NURSING EXAM 2 1030|43 Questions with Verified Answers
Clients of LTC –
CORRECT ANSWER 1. Older adults
2. Children and adolescents
3. young
... [Show More] adults
4. people with HIV/AIDs
5. those needing subacute and specialized care
Nature of LTC - CORRECT ANSWER 1. variety of services
2.individualized services
3.well-coordinated total care
4.promotion of functional independence
5. extended period of care
6. holistic care
7.quality of life
Variety of Services - CORRECT ANSWER 1. medical care
- management of chronic condition
2.mental heath services
- anxiety, depression, delirium, dementia ( mental disorder not a normal part of aging)
3.social support
- changing life events require coping and adaptation
4.preventive and therapeutic LTC
- prevent and postpone disease and disability
5. community based and institutional services
- when high levels of physical pr cognitive impairment
6.levels of inttensity
- personal care
-custodial care
-restorative care
-skilled nursing care
-subacute care
7.housing
-supportive physical features: support services and companionship
8.end of life care
-prevent needle pain and distress for the terminally ill
Community based LTC services - CORRECT ANSWER 1. home health care
-community or hospital based agency
2. adult day care
- clients stay with family/friends, but cannot be alone during the day
3.adult foster care
- services primarily focus on room and board, supervision and light ADL assistance
4.senior centers
5. Home deliver and congregate meals
-elderly nutrition program
6.Home services
- shopping, light cleaning, errands, minor home repairs
7. emergency response/ telephone reassurance
- personal emergency response system
8.case management
-matchig clients with appropriate services
9.hospise care
- variety of social and supportive services for the patient and family are included
Community based LTC Services
four-fold objectives: - CORRECT ANSWER 1. economy and least restrictive setting
2. supplement informal care
3.respite care
4. delay or prevent institutionalization
Institutional LTC
five main categories: - CORRECT ANSWER 1. independent or retirement living centers
-emphasize independence, housing and social support
- private funds
2. residential or personal care facilities
-minimal health care:supervision, personal care( light ADLS)
-private pay
3. assisted living facilities
-personal care 24/7 by nurses and therapist
- private pay
4.skilled nursing facilities
-all facilities are licensed by state
5.subacute care facilities
- transitioncare units in hospitals
-skilled care nursing homes
LTCH ( certified as acute care hospitals)
6.specializd facilities
- inpatient rehabilitation facilites (alzheimer facilities, intermediate care facilities for mental retarded)
Outpatient: reasons for growth - CORRECT ANSWER 1. change in reimbursement
2. fewer payment restrictions
3. development of new technology
4.utilization controls
5.social factors
Scope of Outpatient Services - CORRECT ANSWER 1. Primary Care
- focuses on prevention, diagnostic, therapeutic services, health education
-refer patients to sources of specialized care
-discuss treatment options
2.Secondary Care
- usually short term
- rehab, routine surgery, speciality consultation, includes hospitalization
3. Tertiary Care
- for conditions that are uncommon, highly specialized, may be long term care
Hospital Based Outpatient Care Services
Five main types: - CORRECT ANSWER 1.Clinical Services
- cArdiology,GI, ENT
2. Surgical Services
3. Emergency Services for Acute Services
- urgent- attention within hours
emergent require immediate attention
4.Home health Care
5.Women's Health Center
Outpatient Care Settings - CORRECT ANSWER 1.Private Practice:
- shift from independent solo practice to: group practice, institutional employment
-Group Practice advantages: lower operating cost, start up, sharing of over head, equipment and diagnostics, greater opportunity to contract with managed care
2. Group practice advantages for patients:
- routine services available at one place
- cross referrals
Other types of outpatient care settings - CORRECT ANSWER 1.mobile,medical,diagnosis and screening services
2. Home Health
- services brought to home
3.Hospice
-comprehensive services for the terminally ill with life expectance of six months or less
4. Ambulatiory Long term Care services
-nursing homes and adult day health care
5.Public health services- immunization to full range of inpatient and outpatient services
- from preventive service to treatment
6.public and voluntary clinics
Nursing role in outpatient/primary care - CORRECT ANSWER - extensive teaching and community referrals to keep them out of the hospital
-coordinator/practitioner
-dependent on location
Organizations of Outpatient care - CORRECT ANSWER 1. planned parenthood
2.meals on wheel association of america
3.american red cross
4.doctors without borders
5.mercy ships
Hospital Oversight
Construction and operations of a hospital are governed by: - CORRECT ANSWER 1. federal laws
2. state health regulations
3.city ordinances
4. JCAHO standars
5.Fire codes
6. sanitation standards
Medical Center - CORRECT ANSWER Hospitals that offer specialization and a large scope of services
Hospital/ Health system: - CORRECT ANSWER -multihospital chain
-provides a variety of health care services
6 factors in the growth of hospitals (late 1800s to mid 1980s) - CORRECT ANSWER 1. advances in medical science
2. development of specialized technology
3.advances in medical education
4.development of professional nursing
- florence nightingale transformed nursing
- efficiency of treatment; hygiene
5.growth of health insurance
-insurance allowed people to pay for health care post great depression
- increased demand for health care
6. role of government
- public health insurance (medicare and medicaid)
Hospital Downsizing: Mid-1980s Onward - CORRECT ANSWER 1. changes in reimbursement
-decrease in inpatient utilization
2.Rural hospital closures
-economic constraints
3. Impact of managed care
-emphasis on cost containment
Public owned hospital (government ownership) - CORRECT ANSWER - owned by federal, state or local goverments
-states run mainly psychiatric hospitals
local hospitals serve a high proportion of disadvantaged groups
-specialized to groups (native americans, VA, military)
Voluntary hospital - CORRECT ANSWER - nongovernment, privately owned hospitals operated on nonprofit basis
- owned and operated by community associations or non government organizations
-mission is to benefit the community
-largest group
Proprietary Hospitals (investor-owned) - CORRECT ANSWER -for profit
-operated for the financial benefit of owners or stockholders
-have gained market share in recent years
advantages of multiunit affiliation - CORRECT ANSWER 1. economies of scale
2.wide spectrum of care;variety of markets
3.access to capital
4.access to management resources and expertise
Hospital Classifications
types of services: - CORRECT ANSWER 1.general hospital
-broad set of services (obstetrics, diagnostics, treatment, surgery)
2.Speciality hospital
- narrow range of services (rehabilitation,children's, women, cardiac)
3.psychiatric hospital
-provides psychiatric,psychological and social work services
-state mental hospitals continue to treat people with severe and persistent mental illness
4. rehabilitation hospital
-therapeutic services to restore maximum function in patients
5.children's hospital
- specialize in complex,sever, or chronic illnesses among children
OtherHospital Types - CORRECT ANSWER 1. teaching
-AMA approved residency programs for physicians
2.church-afffiliated
-owned or influenced by church groups
3.oostepathic
- holistic approach along with the use of diagnostics,pharmaceuticals, surgery, etc.
CEO - CORRECT ANSWER - responsible for day to day operations
-leadership
-accomplish mission and objectives
Medical Staff - CORRECT ANSWER - chief of staff(medical director)
-chief of service (for specialities) in major hospitals
-committees:
executive
credentials
medical records
utilization review
infection control
Patient Care Services - CORRECT ANSWER 1. Nursing Governance
-CNO:
- directors/department heads
-unit managers
-charge nurse/unit leader
-staff nurse
Licensure, Certification, Accreditation - CORRECT ANSWER 1.Licensure
-hospital must be licensed
-state government oversees with own set of standards
-building codes, fire safety, climate control, space allocations, sanitation
2. Certification
-not mandatory ( mediatory if hospitals want to participate in medicare and medicaid)
3.Accreditation
-JCAHO or American Osteopathi association
-accreditation is a private function
-confers deemed status
Ethics Principles - CORRECT ANSWER - respect to others
-beneficence- benefit to the patient
-non-maleficence- do no harm
-justice- fairness and equality
Legal Rights - CORRECT ANSWER - Patient bill of rights:
- confidentiality
- info on diagnosis
-right to refuse treatment
-formulation of advance directives
-informed consent:
- right to make an informed choice regarding medical treatment
-advance directives:
-dont not resuscitate
-living will
-durable power of attorney
special population groups - CORRECT ANSWER 1.minorites
-low birth weight is common among black americans
-mammography use of women 40+ is greatest among white females and lowest in hispanics
2.uninsured children
-9.2-9.7 million are children
- tend to be less educated, poor, working part time, younger (25-40 years old)
3.women
- women suffer greater morbidity and have poorer health outcomes
- women have higher percentage of deaths among women than men at all stages of life
-account of half of aids
more likely to be depressed and at greater risk for alzheimer's
4.rural are residents
-poor access by poverty, long distance, topography, weather
5. homeless
- homeless adult and children, have a high prevalence of untreated acute and chronic medical, mental health, and substance abuse problems
-exposure to harsh weather and at greterrisk of assault
6. mentally ill
- depression
- 1 in 4 americans have mental disorder
- industry plagued with disparities in availability and access
7. chronically ill and disabled
- 90 million americans had chronic conditions
-unique challenges to our health system the is oriented towards acute care
9.HIV/AIDS
-6th leading cause of death among people age 25-40 years old
- treatment tries to slow the progression of:
- HIV ad opportunisti infection
-includes cocktails
-medical care is very expensive
3 cornerstones of health care delivery - CORRECT ANSWER 1. cost
2. access
3.quality
Cost Of Health Care - CORRECT ANSWER 1. price (physician's bill, prescription bill, premiums)
2. National Perspective (how much a nation spends on health care)
3.provider perspective(cost of production)
Reasons for Cost Escalation - CORRECT ANSWER -third party payment
-imperfect market
-growth of technology
-increase in elderly population
-medical model of health care delivery
-defensive medicine
-waste and abuse
-practice variation
Cost Containment- Regulatory Approaches - CORRECT ANSWER - all-payer (single payer) system
-healtht planning
-price controls
-peer review
Cost-containment- Competitive approaches - CORRECT ANSWER - demand-side incentives
-supply-side regulation
-payer-driven price competition
-utilization controls
Access to care - CORRECT ANSWER 1.access
- ability to obtain needed, affordable, convenient, acceptable, and effective personal health services timely
2.Key implications:
-determinatn of health
-benchmark in assessing effectiveness
-equity
- quality and efficient use of needed services
Dimensions of Access - CORRECT ANSWER 1. accessibility
- fit between the location of providers and patients
2.affordability
-ability to pay
3. accommodation
- fit between how resources are organized to provide services and the patients ability to use services (time appoitments, quick services, walk in)
4. acceptability
- compatibility
- waiting time, race, culture, gender, etc.
type of access - CORRECT ANSWER 1. potential
- capacity, organization, financing
2.realized
-type, site, purpose of health services
3.equitable/inequitable
- distribution of health care to patient's perceived need
4. effective and efficient
- links realized access to health outcomes
Quality of Care - CORRECT ANSWER 1. Insitute of Medicine
- increased likelihood of desired health outcomes
-use of current professional knowledge
Dimensions of Quality - CORRECT ANSWER 1.Microview
- clinical aspects
-interpersonal aspects
-quality of life
2.Macroview
-mortality
-incidence and prevalence
quality Assurance - CORRECT ANSWER - based on total quality management (TQM)
-a step beyond quality assessment
-system-wide commitment to engage in the improvement of quality on an ongoing basis
Quality Assessment - CORRECT ANSWER -measuremnt of quality against an established standard
-use of data
- subjective measures must be quantified
-measuremnts scales must have validity and reliability
- the donabedian model : structure, proves, outcomes [Show Less]