The Clinical Justification Provided By Blue Shield For Denying My Inpatient Stay

The following summary is an updated case study of a 47 year old male patient, Jim who was diagnosed with Coronary Artery Disease. The patient did receive information on what CAD is and was informed that test were needed to fully diagnose and be evaluated for underlying conditions (high blood pressure, high blood cholesterol levels, diabetes and blockage. I will discuss the type of test needed for this condition and tests for any underlying conditions that are related to this disease. The type of treatment needed to control and lower his risk factor. I will also give the patient information about complementary and alternative medicine so the patient will be well informed about different types of treatment. The patient will be informed about the prognosis of the disease, and the options that the patient has to succeed in the changes in his lifestyle that are needed.

Diabetes is a disease where the body is unable to produce or use insulin effectively. Insulin is needed for proper storage and use of carbohydrates. Without it, blood sugar levels can become too high or too low, resulting in a diabetic emergency. It affects about 7.8% of the population. The incidence of diabetes is known to increase with age. It’s the leading cause of end-stage renal disease in the US, and is the primary cause of blindness and foot and leg amputation. It is known to cause neuropathy in up to 70% of diabetic patients. Individuals with diabetes are twice as likely to develop cardiovascular disease. There are two types of diabetes: Type 1 and Type 2.

Those who are diabetic may also be in risk of blindness (diabetic retinopathy) and nerve damage (diabetic neuropathy). Diabetic neuropathy can lead to numbness in hands and feet, foot ulcers, and eventual limb amputation (World Health Organization). Taking preventive steps can help to avoid many of the complications of diabetes.

Most patients who have diabetes for an extended amount of time may end up with diabetic neuropathy, which is damage caused to the nerves; it affects the peripheral nerves, autonomic nerves, and focal nerves. From the high blood sugar, it can destroy parts of the patient’s blood vessels, heart, and kidneys. If diabetes is not treated, it will almost always cause heart disease or kidney disease.

Why are nerves often damaged in patients with diabetes mellitus, and what are some of the

Diabetic neuropathy can occur with long-term diabetes, usually after several years of uncontrolled high blood glucose. Glucose proteins, called glycoproteins, form in the nerves primarily those in the legs and feet. When the nerves in the feet are damaged, the brain cannot recognize pain in that area. Nerve damage from diabetic neuropathy can lead to weakness in the muscles in the legs and feet. Since the muscles work as a system, neuropathy can lead to other foot problems, such as hammertoes, calluses, bunions, and other foot deformities. These deformities are dangerous because of the risk of infection. A simple blister from a tight shoe can spell disaster

Diabetes mellitus (DM) is a pandemic that affects millions of people. The growth rate of unrecognized pre-diabetes in America is expected to rise up to 52% by 2020 (Lorenzo, 2013). As the prevalence of diabetes increases, so will the complications and burden of the disease. One of the leading causes for cardiovascular disease, renal failure, nontraumatic lower limb amputations, stroke, and new cases of blindness is DM (Lorenzo, 2013).

7. Examine your feet. Diabetes-related nerve damage can mean that you might have minor injuries to your feet that you can’t feel. This can lead to infections and other complications. Check the soles of your feet daily. Put lotion on them at night to keep the skin in good condition. Wear comfortable shoes that fit correctly. Ask your doctor to examine your feet whenever you have an office visit.

Type 2 diabetes mellitus (T2D) is the most common form of diabetes (American Diabetes Association, 2012). T2D is so prevalent that it is estimated to be the fifth most common cause of death worldwide (Yates, Jarvis, Troughton, and JaneDavies, 2009, p. 1). T2D manifests when the body is unable to metabolize glucose properly, resulting in elevated blood sugar, debilitating fatigue, and other serious complications such as distal limb amputations, kidney failure, and blindness. The generally accepted causes of T2D include diet, sedentary lifestyle, and obesity.

The information submitted for this determination was reviewed by our physician. The reason that we are not approving all the requested personal care services is based on the following documents: M11Q-which is your doctor’s order, the home nursing assessment performed on 05/09/2015 and our review of your social support system. We also reviewed all available medical information including information about health services you are receiving concurrently or have received recently.

We denied the medical service listed above because: We received your request for admission to an acute care facility and have reviewed the medical records; the information does not show a need for the acute level of care. You are an 84 year old female who is status post cardiac arrest (condition in which the heart suddenly and unexpectedly stops beating) with hypoxic (a condition in which the body or a region of the body is deprived of adequate oxygen supply) brain injury. You have a Do Not Resuscitate order documented. You have a life expectancy of less than 60 days. You are undergoing comfort care. You can be managed in a lower level of care. For all these reasons the admission is not medically necessary. The request for admission to Calvary

Diabetic Peripheral Neuropathy (DPN) is one of the most common microvascular complications in diabetes and can result in foot ulceration, ampuation and an impaired quality of life(Carrington AL, et al 2002,Boulton AJ,et al 2004). The reported prevalence of diabetic peripheral neuropathy ranges from 16% to as high as 66%2 and its prevelance is believed to increase with the duration of diabetes and poor glucose control.(Boulton AJ.et al 2000) It’s accounts for 50–75% of non-traumatic amputations in diabetic patients.(Holzer SE, et al 1998, Boulton AJM, 1998,Malay DS, et al 2006)

Peripheral neuropathy is a fairly common neurological problem and is a generalized term that means that there is a disorder in the peripheral nervous system. Being that this is a broad definition and includes many varieties and causes of peripheral nerve disease, a proper diagnosis is needed for the definition to be specified. The overall prevalence of the condition is about 2400 (2·4%) per 100 000 population, but in people older than 55 years, the prevalence rises to about 8000 (8%) per 100 000. (Simpson, 2010) Yet this does not include traumatic peripheral nerve injuries meaning that the number of peripheral neuropathy in our society is greater. In first world countries, the most common cause of peripheral neuropathy is diabetes mellitus. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. (Loganathan, 2006) Due to the fact that the diagnose of diabetes mellitus has increased in our general population of the USA, the amount people in risk of diabetic peripheral neuropathy is also expected to increase.

ECG : ventricular rate 54 beats/min, HR varying from 39 to 60 during a 45 minute period of monitoring, infrequent PVCs, ST elevation in leads II, III and avF indicating inferior injury or ischemia secondary to acute MI.

In addition, scientists have found that genetics also plays a role in cardiac arrhythmias and that in some cases patients have commented that they had no symptoms before they succumbed to some form of episode of cardiac distress, like a sudden heart attack. This has proven to be standard for many different forms of arrhythmias, whether it’s due to genetics or not. One such case is the long QT syndrome (LQTS) which is estimated to affect one in every 5000 people and is recognized as a family disorder, frequent in children during their childhood years (Wilde, and Bezzina 1352–1358.) Patients with this disorder can have symptoms of a fluttering heartbeat, shortness of breath, and chest pain, while other patients might not experience any symptoms at all (Wilde, and Bezzina 1352–1358.) Another known disorder is cardiac conduction disease, which is mostly due to some form of cardiac injury (Wilde, and Bezzina 1352–1358.) Symptoms for this