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Flashcards in Exam 1 / Part 1 Deck (53)
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1
Q

T or F: Uninsured patients are more likely to skip or delay treatment for acute or chronic illnesses and die prematurely.

A

True

2
Q

Name two public, federally-funded programs.

A

Medicare - Over the age of 65 & Permanent disabilities, Diagnosis related groups (DRGs)-fixed reimbursement amount with adjustments
Medicaid - Low income families, Individual states determine eligibility requirements

3
Q

List Private Insurance Plans.

A
    • Traditional insurance reimburses for servises on a fee-for-service basis.
    • MCOs: managed care organizations (primary care providers oversee comprehensive care)
    • PPOs: preferred provider organization (clients choose from a list of providers)
    • EPOs: exclusive provider organization (clients choose from a list of providers within a certain organization)
    • Long-Term Care Insurance: for what Medicare does not cover
4
Q

T or F: Health Promotion reduces healthcare costs.

A

True

5
Q

List the Levels of Health Care

A
    • Preventive: focuses on educating and equipping clients to reduce and control risk factors for disease. (immunization, stress mgmt, seat belt)
    • Primary: emphasizes health promotion (office/clinic visits, vision/hearing/obesity screenings)
    • Secondary: diagnosis and treatment of acute illness and injury. (inpatient and ED, diagnostic centers)
    • Tertiary: specialized and highly technical care (ICU, oncology/burn units)
    • Restorative: follow up (home health, rehab, skilled nursing facilities)
    • Continuing: addresses long term or chronic health care needs. (end-of-life, palliative, hospice, adult day care, in-home respite care)
6
Q

Health Care Accreditation/Certification is earned by the entire organization or for specific programs/services within an organization. List the regulatory agencies.

A
    • The Joint Commission
    • U.S Food and Drug Administration
    • U.S. Department of Health & Human Services
    • Professional Standards Review Organizations (PSROs)
    • State licensing boards
    • State & local public health agencies
    • Utilization review committees
7
Q

Describe restorative care (rehabilitation).

A

Focus: To restore patients to their fullest physical, mental, social, vocational, and economic potential. Includes physical, occupational, and speech therapy, as well as social services. Occurs in many health care settings, both inpatient and outpatient

8
Q

Describe restorative care (skilled nursing facility)

A

Provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities. Provides care for patients until they can return to their community or residential care location

9
Q

Describe continuing care

A

For people who are disabled, functionally dependent, or suffering a terminal disease. Available within institutional settings or in the home

10
Q

Describe continuing care (Nursing Centers or Facilities).

A

Provide 24-hour intermediate and custodial care. Nursing, rehabilitation, diet, social, recreational, and religious services. Residents of any age with chronic or debilitating illness. Regulated by standards: Omnibus Budget Reconciliation Act of 1987. Interdisciplinary functional assessment is the focus of clinical practice: MDS, RAIs

11
Q

Describe continuing care (Respite Care)

A

The service provides short-term relief or “time off” for persons providing home care to an ill, disabled, or frail older adult. Settings include home, day care, or health care institution with overnight care. Trained volunteers allow family caregivers to leave the home for errands or social time.

12
Q

Describe continuing care (Adult Day Care Centers)

A

Provide a variety of health and social services to specific patient populations who live alone or with family in the community. May be associated with a hospital or nursing home or may operate independently. Offer services to patients such as daily physical rehabilitation and counseling

13
Q

Describe continuing care (Hospice)

A

Family-centered care that allows patients to live and remain at home. Focuses on palliative (not curative) care: comfort, independence, and dignity. Provides patient and family support during terminal illness and time of death. Many hospice programs provide respite care, which is important in maintaining the health of the primary caregiver and family.

14
Q

Safety

A

The minimization of risk factors that could cause injury or harm while promoting high-quality care and maintaining a secure environment for clients, self, and others.

15
Q

Patient-Centered Care

A

The provision of caring and compassionate, culturally sensitive care that addresses clients’ physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values.

16
Q

Evidence Based Practice

A

The use of current knowledge from research and other credible sources on which to base clinical judgment and client care.

17
Q

Informatics

A

The use of information technology as a communication and information-gathering tool that supports clinical decision making and scientifically based nursing practice.

18
Q

Quality Improvement

A

Care-related and organizational processes that involve the development and implementation of a plan to improve health care services and better meet clients’ needs.

19
Q

Teamwork and Collaboration

A

The delivery of client care in partnership with multidisciplinary members of the health care team to achieve continuity of care and positive client outcomes. The Future of Health Care

20
Q

What is Health?

A

World Health Organization (WHO) defines health as a “state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.”

21
Q

What is Illness?

A

A state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired

22
Q

What is Illness Behavior?

A

Involves how people monitor their bodies and define and interpret their symptoms. Influenced by many variables (internal & external) and must be considered by the nurse when planning care

    • Internal variables: Perception of illness and nature of illness
    • External variables: Visibility of symptoms, social group, cultural background, economics, and accessibility to health care
23
Q

List the Healthy People 2020 Goals.

A
    • Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
    • Achieve health equity, eliminate disparities, and improve the health of all groups.
    • Create social and physical environments that promote good health for all.
    • Promote quality of life, healthy development, and healthy behaviors across all life stages.
24
Q

List the Models of Health and Illness

A
    • Health Belief Model: Addresses the relationship between a person’s beliefs and behaviors
    • Health Promotion Model: Directed at increasing a patient’s level of well-being
    • Basic Human Needs Model: Attempts to meet the patient’s basic needs
    • Holistic Health Model: Attempts to create conditions that promote optimal health
25
Q
1. According to Maslow’s hierarchy of needs, which of these needs would the patient seek to meet first?
A. Self-actualization
B. Psychological security
C. Shelter
D. Love and belonging
A

C. Shelter

26
Q
2. After evaluating a patient’s external variables, the nurse concludes that health beliefs and practices can be influenced by 
A. Emotional factors.
B. Intellectual background.
C. Developmental stage.
D. Socioeconomic factors.
A

D. Socioeconomic factors.

27
Q

What are Risk Factors?

A

Variables that increase the vulnerability of an individual or a group to an illness or accident. Risk factors include: Genetic and physiological factors, Age, Environment, Lifestyle

28
Q

List the stages of Changing Behaviors/ Risk Factor Modification.

A
    • Precontemplation: Not intending to make changes within the next 6 months
    • Contemplation: Considering a change within the next 6 months
    • Preparation: Making small changes in preparation for a change in the next month. Improvement in health may involve a change in health behaviors.
    • Action: Actively engaged in strategies to change behavior; lasts up to 6 months
    • Maintenance stage: Sustained change over time; begins 6 months after action has started and continues indefinitely
29
Q
Sally has decided to set aside 30 minutes a day to walk after work next week. Sally is in what stage of risk factor modification?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action
E. Maintenance
A

C. Preparation

30
Q

What is Critical Thinking?

A

A continuous process characterized by open-mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant. Recognizing that an issue exists, analyzing information, evaluating information, and making conclusions

31
Q

List the steps of the Nursing Process (ADPIE).

A
A= assessment 
D= (nursing) diagnosis
P= plan care
I= implementation of care
E= evaluation of care
32
Q

A = Assessment

A

Assessment involves collecting information from the patient and from secondary sources (e.g., family members), “the patient’s story” along with interpreting and validating the information to form a complete database. (Obtain permission first when asking family members information).

33
Q

D = Diagnosis

A

Diagnosis involves clustering data and identify patterns and problems. Differs from medical diagnosis. Identifies health problem and which healthcare professional can best treat the problem. Nursing diagnoses include actual or potential health problems.
**NANDA: North American Nursing Diagnosis Assosication Conferences held Q 2 yrs. >201 approved, defined diagnoses. Their purpose is to Individualize care. They will affect the entire plan of care.

34
Q

What is a data cluster?

A

A set of signs or symptoms gathered during assessment that you group together in a logical way. Data clusters are patterns of data that contain defining characteristics—clinical criteria that are observable and verifiable. Each clinical criterion is an objective or subjective sign, symptom, or risk factor that, when analyzed with other criteria, leads to a diagnostic conclusion.

35
Q

What is a related factor?

A

A condition, historical factor, or causative event that gives a context for the defining characteristics and shows a type of relationship with the nursing diagnosis. A related factor allows you to individualize a nursing diagnosis for a specific patient. When you are ready to form a plan of care and select nursing interventions, a concise nursing diagnosis allows you to select suitable therapies.

36
Q

P = Planning

A

Follows the nursing diagnosis. This phase consists of writing measurable patient/client outcomes and nursing interventions to accomplish the outcomes. These outcomes and interventions are designed to change the client’s nursing diagnosis/problem.

37
Q

How to establish priorities?

A
    • Follow Maslow’s Hierarchy of Needs
    • Follow the A B Cs: Airway, Breathing, Circulation
    • Priority setting begins at a holistic level when you identify and prioritize a patient’s main diagnoses or problems. Patient-centered care requires you to know a patient’s preferences, values, and expressed needs. Ethical care is a part of priority setting.
38
Q

Name the two parts of planning.

A
  1. Planning the OUTCOMES or goals you want to achieve. (PO)

2. Planning the INTERVENTIONS that will make those outcomes or goals happen. (PI)

39
Q

How to plan SMART outcomes?

A

Make them

    • Singular, Specific
    • Measurable (observable)
    • Attainable
    • Realistic
    • Timely
40
Q

How to plan interventions, SIRS?

A

Make them

    • Safe
    • Individualized to the patient
    • Relevant to the nursing diagnosis
    • Specific (how frequent? when? where? ex.: Turn the patient every two hours on the even hours. NOT Turn the patient.)
41
Q

List the types of Interventions.

A
    • Assessment: Always the number one intervention listed
    • Nurse initiated: Independent actions that a nurse initiates.
    • Physician initiated: Dependent actions that require an order from a physician or other health care professional.
    • Collaborative: Interdependent actions that require combined knowledge, skill, and expertise of multiple health care professionals.
    • Teaching: Referral/Community resources/consultation
    • Pharmacology: Medications. Those involving protocols, standing orders, preventive measures
42
Q

What occurs when Consulting Other Health Care Professionals?

A

Planning involves consultation with members of the health care team. Consultation is a process by which you seek the expertise of a specialist such as your nursing instructor, a physician, or a clinical nurse educator to identify ways to handle problems in patient management or in planning and implementation of therapies. Consultation occurs at any step in the nursing process, most often during planning and implementation.

43
Q

I = Implementation of Care

A

Initiation of the nursing care plan. Performing the nursing interventions. Delegation of appropriate nursing interventions. Using skills – Psychomotor, Interpersonal, Cognitive, Performing continuous assessment.

44
Q

List the types of order.

A
    • On-Line: Specific verbal order from a qualified provider
    • Standing Order/Off-Line: a preprinted document containing orders to the conduct of routine therapies, monitoring guidelines, and diagnostic procedures for specific patients with identified clinical problems. after completed, the nurse then notifies the physician
    • Protocol: a clinical practice guideline. a suggested outline of steps for treating a particular problem. You sometimes can’t follow them by the letter, but if you deviate from them, be prepared to defend your logic
45
Q

Nurse-initiated interventions are
A. Determined by state Nurse Practice Acts.
B. Supervised by the entire health care team.
C. Made in concert with the plan of care initiated by the physician.
D. Developed after interventions for the recent medical diagnoses are evaluated.

A

A. Determined by state Nurse Practice Acts.

46
Q

What is Direct Care?

A

It includes activities that nurses perform through patient interactions, such as:

    • ADLs
    • instrumental ADLs
    • physical care techniques (like repositioning or passing meds)
    • lifesaving measures (like cardiopulmonary resuscitation, obtaining immediate counseling from a crisis center for an anxious pt)
    • counseling, teaching
    • preventive measures 1. primary = health promotion (education, immunizations, fitness activities), 2. secondary = prevent progression of illness (screening and treating at early stages), and 3. tertiary = minimize effects (rehabilitation measures)
    • controlling for adverse reactions (like after giving a medication and monitoring a pt for side effects)
    • the work of other health care team members.
47
Q

What is Indirect Care?

A

Indirect Care: 1. Communicating nursing interventions, written or oral or 2. Delegating, supervising, and evaluating
Examples include:
– documentation (electronic or written)
– delegation of activities
– medical order transcription
– infection control
– environmental safety mgmt
– telephone consults
– change of shift reports
– collecting, labeling, and transporting specimens
– transporting pts to procedural areas and other nursing units

48
Q
Isolation Precautions as a treatment intervention are an example of which type of care?
A. Direct
B. Indirect
C. Prevention
D. Safety
A

B. Indirect

49
Q

E= Evaluation of Care

A

On-going. Collaborate with the patient and family. Use evaluative measures. Interpret and summarize findings. Document results. Revise care plan. Client outcomes/goals evaluated, and labeled as Met, Partially met, or Not met

50
Q

When revising a Care Plan after a goal is not met, what must occur?

A

When a goal is not met, no matter what the reason, repeat the entire nursing process sequence for that nursing diagnosis to identify necessary changes to the plan. By consistently incorporating evaluation into practice, you minimize errors and ensure that the patient’s plan of care is appropriate and relevant

51
Q
During which of the five steps in the Nursing Process are outcomes of care determined to be achieved?
A - Diagnosis
B - Evaluation
C - Implementation
D - Planning
A

B - Evaluation

52
Q

You have finished with several nursing interventions. To evaluate interventions, you need to examine the:
A. Appropriateness of the interventions and the correct application of the implementation process.
B. Nursing diagnoses to ensure that they are not medical diagnoses.
C. Care planning process for errors in other health care team members’ judgments
D. Interventions of each nurse to enable the nurse manager to correctly evaluate performance.

A

A. Appropriateness of the interventions and the correct application of the implementation process.

53
Q

Your patient has met the goals set for improvement of ambulatory status. You would now
A. Modify the care plan.
B. Discontinue the care plan.
C. Create a new nursing diagnosis that states goals have been met.
D. Reassess the patient’s response to care and evaluate the implementation step of the nursing process.

A

B. Discontinue the care plan.