Pc617 Exam1 Review Mod 1-3

Front 1

Define Primary Care by Location

Back 1

Community-based care that offers accesible "first contact" that is less technical than secondary or tertiary care; Offered in medical centers and rehab facilities

Front 2

Define Primary Care by Clinical Tasks

Back 2

a. Medical diagnosis & treatment
b. Psychological diagnosis
c. Personal support of all patients regardless of background or stage of illness
d. Communication of information about prevention, diagnosis, treatment, & prognosis
e. Prevention & care of chronic disease & disability through risk assessment, health education, early disease detection, preventive treatment & behavioral change

Front 3

Name types of problems seen in primary care

Back 3

URI’s, common abdominal complaints, skin rashes, vaginal discharges; Different presentations of chronic problems: HTN, CHF, arthritis, DM, present day-to-day management problems; Psychosocial problems: anxiety, depression may present as vague, nonspecific somatic complaints

Front 4

Describe difference in pace of care r/t primary care vs. acute care

Back 4

Mental fatigue comes from diagnosing & treating up to 30 different patients or families a day. The sheer variety of possible problems faced in a day’s time is exciting & interesting, but it is also challenging. Office visits allow for focused attention with each individual patient-longterm relationships develop

Front 5

How is patient teaching different in primary care compared to acute care?

Back 5

Primary care includes screening for problems as yet undetected, as well as supporting health promotion and disease and injury prevention at every opportunity. Educating patients of all ages about how their bodies work, about risk reduction, and treatment options helps patients assume more responsibility for their own wellness.

Front 6

How can delivery of primary care bring an increase in uncertainty?

Back 6

With increased autonomy of primary care, APN’s must assess & diagnose patient problems, currently “unlabeled”-many different conditions present in similar ways-labs must be evaluated, multiple treatment approaches are available for simple problems, & many patients don’t comply with plan of care. APN’s may have doubts in decision-making (r/t confidence in diagnostic & treatment planning).

Front 7

Define Critical Thinking

Back 7

Reflective thinking, because the process involves one’s thinking to determine if all possible avenues have been explored and if the conclusions that are being drawn are based on evidence. (Diagnostic reasoning is a kind of critical thinking that supports clinical judgement)—This type of thinking becomes a habit of mind to have humility about one’s thought processes and to know that even the most experienced thinker can be mistaken. It becomes a systematic way of generating creative ways of thinking about problems. Critical thinking returns one to an examination of the strength of evidence for a given conclusion.

Front 8

List & Define each step of the diagnostic process

Back 8

a. Data collection/acquisition - history taking & physical exam
b. Hypothesis evaluation - from clustered data
c. Problem naming - used to help focus the physical exam, lab test evaluation, & initial management plan
d. Goal setting - discussion with patient regarding mutually shared goals
e. Therapeutic option consideration - modalities & preferences discussed with the patient
f. Evaluation - follow-up plan, knowing when to return fro a visit & under what circumstances they should phone

Front 9

What does Data Collection involve?

Back 9

Physical examination serves to clarify diagnostic hypotheses and to detect unanticipated problems of which the patient is unaware. Diagnostic tests can be used to confirm or to rule out diagnostic hypotheses, or as screening devices for conditions with subtle presentations.

Front 10

What is involved in Management Planning?

Back 10

This skill involves taking all the data collected in the history & physical assessment, organizing the content, & presenting the major findings in a coherent way.

Front 11

What is the differential diagnosis?

Back 11

List of possible diagnoses, usually in priority order. One approach considers from the “skin in”-keeps from jumping too early to conclusions without considering a wide range of problems.

Front 12

What are the elements of documentation?

Back 12

Preparing concise, comprehensive, and meaningful documentation of one’s thoughts and activities as primary care provider. Recording the patient’s report of symptoms, past med. History, lifestyle and family factors, positive and negative findings on PE, and the clinician’s decisions and actions. Accurate records essential to remind of findings and actions for the next F/U visit. Documentation aids with evaluation of effectiveness of treatment plan, and to serve as protection for the provider or the practice.

Front 13

What is the purpose of documentation of care?

Back 13

a. Includes details regarding any therapeutic plan that is to be carried out-prescriptions, various therapies, counseling, activity promotion or restriction, dietary changes, or any of the therapeutics discussed.
b. Documentation of instructions for F/U, enabling other providers to manage the patient.
c. Documentation to convey the scope and tone of the visit.
d. Opportunity for clinicians at all levels to review the level of their thought (third-party payers)

Front 14

What are evidence-based practice & outcome considerations for each patient encounter?

Back 14

To justify a treatment approach for patients-working alongside patient to make informed choices about treatment, most up-to-date treatment approaches—there must b evidence (clinical trials or from case studies. These practices serve as guidelines to form the basis of protocol development and for peer evaluation. Outcomes decided between patient and provider-the simple, acute health problem to be resolved. When evaluating long-term, chronic issues, outcome determinations must be discussed and determined.

Front 15

Where do the largest number of errors occur in primary care?

Back 15

Administrative

Front 16

What are the greatest administrative errors that occur in primary care?

Back 16

a. information filed in the wrong place or time
b. charts not being available at the time of the visit
c. lack of documentation

Front 17

Define evidence-based practice.

Back 17

Using research findings from several studies that are convincing enough to the majority of a community of scientists and clinicians to recommend that the findings be used for clinical decision-making and that, to come degree, they become a standard of care. Also involves inclusion of patient and practitioner preferences and patient values in the clinical decision-making process.

Front 18

Define research-based practice.

Back 18

Incorporates research findings in clinical decision-making, but the research findings may not be endorsed by the clinical or scientific community as meeting the stringent criteria often used to evaluate findings that constitute evidence and may incorporate only findings from one study.

Front 19

Define practice standards.

Back 19

Inflexible and are intended to be used under all circumstances. They define correct practice rather than a framework that can be tailored to fit different contexts.

Front 20

Define practice guidelines.

Back 20

Allow for flexibility when making individual patient-care decisions. They are intended to provide a reference point and general direction for decision-making and are not to be interpreted as rigid criteria that must be followed regardless of the context in which they are being used. Guidelines should be followed in the majority of cases, unless there is a clear rationale for deviating from them to serve the particular needs of the individuals.

Front 21

List the 5 quality of evidence for clinical guidelines.

Back 21

I. Evidence obtained from at least one properly designed RCT
II-1. Evidence obtained from well-designed controlled trials w/out randomization
II-2. Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group
II-3. Evidence from multiple time series w/ or w/out the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940's) could also be regarded as this type of evidence
III. Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees

Front 22

Define Confidentiality

Back 22

Respect for privileged information

Front 23

Define Autonomy

Back 23

Personal liberty of action and self-determination and respect for all persons as individuals

Front 24

Define Beneficence

Back 24

Provision of benefits & a balancing of harms & benefits; requires choice of positive action

Front 25

Define Fidelity

Back 25

Keeping promises

Front 26

Define Veracity

Back 26

Truth telling

Front 27

Define Justice

Back 27

Fairness; like cases should be treated alike

Front 28

Define Nonmaleficence

Back 28

Above all "do no harm"

Front 29

List the 5 elements of deontology

Back 29

1. Principle of ability for universalism; acting the same in similar situations
2. Consider the nature of the act itself & the principles or rules involved
3. Duties are based on rights
4. The means justify the ends
5. Do unto others as you would have others do unto you

Front 30

List the 5 elements of teleology

Back 30

1. Utilitarianism: the greatest amount of happiness or the least amount of harm for the greatest number
2. Considers consequences; calculates benefits
3. Theories that focus on goals or ends
4. Ends justify the means
5. Community-oriented theory; also thinks of future generations

Front 31

What ethical principle is being used:
Pateints's competence & capacity are considered when dealing w/ patients who exhibit mental status changess

Back 31

Autonomy

Front 32

What ethical principle is being used:
Cancer patient receiving chemotherapy - considered a positive benefit, but the side effects are definitely deleterious

Back 32

Nonmaleficence - Do no harm

Front 33

What ethical principle is being used:
May be omissions/half-truths from clinicians when patients "can't handle it"

Back 33

Veracity - truth telling

Front 34

What ethical principle is being used:
HIPPA

Back 34

Confidentiality - maintenance and respect of privileged information

Front 35

What ethical principle is being used:
Doing all that can be done for patients until the type of care is custodial rather than curative

Back 35

Fidelity - keeping promises

Front 36

What ethical principle is being used:
Basing decisions on principle rather than emotion

Back 36

Justice - weighing individual rights

Front 37

Ethical resolution guidelines Acronym:
E

Back 37

Examine the data: all info collected, key participants identified

Front 38

Ethical resolution guidelines Acronym:
T

Back 38

Think about which person(s) should be making the decision) Involve other family members? Consulting members?

Front 39

Ethical resolution guidelines Acronym:
H

Back 39

Humanize the options by constructing a decision tree: All options to be considered along with all the consequences of those options; visualize results in this fashion for acceptable options

Front 40

Ethical resolution guidelines Acronym:
I

Back 40

Incorporate the ethical principles, legal statutes, standards of care, etc... : Patient's own choice to maintain autonomy - to protect individual rights

Front 41

Ethical resolution guidelines Acronym:
C

Back 41

Choose an action

Front 42

Ethical resolution guidelines Acronym:
A

Back 42

Acting on the decision

Front 43

Ethical resolution guidelines Acronym:
L

Back 43

Look back and evaluate