Reference no: EM133564291

Read the case study below and answer all questions fully and professionally. OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Acute on Chronic Respiratory Failure with Hypoxia POSTOPERATIVE DIAGNOSIS: Same PROCEDURE: Permanent tracheostomy INDICATIONS: The patient is a 64-year-old male who had long suffered from panlobular emphysema and became respiratory dependent after being admitted to the hospital because of an onset of a gram-negative pneumonia. Because the patient was unable to be weaned from mechanical ventilation and will need long-term respiratory support, a tracheostomy was recommended to the patient's wife, the patient's agent according to his advanced directive for health care, who consented to the procedure because her husband was unconscious and unable to consent. PROCEDURE: The patient was brought to the operating room. After being placed under general anesthesia, the neck was prepped and draped for the procedure. A 2.5 cm incision was made approximately 2 fingerbreadths above the sternal notch. The strap muscles were identified and divided exposing the thyroid thymus. Dissection was taken down to the cricoid. The thyroid isthmus was divided exposing the trachea. An incision was made between the second and third tracheal rings and an inferior-based tracheal flap was created. The flap was sewn to the skin edge creating a skin flap in order to mature the tracheal stoma with a 3 - 0 Vicryl. The endotracheal tube was withdrawn to just above the tracheostomy site. An appropriate-sized Shiley trach was inserted with no difficulties. The balloon was inflated and connected to the anesthesia circuit and CO2 was confirmed. The tracheostomy was secured to the skin with 2 - 0 silk sutures. Straight ties and a drain sponge were applied. The patient was returned to the ICU in stable condition with no obvious adverse reaction to the procedure.

Question 1: Identify the principal diagnosis and list the appropriate code and include the appropriate POA status indicator.
Question 2: Explain your rationale for selecting the principal dx.
Question 3: Identify any secondary diagnoses and list the appropriate code(s) and include all appropriate POA status indicators for each code.
Question 4: Explain your rationale for selecting secondary diagnoses and the sequencing of these codes
Question 5: Identify the principal procedure and list the appropriate code.
Question 6: Explain your rationale for selecting the principal px.
Question 7: Identify any secondary procedures and list the appropriate code(s).
Question 8: Explain your rationale for selecting the secondary procedures and the sequencing of these codes.