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NUR229 > Exam #1 > Flashcards

Exam #1 Flashcards

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1
Q

What is the Accountable Care Organization (ACO)?

A

This departs from the fee-for-service model so instead they offer incentives to provide integrated, well coordinated care to patients.

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2
Q

What is the meaning of Fee-for-Service?

A

Everything a provider does comes out as a fee
-Instead of doing the necessary and better care,, they’ll do more unnecessary care

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3
Q

HMO and copayments

A

This is a prepaid group managed care plan that gives its subscribers all the medical services one requires through an affricated group
Copayments: pay a little out of pocket or nothing at all

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4
Q

PPO’s

A

Pay healthcare providers to provide services for a lower fee in return to a prompt day
Prompt day= A fair and reasonable payment

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5
Q

Inpatient

A

Patients that stay at the hospital for treatment

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6
Q

Outpatient

A

Patients that receive outside care in their homes
-like a clinic

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7
Q

ACA is?

A

A law that aims to expand and improve health insurance coverage in the healthcare system

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8
Q

What is Medicare?

A

This is a plan for adults older than 65
They receive
–Hospital care, extended care and home health care

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9
Q

What is Medicaid?

A

A federally funded public assistance program for people of any age and low income

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10
Q

T/F: Preferred provider organizations (PPOs) are prepaid, group-managed care plans that allow subscribers to receive all medical services through a group of affiliated providers.

A

F

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11
Q

What is a Occupational therapists?

A

evaluate the patient’s functional level and teaching activities to promote self-care in activities of daily living. They assess the home for safety and provide adaptive equipment as necessary.

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12
Q

speech therapist is?

A

trained to help patients who are deaf or hard of hearing speak more clearly, to assist patients who have had a stroke to relearn how to speak, and to correct or modify a variety of speech disturbances in children and adults. Speech therapists also diagnose and treat swallowing problems in patients who have had a head injury or a stroke.

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13
Q

physical therapist

A

seeks to restore function or to prevent further disability in a patient after an injury or illness. PTs use various techniques to treat patients, including massage, heat, cold, water, sonar waves, exercises, and electrical stimulation. Most PTs are also educated in the use of psychological strategies to motivate patients.

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14
Q

Respiratory Therapist

A

A respiratory therapist (RT) is trained in techniques that improve pulmonary function and oxygenation. RTs may also be responsible for administering a variety of tests that measure lung function and for educating the patient about the use of various devices and machines prescribed by the health care provider.

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15
Q

What are ways quality and safety have improved? (p. 276-278)

A
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16
Q

What is the difference between primary, secondary, and tertiary health care? (p. 282)

A

Definition: This is the first point of contact for individuals with the health care system. It focuses on overall health maintenance and prevention of disease.
Services: Includes routine check-ups, immunizations, health education, and treatment for common illnesses and conditions. Primary care is often provided by general practitioners, family physicians, pediatricians, and internists.
Goals: To provide comprehensive, accessible, and continuous care that is patient-centered and preventive. Secondary Health Care:
Definition: This level provides more specialized services typically requiring referral from a primary care provider.
Services: Includes specialty care like cardiology, dermatology, and orthopedics, often involving diagnostic tests and more advanced procedures. Care is usually provided by specialists or through hospitals.
Goals: To address specific health issues that need specialized expertise and to provide a higher level of intervention compared to primary care.
Tertiary Health Care:
Definition: This is highly specialized medical care usually provided in specialized centers or teaching hospitals.
Services: Includes complex treatments and procedures such as surgeries, advanced diagnostics, and management of severe and complex conditions. It often involves a team of specialists and advanced technology.
Goals: To manage and treat rare or complex conditions that require high-level expertise and resources not available in primary or secondary care settings.

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17
Q

What is the difference between PPOs & HMOs? (p. 284)

A

HMOs are known for their provider networks and lower costs. They are also restrictive and don’t cover out-of-network care unless it’s an emergency. PPOs offer more flexibility and allow out-of-network care, but that type of care typically comes with a higher cost.

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18
Q

List health care settings that a nurse can work in? (pp. 288-292)

A

Acute Care Settings:
Hospitals: Including emergency departments, intensive care units (ICUs), and surgical units.
Urgent Care Centers:Providing immediate care for non-life-threatening conditions.
Critical Care Units: Specialized areas such as cardiac care units (CCUs) and neonatal intensive care units (NICUs).
Primary Care Settings:
Private Practice: Working with individual or group practices focusing on general health maintenance and disease prevention.
**Community Health Clinics: **Providing primary care services to underserved populations.
Public Health Departments: Focusing on community health, disease prevention, and health education.
Long-Term Care Settings:
Nursing Homes: Offering extended care for individuals with chronic illnesses or disabilities.
Assisted Living Facilities: Providing support with daily activities while allowing for greater independence.
Rehabilitation Centers: Assisting with recovery and rehabilitation from injuries or surgeries.
Home Health Care:
Home Health Agencies: Delivering care in patients’ homes, including wound care, medication management, and health monitoring.
Palliative and Hospice Care: Providing end-of-life care and support for terminally ill patients and their families.
Specialty Care Settings:
**Oncology Clinics: **Focusing on cancer care and treatment.
**Cardiology Clinics: **Specializing in heart conditions and diseases.
Diabetes Clinics: Managing and educating on diabetes care and prevention.
Educational and Research Settings:
Academic Institutions: Teaching and training nursing students and professionals.
Research Facilities: Conducting studies and clinical trials to advance nursing practice and health care knowledge.
Occupational Health Settings:
Corporate Wellness Programs: Providing health assessments and education in the workplace.
**Industrial Clinics: **Managing health and safety for employees in industrial settings.
Military and Correctional Facilities:
**Military Health Services: **Delivering care to service members and their families.
**Correctional Facilities: **Providing health care within prisons and jails.

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19
Q

Describe what role the hospitalist has in the healthcare team. (p. 296, Box 11-3)

A

A hospitalist specializes in managing the care of hospitalized patients, coordinating treatment, communicating with the healthcare team and families, and ensuring efficient and effective inpatient care.

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20
Q

What do consumers want from their health care? (p. 297)

A

In addition to quality and affordability, convenience and personalization are key drivers of consumer choice and perception of their healthcare.

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21
Q

What are today’s healthcare primary foci? (p. 297)

A

Today’s healthcare primary foci include improving quality of care, enhancing patient safety, reducing costs, promoting preventive care, and integrating services to ensure a patient-centered approach.

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22
Q

What can nurses do to help health care reform? (p. 298)

A

Nurses can help health care reform by advocating for policy changes, participating in quality improvement initiatives, providing evidence-based care, and educating patients and communities about health and wellness.

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23
Q

What are the steps of the nursing process?

A

1.Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation
A dad paints in evergreen

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24
Q

What is the nursing process?

A

A systematic way we can make clinically safe decisions for our patients.

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25
What kind of practice is thoughtful person-centered practice?
focuses on the individual within multiple complicated contexts, including family and/or important others. Person-centered care is holistic, individualized, just, respectful, compassionate, coordinated, evidence-based, and developmentally appropriate.
26
What is clinical reasoning?
Refers to the ways of thinking about patient care issues (determining, preventing, and managing patient problems).
27
What are the types of problem solving?
Trial-and-error, scientific, and intuitive.
28
What type of problem solving may be chosen when approaching a rare medical condition, is not recommended, and is NOT a first line of problem solving? Ex. Trying to heal a cut on someone's arm with baking soda.
Trial-and-error problem solving
29
What type of problem solving has a logical 7 step method and consists of problem identification, formulating a hypothesis, and gathering info needed to make a decision?
Scientific problem solving.
30
What type of problem solving comes with experience and is essentially one knowing what to do because they have seen and dealt with it before?
Intuitive problem solving.
31
What are the 10 guiding principles of person-centered care?
-All team members are considered caregivers. -Care is based on continuous healing relationships. -Care is customized and reflects patient needs, values, and choices. -Knowledge and information are freely shared between and among patients, care partners, physicians, and other caregivers. -Care is provided in a healing environment of comfort, peace, and support. -Families and friends of the patient are considered an essential part of the care team. -Patient safety is a visible priority. -Transparency is rule in the care of the patient. -All caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient. -The patient is the source of control for one's care.
32
Describe the assessing step of the nursing process.
Collecting, validating, and communicating patient data.
33
Describe the diagnosing step of the nursing process.
Analyzing patient data to identify patient strengths and problems.
34
Describe the planning step of the nursing process.
Specifying patient outcomes and related nursing interventions. Plan with the patient.
35
Describe the planning step of the nursing process.
Specifying patient outcomes and related nursing interventions. Plan with the patient.
36
Describe the implementing step of the nursing process.
Carrying out the plan of care.
37
Describe the evaluating step of the nursing process.
Measuring extent to which the patient achieved outcomes.
38
Primary focus of healthcare
Health promotion
39
Health care outcomes by IOM
Safe, efficient , client centered, timely , equitable
40
Health care reform
Ensure were always informed on current topics, being involved in politics, participate in nursing associations , document out care, stronger voice, increasing education, provide care to people neglected, holistic care
41
Strategies to promote quality of care
Strategies to promote quality of care
42
How healthcare is paid for
out of pocket, individual private insurance, employer based insurance, government funding (medicare and medicaid)
43
Roles of health team members
Physician/Doctor: Role: Diagnose and treat medical conditions, develop and oversee treatment plans, and provide overall medical care. Specialties: Can include general practitioners, internists, surgeons, and specialists like cardiologists or oncologists. Nurse: Role: Provide direct patient care, administer medications, monitor patient progress, and educate patients and families. Nurses also coordinate care and advocate for patients’ needs. Types: Includes registered nurses (RNs), nurse practitioners (NPs), and licensed practical nurses (LPNs). Pharmacist: Role: Dispense medications, provide medication counseling, monitor for drug interactions, and contribute to medication management and safety. Physician Assistant (PA): Role: Perform medical examinations, diagnose and treat illnesses, assist in surgeries, and prescribe medications under the supervision of a physician. Social Worker: Role: Assist patients and families with social, emotional, and financial challenges, coordinate community resources, and provide counseling and support services. Occupational Therapist (OT): Role: Help patients develop, recover, or maintain daily living and work skills through therapeutic activities and adaptive techniques. Physical Therapist (PT): Role: Work with patients to improve movement, strength, and physical function through exercise and rehabilitation therapies. Speech-Language Pathologist (SLP): Role: Assess and treat speech, language, and swallowing disorders to improve communication and functional abilities. Dietitian/Nutritionist: Role: Develop and implement nutrition plans, provide dietary counseling, and manage nutritional aspects of patient care, including special diets. Clinical Psychologist: Role: Provide psychological assessments, therapy, and counseling to support mental health and address behavioral issues. Healthcare Administrator/Manager: Role: Oversee healthcare facilities or departments, manage operations, ensure compliance with regulations, and implement policies to improve service delivery. Medical Assistant: Role: Support physicians by performing clinical tasks such as taking vital signs, preparing patients for exams, and handling administrative duties.
44
Why has health care become so complex?
as people live longer, they get more diseases and issues
45
Qualities of community-based nurses
knowledgable and skilled, independent in decision making, accountable, advocate, coordinator of services, client and family educator
46
Responsibilities of the community-based nurse
Community-based nurses are responsible for promoting health, preventing disease, providing home health care, coordinating with other services, advocating for patients, conducting assessments, and preparing for emergencies within the community.
47
Continuity of care
HCT gives appropriate uninterrupted care and facilitate the clients transition between different settings and levels of care, critical for good client outcomes
48
ISBAR
introduction, situation, background, assessment, recommendation, question and answer
49
Care coordination
continuous process which a clients care shifts from being provided in one setting of care to another
50
Safety measures required by Joint Commission
The Joint Commission requires safety measures such as implementing infection control protocols, conducting regular staff training, ensuring proper patient identification, and maintaining accurate and confidential patient records to enhance overall patient safety and quality of care
51
Discharge planning
always trying to get client back to their normal, guidelines, healthcare needs, goals, teaching, referrals, evaluate discharge planning effectiveness
52
Delete
53
AMA
against medical advice, client is legally free to leave, carries a risk for increased illness or complications, client must sign a release form
54
Definition of health
The state of being free from illness or injury
55
Maslow’s Hierarchy of Needs, Prioritization
physiologic- oxygen, water, food, elimination, temp, sexuality, physical activity safety and security- physical and emotional love and belonging- giving and receiving self esteem, self actualization
56
Health disparities
preventable difference in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. racial and ethnic groups, poverty, gender age, mental health, education level, disabilities, sexual orientation, health insurance and access to care
57
Social Determinants of Health
economic stability, neighborhood and physical environment, education, food, community and social context, health care system
58
Primary health prevention vs secondary vs tertiary
Primary health prevention Promotes health and preventing development of a a disease Secondary prevention is early detection Tertiary prevention After an illness is diagnosed and treated, goal of reducing disability. Minimizing suffering
59
2030 Healthy People Goals
Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury and premature death. Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all. Create social, physical, and economic environments that promote attaining full potential for health and well-being for all. Promote healthy development, healthy behaviors and well-being across all life stages. Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.
60
Characteristics of chronic illness/disease
broad term, slow onset but lasts 3 or more months, can usually be controlled but not cured, irreversible
61
Why chronic conditions increasing
some communities may not have access to live a healthy lifestyle, decrease in people dying from infectious disease
62
Modifiable vs unmodifiable risk factors
Motifiable means that t hings that can be changed, alcohol use, tobacco use, poor nutrition, lack of physical activity Unmodifiable Can not be changed such as family history, genetics, age
63
Types of disabilities:
occur from birth -22, and result in impairment of physical or mental health, cognition, speech/language or self care intellectual occurs before 18, significant limitations in both intellectual function and adaptive behavior sensory impairment of sense of sight, hearing, smell, touch and taste importance of language use people first language, mr smith who has diabetes
64
Importance of language
use people first language, mr smith who has diabetes
65
Management of chronic diseases
learning to live with symptoms or disabilities, lifestyle changes and prevent complications, patient education, at risk for receiving conflicting information, difficulty adjusting, one chronic disease can lead to development of another
66
Human dignity and respect
Human dignity and respect are fundamental principles that underpin our interactions and ensure that everyone is valued and treated fairly.
67
Thoughtful person-centered care
the person, nurse -personal attributes knowledge based, clinical experience, blended competencies, QSEN -reflective practice leading to personal learning - nurses action in response to individual care - person centered nursing process - focus on patient not task
68
Blended competencies
cognitive, technical, interpersonal, and ethical/legal skills combined with the willingness to use them creatively and critically when working with patients.
69
QSEN goals
knowledge, skills attributes, competencies-person centered care, teamwork and collaboration, evidence based practice, QI, safety, informatics
70
Problem solving
trial and error, scientific intuitive, critical thinking, clinical reasoning
71
Critical thinking/Clinical reasoning
evidence based descriptions of behaviors, that demonstrate knowledge, characteristics, and skills that promote critical thinking in critical practice
72
Critical thinking indicators
analytical and insightful, honest and upright, careful and prudent, open and fair minded, creative, courageous, flexible
73
Reflective practice
reflection in action- thinking on your feet, reflection on action, after the fact, reflection for action- how future actions might change as a result of reflection, thinking about future actions
74
Reasons for documentation/having client records
communication, diagnostic and therapeutic orders, care planning, quality process and performance improvement, research, education, credentialing, reimbursement, legal and historical documentation
75
Documentation Guidelines
consistence with professional agency standards, complete, accurate, concise, factual, organized and timely, legally prudent, confidential, non judgmental, content, format, accountability
76
Methods of documentation
charting by exception, focused DAR notes, narrative notes, SOAPIE progress notes, client discharge summaries, and Minimum Data Set (MDS) charting.
77
Formats of documentation
Documentation and Reporting -Methods of documentation-Types of charting/progress notes-SOAP charting, narrative notes Documentation and Reporting -Electronic Documentation Documentation and Reporting -Documentation Guidelines Documentation and Reporting -Formats for nursing documentation Documentation and Reporting -SBAR-ISBARR
78
Telephone/verbal orders
record, always read back to confirm, date/time, write verbal order, tour name and prescribers name, prescriber will review
79
Abbreviations
80
Handoff reports
basic identifying information, current health status, orders, anything abnormal that happened during your shift, anything that needs to be continued, client/family questions or concerns, reports on transfers/discharges
81
Incident reports
provide a record of an unexpected occurrence, such as a fall or administration of a wrong medication dose, that involved a patient, a family member, or an employee
82
What are the steps in the nursing process and what is involved in each step -Assessment Validating data
identify specific problems, establish prioritize goals, plan of action to achieve desired outcomes, interventions, evaluate outcomes, reassess problems
83
Missing. Nursing something
84
Nursing Diagnosis: PES format and how to use it to write types of nursing diagnoses
The PES format for nursing diagnoses includes three components: Problem (the nursing diagnosis), Etiology (the cause or contributing factors), and Symptoms (evidence or manifestations). For example, "Impaired gas exchange related to alveolar-capillary membrane changes as evidenced by decreased oxygen saturation and shortness of breath." This format helps ensure that the diagnosis is comprehensive and targeted, guiding effective care planning.
85
Nursing Diagnosis: Nursing diagnoses vs medical diagnoses
nursing diagnoses may change from day to day, focus on unhealthy response to health and wellness, describe problems treated by nurses with their scope of practice medical remain the same for as long as disease is present, medical diagnoses identify diseases, describe problems for which the MD/PA/APN directs primary treatment
86
Outcomes/Goals, Planning:Determining desired outcomes
happens after the assessment and diagnosis -plans for nursing actions -work with patient and families
87
Outcomes/Goals, Planning: How to write goals
should have a subject, verb, performance criteria, target time
88
Outcomes/Goals, Planning: Nurse-initiated interventions
those providing direct and indirect care, those aimed at individuals, family, and community, those for nurse initiated and other provider initiated treatment
89
Implementation o Modifying care plans
Help the patient achieve valued health outcomes. Promote health. Prevent disease and illness. Restore health. Facilitate coping with altered functioning.
90
Implementation: Direct vs indirect care
Direct doing something with the patient indirect doing something for the patient
91
Evaluation o Evaluation statements
decide how well outcome was met (met, partially met, not met), list patient data or behaviors that support this decision
92
Evaluation o Evaluation statements
Cognitive - knowledge Psychomotor - skills Effective - values, beliefs, attitudes Psychological - condition change
93
Types of outcome? Cognitive - knowledge Psychomotor - skills Effective - values, beliefs, attitudes Psychological - condition change
94
Types of outcome? Cognitive - knowledge Psychomotor - skills Effective - values, beliefs, attitudes Psychological - condition change
95
Maslow's Hierarchy of needs
physical -> safety -> love/belonging -> self-esteem -> self-actualization
96
Nursing Dx
Only what the nurse is able to do (holistic care) interpret data by looking at ALL info
97
Kardex
Has PT summary on it
98
ADPIE - Assessment
Collect info from PT/secondary sources, interpret & validate info gathered
99
ADPIE - Diagnosing
Analysis of PT data to identify PT strengths/health probs that nursing intervention can prevent/resolve; uses subjective AND objective data
100
ADPIE - Planning
Develop individualized care plan, identify PT strengths that can be used
101
ADPIE - Implementing
Carrying out the plan, assisting PTs to achieve desired outcomes (promote wellness, prevent disease/illness, restore health)
102
ADPIE - Evaluating
Continue, modify, or terminate nursing care, measure extent to which PT has achieved outcomes from nursing care plan, identify factors that influenced this
103
SCIENTIFIC problem solving
Problem identification, Data collection, hypothesis formation, plan of action, hypothesis testing, interpretation of results, evaluation
104
A nurse working in an ambulatory care center provides care for patients experiencing varying levels of health and illness. The nurse bases care on which concepts of health and illness? Select all that apply. a. Health and illness are the same for all people. b. Health and illness are individually defined by each person. c. People with acute illnesses may consider themselves healthy. d. People with chronic illnesses have poor health beliefs. e. Health is more than the absence of illness. f. Illness is the response of a person to a disease.
105
A community health nurse is developing a support group for patients coping with chronic health prob-lems. What chronic health conditions does the nurse anticipate group members might want to discuss? Select all that apply. a. Diabetes mellitus b. Bronchial pneumonia c. Rheumatoid arthritis d. Ulcerative colitis e. Fractured hip f. Otitis media
106
Nurses from hospital in a low-income area of the city are developing educational materials and programs focused on health care for vulnerable populations. When planning community outreach, which members of the community will the nurses include? Select all that apply. a. White male diagnosed with HIV b. Black teenager who is 6 months pregnant c. Hispanic male who has type 2 diabetes genetic characteristics of underrepresented and under- d. How-income family ving in a lal America served populations explain the health disparities expe- c. Middle-class teacher living in a large city d.white infant born with cerebral palsy
107
A nurse has volunteed chine inferra immu. health care? nizations at a local health elinic. In which level of 4. Not infrequently, nurses become the target of disrespect, health promotion and ines prevention is the mutes racist beliefs, and biases. How would you respond if a participating? White new father asked you to post a sign in the nurs- a. Tertiary ery stating that no Black nurses were to touch his baby? b. Secondary What if a patient told you that they didn't want you to c. Primary be their nurse because of your race, ethnicity, gender, or d. Promotive
108
A community health murse cares for yulnerable popu and assault. One in 5 women and 1 in 16 men will face lations. What problem will the nurse prioritize for a patient who is homeless? sexual assault while in college, according to a govern- a. Love and belonging ment report. What is your perception of your risk for b. Safety sexual assault or misconduct? Describe the model of c. Self-esteem health professional nurses might use to reduce sexual d. Self-actualization
109
A dinic nurse works with a pipulation experiencing health disparities. Which patient does the nurse iden. tify as having the highest risk for postponing annual PRACTICING FOR NCLEX 1. A nurse working in an ambulatory care center provides care for patients experiencing varying levels of health and illness. The nurse bases care on which concepts of health and illness? Select all that apply. a. Health and illness are the same for all people. b. Health and illness are individually defined by each person. c. People with acute illnesses may consider themselves healthy. d. People with chronic illnesses have poor health beliefs. e. Health is more than the absence of illness. f. Illness is the response of a person to a disease. 2. A community health nurse is developing a support group for patients coping with chronic health prob-lems. What chronic health conditions does the nurse anticipate group members might want to discuss? Select all that apply. a. Diabetes mellitus b. Bronchial pneumonia c. Rheumatoid arthritis d. Ulcerative colitis e. Fractured hip f. Otitis media 3. Nurses from hospital in a low-income area of the city are developing educational materials and programs focused on health care for vulnerable populations. When planning community outreach, which members of the community will the nurses include? Select all that apply. a. White male diagnosed with HIV b. Black teenager who is 6 months pregnant breast examinations and mammograms? a. Patient whose best friend had a benign breast lung removed b. Patient who lives in a low-income neighborhood c. Patient who has a family history of breast cancer d. Patient whose family encourages regular physical examinations
110
A nursing student is writing a paper about nurses performing health promotion activities at the tertiary level. Which nursing actions will the student include Select all that apply. a. Running an immunization clinic in a lower-income area of a city b. Teaching a patient with an amputation how to care for the residual limb c. Providing range-of-motion exercises for a patient who is paralyzed d. Teaching parents of toddlers how to childproof their homes e. Providing screening for scoliosis for school students f. Teaching new parents how to choose and use an infant car seat
111
A nurse is caring for a patient who has been managing their chronic spasticity well for 10 years. The patient states having had increasing spasticity and few falls due to unremitting muscle spasms. The nurse, patient, and health care provider discuss the possibility the patient may be experiencing which phase of illness? a. Acute onset of illness b. Permanent complication c. Need for hospice care d. Exacerbation of disease

NUR229 (4 decks)

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