Discussion: Risk Stratification:

Discussion: Risk Stratification:
Risk stratification is an important technique that allows patients to be classified according to their health risk status, taking into consideration many factors, such as diagnosis, age, BMI, comorbidities, labs and other assessment scores, health behaviors and health literacy, and social and caregiver support needs, to name a few. Utilizing such a framework or model can be used not only to identify patient-specific risks to refine treatment plants, but can also be applied to improve workflows, better manage population health, and effectively use resources.

For this Discussion, you will consider risk stratification in the preoperative environment.
To prepare:

Review the risk stratification video in this week’s Learning Resources.
You will receive a set of patient scenarios from your Instructor. Review each of the three patient scenarios provided. Identify each patient as high, intermediate, or low risk.
(Week 1 Discussion Question see below)
Post your assessment of which level of risk each patient in the case scenarios corresponds with (high, intermediate, or low). Explain the rationale for your decision-making.
DQ A: A 42-year-old hypertensive, diabetic male presents to the ED after falling off of a ladder. He has a fractured ankle and needs surgery. He reports passing out on the ladder and falling. He has no previous cardiac history. His ECG is abnormal with inverted t-waves in the inferior leads. He reports chest pain with minimal exertion and at rest on one occasion. His echocardiogram shows a wall motion abnormality in the inferior wall. His EF is 45%.
DQ B: You are asked to evaluate a 49-year-old female set for preoperative or stratification for proposed laparoscopic shoulder surgery. She is active, participating in soccer both as a player and a coach several times a week. She has no cardiac history and no exertional symptoms.
DQ C: You evaluate a 72-year-old male with previous coronary disease, including multiple stents, hypertension, hypothyroidism, and hyperlipidemia for proposed knee replacement surgery. Given his lack of mobility due to knee pain, you are unable to evaluate his functional status. His ECG shows sinus rhythm with the left axis deviation and an intraventricular conduction delay. Ejection fraction is 50% with no wall motion abnormality. He reports no anginal symptoms and no dyspnea.
Consider patient education needs and strategies for each patient, as well as what the informed consent for each procedure would be.
By Day 3 of Week 1
Post your assessment of which level of risk each patient in the case scenarios corresponds with (high, intermediate, or low). Explain the rationale for your decision-making.

Barkley, T. W., Jr., & Myers, C. M. (2015). Practice considerations for adult-gerontology acute care nurse practitioners (2nd ed.). Barkley & Associates.
Ch. 85, “Hospital Admission Considerations”
Ch. 86, “Managing the Surgical Patient”
University of Washington School of Medicine. (2014). Informed consent. https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/67
iHuman Patients. (2020b). I-Human Patients graduate programs manual. https://ih2.i-human.com/home/graduate_programs

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