her tests, procedures, room charges, supplies and medications. Using her EHRs, Virtual Physical Exam (VPE) and Internet research, answer the questions and be prepared to verify the responses with the rest of Pam’s healthcare team.

• MHSM – Bill (which includes both a PCP and outpatient statement)
• MHSM — Bill Reference
• Pam’s EHR–PCP Chart
• Virtual Physical Exam (link below)
• Pam’s EHR–Outpatient Chart (link below)

1. Use the blank copies of Pam’s PCP and outpatient bills and the Bill Reference to calculate and track her costs. In her EHRs, look for costs in the areas of labs, pathology, medication and diagnostics. You may need to do additional Internet research. Some helpful sites are www.healthcarebluebook.com, www.fairhealthconsumer.org and www.pharmacychecker.com.

Below is a summary of Pam’s electronic health record (EHR) activity while she is in the hospital. As a health coach, your job is to recommend lifestyle changes to alleviate symptoms, prevent symptoms from recurring and decrease the need for future emergency care or hospitalization. You will also provide the education Pam needs to understand her diagnosis and the risk factors that may have caused her condition. Using her EHR, Virtual Physical Exam and Internet research, answer the questions and be prepared to discuss the responses with the rest of Pam’s healthcare team.

1. Internet Research: After using her bronchodilator, Pam completes another spirometry test and the results are similar, so the pulmonologist orders a pulmonary plethysmography and a diffusing capacity (DLCO) test. Explain these tests to Pam.
   
   Review Pam’s Outpatient EHR What do the results of these tests indicate?



2. Internet Research: Pam’s PCP physician, Dr. Jamison, prescribes albuterol (Ventolin), a short-term bronchodilator, and the pulmonologist prescribes a combination inhaler of fluticasone and salmeterol (Advair HFA), a long-term bronchodilator. What is a bronchodilator?
   
   Review Pam’s VPE: Using VPE, explain how a bronchodilator with a metered-dose inhaler is administered.



3. Internet Research: Regardless of her diagnosis, the first thing Pam MUST do is to stop smoking. As Pam’s health coach, what advice do you give her to quit smoking?



4. Internet Research: As part of a nicotine replacement therapy, the pulmonologist prescribes varenicline (Chantix). Explain the purpose of this medication.