COPE Health Scholars Written Exam

Things to remember when positioning a patient

Things to remember when positioning a patient

Never leave the bedside unattended without putting up the rails.

Never have 4 rails up at a time, even for a second. Ask the CNA to put down a rail, and you should immediately put up your rail.

When log-rolling the patient, ALWAYS check for bedsores.

Mandatory reporting

Reporting of suspicious events or behavior to authorities.

Code Red

Fire.
Call code when you see smoke or fire.
Close all doors.
Follow RACE

RACE

RESCUE
ALARM
CONFINE
EXTINGUISH

Code Blue

Adult medical emergency (14+).
Follow instructions from nurse.

Code Orange

Hazardous material spill.
Block off area. Do not clean.

Code Pink

Infant abduction.
Guard entrance/exit. Look for suspicious items
Nurses must use bassinets. Visitors must have badge.

Code Purple

Missing child patient.
Report to security/public safety. Look for suspicious situations.

Code Yellow

Bomb threat.
If called, get information about location, appearance, and when it will go off. Look for suspicious situations.

Code Silver

Person with weapon, or hostage situation.
DO NOT go to location. Follow instructions from nurse.

Class A Fire

Ordinary combustibles (wood, etc.)

Class C Fire

Electrical

Class D Fire

Combustible metals

PASS

PULL pin out of extinguisher.
AIM extinguisher at base of fire.
SQUEEZE handle.
SWEEP back and forth.

CVA

Cerebral Vascular Accident (aka stroke). Leading cause of serious long-term disability in U.S.

Are Health Scholars allowed to handle blood?

We can only take blood samples to the lab. We cannot bring bags of blood back to the patient.

Tier II of Infection Prevention

Transmission-Based Precautions:
Used when Standard Precautions may not be enough.
Handwashing, PPE, environmental controls
3 types of precautions for transmission type (contact, droplet, airborne)

Spore/enteric pathogens

Contact-based. Do not eat in same room.
Use: gloves, gown, NO hand sanitizer, bleach, orange-top wipes
Ex: C. Difficile

Droplet-based transmission precautions

Can become infected from: coughing, talking, mucus, etc.
Use: mask, hand hygiene

Airborne-based transmission precautions

Can become infected from: inhalation of air over long distance
Use: N95 or PAPR mask, hand hygiene, etc.

*Scholars are NEVER allowed to enter Airborne Isolation Rooms.*

What types of isolation rooms are scholars allowed to enter?

Contact isolation rooms
Enteric contact isolation rooms
Droplet isolation rooms

Tier III of Infection Prevention

Patient Protection Precautions:
For immunocompromised patients -- PPE, mask, environmental cleaning, no flowers/fruit

HIPAA

Health Insurance Portability & Accountability Act

Ensure privacy of information. Standardize healthcare. Insurance portability.

PHI

Protected Health Information:
- Health information
- Payment methods
- Care provided
- Identifying information

Minimum Necessary Rule

Use the minimum amount of information required for your task.

HIPAA Security Rule

- Integrity: PHI is not destroyed or changed unless authorized
- Availability: PHI must be available to patient upon request
- Confidentiality: PHI is unavailable to unauthorized persons

When can PHI be disclosed?

For TPO purposes:
Treatment (providing care)
Payment (paying or being paid)
Operations (legal, administrative, business, etc.)

TPO

Treatment, Payment & Operations

Social media guidelines to avoid HIPAA breaches

- Do not post identifying information about patients
- Do not friend patients on social media
- Do not take photos or videos with patient

Neonates (1 month) and infants (1-12 months) are at high risk for what?

Aspiration (choking)
Suffocation
Falls (infants)

Toddlers (1-3 years) are at high risk for what?

Choking
Injury
Infection

Adolescents (13-18 years) are at high risk for what?

Depression/suicide
Sexually-transmitted diseases
Substance abuse

Young adults (18-40 years) are at high risk for what?

Quarter-life crisis
Midlife crisis
Substance abuse
Increased stress

Middle adults (40-64 years) are at high risk for what?

Late midlife crisis
Hearing and eyesight decline
Bone and joint pain

Older adults (65+) are at high risk for what?

Decreased skin integrity
Aspiration (choking)
Sleep disturbances, loss of sleep
Falls
Sensory/perceptual alterations (visual and auditory)

What counts towards graduation hours? What doesn't?

Does:
- Initial training hours
- Floor hours
- Meeting hours
- DST (department-specific training) hours
- Recruitment of referred applicants
- Projects
- Pre-rotational shifts

Doesn't:
- Leaders
- Shadowing a health professional

What is the Scope of Service document?

A document in each department that lists:
- Green: things a scholar can do without supervision
- Yellow: things a scholar can only do with supervision
- Red: things a scholar cannot do at all

How many hours must you complete in a rotation before moving onto a new rotation?

48 hours or more

What is a rescheduled shift?

A shift that has been rescheduled more than 48 hours prior.

What is an unexcused missed shift?

A missed shift where the scholar does NOT email the Department Coordinator within 48 hours of the shift.

How many excused missed shifts are allowed?

2 per rotation. No more than 1 per month.

How many unexcused missed shifts are allowed?

0

How long can a Leave of Absence be?

14 - 180 days. A leave between 110-179 days requires re-training.

What if a Leave of Absence is greater than 180 days?

The scholar must re-apply to the program.

How many days must the scholar work between Leaves of Absence?

90 days, or 48 floor hours

How many days maximum can a scholar take in a Leave of Absence during their first rotation?

30 days max

How far in advance should a scholar submit a Leave of Absence request?

At least 2 weeks

Who should the scholar submit a Leave of Absence request to?

The Leave of Absence Coordinator (LOA Coordinator)

What do you do when you are going to miss a shift?

1. Call Charge Nurse at least 15 minutes prior
2. Email the Department Coordinator at least 24 hours prior with a valid reason and a proposed make-up time

5 ways to identify a patient

1) nurse
2) wristband
3) patient's chart
4) whiteboard in nurses station
5) open ended question (what is your name/b'day?)
6) whiteboard in patient's room?

What steps should you follow if a patient issues you a complaint?

1. Listen to the complaint
2. Assure them that you'll tell the appropriate people
3. Report the complaint to Leadership
4. Follow-up with the patient to say that you reported the complaint

How to abide by professional boundaries

- Do not connect on social media
- Do not socialize outside of work
- Do not give/receive gifts
- Do not disclose sensitive personal information

Are scholars allowed to operate mechanical lifting equipment?

No

Caudal

Away from the head, towards the tail/hind parts

Trendelenburg position

Lying on back with bed tilted so that the head is lower than the feet

Used during insertion/removal of peripheral or jugular PICC lines

Reverse Trendelenburg Position

Lying on back with bed tilted so that the head is higher than the feet

Used for head trauma patients (open wound)

Fowler's position

a semi-sitting position; the head of the bed is raised between 45 and 60 degrees

Used after abdominal operations

PACU

Post-Anesthesia Care Unit: Provide care for patients recovering from anesthesia after undergoing surgery

PRN

Pro Re Nata: Administer as needed

Atherosclerosis

Disease in which fatty material is deposited on the walls of the arteries

MI

Myocardial infarction: heart attack; loss of blood supply to the heart

CHF

Congestive heart failure: failure of the heart to pump blood effectively

Stroke

Brain attack; loss of blood supply to the brain

Shock

decreased perfusion of blood to body tissues

Risk factors for myocardial infarction

Smoking, atherosclerosis, hypertension, hyperlipidemia

Pneumonia

inflammation of the lungs by any microorganism

Tuberculosis

infectious disease caused by mycobacterium tuberculosis

Asthma

Chronic condition characterized by airway inflammation, bronchoconstriction, and hypersecretion of mucus

COPD

chronic obstructive pulmonary disease. due to a variety of pulmonary conditions

Emphysema

Chronic expiratory airflow obstruction accompanied by permanent enlargement of the airspace (alveoli); subset of COPD

Neoplasia

uncontrolled, disorderly proliferation of cells

Benign neoplasia

does not metastasize; can still be harmful (e.g. compress adjacent tissues)

Patient history

chief complaint, history of present illness, past medical history

CC

Chief complaint: why is the patient currently seeking medical attention

HPI

history of present illness, detailed chronological account of the symptoms which prompted the patient to seek care; location, quality, quantity, severity, timing, aggravating/relieving factors

PMH

"past medical history"
adult and childhood illnesses, injuries, hospitalizations, surgeries, immunizations, screening tests and psychiatric visits

Stakeholders in US healthcare system

Patients (care, goods)
Providers
Regulators (policy, compliance)
Payers (government, private, uninsured)
Community social determinants of health (SDOH)

social determinants of health

Education, screening, public health, food, transportation, medication

Patients in the inpatient setting complain about?

Beds, food, service

Patients in the outpatient setting complain about?

Wait times, short time with provider, inability to ask clarifying questions, lack of follow-up

the 6 vital signs are

Temperature, pulse (heart rate), blood pressure, respiratory rate, oxygen saturation, pain level

Can health scholars take vital signs of newly admitted patients?

No. They can only take vitals signs of patients whose signs have been taken before.

What can increase body temperature?

Exercise, digestion, drinking a warm beverage, illness, stress, taking a warm bath, high progesterone after ovulation

What can decrease body temperature?

Sleeping, fainting, illness, drinking a cold beverage, dehydration, fasting, high estrogen before ovulation

Normal pulse/heart rate

60-100 bpm adults
60-140 bpm children
100-190 bpm toddlers
100-205 bpm infants

What vessel should be used to take the pulse when the patient is unconscious?

Brachial artery

What vessel should be used to take the pulse when the patient is conscious?

Radial artery

What increases blood pressure?

Pain, immediate exercise, stress, obesity, age, ethnicity, family history, sodium

What decreases blood pressure?

Shock, rest, low sodium, exercise, stopping smoking

Normal oxygen saturation

97-99%

Advanced directive

a legal document prepared by a living, competent adult to provide guidance to the health care team if the individual should become unable to make decisions regarding his or her medical care because of a life-threatening scenario

POLST

Physician Orders for Life-Sustaining Treatment.

A medical document completed by the patient that states the type of life-sustaining treatment(s) they may or may not want. An approach to end-of-life planning based on conversations between patients, loved ones, and healthcare providers.

Signs of dying

Lethargy, disorientation, incontinence, restlessness, reduced intake and output, temperature sensitivity, breathing changes

Doffing PPE

Dirty to clean
1. Gloves
2. Gown
3. Gel
4. Mask
5. Gel

3 healthcare accrediting agencies

1. The Joint Commission (TJC) (3 years)
2. DNV GL (1 year)
3. Healthcare Facilities Accrediting Program (HFAP) (3 years)

TJC

The Joint Commission; on-site survey every 3 years; standards for accreditation: National Patient Safety Goals (NPSGs)

2018 NPSGs

- Identify patients correctly (2 ways, to make sure correct blood is transfused)
- Improve staff communication (get important test results to right person at right time)
- Identify patient safety risks (suicide)
- Use alarms safely (make sure alarms are heard and responded to each time)
- Prevent infection (hand cleaning)
- Use medicines safely (label them, be careful about patients who take blood thinners, pass along correct info)
- Prevent mistakes in surgery

HFAP

On-site survey every 3 years; standards for accreditation: CMS CoPs

Relevance of accreditation agencies to Health Scholars?

- Maintain updated health records and CPR files
- Complete all competency checklists

Members of allied health team

EMT/paramedic, PA, physical therapist, occupational therapist, respiratory therapist, registered dietitian, ultrasound technician, surgical technologist, CNA