Fundamentals exam 1

what was signed into law in 2010 with the intent of improving healthcare quality while lowering its costs, increasing access for all, encouraging prevention, and providing protection to those who access health care

the affordable care act (ACA)

what do regulatory agencies in health care do

enforce standards and practice requirements that play a major role in the quality and costs of care delivered

the NCLEX and Medicare are examples of…

federal regulatory agencies

boards of nursing is an example of _______

state regulatory agency

what is the joint commission

nonprofit that accredits health care organizations

what does the Joint Commission monitor and update

state legislative and regulatory changes

who makes the National Patient Safety Goals

the Joint Commission

the Joint Commission partners with other organizations to do what?

make safe practices, identify causes of errors, and lower future risks

what is an event that results in a client death or severe temporary harm?

sentinel event

what is reported to TJC and tracked to help health care organizations improve client safety and quality of care

sentinel events

what does the National Committee for Quality Assurance measure

quality of care based on satisfaction scores and HEDIS tool

what does HEDIS stand for

healthcare effectiveness data and information set

what is awarded when organizations demonstration a promotion of quality in a setting that supports professionalism, excellence in delivering nursing services, and spreading “best practices”

magnet recognition

magnet organizations demonstrate better client quality indicators such as… (3 things)

lower fall rates, improved skin quality, and higher client satisfaction score

what is the pathway to excellence program

4 year designation awarded to organizations that show commitment to a healthy workplace for their staff

what does the hospital consumer assessment of healthcare providers and systems do (HCAHPS)

uses a standardized questions to measure and compare client satisfaction between health care facilities

when is HCAHPS administered and when

randomly to clients between 48 hours and six weeks after discharge

what is the Press Ganey

survey that measures health care delivery and client satisfaction in acute care

what kind of things does the Press Ganey measure

access to care, wait times, client interactions, and the visit

how is the Press Ganey sent and when

emailed to every client at the end of their visit

what is Fee for Service

reimbursement system where organizations receive payment based on the volume of services provided versus quality care

clients are coded into DRGs based on what

primary diagnosis, age, and sex

what are resource utilization groups (RUGs)

payment system used in long term care settings where reimbursement is based on DRGs and the expected use of resources

what is a minimum data set

assessment in addition to DRG

what does the minimum data set evaluate

cognitive status, need for assistance with ADLs, and number of treatments and therapies

what are the 5 social determinants of health

economic stability, education, social and community, neighborhood and built environment, and health care

employment, income, expenses, debt, medical bills, and support are all examples of _______ determinants

economic stability

housing, transportation, parks, playgrounds, walkability, and geography are all examples of _____ determinants

neighborhood and physical environment

literacy, language, early childhood education, and vocational training are all examples of _______ determinants

education

support systems, stress, exposure to violence, and policing are all examples of _______ determinants

social and community

provider and pharmacy availability, health coverage, and quality of care are all examples of ______ determinants

health and health care

what level of care does general screenings, refers to specialists, and overall prevention

primary

what level of care id prevention in the population such as schools

community

what level of care does emergencies and is usually short term

acute

what level of care is usually a place to live such as nursing homes

long term care facility

what level of care is usually an oversight for living such as nursing homes or occupational rehab

skilled nursing facility

what level of care usually cares for stable clients (on ventilators or burned)

long term care hospital

what level of care is for patients that are mostly independent but need some help

assisted living

what level of care is for patients that have 6 months or less to live

hospice

what level of care is for comfort during last stages but can still be treated

palliative

what level of care gives caregivers a break

respite

what level of care gives services inside a client’s home

home care

what is an APRN

advanced practice registered nurse; RN who can diagnose and prescribe

what is a case manager

does coordination, education, and find most cost effective things

what is an LPN

licensed practical nurse; under RN supervision, basic care, gathers data, and some treatments

what is a neuropathic physician

more natural methods

what is an occupational therapist

helps people recover or make new skills or ADL

what is a physical therapist

assists in recovering from injury or illness

what is a PA

physician assistant; treats, diagnoses, and prescribes under supervision

what is an RT

respiratory therapist; manages oxygen, does tests, educates, and prescribes

what do social workers do

finds challenges and advocates to find their solution

what is the steps of the nursing process

assessment, analysis, planning, implementation, evaluation

what established expectations for professional behavior to protect the nurse, client, and facility

standards of professional practice

what do the standards of professional practice hold nurses accountable for

following a code of conduct and upholding ethical values

what has established standards for both nursing practice and professional performance

the American nurses association

what regulates nursing within each state, identifies what conditions must be met for licensure, identifies specific titles, and determines scope and standards of practice

state nurse practice acts

what are the 2 steps to defining scope of practice

state legislature makes NPA and identifies a regulatory body to enforces them

what are the two accrediting organizations for nursing schools

ACEN or CCNE

what are the 6 competencies from the quality and safety education for nursing institute

patient centered care, teamwork, evidence based practice, quality improvement, safety, and informatics

what is the purpose of the national league for nursing

foster excellence in nursing education

what are the 4 national league for nursing competencies

human flourishing, nursing judgement, professional identity, and spirit of inquiry

formula for writing credentials

name, education, licensure, certification(s)

what is something that contains bacteria, fungi, virus, parasite, or prion

infectious agent

what is the habitat of the infectious agent and where it lives, grows, and reproduces

reservoir

what is the means by which the infectious agent can leave the reservoir

portal of exit

what are the 3 modes of transmission

contact, droplet, airborne

what mode of transmission occurs when microorganisms move from an infected person to another

contact

what mode of transmission occurs when airborne droplets from the respiratory tract of a client travel through the air and into the mucosa of a host

droplet

what mode of transmission occurs when small particulates move into the airspace of another person

airborne

what is the place for the infectious agent to replicate or for its toxin to act (any body orifice)

portal of entry

what is required for the infectious agent to take hold and become a reservoir for infection

susceptible host

immunizations, treatment of disease, health insurance, and patient education are all breaking the chain at ________

susceptible host

diagnosis, treatment, and antimicrobial stewardship are all breaking the chain at _______

infectious agent

cleaning, disinfection, sterilization, infection prevention policies, and pest control are all breaking the chain at _______

reservoir

hand hygiene, PPE, control of aerosols and splatter, respiratory etiquette, and waste disposal are all breaking the chain at _______

portal of exit

hand hygiene, PPE, food safety, cleaning, disinfection, sterilization, and isolation are all breaking the chain at ______

mode of transmission

hand hygiene, PPE, personal hygiene, first aid, and removed of catheters are all breaking the chain at ______

portal of entry

what are the 4 body defenses

physical/chemical, nonspecific immunity, and specific immunity

______ refers to neutrophils and macrophages and their work as phagocytes

nonspecific immunity

_______ eat and destroy microorganisms

phagocytes

_______ and ______ are released during the inflammatory response

neutrophils and macrophages

______ refers to the work of antibodies and lymphocytes

specific immunity

antibodies are also called _______

immunoglobulins

4 steps to inflammation

pattern receptors recognize harm, inflammatory pathways activated, inflammatory markers released, inflammatory cells recruited

what are the 3 steps to inflammatory response

vascular/cellular, exudate, reparative

what is the vascular response for inflammation

initially, vasoconstriction but histamine causes vasodilation; permeability increases for WBCs; swelling

what is exudate production during inflammation

fluid/cellular components leak from vessels into tissues for facilitate healing

what happens during the 1st stage of inflammation (local)

heat, redness, swelling, pain, loss of function

what are systemic findings for inflammation

fever, aches, chills, nausea, vomiting, increased HR and RR, increased WBCs, large lymph nodes, sweating

signs of inflammation in older adults

confusion, decreased immune response (low grade fever), agitation, incontinence

what are the 5 stages of infection

incubation, prodromal, acute illness, decline, convalescence

______ is when an infection enters host and begins to multiply

incubation

______ is when the client begins having symptoms

prodromal

_______ is when manifestations of the specific disease process are obvious and may become severe

acute illness

______ is when manifestations begin to wane as the degree of infectious disease decreases

decline

_______ is when the client returns to a normal or a “new normal” state of health

convalescence

_______ infections are confined to one area of the body and can be treated with antibiotics

local

______ infections spread to the bloodstream

systemic

5 nursing interventions for prevention of infection

hand hygiene, education, client hygiene, fluid intake, PPE

the goal of _______ is to control the number of microbes

medical asepsis (clean technique)