Nurs1130 Exam 2

Public Hospitals

Funded by federal, state or local govt. (John Dempsey Hospital a.k.a UConn Health Center)

Community

Privately owned (don't really exist anymore)

For profit

Focus is on financial gain not necessarily service

Federal

Don't serve general public (e.a. VA)

Outpatient Care

Services that do not require an overnight stay; Hospitals in Ed or outpatient clinic; ambulatory care

4 categories of ambulatory care

1. Wellness - primary care physician
2. Diagnosis - x-ray, mri's, bloodwork
3. Treatment - same day surgeries, chemo, dialysis
4. Rehabilitation = OT (Occupational Therapy) or PT (Physical Therapy)

Medicare and Hospital Reimbursement

Medicare Part A covers hospital stays and related costs for 65 and older; does not pay for cost of care due to errors (ex. catheter associated urinary tract infections [CAUTI], ventilator associated pneumonia [VAP], bloodstream infections [BSI]), 38.4 billion is uncompesated hospital care expenses in 2017 across 5256 hospitals (American Hospital Association)

Respite Care

For the caregiver

Hospice

Palliative care for those where there is no curative treatment

Palliative Care

Comfort

Difference between Palliative and Hospice

Not all palliative care is hospice, but hospice is always palliative

Industrial Revolution

Younger people moved to city, childless but wealthy = paid for health, no children and no wealth = fended for themselves, local government helped with almshouses, poorhouses, poor farms, country infirmaries, asylums

Disability Requiring Care

Mobility, eyesight, hearing, cognition, self-care; 20% of all adults; 1/3 of all adults aged 65+

Long-Term Care Settings

Skilled nursing facilities, assisted living facilities, senior centers, continuing care retirement communities, respite care, hospice care

Skilled nursing facilities

Licensed Facility, provides general nursing care; custodial care and medical services; licensed nurse present; regulated by state, HHS, CMS

Assisted Living Facilities

Residential Care Communities, assistance with ADLs, less intensive, allows for some independence, majority of residents are "oldest of old"

Continuing Care Communities

Retirement Complex, wide range of services, social activities + home maintenance, may provide assisted living and/or skilled nursing, most expensive

Lowest # of Nursing and Social Work FTEs

Adult Day Service Centers

Highest # of Nursing and Social Work FTEs

Skilled Nursing Facilities

Nursing Aides

CNS, home healthcare aides, and home care or personal care workers, aka "direct care workers"; duties = feeding, bathing, dressing, moving patients, changing linens; high school education, some additional training; backbone of formal LTC system, most influence over client's type of care and quality of life, most difficult jobs to fill

Private Long-Term Care Insurance

High premiums (not feasible for current or near-future needs ), must estimate when insurance will be needed, must estimate how long insurance will be needed, LTC insurance claims climbed by $2 billion (2015-2018)

Elder Abuse

1 in 10 experience abuse (60+); physical, emotional, neglect, abandonment, sexual, financial, fraud; most victims are women, most abusers are family; caregivers and stress-one of the causes

More key Trends in LTC

Aging of baby boomers, emphasis on personal choice, emphasis on quality improvement, technological innovation, new treatments for dementia, home care rather than institutional care

6 Aims (IOM Report 2001)

Safe (avoid injuries), effective (scientific based care), patient centered, timely, efficient (avoid waste), equitable

IOM 10 Rules (Values) of Redesigns (top 5)

1. Customized based on patient needs and values
2. Patient in control of own care
3. Evidence based decision making
4. Anticipate rather than react to patient needs
5. Cooperation among clinicians

3rd Leading Cause of Death in US

Medical Errors

Failure of planned action to work or selection of an incorrect action examples

1. Adverse Drug Events
2. Misdiagnosis
3. Surgical Injuries
4. Falls
5. Pressure Sores
6. Infections

Model for Improvement Questions

1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
3. What change can we make that will result in improvement?

Registered Nurses Scope of Practice

1. Who - Registered Nurses (RN) and Advanced Practice Registered Nurses (APRN)
2. What - Protect, promote, and optimized health and abilities, prevent illness and injury, facilitate healing, alleviate suffering
3. Where - Patient needs to care
4. When - When there is a need for our knowledge, compassion, and expertise
5. Why - To achieve the most positive patient outcomes in keeping with nursing's social contract and obligation to society

Most Common Practice Settings for Registered Nurses

Highest - Hospitals (60%)
Lowest - Education (3%)

Most Common Degree For Nurses to Obtain

BSN (Baccalaureate Degree - Nursing)

Least Common Degree for Nurses to Obtain

Doctoral Degree - Nursing (any)

Decreasing Degree for Nurses to Obtain

Associate and Diploma Degrees

Increasing Degree for Nursing to Obtain

Masters Degree

LPN

-Licensed Practical Nurse
-Fastest track to become a nurse - 1 year
-Can find classes at local hospitals or community colleges
-Eligible to receive license after completing state registered exam
National Council Licensure Examination for Practical Nurses (NCLEX-PN)

RN

-Associate’s Degree in Nursing (ADN)
-Registered Nurse
-Completed in about 2 years
-Blends liberal art classes w clinical nursing classes
-Higher pay and more responsibility
-Transition to the business side of healthcare
-Have to take National Council Licensure Examination for Registered Nurses (NCLEX-RN)

APRN

- Masters or Doctorate
- Different types
- Nurse Practitioner, Nurse-Anesthetist, Nurse - Midwife, Clinical Nurse Specialist
-Doctorate = Highest Degree

Physicians Assistant (PA)

- Advanced Practice Provider (APP)
- Any Bachelor’s Degree (Must complete prerequisites)
-No formal clinical (Must complete between 1000-4000 hours of direct patient healthcare experience -ex. EMS, CNA, Scribe)
-Immediately move to PA Master's Program
-Complete Master’s of: Physician Assistant Studies,Health Science,Medical Science
-Trained as Generalists (Can work in any clinical setting under Physician supervision)
-Will have to pass P.A.N.C.E. Exam (Physician Assistant National Certifying Exam)
-Obtain H&Ps
-Order/Interpret Diagnostics
-Rx Meds/Therapies
-Perform Bedside Procedures
-Consult Specialists As Needed
-Work in all specialties (Outpatient offices,Impatient Hospitalists,
ICU,Emergency Department,Hospice,Surgery [More likely to scrub into surgery])
-Must work under direction and supervision of a physician
-Degree of supervision will vary based on State
-Discussing complicated case
-Co-signing on controlled RXs
-Co-signing on documentation
-National Average Salary - 107k

Nurse Practitioner/ Advanced Practice Registered Nurse (NP/APRN)

-Advanced Practice Provider (APP)
-Bachelor of Science in Nursing (BSN)
-800 - 1000 Clinical Hours - Learning to be a Bedside Nurse
-Take NCLEX-RN
-Work as a nurse for 1-20+ years
-Complete Master of Science in Nursing (MSN)
-Trained in specific patient population
-Will have to pass either AANP or ANCC (Nurse Practitioner Certification in Specific Specialties)
-Obtain H&Ps
-Order/Interpret Diagnostics
-Rx Meds/Therapies
-Perform Bedside Procedures
-Consult Specialists As Needed
-Work in all specialties
(Outpatient offices,Impatient Hospitalists,
ICU,Emergency Department,Hospice,Surgery)
-Full Practice Authority in 23 states and counting
-No required supervision or collaboration by a physician
-If working in a FPA state - have a collaborative agreement
(Outlines collaborative practice protocols, documentation oversight, and prescriptive authority [depending on state legislature],Occasional chart reviews,Access for consultation)
-More Autonomy (especially in an FPA State)
-National Average Salary -$117k

What is the P.A.N.C.E. Exam for PAs?

Physician Assistant National Certifying Exam

Jane Brown is a 5 yo female who has a history of sleep apnea. She was referred to your hospital
for a tonsillectomy and adenoidectomy (T&A). Jane went in for surgery this morning. You, the
nurse, are receiving Jane postop.

1. Pt sitting in wheelchair (fall risk) which is not locked
2. Mom brought in snack to make her feel better! Put candy etc in pt’s hands
3. Baby sister in Jane’s arms and pulling on O2 tubing
4. Pulse ox is on ground and wire tangled in wheel of chair
5. Pt pulled IV out
6. Jane didn’t like the tube in her nose so she put cannula in her mought
7. Nasal cannula not connected to O2 and lying on floor
8. Pt bracelet with wrong name and DOB
9. Dirty/bloody gauze hanging out of pt’s mouth and on chest by her sister
10. Toys scattered across ground/fall risk

Noelle Escobar is a 34 yo patient who delivered vaginally 3 hours ago. She had been in the
hospital for 7 days on bedrest due to preeclampsia. She experienced a Stage 2 postpartum
hemorrhage and is therefore on bedrest with a foley catheter and is NPO. She reports maternal
exhaustion and is bonding with her baby (Baby Girl Escobar). She is anxiously awaiting a call
from the father of the baby.

1. NPO, but holding McDonalds soda and empty McDonalds fries in baby crib.
2. Bracelet says Nancy Escobar
3. Babies bracelet says Labore Baby (wrong ID)
4. Cell phone cable attached to IV pole
5. IV out of date
6. Holding baby in bed with no side rails
7. Scissors in bassinett
8. Urine on bedside table
9. Foley on ground
10. ASA allergy – bottle of ASA on bedside table, open

Johnathon Wu is receiving a blood transfusion and care for his foot wounds

1. Blood tubing hanging on floor
2. IV tubing expired label
3. ASA Allergy with ASA on table
4. Urine on table
5. Phone and cord draped across patient
6. Bugs in bed
7. Gown in trash

Henry Williams, is inpatient for uncontrolled diabetes

1. ID band incorrect patient
2. Left restraint tied to “side rails”
3. Lantus needle and vial on table
4. Candy on table (he is diabetic
5. D5W hanging
6. PCN infusing (allergy to PCN)
7. IV labels are expired
8. Catheter