Fundamentals Ati Unit 1

Front 1

Who are the PEOPLE in the health care system?

Back 1

*Consumers(clients)
*Providers:Licensed vocational/practical nurses, Advanced practice nurses, Doctors, Pharmacists, Dentists, Therapists, Assistive personnel

Front 2

SETTINGS-Where is health care provided?

Back 2

*Hospital
*Home
*Skilled-nursing, assisted-living, and extended-care facilities
*Community/Health departments
*Adult Day Care centers
*Schools
*Hospices

Front 3

Regulatory agencies-enforce regulations for practice

Back 3

*US department of Health and Human services
*FDA
*State and local public health agencies
*State licensing boards-to ensure that health care providers and agencies comply with state regulations.
*The Joint Commission-to set set quality standards for accreditation of hospitals
*PSROs Professional Standards Review Org.
*Utilization review committees-to monitor for appropriate diagnosis and treatment of the hospitalized client

Front 4

Health care financing mechanisms-how health care is paid

Back 4

1. Public federally funded programs(medicare, medicaid)
2. Private plans(MCOs, PPOs, EPOs, Insurance)

Front 5

Medicare

Back 5

*For clients > 65 years of age
*Insurance program-reimburses providers based on diagnosis-related groups(DRGs)
*Managed care organizations(MCOs)-enrolled clients receive comprehensive care overseen by a PCP

Front 6

Medicaid

Back 6

*For the client with low income
*Federally Funded
*Individual states determine eligibility requirements.

Front 7

Private Plan-Traditional insurance

Back 7

It reimburses for services on a fee-for-service basis.

Front 8

MCOs

Back 8

Comprehensive care is overseen by a PCP and focuses on PREVENTION. Providers receive a fixed fee every month for each client.

Front 9

PPOs(Preferred provider organizations)

Back 9

the client chooses from a list of contracted providers. Using noncontracted providers increases the client out-of-pocket costs.

Front 10

EPOs(Exclusive provider organizations)

Back 10

the client chooses from a list of providers withina contracted organization.

Front 11

Long-term care insurance

Back 11

This provides for long-term care expenses and is in addition to medicare

Front 12

Levels of Health Care

Back 12

1.Preventive
2.Primary
3.Secondary
4.Tertiary
5.Restorative
6.Continuing

Front 13

Preventive

Back 13

Focuses on educating and equipping the client to REDUCE and CONTROL RISK FACTORS of diseases.
Examples: Immunizations, Stress management classes, and advocating seat belt use.

Front 14

Primary

Back 14

ROUTINE CARE WITH PERIODIC SCREENING.
This is designed to detect disease at its earliest stage. This is based on sustained partnership of client and PCP.
Examples:office/clinic visits, scheduled school or work-centered screenings(e.g., vision, hearing, obesity)

Front 15

Secondary

Back 15

DIAGNOSIS and TREATMENT of emergency or acute illness. Examples: care that is given in hospital settings or emergency departments.

Front 16

Tertiary

Back 16

Provides the PROVISION of SPECIALIZED highly technical care for the client. Examples: oncology centers, burn centers, and psychiatric facilities.

Front 17

Restorative

Back 17

INTERMEDIATE FOLLOW-UP CARE for restoring health. Examples:Home health care, rehab, and skilled nursing facilities

Front 18

Continuing

Back 18

Addresses LONG-TERM/CHRONIC health care needs. Examples: hospice, adult day care, and in-home respite care.

Front 19

What are the relationships between health care systems and levels of care based upon?

Back 19

People, setting, regulatory agencies, health care finance

Front 20

People(Levels of care)

Back 20

-The level of care provided depends on the needs of the client. Licensed and unlicensed health care personnel work in every level of care.

Front 21

Setting(Levels of care)

Back 21

The settings for secondary and teriary care are usually within a hospital or specific facility/agency. Other levels of care can occur in a variety of settings.

Front 22

Regulatory agencies(Levels of care)

Back 22

Are involved with ensuring the quality and quantity of health care, and the protection of the health care consumer.

Front 23

Health care finance(Levels of care)

Back 23

influences the quality and type of care by setting parameters for cost containment and reimbursement.

Front 24

Hospice is an example of what level?

Back 24

Continuing

Front 25

Immunizations are examples of what level?

Back 25

Prevention

Front 26

School-based screenings are examples of what level?

Back 26

Primary

Front 27

Intensive care services are examples of what level?

Back 27

Secondary

Front 28

Regional cancer center are examples of what level?

Back 28

Tertiary

Front 29

Home health care is an example of what level?

Back 29

Restorative

Front 30

Which of the following are health care regulatory agencies? Select all that apply.

American Nurses Assoc. ANA
The Joint Commission
State Boards of Nursing
National League of Nursing NLN
Federal Drug Admin FDA

Back 30

The Joint Commission
State Boards of Nursing
Federal Drug Admin FDA

Front 31

Which of the following health care financing mechanisms is federally funded? Select all that apply.
(PPO) Preferred Provider Organization
Medicare
(MCO)Medicare Managed Care Organization
(EPO)Exclusive provider Organization
Medicaid

Back 31

Medicare
Medicare Managed Care Organization(MCO)
Medicaid
All of these are federally funded.

Front 32

A hospital conducts a community blood pressure screening in its lobby. This is an example of what level of care?

Back 32

Primary

Front 33

A client in a managed care organization(MCO) requires hospitalization. The admission must first be approved by the ?

Back 33

Primary care provider (PCP)

Front 34

Unit 2 Key Points

Back 34

*The interdisciplinary health care team works collaboratively to provide holisitic care to the client.
*The interdisciplinary health care team consists of health care providers, including nurses, physicians, specialty area clinicians(e.g., physical, occupational, respiratory therapists), and assitive personnel.
*The nurse is most often the manager of care and must understand the roles and responsibilities of other health care team members in order to collaborate in the care of the client and make appropriate referrals.
*The roles and responsibilites of nurses are based on knowledge and skill acquisition that is regulated by state nurse practice acts. Nursing care delivery models provide various formats for nurses to meet the needs of the client.

Front 35

Who provides spiritual care to the client? (e.g., pastors, rabbis, priests)

example: The client requests for communion, or the family asks for prayer prior to the client undergoing a procedure.

Back 35

Clergy

Front 36

Who assesses, plans for, and educates the client regarding nutrition needs? Direct care of nutritional aides

The client has a low albumin level and has experienced a recent unexplained weight loss.

Back 36

Registered dietitian

Front 37

Who obtains specimens of the client's body fluids and performs the necessary diagnostic tests?

PCP orders a CBC to be performed immediately.

Back 37

Laboratory technician

Front 38

Who assesses and plans for the client to regain ADLs, esp motor skills of the upper extremities? Direct care of occupational therapy assistants.

A client has difficulties using an eating utensil with her dominant hand following a stroke.

Back 38

Occupational technician

Front 39

Who provides and monitors medications for as the client as prescribed by the PCP?

A client is concerned about whether or not a new medication will interact with any of his other medications.

Back 39

Pharmacist

Front 40

Who assesses and plans for the client to increase musculoskeletal function, esp of the lower extremities, to maintain mobility. Direct care of physical therapy assistants.

Following a hip replacement, a client requires assistance learning to ambulate and regain strenght.

Back 40

Physical therapist

Front 41

Who assesses, diagnoses, and treats the clients for disease/injury and supervises care delivered by PAs?

A client experiences a change in vital signs. Temp is 39 degree C, Client is achy, shaking, and reports "feeling cold"

Back 41

PCP Primary care provider

Front 42

Positions the client and performs x-rays and other imaging procedures for PCP to review for diagnosis of disorders of various body parts?

A client reports severe pain in his hip after a fall, and the primary care provider orders and x-ray of the client's hip.

Back 42

Radiology Technician

Front 43

Who assesses respiratory status and provides prescribed respiratory treatments?

A client with resp. disease is SOB and requests a nebulizer treatment that has been orders "as needed"

Back 43

Respiratory Therapist

Front 44

Who works with the client and the client's family by coordingatin inpatient and community resources to meet psychosocial and environmental needs that are necessary for recovery and/or discharge?

A client who is dying of cancer wishes to go home but is no longer able to perform many ADLs. The spouse needs medical equipment in the home to care for the client.

Back 44

Social Worker

Front 45

*Evaluate and make recommendations regarding the functions of speech, language, and swallowing impacted by various client disorders or injuries.
*Teaches the client techniques and exercises to improve function when possible.

Back 45

Speech therapist

Front 46

Nursing Personnel

Back 46

*The nursing team is responsible for working together to advocate for and meet the needs of the client within the health care delivery system.
*The RN is the lead team member, soliciting, input from all nursing team members, setting priorities, sharing information with other disciplines, and coordinating the care of the client.

Front 47

What are the education/Role/Responsibilitesfor a RN?

Back 47

Educational-varies by state
Required completion of a diploma program, an associate degree, or baccalaureate degree in nursing prior to taking the licensure exam (licensed)

*Function legally under state nurse practice acts.
*Perform assessments; establish nursing diagnoses, goals, and interventions; and conduct ongoing client evaluations.
*Participate in developing interdisciplinary plans for client care.
*Share appropriate information among team members, initiate referrals for client assitance, including health education, and identify community resources.

Front 48

What educational preparation does a LVN/LPN need?

Back 48

Varies by each state's board
Vocational or community college education required prior to taking the licensure exam

Front 49

What are the roles and responsibilites of an LVN/LPN?

Back 49

*Work under the supervision of the RN
*Collaborate within the nursing process, coordinate the client plan of care, consult with other team members, and recognize the need for referrals to assist the cliet with actual or potential problems.
*Possess technical knowledge and skills
*Participate in the delivery of nursing care, using the nursing process as a framework.

Front 50

What educational preparation does Assistive Personnel (AP) need?

Assitive Personnel-CNAs, CMAs

Back 50

*Varies by state
*Specialized roles:nutritional aides, monitor techs, and physical therapy aids
*Requirement by most states for training and examination to attain CNA status.
*Usually under the direct supervision of an RN

Front 51

What are some roles/responsibilites of Assistive Personnel (AP)?

Back 51

*Specific tasks are outlined in job description
*Tasks may include feeding clients, preparing nutritional supplements, lifting, basic care, measuring and recording vitals, and ambulating clients

Front 52

Describe an APN(Advanced Practice Nurse)

Back 52

*Has a great deal of autonomy
*usually possesses a minimum of a master's degree in nursing(or related field), advanced education in pharmacology and physical assessment, and certification in a specialized area of practice

Front 53

Describe CNS Clinical Nurse Specialist

Back 53

Typically specializes in a practice setting or a disease field

Front 54

Describe NP Nurse Practitioner

Back 54

collaborates with one or more providers to provide nonemergency primary health care in a variety of settings.

Front 55

Describe CRNA Certified Registered Nurse Anesthetist

Back 55

administers anesthesia and provides care to the client during procedures. The RNA is under the supervision of an anesthesiologist.

Front 56

Describe CNM Certified Nurse- Midwife

Back 56

collaborates with one or more providers to provide care to maternal-newborn clients and their families

Front 57

Describe Nurse Administrator

Back 57

provides leadership to nursing departments within a health care facility/agency

Front 58

Describe Nurse Educator

Back 58

may teach at the associate degree, baccalaureate, master's or doctoral level

Front 59

Describe Nurse Researcher

Back 59

conducts research that will provide more nursing knowledge to improve the quality of client care

Front 60

A nursing team comprised of an RN team leader, a LPN, and a CNA, is assigned to nine clients on a med-surge unit. One of the nine clients has leg stasis ulcers and requires wound care. Which of the following team members should be assigned to complete this task?
A. The CNA who is 2 months away from completing her RN program.
B. The RN who is licensed to perform this task.
C. The LPN who has worked on the unit for 6 years.
D. A wound care nurse specialist

Back 60

The LPN/LVN who has worked on the unit for 6 years because the RN can delegate the task to the LPN.

Front 61

The nursing team is directed by the :
A. assistive personnel
B. LPN
C. RN
D. nutrition aide

Back 61

The RN is ultimately responsible for the care given to clients. The nurse has to supervise the LPNs, CNAs,etc

Front 62

Who evaluates the client's nutritional status?

Back 62

Registered Dietician

Front 63

Who dispenses medications as prescribed by the PCP?

Back 63

Pharmacist

Front 64

Who draws blood specimens?

Back 64

Laboratory technician

Front 65

Who would provide the client with a fork with an enlarged handle?

Back 65

Occupational therapist

Front 66

Who would observe the client swallow gelatin?

Back 66

Speech therapist

Front 67

Who removes the client's wristwatch prior to MRI scan?

Back 67

Radiologist Tech

Front 68

Who teaches the client how to use a walker to ambulate?

Back 68

Physical Therapist

Front 69

An older adult client who lives alone is to be discharged in 3 to 4 days.He is assigned a prescribed diet but states that it is difficult to prepare adequate nutritious meals at home just for one person. Which of the following members of the health care team should he be referred to?
A. Registered dietician
B. Occupational therapist
C. Speech therapist
D. Social worker

Back 69

Social worker; they can make necessary arrangements.

Front 70

What are Chapter 3's main points?

Back 70

*DELEGATING is the transfer of responsibility for the performance of a task of activity while retaining accountability for its outcome.
*To delegate a task, the nurse directs another person to perform nursing-related tasks and activities.
*The risk of liability with delegation relates to the appropriateness of the DELEGATION to an individual and the monitoring of the performance.
*Nurses need to use informed judgement when decisions are made regarding the delegation process.

Front 71

State nurse practice acts hold the RN ________ and ________ for providing client care.

Back 71

responsible; accountable

Front 72

The RN decides on the ________ of delegating direct client care.

Back 72

appropriateness

Front 73

Parts of nursing care can be delegated, but the RN cannot delegate the care related to the ________ _________.

Back 73

nursing process

Front 74

Effective ___________ skills are needed by the RN and other health care team members.

Back 74

communication

Front 75

Professional judgement and critical thinking skills are used when implementing the five rights of delegation. What are the five rights?

Back 75

1. Right task
2. Right circumstance
3. Right person
4. Right direction/communication
5. Right supervision

Front 76

Describe "Right task"

Back 76

a task that is appropriate to be delegated for a particular client. A right task is one that is performed basically the same way each time and does not require direct supervision by the nurse. It is a task for which the risk of harm to the client is minimal.

Front 77

Describe "Right circumstance"

Back 77

the setting provides adequate supports and resources to ensure client safety. If the circumstances have not been assess or are deemed too complicated, the nurse takes the responsibility and does not delegate a task to AP.

Front 78

Describe "Right person"

Back 78

the person to whom the task is delegated has the competency and skill; it is within the scope of practice and part of the job description. The nurse determines whether or not it is appropriate to be delegated for the specific client.

Front 79

Describe "Right direction/communication"

Back 79

the nurse explains exactly what is to be done and when, what is to be reported back to the nurse and when, as well as any follow-up communication.

Front 80

Describe "Right supervision"

Back 80

the nurse has the time and resources to provide supervision, intervenes if necessary, and evaluates the client outcomes. The nurse remains accountable for the tasks that were delegated and for making clinical judgements.

Front 81

Right task vs Wrong task

Back 81

Right task: Delegate LPN to perform a dressing change on a client with cellulitis

Wrong task: Delegate LPN to develop the care plan for a client with cellulitis

Front 82

Right circumstance vs Wrong circumstance

Back 82

Right circumstance: Delagate AP to take and record routine check-in vital signs of office client.

Wrong circumstance: Delegate AP to take vital signs on a client receiving IV therapuy for hypovolemic shock.

Front 83

Right person vs Wrong person

Back 83

Right person: Delegate LPN to perform tracheostomy care on a client.

Wrong person: Delegate AP to perform tracheostomy care on a client.

Front 84

Right direction/communication vs Wrong direction/communication

Back 84

Right direction/communication: Delegate AP the task of obtaining a clean-catch urine specimen from the client in room 423, bed 2.

Wrong direction/communication: Delegate AP the task of obtaining a urine specimen on a client in room 423, but not informing her of what type of urine specimen, or which specific client in the room needs the specimen.

Front 85

Right Supervision vs Wrong Supervision

Back 85

Right supervision: An RN delegates to an LPN the task of administering enteral feedings to a client(after the RN performs a physical assessment to evaluate the client's tolerance to feedings thus far.

Wrong Supervision:
An RN delegates to an LPN the task of providing client teaching to a client without a written care plan in place.

Front 86

RNs can delegate what tasks to LPNs?

Back 86

*Monitoring client findings
*Reinforcement of client teaching from a standard care plan
*Tracheostomy care
*Suctioning
*Checking NG tube patency
*Administration of enteral feedings
*Insertion of a urinary catheter
*Medication administration(excluding IV meds, in several states)

Front 87

RNs can delegate what tasks to AP(Assistive Personnel)?

Back 87

*ADLs
*Bathing
*Grooming
*Dressing
*Toileting
*Ambulating
*Feeding(w/o swallowing precautions)
*Positioning
*Bed making
*Specimen collection
*Intake and output (I & O)
*Vital signs

Front 88

Which of the following tasks may be delegated to AP?

A. Establishing an IV route
B. Transcribing a medical order
C. Assisting a client to take a shower
D. Providing fresh water to a client tolerating a clear liquid diet started 2 hours ago
E. Assessing vitals on a client who is expected to be discharged later in the day.

Back 88

Assiting a client with a shower, providing fresh water, and assessing vitals on pre-discharged patient

Front 89

What information should be shared by the nurse delegating the ambulation of a client who had left knee replacement 5 days ago to AP?

Back 89

*The client is in room 203-bed 3 (This tells exact location)
*The client ambulates with his gray slippers on over his antiembolic stockings.(This tells exactly how pt. moves)
*The client uses the front-wheeled walker when ambulating
*The client had pain meds 30 min ago. (Be careful for dizziness)
*The client needs to try and ambulate at least 50 feet.
*The client mainly needs assistance getting in and out of bed.