TERM 3- MY NOTES FOUNDATIONS OF NURSING CH.38 "Long-Term Care" Flashcards Preview

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Flashcards in TERM 3- MY NOTES FOUNDATIONS OF NURSING CH.38 "Long-Term Care" Deck (200):
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Long-Term Care

,

1

Long-term care is defined by the American Nurses Association (ANA) as the provision of physical, psychological, spiritual, social, and economic services to help people attain, maintain, and regain their optimum level of functioning.
A)true
B)false

A

2

It encompasses a range of services, including health maintenance and care, to people who have lost their ability to function independently because of a chronic illness or condition
A)long term care
B)acute care

A

3

The need for long-term care services arises after the acute stage of an illness has resolved, and when the patient continues to need services to support and maintain physical and psychological status and functional abilities.
A)true
B)false

A

4

Patients in need of long-term care are primarily older adults who are frail or disabled, but they are sometimes also young and middle-age adults, or even -children with chronic illnesses, developmental disabilities, or traumatic injuries.
A)true
B)false

A

5

It is possible to define quality of life as a measure of the optimum energy or force that endows a person with the power to cope successfully with the full range of challenges he or she encounters in the real world.
A)true
B)false

A

6

Quality of life is important in maintaining self-esteem and a sense of well-being, as well as experiencing the pleasures of life
A)true
B)false

A

7

Culture is a system of values, beliefs, and practices that guide a person's behavior.
A)true
B)false

A

8

Cultural influences play a large role in shaping patients' beliefs about health and illness, therefore greatly influencing health behaviors.
A)true
B)false

A

9

Ethnicity is a person's identification with a certain ethnic group based on shared traditions, national origin, physical characteristics, and other markers such as language, religion, food, and dress.
A)true
B)false

A

10

. Patient safety in any setting has and always will be a priority.
A)true
B)false

A

11

Cultural Considerations
Religion among Older Adult Populations

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12

• In the long-term care facility, one goal of the interdisciplinary team is to provide opportunities for the resident to participate in worship services that support his or her religious beliefs. Worship services to meet spiritual needs are important; also encourage visitation and support from clergy of any denomination.

• Nursing, social services, and the dietary department provide support through an interdisciplinary team approach. The team discusses the care of the resident and the appropriateness of attendance at worship services.

• Dietary services take into consideration any food preferences or foods to avoid, based on the resident's culture and religion.

• The long-term care facility consistently provides opportunities to practice one's religious faith.

True

13

SETTINGS FOR LONG-TERM CARE

,

14

At present, numerous settings provide long-term care, but they all fall under one of three basic categories, from least restrictive to most restrictive:
1. The home
2. Residential care settings
3. Institutional settings

True

15

THE HOME

,

16

Most older adults live in a home setting, with only a small percentage of those age 65 and older residing in an institutional setting
A)true
B)false

A

17

Care of the older adult at home sometimes involves a great deal of participation from loved ones. Much of the responsibility for care often falls on women. Older women will in some cases be caring for a spouse, children, grandchildren, and even great-grandchildren in a multigenerational household.
A)true
B)false

A

18

It costs approximately half as much to care for an older adult at home as it would cost in a long-term care facility, unless the older adult has a great degree of physical impairment.
A)true
B)false

A

19

Although the typical home health patient is female, older than age 85, with circulatory or cardiac disorders, some home care patients require only minimal assistance, such as help with activities of daily living (ADLs), those routines of hygiene, dressing and grooming, toileting, eating, and ambulating each person carries out independently throughout life; others are perhaps receiving complex medical therapies such as mechanical ventilation and renal dialysis.
A)true
B)false

A

20

Services that home health agencies provide focus on rehabilitation with physical therapy, occupational therapy, speech therapy, respiratory therapy, access to social services, nutritional support by a registered dietitian, the rental or purchase of durable medical equipment, and nursing services.
A)true
B)false

A

21

Home health agencies offer nursing services from professionals including homeemakers, shoppers, respite care workers, personal care attendants, certified nursing assistants (CNAs), home health aides (HHAs), licensed practical nurses and licensed vocational nurses (LPNs/ LVNs), and registered nurses (RNs) to provide the more complex care and education.
A)true
B)false

A

22

In recent years, Medicare has developed two programs that promise to allow older adults with health care needs to continue living at home while receiving services. These programs are called Program of AllInclusive Care for the Elderly (PACE) and Social Managed Care Plan
A)true
B)false

A

23

PACE, on the other hand, has sites in 14 states and requires only that the patient be 55 years of age or older, live in a "service area," be screened by a group of health professionals, and sign and agree to enrollment terms.
A)true
B)false

A

24

PACE offers and manages all of the "medical, social, and rehabilitative services their enrollees need to preserve or restore their independence, to remain in their homes and communities, and to maintain their quality of life"
A)true
B)false

A

25

Role of the Licensed Practical Nurse/Licensed Vocational Nurse and the Registered Nurse

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26

The LPN/ LVN also provides a valuable human resource as staffing coordinator, intake coordinator, or medical chart auditor or reviewer.
A)true
B)false

A

27

The staffing coordinator receives information from the intake coordinator describing the requested home care for the patient. The staffing coordinator, based on established protocols, schedules the appropriate care provider to meet the needs of the patient and verifies financial coverage for the care.
A)true
B)false

A

28

A medical chart auditor or reviewer uses knowledge of health care to fulfill the quality assurance documentation guidelines.
A)true
B)false

A

29

ln home health care, the RN provides intermittent visits for holistic care, supervisory home visits, comprehensive assessments, referrals, nursing interventions, health care education, health maintenance, and home management. Within the home health care agency, the RN also functions as a manager and administrator.
A)true
B)false

A

30

Services to Support Home Care -
Providers for Older Adults

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31

• Respite care: Scheduled stays for the older adult needing care at a long-term care facility (e.g., 1 week every 4 months) to give caregiver and older adult with needs "time off."

• Daycare: A setting providing structured activities during the day, similar to daycare for children.

• Home health care: Including homemakers, shoppers, respite care workers, personal care attendants, home health aides, and nursing care staff.

• Nutrition programs: Congregate meals (at senior center) or home delivery of one hot meal per day (Meals-onWheels) for a nominal fee.

• Senior centers: Government-funded centers that provide recreational activities, lunch, health screening, classes, and transportation to and from the site if needed.

• Transportation services: Dial-a-Ride service to grocery shopping or medical appointments.

True

32

Coordinated Care Delegation

,

33

THE LICENSED PRACTICAL OR LICENSED VOCATIONAL NURSE AS STAFF COORDINATOR

An important example of the LPN/LVN delegating care is when the LPN/LVN performs the role of staffing coordinator.

As with any delegation, it is critical that the LPN/LVN consider the scope of practice and the individual abilities of the caregiver when scheduling and assigning care. In some states, LPNs/ LVNs are not authorized to delegate; only RNs have the power to delegate, by regulation.

True

34

HOSPICE

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35

Hospice agencies provide services to patients and families as the end of life approaches. These services are available to any age-group, not just older adults. -Medical certification is required for terminal care.
A)true
B)false

A

36

Hospices care for more than half of all Americans who die from cancer and a growing number of patients who suffer from other chronic, life-threatening illnesses, such as end-stage heart and lung disease
A)true
B)false

A

37

Palliative care extends the principles of hospice care to a broader population that has the possibility to benefit from comfort care earlier in their illness or disease process.

This agency provides nursing interventions to meet basic needs, ADLs, pain and symptom management, and spiritual and psychosocial support for the patient, the family, and significant others.

Care providers include CNAs, HHAs, LPNs/ LVNs, and RNs for case management.

Volunteers provide respite relief for caregivers and socialization and companionship for the patient

True

38

Hospice or terminal care is possible to provide in the home setting; in an inpatient hospice unit located in an institutional setting, such as a long-term care facility; or in a stand alone "hospice house."
A)true
B)false

True

39

Patients enter into an inpatient hospice unit generally for one of the following reasons: pain or symptom management, respite for the family, or terminal care.
A)true
B)false

A

40

Home Care Considerations
Hospice

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41

Hospice Care

Providers of hospice care usually do so in the patient's home. Typically, a family member serves as the primary caregiver, with hospice staff on call 24 hours a day and making regular visits.
A)true
B)false

A

42

ADULT DAYCARE

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43

Adult daycare services are community-based programs designed to meet the needs of functionally or cognitively impaired adults through supervised health care and social and recreational activities (Alzheimer's Association, n.d.).
A)true
B)false

A

44

These structured, comprehensive programs provide a variety of services, including physical care, mental stimulation, socialization, assistance with health maintenance, and health referrals, during any part of the day, but for less than 24 hours a day
A) Adult daycare
B)false

A

45

These centers generally operate during regular business hours, with the patient returning home to family or caregivers at night, although some offer services during evening and weekend hours.
A)adult daycare
B)false

A

46

Adult daycare centers are designed to serve adults who require supervision, social opportunities, or assistance, owing to a physical or cognitive impairment. The typical adult attending daycare is disabled and averages 75 years of age. Many require assistance with one to three ADLs .
A)true
B)false

A

47

Adult mental health centers and senior centers are additional places where families are able to turn for adult daycare services. These centers are sometimes located in churches or public-use areas within the community. Their staff includes a director, an activities coordinator, and a personal care attendant.
A)true
B)false

A

48

The director of an adult daycare center is sometimes a social worker, and more preferably, an RN. It is appropriate for the activities coordinator to have specialized training and education in activities to promote maintenance of functional abilities and independence in the environment .
A)true
B)false

A

49

The CNA or personal care attendant has to meet state requirements of training in assistance with ADLs and basic observation skills
A)true
B)false

A

50

Typical Services Offered by Adult Daycare Centers

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51

-Transportation
• Personal care
• Social seRvices
• Counseling
• Meals
• Therapeutic activities •
Nursing interventions
• Rehabilitation therapies

True

52

RESIDENTIAL CARE SETTINGS

,

53

Residential care settings serve primarily an older adult population, offering a wide variety of services. Among the most popular types of residential care facilities are assisted living facilities, congregate care facilities, and retirement communities
A)true
B)false

A

54

ln the following section, we will examine two of the more popular types of settings that have flourished in the past decade: assisted living and continuing care retirement communities.

,

55

Assisted Living

,

56

Assisted living is a type of residential care setting in which the adult patient rents a small one-bedroom or studio-type apartment and has the option of receiving several personal care services such as bathing, dressing, and taking medications.
A)true
B)false

A

57

Assisted living services are possible to provide in freestanding residences, near or integrated with skilled nursing homes or hospitals, as components of continuing care retirement communities, or at independent housing complexes.
A)true
B)false

A

58

The typical resident of an assisted living setting is an 80-year-old woman who is mobile but needs assistance with two ADLs .
A)true
B)false

A

59

Personal care services included in assisted living environments include housekeeping and laundry. They patient receives encouragement to partake in communal dining and various social activities. Some facilities offer transportation for organized recreational activity or personal business .
A)true
B)false

A

60

Nursing care varies from minimal care for patients with impairments in ADLs or instrumental activities of daily living (IADLs, to more complex daily tasks such as shopping and using the telephone, as well as assistance with medications to more complex care such as tube feeding and oxygen therapy.
A)true
B)false

A

61

Key Features of Assisted Living

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62

• Services and supervision available 24 hours a day

• Services to meet scheduled and unscheduled needs

• Care and services provided or arranged to promote independence

• Emphasis on resident's dignity, autonomy, and choice

• Emphasis on privacy and a homelike environment

True

63

Continuing Care Retirement Communities

,

64

A continuing care retirement community (CCRC) offers a complete range of housing and health care accommodations, from independent living to 24-hour skilled nursing care.
A)true
B)false

A

65

Usually, an older adult will enter a CCRC when he or she is in relatively good health and capable of Living independently or with little assistance. In most cases, signing a contract to enter a CCRC is a Lifetime commitment.
A)true
B)false

A

66

The CCRC offers the resident this complete range of housing and care for the rest of his or her life, enabling the older adult the opportunity to experience a gradual transition from independent Living to continuous skilled nursing care (if needed) while remaining at the same location. For an older couple, it is comforting to know that they will be able to stay together, even though one of them will possibly come to require long-term care.
A)true
B)false

A

67

The typical resident is a woman and 83 years of age, although most adults enter the CCRC at age 78.
A)true
B)false

A

68

CCRCs offer apartments, townhomes, or detached dwellings, or a combination of these; they sometimes accommodate several hundred residents, although they sometimes also provide much smaller settings. Facilities range from luxurious settings with tennis courts, swimming pools, and hotel-style dining rooms to more modest facilities with similar but less plush amenities.
A)true
B)false

A

69

Nursing interventions a resident in a CCRC takes advantage of depend on the functional abilities of the older adult. With more independent residents, a personal care attendant, CNA, or HHA will perhaps provide assistance with ADLs or IADLs. Nursing interventions are possible to provide for residents requiring skilled nursing interventions by LPNs/ LVNs or RNs.
A)true
B)false

A

70

INSTITUTIONAL SETTINGS

,

71

Subacute Unit

,

72

The subacute unit is a type of institutional setting that has become extremely popular since the late 1980s, when the advantage became clear of providing a less expensive alternative to acute care when patients have high-acuity medical and nursing intervention needs.
A)true
B)false

A

73

The subacute unit is possible to view as a bridge between acute care and long-term care.
A)true
B)false

A

74

Most subacute units are located in freestanding skilled nursing facilities; others are former hospital units that have been reclassified to provide subacute care.
A)true
B)false

A

75

Subacute units have a stronger rehabilitative focus and shorter length of stay than a long-term care facility. The level of care that subacute units provide is at nearly the same acuity as in the hospital. In fact, the typical older adult in a subacute unit today corresponds to the typical medical-surgical patient of the 1980s.
A)true
B)false

A

76

Why is this happening? It is a combination of our increased life span and changes in hospital reimbursement. Modern medicine is saving lives that, before technologic advances, we were unable to save. This has led to a ripple effect: Those people who did not have a chance to survive before technologic advances are now occupying beds in the intensive care unit (ICU).
A)true
B)false

A

77

People who used to occupy the ICU beds are now on the medical-surgical floor. Those who used to occupy beds on the medical-surgical floor are now discharged out of the hospital, but often their conditions are too complicated for home care; hence the evolution of the subacute unit.
A)true
B)false

A

78

You will find older adults with numerous disorders in a subacute facility. Patients are able to receive numerous therapies, including intravenous medication administration via peripheral or central venous catheters, complex dressing changes, and even mechanical ventilation.
A)true
B)false

A

79

The four most common patient care needs in subacute care are physical rehabilitation, stroke rehabilitation, wound care, and recovery from hip fracture
A)true
B)false

A

80

Long-Term Care Facility

,

81

Commonly known as a nursing home or extended-care facility, this institutional setting provides services to adults, primarily older adults (older than 65).
A)long term
B)false

A

82

Long-term care facilities provide 24-hour care to individuals who do not require expensive inpatient hospital services but who do not have options for care at home or by other commtutity agencies or services
A)true
B)false

A

83

the older adult is referred to as a resident rather than patient. The average age of a long-term care resident is 81 years, and more than half of long-term care facility residents are age 85 or older
A)true
B)false

A

84

Most residents of long-term care facilities have more than one health disorder when they are admitted, and more than half have three or more medical diagnoses. These are the most common disorders on admission:

• Cardiovascular disease, including hypertension and cerebrovascular accident

• Mental and cognitive disorders, including depression, anxiety, and dementia

• Endocrine disorders, including type 2 diabetes mellitus and hypothyroidism

True

85

Although cardiovascular disorders are the most common diagnoses on admission, they are not necessarily the main reasons why an older adult enters into long-term care.
A)true
B)false

A

86

Cognitive impairment, incontinence, inability to perform ADLs, and being single or widowed are also important factors determining placement into a long-term care facility.
A)true
B)false

A

87

Patients with cognitive disorders, such as Alzheimer's disease, are difficult to manage at home or in other less restrictive care environments, owing to the patient's short-term memory loss, confusion, disorientation, restlessness, wandering, and hallucinations
A)true
B)false

A long term is appropriate for this situation

88

A major safety event, such as forgetting to turn off the stove, is often the precipitating event in long-term care facility placement. As patients with Alzheimer's disease advance in age, they also experience a decline in their ability to participate in their ADLs, and eventually become totally dependent on others for care. In the final stages of the disorrder, they become immobile.
A)true
B)false

A

89

Two categories of residents generally are found in a long-term care facility.

The first category is the short-term resident, sometimes called the short-stay resitdent. Typically, this type of resident has been transferred from an acute care facility to which he or she had been admitted for an acute illness or the worsening of a chronic illness. The resident is admitted principally for rehabilitation and is expected to be discharged within 6 months. There are many similarities between this type of resident and the resident of a subacute unit.

The second category is the traditional type of resident who lives in the facility on a long-term -basis. Such a resident usually stays in the facility until he or she dies or is transferred to an acute care facility. This resident possibly has numerous nursing intervention needs and is perhaps cognitively impaired. Most residents in the typical long-term care facility are of the traditional category, although the trend is toward admitting more short-term residents. As a result, the overall nursing interventions of long-term care residents have become increasingly complex.
A)true
B)false

A

90

The philosophy in a long-term care facility is to maintain and restore health and functional abilities to the resident's highest level and to provide a home like atmosphere, promoting dignity, independence, restoration, maintenance, and assistance in ADLs, and skilled nursing interventions
A)true
B)false

A

91

The Long-Term Interdisciplinary Care Team

,

92

The long-term care facility is an interdisciplinary setting. ln this setting, health care professionals work together as an interdisciplinary team to meet the needs of the older adult. Members of the team will possibly include the resident, nursing personnel (gerontologic clinical nurse specialists, RNs, LPNs/ LVNs, CNAs), a physician, social worker, pharmacist, dietitian, activiities director, and rehabilitation specialists (from the areas of physical therapy, occupational therapy, and speech therapy), as well as a podiatrist, psychiatrist, audiologist, and dentist.
A)true
B)false

A

93

The interdisciplinary care planning meetings (often called ICPs) are mandated by OBRA to occur on a regular basis. The team meets regularly to review a resident's care plan, with each team member offering his or her unique perspective
A)true
B)false

A

94

Managing the long-term care facility is an administrator, and there is also a director of nursing (DON). The facility has nursing services, social services, dietary services, activities or recreation, rehabilitation or physical therapy, building maintenance, and housekeeping departments. These facilities and the provision of care are highly regulated by state and federal agencies to ensure quality services to a potentially vulnerable population, the frail older adult
A)true
B)false

A

95

CNAs provide the largest percentage of nursing care. The CNA receives educational preparation to encourage the patient's independence within the environment, offer restorative nursing interventions, and assist with ADLs
A)true
B)false

A

96

A unique member of the caregiving team in the long-term care facility setting, in some states, is the certified medication aide or certified medication technician (CMA/CMT). This caregiver is first required to be a CNA and then has the option to complete an educational course in administering medications. .
A)true
B)false

A

97

Restorative nursing assistants are CNAs who have completed an educational program that focuses on restorative nursing care, or basic concepts of physical therapy for maintenance of functional mobility and physical activity.
A)true
B)false

A

98

Selection of a Nursing Home
SIX ASPECTS OF QUALITY TO CONSIDER

,

99

An important step in the process of selecting a nursing home is to visit the nursing home. While looking around the nursing home, consider whether you observe these aspects of quality:

• Home: The nursing home does not feel like a hospital. It is a home, a place where people live. Staff encourages residents to personalize their rooms. Privacy is respected.

• Care: In addition to assistance with basic activities of daily living such as bathing, dressing, eating, oral hygiene, and toileting, staff assists residents with social and recreational activities. Residents are out of bed and dressed according to their preferences. Visitors are able to see the staff actively assisting and interacting socially with residents.

• Family involvement: Staff welcomes families when they visit the facility. Staff encourages family involvement, whether families wish to provide information, ask questions, participate in care planning, or assist with social activities or physical care.

• Environment: Residents, their clothing, their belongings, and their surroundings are clean. Staff are clean and well-groomed. There are no pervasive odors in the facility. Ample nonglare lighting, minimal noise, plants, comfortable furniture, and pets contribute to a homelike environment.

• Communication: Good communication among residents, families, and staff is necessary for quality care. Good communication is respectful and considerate.

• Staff: Members of the nursing home staff are attentive to resident requests and actively involved with assisting the residents. They focus on the person, not on the task. The assistance that they provide to residents includes assistance with social or recreational activities, as well as the performance of nursing duties.

True

100

Legal, Ethical, and Financial Issues

,

101

The Omnibus Budget Reconciliation Act (OBRA) of 1987, also known as the nursing home reform legislation, was a landmark law affecting long-term care facilities.
A)true
B)false

A

102

OBRA defines requirements for the quality of care given to residents and covers many aspects of institutional life, including nutrition, staffing, qualifications required of personnel, and man y others
A)true
B)false

A

103

Some of the positive outcomes of OBRA include empowerment of residents, focus on residents' rights, reduction or elimination of physical restraint use, and improved staffing, although many nurses believe that staffing continues to require greater improvement in many facilities.
A)true
B)false

A

104

The enactment of OBRA led to the requirement for long-term care facilities to use greater numbers of licensed nursing staff; this led to greater opportunities for employment for the LPN/LVN. Other aspects of the OBRA law helped expand the role of the LPN/LVN to include areas such as intravenous therapy and team leading.
A)true
B)false

A

105

The Health Care Financing Administration (HCFA) administers and monitors the OBRA guidelines through institutional surveys.
A)true
B)false

A

106

Surveyors are required by law to visit the long-term care facility unannounced (on an annual basis and as needed) to assess the quality of life for the residents by assessing each department and its serrvices, the physical layout of the facility, and records.
A)true
B)false

A

107

The HCFA makes available the information it obtains about quality of long-term care facilities to beneficiaries, providers, researchers, and state surveyors.
A)true
B)false

A

108

The long-term care facility is able to receive Medicare (a federally funded national health insurance program in the United States for people older than age 65) funding by adhering to the HCFA guidelines for reimbursement.
A)true
B)false

A

109

Medicaid (a federally funded, state-operated program of medical assistance to people with low incomes), financial assistance provided to anyone who qualifies, is a large source of revenue for the long-term care facility.
A)true
B)false

A

110

Advance directives are imperative and valuable in the long-term care facility. Do not resuscitate (DNR) orders from the physician are always the result of discussion with the resident, family, and significant others and documentation by the physician is required. These directions help promote dignity in the last stages of life.
A)true
B)false

A

111

Applications of the Omnibus Budget Reconciliation Act of 1987

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112

Resident rights
The resident is fully informed in advance and participates in decisions about care and services or changes in care and services

Physical restraints
No restraints are applied for discipline or convenience

Resident assessment
Comprehensive resident assessment is performed and serves as the foundation of planning and delivery of care

licensed nursing services
There is 24-hour licensed nursing service

Registered nurses
Registered nurse coverage 8 consecutive hours per day, 7 days per week

Nursing assistants
Nursing assistants are trained and competency tested

True

113

Other Ethical Issues Related to Long-Term Care

,

114

• Adherence to a Patient's Bill of Rights
• Advance directives
• Do not resuscitate (DNR) orders
• Power of attorney
• Guardianship
• Responsible party designation

True

115

Functional Assessment and Documentation

,

116

The interdisciplinary functional assessment of the resident is the cornerstone of clinical practice in this setting. OBRA prescribed the method of resident assessment and care plan development in an instrument known as the resident assessment instrument (RAI).
A)true
B)false

A

117

The RAI consists of three parts: the minimum data set (MDS), the resident assessment protocols (RAPs), and the utilization guidelines.

The MDS provides a system for assessment of each resident's functional, medical, mental, and psychosocial status on admission to a facility and at regular intervals thereafter. It is an assessment instrument consisting of more than 400 items that usually help identify a resident's problems, strengths, needs, and preferences so that it is possible to maintain or enhance a resident's function.

RAPs are assessment guides that address common clinical problems, such as delirium, falls, and urinary incontinence. RAPs have accompanying utilization guidelines, the third component. These contain a wealth of clinical information to assist in assessment and care planning.

True

118

Safety Alert!
Herbal Products and Nutritional Supplements

A

119

When eliciting a medication history and current medication usage patterns, it is crucial to ask about the use of herbs and nutritional supplements. These products, which are marketed as "safe" and "natural," are unregulated by the U.S. Food and Drug Administration (FDA) and potentially have actions and side effects similar to medications.

They also have the potential to interact with medications the health care provider prescribes for the resident and in some cases affect medical conditions (either beneficially or detrimentally).

Take a complete history of vitamin and mineral usage (and look at the label on the bottle if available); some multivitamin and multimineral products actually contain multiple herbs as well. The resident will sometimes be unaware that he or she is consuming herbal products.

True

120

Nursing Diagnosis

,

121

Possible selections are available in the following list of nursing diagnoses (which is not inclusive ):
• Risk for aspiration, related to impaired swallowing, ill-fitting dentures, musculoskeletal weakness, and medical conditions such as stroke

• Ineffective airway clearance, related to chronic respiratory conditions and musculoskeletal weakness

• Impaired gas exchange, related to chronic respiratory conditions

• Decreased cardiac output, related to cardiovascular disease

• Imbalanced nutrition: less than body requirements, related to decreased appetite and cognitive impairment

• Risk for deficient fluid volume, related to altered thirst mechanism

• Functional urinary incontinence, related to decreased bladder capacity

• Disturbed thought processes, related to cognitive impairment

• Chronic confusion, related to cognitive impairment

• Bathing/ hygiene self-care deficit, related to musculoskeletal weakness

• Risk for injury, related to forgetfulness, impaired balance

• Impaired physical mobility, related to abnormal gait

• Risk for impaired skin integrity, related to malnutrition

• Chronic low self-esteem, related to physical impairment

• Dysfunctional grieving, related to multiple losses

• Anxiety, related to financial difficulties

• Social isolation, related to homebound status

True

122

Key Points

,

123

• The need for long-term care services arises after the acute stage of an illness has resolved, when the patient continues to need services to maintain his or her current and changing physical and psychosocial status and functional abilities.

• Settings that provide long-term care include the home, residential care settings, and institutional settings.

• Services that assist those caring for older adults in the home include adult daycare, hospice, home health agencies, and other community agencies and services.

• Residential care settings offer a wide variety of services to the older adult; two of the more popular types are assisted living facilities and continuing care retirement communities.

• Institutional facilities include subacute units and longterm care facilities.

• The majority of long-term health care providers are under regulation by federal and state guidelines or use them as minimum standards for health care services, reimbursement, and quality indicators.

• Ethical issues related to long-term care services include adherence to a Patient's Bill of Rights, advance directives, DNA orders, power of attorney, guardianship, and responsible party designation.

• In the long-term care facility, the resident's plan of care is reviewed every 90 days for resolution of problems or revision of expected outcomes and interventions by the team.

True

124

NCLEX PREP

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125

What defines long-term care?
1. Nursing home care for 6 months
2. Care provided after the acute stage of an illness has resolved
3. Care provided in an institutional setting
4. Care provided to someone older than age 65

2

126

2. Which patient will probably best benefit from long-term care services?
1. A 98-year-old widow who lives at home independently, can perform ADLs and IADLs, but needs a ride to church every Sunday
2. A 65-year-old widower who is recovering from a stroke and is unable to move his left side
3. A 75-year-old woman who lives with her husband and has arthritis and osteoporosis with complaints of mild to moderate stiffness every morning
4. A 70-year-old man who lives alone and has a history of coronary artery disease and hypertension

2

127

3. Which patient is an inappropriate candidate for hospice care?
1. A 65-year-old woman who has metastatic lung cancer and receives home health services
2. A 77 -year-old man who has end-stage prostate cancer and lives in a long-term care facility
3. A 44-year-old woman who has AIDS and lives in a continuing care retirement community
4. A 70-year-old woman who had total knee replacement surgery 1 week ago

4

128

4. A 78-year-old patient is receiving hospice care for his end-stage cardiac disease. Which statement by his wife will the nurse report to the RN?
1. "What are the side effects of my husband's pain medication?"
2. "Are there support groups to help with the grieving process?"
3. "My husband finally slept for more than two hours last night."
4. "How will I know when it is time to call 9-1-1 ?"

4

129

5. What institutional setting is a bridge between acute care and long-term care?
1. Subacute care
2. Nursing home care
3. Residential care
4. Adult daycare

1

130

6. Which scenario best illustrates the effect OBRA has had on the professional practice of LPNs/LVNs in the long-term care setting? The LPN:
1. is responsible for administering intravenous therapy.
2. provides direct bedside resident care.
3. performs dressing changes.
4. functions as medication nurse.

1

131

7. Which correctly states one of the two broad goals of Healthy People 2010?
1. Increase quality and years of healthy life.
2. Stop Americans from smoking.
3. Decrease the number of Americans admitted to long-term care facilities.
4. Reduce deaths from falls and fall-related injuries.

1

132

8. Which is the best example of an interdisciplinary team?
1. Director of nurses, charge nurse, staff nurse, CNA, resident
2. Resident, nurses, physician, social worker, pharmacist, dietitian, activities director, rehabilitation specialists, podiatrist, psychiatrist, audiologist, dentist
3. Attending physician, resident physician, intern, medical student 1205
4. Gerontologic clinical nurse specialist, physician, pharmacist, social worker, clergy, resident

1

133

9. Select the statement that best describes palliative care.
1. Palliative care is usually provided in acute care facilities.
2. Palliative care is typically recommended for individuals with less than 6 months' life expectancy.
3. Palliative care is usually affiliated with a church and provided by parish nurses.
4. Palliative care extends the principles of hospice care to a broader population that has the possibility to benefit from comfort care earlier in their disease process.

4

134

10. Most older adults in the United States live in a(n):
1. long-term care facility.
2. adult daycare facility.
3. home setting.
4. assisted living setting.

3

135

11. PACE and the Social Managed Care Plan are:
1. exercise programs that attempt to help older adults meet the goals of Healthy People 2010.
2. Medicare programs that allow older adults to continue living at home while receiving medical services.
3. insurance fraud schemes that target older adults.
4. classes offered by senior centers.

2

136

STUDY GUIDE

,

137

The Omnibus Budget Reconciliation Act (OBRA) of 1987 was a landmark law that defined requirements for the quality of care given to residents of long-term care facilities. It covered areas such as nutrition, staffing, and qualifications of personnel. Resident’s rights, assessments, and use of physical restraints were also identified.
A)true
B)false

A

138

OBRA required that 24-hour nursing services be provided to residents. This led to the greater use of LPNs/ LVNs and the expansion of their role in long- term care facilities.
A)true
B)false

A

139

Legal and ethical issues in long-term care include adherence to the patient’s bill of rights, advance directives, do not resuscitate (DNR) orders, power of attorney issues, guardian- ship, and responsible party designation.
A)true
B)false .

A

140

Reimbursement is available for long-term facilities from Medicare and Medicaid (if eligibility criteria are met), some private insurances, and private pay by the residents or their families (often resulting in the depletion of their resources in a very short time).
A)true
B)false

A

141

The Program of All-Inclusive Care (PACE) is aimed at keeping individuals in the home while they receive care. Eligibility for the program is based on residence in the service area, being more than 55 years of age, and requiring medical, social, and/or rehabilitation services
A)true
B)false

A

142

Cultural and ethnic considerations in long- term care involve the changing demographics of the population, with residents being older and more diverse in background. This influences the types of services that are provided to residents, such as nutritional and spiritual services.
A)true
B)false

A

143

The different types of settings for long-term care are:
• Community-based–home, hospice, adult day care

• Residential care–assisted living, continuing care retirement community

• Institutional care–subacute units, long- term care facilities.

True

144

A hospice is an appropriate referral for a patient with a terminal illness.
A)true
B)false

A

145

An adult day care center will probably meet this family’s needs.
A)true
B)false

A If The daughter has to work doing today

146

Assisted living provides residents with services and supervision 24 hours a day, services for scheduled and unscheduled needs, care and services arranged to promote independence, emphasis on dignity, autonomy, and choice, and privacy in a homelike environment.
A)true
B)false

A

147

A continuing care retirement community differs from assisted living in that is has a wider range of living arrangements available.

Residents usually sign contracts committing for the remainder of their lives, allowing for movement, if necessary, from independent living to continuous skilled nursing care in the same location.
A)true
B)false

A

148

Subacute care has the advantage of providing skilled nursing care, such as IV fluid therapy, complex dressing changes, and mechanical ventilation, in an environment that is more cost-effective than acute care.

Reimbursement criteria that limit the length of stay and costs do not apply to the subacute area. This type of setting serves as a bridge between acute care and long-term care or independence.
A)true
B)false

A

149

The usual patient or resident in a long-term care facility demonstrates cognitive impairment, incontinence, inability to perform ADLs, and an inability to be supported in a home environment. Residents usually experience cardiovascular disease (hypertension and stroke), mental and cognitive disorders (Alzheimer’s), and endocrine disorders (diabetes).
A)true
B)false

A

150

Medications in long-term care facilities may be administered by certified medication aides or technicians because of the large number of residents who require medications. There is also a 2-hour window of administration in this setting because of the volume of administration
A)true
B)false

A

151

The Resident Assessment Instrument (RAI) serves as the cornerstone of clinical practice and care planning for the residents in long- term care. The assessment includes information on the resident’s functional, medical, mental, and psychosocial status. It triggers action on common problems, such as tendency for falls or degree of need for assistance with ADLs.
A)true
B)false

A

152

Documentation in long-term care is primarily based on summaries of resident status over a longer time frame, usually monthly. Any change in condition, however, is charted as it occurs
A)true
B)false

A

153

Examples of nursing diagnoses associated with safety concerns are:
• Aspiration, risk for
• Cardiac output, decreased
• Thought processes, disturbed

True

154

Making rounds to monitor residents– every 2 hours
A)true
B)false

A

155

Reviewing the plan of care–every 90 days and prn
A)true
B)false

A

156

Charting for a resident who has no change in status–monthly and prn
A)true
B)false

A

157

Ethical issues that may arise in long-term care include:
• Adherence to the Patient’s Bill of Rights
• Advance directives
• Do not resuscitate (DNR) orders
• Power of attorney
• Guardianship
• Responsible party designation

True

158

The nurse is assisting training a new certified nurse assistant at a long term care facility. The nurse would be correct in describing activities of daily living as;(Select all that apply)
A) Bathing
B) Brushing teeth
C) Exercise
D) Ambulating

A B C D

159

Mr.M is requiring extensive wound care and intravenous antibiotics due to an infection in his surgical wound. A_________ Will best meet his needs
A) Long term care facility
B) Sub acute unit
C) Hospice unit

B

160

______ Define requirements for the quality of care given to residents and covers many aspects of Institutional Life, including nutrition staffing and qualifications required of personnel
A) OBRA
B)HCFA

A

161

The adult children of an elderly couple are concerned about their parents and feel that the parents, at times need assistance with bathing, dressing, and taking medication. Both of the parents are alert and oriented at all times. They are mobile, but suffer from arthritis. The setting that patients would most benefit from would it be
A) an assisted living community
B) An adult daycare facility

A

162

The interdisciplinary team at a long-term care facility is meeting to discuss the care plan of one of the residence, Mrs.H. Who should attend this meeting
A) Activities director
B)Mrs.H
C) Director of nursing
D) Nursing unit manager

A B C D

163

Key terms

,

164

Assisted living-Residential care where by the adult patient rents a small one bedroom or studio apartment and can receive care services, for example, for bathing, dressing, eating, etc.
A)true
B)false

A

165

Continuing care retirement community-Offers complete range of housing and healthcare accommodations from independent to 24 hours skilled nursing care
A)true
B)false

A

166

Functional assessment-Assessment of the functional status of the patient, which is the ability of an individual to perform normal, expected, or required activities of daily living
A)true
B)false

A

167

Instrumental activities of daily living-Daily tasks that are more complex than activities of daily living such as shopping or using the telephone
A)true
B)false

A

168

Minimum data set-a part of the patient assessment instrument that incorporates many of the same assessment practices as a functional assessment tool and requires input from nursing and social services within a specific time
A)true
B)false

A

169

Omnibus budget reconciliation act-federal legislation that mandate specific standards governing the care of older adults in U.S. nursing facilities prohibits routine use of safety reminder devices nursing home
A)true
B)false

A

170

Quality of life-a measure of the optimum energy that endows a person with the power to cope successfully with the full range of challenges encountered in the real world
A)true
B)false

A

171

Residential care-a care setting for older adults, providing a wide range of services, such as assisted living and continuing care
A)true
B)false

A

172

Restorative nursing care-Basic concepts of physical therapy for maintenance of functional mobility and physical activity
A)true
B)false

A

173

Skilled nursing facility-Houses a subacute unit with a stronger rehabilitative focus and shorter length of stay than a long-term facility
A)true
B)false

A

174

Subacute unit-Institutional setting that provides a less expensive alternative to acute-care, a bridge between acute care and long-term care
A)true
B)false

A

175

A measure of the optimum energy or force that endows a person with the power to cope successfully with the full range of challenges encountered in the real world is the definition of:
A)Quality of life
B)Culture

A

176

In both the acute care and long-term care setting, a main priority in providing care is patient:
A)Safety
B)Services

A

177

Which of the following services provides care to those with a terminal illness?
A)Hospice
B)Respite care

A

178

A patient has just had a hip replacement. Before being transferred to a long-term care facility, the patient begins rehabilitation in a(n):
A)Subacute unit
B)Short-term residence

A

179

Which type of financial assistance provides payment for medical assistance to people with low income?
A)Medicaid
B)Medicare

A

180

What landmark law affected long-term care facilities regarding the requirements for quality of care provided?
A)OBRA
B)MDS

A

181

HCFA is the Health Care Financing Administration, which administers and monitors the OBRA guidelines through institutional surveys.
A)true
B)false

A

182

OSHA is the Occupational Safety and Health Administration, which regulates the setting to ensure patient safety.
A)true
B)false

A

183

MDS is the Minimum Data Set, one part of the Resident Assessment Instrument (RAI), which provides a system for assessment of each resident's functional, medical, mental, and psychosocial status.
A)true
B)false

A

184

OBRA is the Omnibus Budget Reconciliation Act, which defines requirements for the quality of care given to residents of long-term care facilities.
A)true
B)false

A

185

In the long-term care setting, the interdisciplinary team reviews the resident's plan of care every _____ days.
A)60
B)90

A

186

Interventions basic to long-term care include making rounds and monitoring for resident safety:
A)Every 2 hours
B)Every 4 hours

A

187

Nursing services in long-term care are centered around a functional assessment. Place the following nursing needs in the correct priority by number. Do not use commas or spaces: _________
1. Elimination
2. Self-respect
3. Belonging
4. Security

1432

188

The nurse is talking with a neighbor who takes care of her elderly mother in the home. The woman reports that her mother has been having increased behaviors, not sleeping through the night, and requires constant watching. Her spouse works outside the home and tries to give her some time alone in the evening, but it doesn't seem to be enough. What type of care service should this nurse recommend?
A)Respite care
B)hospice

A

189

This family needs respite care, which involves scheduled stays for the older adult needing care at a long-term care facility (1 week every 4 months) to give the caregiver and older adult with needs "time off."
A)true
B)false

A

190

Hospice care is provided for patients with terminal illnesses.
A)true
B)false

A

191

Long-term care services are provided after the acute stage of an illness has resolved, but the patient continues to need services and maintain his or her current and changing physical and psychosocial status and functional abilities
A)true
B)false

A

192

Home health care would not necessarily provide this woman with relief from the strain of her caregiver role
A)true
B)false

A

193

Most older adults live in a home setting, with only a small percentage of those age 65 or older residing in an institutional setting
A)true
B)false

A

194

Continuing care retirement communities-Offer a complete range of Housing and healthcare accommodations, from independent living to 24 hours skilled nursing care
A)true
B)false

A

195

Set acute unit-Most are located in freestanding skilled nursing facilities, others are formal hospital units that have been reclassified to provide subacute care. They provide a stronger rehabilitative focus and shorter length of stay than a long-term care facility
A)true
B)false

A

196

The most common disorders on admission of a long-term facility are;
-Cardiovascular disease, including hypertension and cerebrovascular accident
- Mental and cognitive disorders, including depression, anxiety, and dementia
- Endocrine disorders, including type two diabetes mellitus and hypothyroidism

True

197

Two categories of residents in a long term facility;
Short-term-Transferred from an acute care facility to which he or she have been admitted for an acute illness or worsening of a chronic illness. Admitted primarily for rehabilitation and expected to be discharged within six months

Long-term-Usually stays in the facility until he or she dies or is transferred to an acute care facility. Most residents are long time

True

198

Long-term care facility-Facility is managed by administrator and has a director of nursing
A)true
B)false

A

199

Resident assessment instrument(RAI)-Consists of three parts;
-Minimum data set(MDS)
- Resident assessment protocols(RAP)
- Utilization guidelines

True