Professional and Legal Flashcards
(70 cards)
1
Q
Describe: Acute Care
(Setting, Patient Acuity, Focus of Care, Length of Stay)
A
Setting
- Hospital
Patient Acuity
- Acutely ill (require immediate hospitalization)
Focus of Care
- Tests, treatment, surgery
-> 24 hour services
Length of Stay
- Short term, but usually more than 24 hours
2
Q
Describe: Sub-acute Care
(Setting, Patient Acuity, Focus of Care, Length of Stay)
A
Setting
- Long-term acute facility
Patient Acuity
- Not in acute phase/severely ill, but requires skilled care
Focus of Care
- Provides assistance to regain function
Length of Stay
- Range: days - months
-> Transitional period
3
Q
Describe: Post-acute Care
(AKA, Setting, Focus of Care, Length of Stay)
A
AKA
- LTAC facilities
Setting
- SNF (Skilled Nursing Facility)
- Nursing home
Patient Acuity
- x
Focus of Care
- Provides residential accomodations with long-term personal nursing care
-> help with ADLs/simple skills
-> contains physical/occupational/speech therapy
Length of Stay
- Range: variable (week - months)
-> depends on pt progress
4
Q
T/F: Immediate Care is a type of healthcare delivery system
A
True
5
Q
Describe: Long Term Care
(Setting, Focus of Care, MISC)
A
Setting - BRAM
- Board and Care
- Residential Care
- Assisted Living
- Memory Care
Patient Acuity
- x
Focus of Care
- Need assistance with ADLs, but not required care like SNF
-> Ex: medication management
MISC
- Can be in pt homes
6
Q
Describe: Ambulatory Care
(Setting, Patient Acuity, Focus of Care, MISC)
A
Setting
Outpatient care
- Walk-in clinicals
- Urgent Care
- Home health
- Dialysis centers
- Out-patient surgery
- Hospice
Patient Acuity
- Patients who do not require overnight hospitalization
Focus of Care
- Diagnosis and treatment of minor illness (technical services)
- Minor surgical procedures
-> same day surgery/procedures
Length of Stay
- x
MISC
- Less expensive
7
Q
What are the main purposes of Community Senior Centers for older adults?
A
To improve health, socialization, and life satisfaction for older adults
8
Q
What are some examples/types of services do Community Senior Centers offer to assist seniors?
A
- Meals and nutrition
- Transportation services
- Public benefit counseling
- Fitness programs
- Social and recreational activitie
9
Q
How are Community Senior Centers funded?
A
Through federal, state, local, and private support
10
Q
How often do older adults typically attend Community Senior Centers?
A
1–3 times per week, with an average visit lasting about 3 hours
11
Q
Are more participants in Community Senior Centers men or women?
What percentage of older adults attending Community Senior Centers live alone?
What is the average age of participants at Community Senior Centers?
What is a common socioeconomic characteristic of many Community Senior Center attendees?
A
- 70% are women
- 50% live alone
- Average age: 75 years old
- Most attendees come from lower income levels compared to non-attending peers
12
Q
Premiums
A
monthly fees required by private insurances
13
Q
What are the two types of private insurances?
A
- HMO - health maintenance organiztaion
- PPO - preferred provider organization
14
Q
Describe this insurance type: HMO
Include: Monthly Premium, Patient Autonomy, Provider Choice/Network, Referral, Goal
A
Monthly Premium
- Lower (cheaper)
-> Usually no out of pocket feeds
Patient Autonomy
- Case manager review intervention via utilization review
-> Supervises finances and healthcare resources - Policy determines necessary procedures, NOT physician
Provider Choice/Network
- Do NOT have choice of provider (limited)
-> Receive care through network of affiliated provider
Referral
- Yes, primary physician must refer to specialist
Goal
- Keep costs down by controlling amount of services provided
-> FOCUSES ON ILLNESS PREVENTION
-» Wellness visits
-» Immunizations
-» Smoking cessation
15
Q
Describe this insurance type: PPO
Include: Monthly Premium, Patient Autonomy, Provider Choice/Network, Referral
A
Monthly Premium
- Higher (more expensive)
Patient Autonomy
- Large choice of doctors and specialist
-> Increased care
Provider Choice/Network
- Able to choose provider (no gatekeeper)
-> Encourage in-network provider, but patients can seek care from out-of-network without referrals
Referral
- No
Goal
- x
16
Q
In regards to HMO, ______ determines necessary procedures, NOT _______
A
policy
physician
17
Q
HMO focues on illness __________
A
prevention
18
Q
just be familiar
All offer HMO & PPO:
Blue Cross
Blue Shield
Aetna
Cigna
Health Net
Pacificcare
A
19
Q
Which model/framework does Kaiser follow?
What type of care does it focus on?
Who is the provider of care?
A
- based on HMO model
-> focuses on preventative care - provider of care: physicians that work at Kaiser
20
Q
What major health insurance law was passed in 2014?
A
The Affordable Care Act (ACA), also known as ObamaCare
21
Q
What did the ACA require all citizens to do in 2014?
What happened if someone did not purchase health insurance under the ACA?
A
- Buy health insurance or face a fine
- They were fined
22
Q
Under the ACA, how affordable were insurance policies supposed to be?
A
They were developed to cost less than 8% of an individual’s income
23
Q
How did the government assist individuals under the ACA who couldn’t afford insurance?
Who were some groups exempt from the ACA insurance requirement?
A
- The government helped pay for insurance for those who qualified
- Exceptions: People in extreme poverty, Native Americans, and undocumented immigrants
24
Q
What were large companies (more than 50 employees) required to do by 2016 under the ACA?
Were small companies (less than 50 employees) required to offer health insurance under the ACA?
A
Large Companies
- Offer health insurance or pay a fine
Small Companies
- No, they were not required to offer insurance
25
Did more US companies employ more than or fewer than 50 employees?
Fewer, 96% of US companies employed fewer than 50 employees
26
Describe: **Medicare**
Funding, Qualifications, Coverage, Payment to Hospitals, Impact on Hospitals
**Funding**
- Federal
**Qualifications**
- 65 years and older
**Coverage**
80% - may need to pay premium/deductible - DOES NOT COVER DENTAL, GLASSES, HEARING AIDS
- Part A: covers hospital costs (inpatient)
- Part B: covers physician costs (outpatient)
-> Require monthly premium
- Part D: prescription drugs
**Payment to Hospitals**
- Pays set amount ahead of time (prospective payment)
-> Based on medical diagnosis (DRG), NOT number of days in hospital
-> DRG = diagnositc related group
- Will not pay for conditions resulting from preventable errors (CAUTI, Falls)
**Impact on Hospitals**
- More profitable for hospitals to discharge patients early
- If patient is an outlier (someone who needs abnormally long or needs extra care), hospital can bill Medicare for extra money
27
Describe: **Medicaid/MediCal**
Funding, Qualifications (for medicaid and medical)
**Funding**
- State
- Federal
**Qualifications**
Individuals under poverty level
- Low income adults
-> Less than $20,783 per individual or $43,056 for a family of 4
- Children under 19 years of age
- Pregnant women
- 65 years and older
- People with disabilities
**Qualifications - MediCal**
- CA resident
- Meet income/household eligibility requirements
- Immigration status doesnt matter
28
T/F: Medicaid does NOT cover dental, glasses, and hearing aids
False, Medicare does not cover dental, glasses, and hearing aids
29
Describe: **Veterans Affairs (VA)**
Funding, Qualifications, Focus/Goal
**Funding**
- Federal
-> US sponsored healthcare
**Qualifications**
- Based on eligibility
**Focus/Goal**
- Cost control focus
30
What are Diagnostic Related Groups? How are hospital paid for DRG?
**cost control measures implemented by Medicare to ensure efficient treatment of patients**
- hospitals are paid a fixed amount based on the patients diagnosis
31
What happens if the cost of care exceeds the fixed amount under DRGs?
- The hospital eats the cost = (loses money)
32
What happens if the cost of care is below the fixed amount under DRGs?
- The hospital makes profit
33
What happens to hospitals if patients are readmitted with the same diagnosis?
- Hospitals are finacially penalized
34
What are outliers in hospitlas?
- when a patietn exceeds the average saty for their dx = increasing cost, charges & payments
35
How do hospitals benefit from outliers?
- hospitals rely on outllier payments as a source of revenue
36
How does an icnrease in speciaization, complexity and technology affect cost of care?
- increase in cost of care
37
An increase in age of the general population leads to a ____ need for healthcare
increase
38
How does evidence based pracitce relate to patient care?
- EBP uses best current evidence, pt preferences, and clinical experience to guide nursing care & improve pt outcome.
39
Why are hospitals required to use EBP?
- Medicare/Medical provide funding for hoispitals and EBP
40
Who develops the standards of care for Evidence Based Practice?
- BRN (Board of Registered Nursing)
- ANA (American Nurses Association)
- AHRQ (Agency of Healthcare Research Quality)
41
What infection control data is provided by Evidence Based Practice
- CAUTI
- CLABSI
- Ventilator Associated Pneumonia (VAP)
42
A paitent is admitted and is incontinent. Josh, the nurse, insists on inserting a foley catheter because he is tired of constantly cleaning his patient. Abby tells Josh that he should wait on doctors order but Josh cuts her off and says he doesnt care and hes doing it anyway. Is Josh within his rights to use a catheter on this patient?
- No, Josh **cannot** **insert** or **discontinue** a foley without orders from the doctor.
- catherters should not be used to manage incontinece and should only be inserted when **approriate**.
43
What must be performed before and after interacting with a catheter?
- hand hygiene
44
Karen, a student nurse, asks if she can insert a catheter as she has seen multiple nurses do them. Can Karen insert a catheter?
- No, Karen cannot insert a catheter. Only **trained** **professionals** can insert catheters
45
Why would you want to minimize the duration of catheter use?
- decrease the risk of CAUTI
46
A patient is post op and has had their catherter in for about 24 hours. What should be done for this patient?
- Remove the catheter after 24 hours post op (unless it is appropriate to keep it in)
47
A pateient has been on a catheter for 20 hours. A nurse checks the collection bag to document the patients I&Os and noticed that the bag is practically empty. What is a likely cause of this finding? What is an intervention that nurse can do
- the catheter tubing is kinked
-> assess the catheter tubing to ensure it is not kinked to pvt complications
48
Where should you place the catheter drainage bag to prevent backflow and infection?
- place the collection bag below the bladder
49
How often should catheter care be done?
- Daily catheter care is recommended
50
What are Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)?
Surveys given to adult inpatient after hospitlization to give feedback on the most recent healthcare experience.
| (not given to psychiatric pts)
51
Why would hospitals want good results?
- hospitals receive reimbursement for good result
52
Who required that HCAHPS need to be given to patients for all hospitals?
- CEnter for Medicare/Medicaid Services
(CMS)
53
True or False: Results from HCAHPS are private data only seen by Medicare and teh government.
FALSE: results are publically reported and the general public and community have access to these results
54
What is teh Joint Commission fro Accreditation of Healthcare Organizations (JCAHO)?
- independent, non profit organization that helps maintain the standard of care within hospitals
55
What standards of care did JCAHO help implement in hospitals?
- fall precaution policy
- hand hygiene
- quality stroke measures
56
How often does JCAHO survey a hospital?
- occur every 3 years or if there is a complaint
57
If JCAHO is surveying a hospitals, are students allowed to stay?
- No, the hospital asks students to leave
58
What are advanced directives? What are examples of end of life decisions that is helps to make?
**legal document that indicates TX options pt chooses regarding end-of-life decisions**
Examples:
- Medication
- Cardiac Shock
- CPR
- Intubation/Ventilation
59
What did the Patient Self-Determination Act of 1991 do?
- gave pt rigt to make end of life decisions
-> pt wishes became a right and had to be respected "by law"
60
What are the nurses role regarding advance directives?
- respect pt wishes
- involve pt in decision making (based on pt preference, values and needs)
- advocate on pt behalf to caregivers
61
What are some ethical dilemmas that can occur due to advanced directives?
**Conflict between:**
- family & pt wishes
- doctor order for DNR
- nurses own values/beliefs
62
# Describe teh following Advanced Directive"
**Durable Power of Attorney**
## Footnote
(Purpose, Who is Involved?, Coverage, MISC)
**Purpose:**
- Assign trustful person to make medical decisions on behalf
-> (Ensure wishes are honored)
**Who is Involved?:**
- Must be atleast 18 years old
-> can not be pts physician or HCP
**Coverage:**
- covers more options for decision than living will
**MISC:**
- Usually seen in hospital settings
63
# Describe teh following Advanced Directive"
**Living Will**
## Footnote
(Purpose, Who is Involved?, Coverage)
**Purpose:**
- Pvds directions regarding preferences for end-of-life care
-> States wishes to specific types of care
**Who is Involved?:**
- Only pt
-> does not have to appoint anyone to make healthcare decisions
**Coverage:**
- can not account or cover every possibility or emergency situation
-> less option than DPOA
**MISC:**
- X
64
# Describe the following:
**Conservatorship**
| (Purpose, Pros, Cons, MISC)
**Purpose:**
- Court gives authority to manage care and finances for incapacitated individuals (developmental disability, mental illness)
**Pros:**
- Conservator submit periodic reports to courts
- Seek court permission for major decisions
- Must show proof to justify decisions
**Cons:**
- Mismanagement of assets
- Poor health care decisions
- Incompetence/mistreatment go unnoticed
- Expensive & time consuming
**MISC:**
- Conservator reimbursed from conservatee assets
65
# Describe the following Advance Directive:
**DNR/DNAR**
(Do Not Resuscitate/Do Not Attempt Resuscitation)
| (Purposes, Legal Requirements, Who is it used for?, Special Consideratio
**Purpose:**
- Withhold CPR/ACLS
**Legal Requirements:**
- Requires physician order
**Who is it Used For:**
- pt who don't want to be resusitated
-> respect pt wishes
**Special Considerations:**
- DNR cancelled in OR
-> Document specific time and situation
- Full code is implemented until DNR is obtained
**MISC:**
- AKA: No Code or Allow Natural Death
- DNR does not mean “Do Not Treat”
66
# Describe the following Advance Directive:
**POLST**
(Physician Orders for Life Sustaining Treatment)
| (Purposes, Legal Requirements, Who is it used for?, Special Consideratio
**Purpose:**
- Medical form that gives directions for care that should be provided in an emergency
**Legal Requirements:**
- Signed by physician & patient
**Who is it Used For:**
- Recommended for seriously ill pts
**Special Considerations:**
-In case of medical emergency, should be placed in a visible location (usully brightly colored)
-> On refrigerator
-> Medicine cabinet
**MISC:**
- honored by paramedics in CA
67
A pt is unsure about whether a pt wants be be on DNR status. What should the nurse do?
- ensure DNR reflects pt's true wishes
-> prioritize choices & values of competent pt
68
True or False: a RN can refuse an assignment if DNR goes against their religion
TRUE
69
What is discussed with a pt regarding Partial/Modified Code?
- Explain choices b/w intubation, CPR/defibrillation and medication
70
What is the nurses role in DNR/DNAR?
- Advocate/Be Active/ Discuss DNR with pt, family, and healtcare team
