Below is a summary of Stefani’s electronic health record (EHR) activity during her hospital visit. As an oncology physician, you are responsible for examining Stefani, ordering tests and procedures and diagnosing her condition. Using her EHR and Internet research, answer the questions and be prepared to discuss the responses with the rest of Stefani’s healthcare team.

1. Review Stefani’s Inpatient EHR: You order additional blood work for Stefani and the results are quickly shown as normal or abnormal in her EHR. Identify which tests are abnormal and explain how this is indicated.
   
   Internet Research: Explain how these tests help the team determine Stefani’s diagnosis.



2. Internet Research: You perform a sentinel node biopsy and PET scan to help determine if and how far her cancer has metastasized. Provide a brief description of these procedures.
   • Sentinel Node Biopsy
   • PET Scan


3. Internet Research: During the sentinel node biopsy you remove a couple of Stefani’s lymph nodes. What is the purpose of lymph nodes?

As a nurse, you are the first member of the hospital’s healthcare team that Stefani encounters. You are responsible for obtaining and recording Stefani’s vital signs: weight, height, medications and medical history. You also are responsible for electronically charting Stefani’s medical information and keeping it current during her stay. Using Stefani’s EHR and Internet research, answer the questions and be prepared to discuss the responses with the rest of Stefani’s healthcare team.

1. Review Stefani’s Inpatient EHR: The oncologist has ordered additional blood work for Stefani and the results are shown as normal or abnormal in her EHR. Identify which tests are abnormal and explain how this is indicated.
   
   Internet Research: Explain how these tests help the team determine Stefani’s diagnosis?



2. Internet Research: A sentinel node biopsy and PET scan are performed on Stefani to help determine if and how far her cancer has metastasized. Provide a brief description of these procedures.
   • Sentinel Node Biopsy
   • PET Scan


3. Review Stefani’s EHR: What areas of concern do you see on Stefani’s EHR?

As a laboratory or radiology technologist, you are responsible for obtaining and providing test results to assist the physician in diagnosing Stefani’s condition. The oncologist has ordered additional blood work, a PET scan and a sentinel node was removed for biopsy. Using her EHR and Internet research, answer the questions and be prepared to discuss the responses with the rest of Stefani’s healthcare team.

1. Internet Research: The oncologist has performed a sentinel node biopsy on Stefani to help determine if her cancer has metastasized. The results are analyzed by a pathologist in the lab. Provide a brief description of what the pathologist is looking for in their analysis.



2. Review Stefani’s Inpatient EHR: The laboratory results are quickly shown as normal or abnormal in the EHR. Which tests are abnormal and explain how this is indicated?
   
   Internet Research: Explain how these tests help the team determine Stefani’s diagnosis?



3. Internet Research: The oncologist ordered a CBC and CMP for Stefani. What do these two acronyms stand for and why are they ordered?
• CBC:
• CMP:
  

As a pharmacist, you are responsible for ensuring that Stefani receives the proper medication and dosage ordered by the oncologist. You are also responsible for reviewing any adverse interactions Stefani might have with her medications. Using her EHR and Internet research, answer the questions and be prepared to discuss the responses with the rest of Stefani’s healthcare team.

1. Review Stefani’s Inpatient EHR: You notice that she has a few allergies. What are her allergies?
   
   Internet Research: Why is this information significant?



2. Internet Research: There are five types of standard treatment for melanoma – surgery, chemotherapy, radiation, biological therapy and targeted therapy. What is the pharmacist’s role as part of the oncology (cancer) team and in the patient’s cancer treatment?



3. Internet Research: Based on the mole’s size, her blood work, results of the sentinel node biopsy and PET scan, the oncologist alerts you that Stefani may have advanced stage melanoma. You know the most common melanoma chemotherapy drug is Dacarbazine (DTIC). List the drug’s adverse reactions.

Below is a summary of Stefani’s electronic health record (EHR) activity during her stay at the hospital. As a medical and health services manager, you are responsible for making sure she receives excellent care. You will also figure Stefani’s bills, consisting of her tests, procedures, room charges, supplies and medications. Using her EHRs, Virtual Physical Exam (VPE) and Internet research, fill out the billing statements and be prepared to share this information with the rest of Stefani’s healthcare team.

• MHSM – Bill; (includes both a PCP and Inpatient statement)
• MHSM – Bill Reference
• Stefani’s EHR – PCP Chart
• Virtual Physical Exam
• Stefani’s EHR – Inpatient Chart (link below)

1. Use the blank copy of Stefani’s PCP and Inpatient bills and the Bill Reference to calculate her costs. In her EHRs, look for the number of times a test is administered, number of days a cost is incurred or the units per day a medication is administered. You may need to do additional Internet research. Some helpful sites are www.healthcarebluebook.com, www.fairhealthconsumer.org and www.pharmacychecker.com.

As a health coach, you will recommend lifestyle changes to alleviate skin-related symptoms, prevent symptoms from recurring and decrease the need for future care. You will also provide the education Stefani will need to understand her diagnosis and the risk factors that may have caused her condition. Using her EHR and Internet research, answer the questions and be prepared to discuss the responses with the rest of Stefani’s healthcare team.

1. Internet Research: Explain why Stefani should continue to perform routine self-examinations of her skin.



2. Review Stefani’s Inpatient EHR: Review the results of her PET scan and sentinel node biopsy. What do these results indicate?
   
   
   
3. Internet Research: What type of additional treatment can she expect and how can you assist her in navigating treatment and preparing for recovery?



4. Internet Research: What changes do you suggest Stefani incorporate into her daily life? What can she teach her students so they don’t make the same mistakes she’s made?



5. On Your Own: Stefani is trying to decide whether she should inform her family, friends, work and/or students of the health plan provided for her. List two reasons why they should be informed and two reasons why they should not be informed.