HSA HPRSA EXAM REVIEW

Pathogens

Disease causing organisms

Types of Disease causing organisms

1.  Bacteria

2.  Virus

3.  Fungi

4.  Rickettsia

5.  Protozoa

Bacteria

• Can be pathogenic or non pathogenic

• Classified by their shape:  round, rod, and spiral

• Treated with antibiotics

• Examples of infections:  tonsillitis, pneumonia, & ear infection

• The body will produce antibodies to help fight off infection

Viruses

• Smallest microbe- must use electron micoscope to see them

• Can only live inside another living organism

• Difficult to treat- antibiotics do not work on this

• Antiviral drugs have been developed which work by inhibiting their development

• Examples:  chicken pox, Hepatitis B, measles, HIV/AIDS and COVID

Fungi

• Two forms of ____ are potential pathogens- yeast and mold

• Penicillin, important antibiotic, is produced from a mold

• Example of fungi infections- ringworm, athlete's foot, and infections of the skin

Parasitic

pathogens that live in or on another organizm and take nutrients from it.  It also injures or makes the host sick.

Rickettsia (type of parasite and bacteria)

• Much smaller than bacteria

• Rod or spherical shaped

• Do not move independently

• Must live inside the cell of another organism like a virus

• Examples of diseases of ______-  typhus and Rocky Mountain spotted fever.

Protozoa (type of parasite)

• Classified as animals

• Found in the environment, decayed materials, contaminated water and unwashed hands

• Reside in and on the body

•  Examples of diseases- dysentery, toxoplasmosis, and malaria

Opportunistic infections-

infections that occurs in people with a weakened immune system.

 

Nosocomial (naa-suh-kow-mee-uhl) infection-

infection that is acquired while receiving health care.  Patient did not have at time of admission.

What does MRSA (BACTERIA) stand for

resistant Staphyloccus aureus (MRSA) aka Superbug

MRSA (BACTERIA)

• Staphyloccus aureus is normally found on people's skin.  ______ has become resistant to many of the antibiotics normally used to treat infection.

• Usually found in hospitals and other healthcare facilities

• Can lead to sepsis or death

How to prevent pathogens

• Treat all patients like they are infected at all times!

• WASH HANDS frequently!  Best way to stop the spread

• Break the Chain of Infection

• Wear PPE (personal protection equipment)- it prevents the spread of airborne, droplets, and contact infections

• Vaccinations

Bacteria Infection Treatment:

Most bacteria can be treated by antibiotics.  There are some bacteria that have become antibiotic resistant where normal antibiotics do not work on them.  (ex:  Methicillin-resistant Staphylococcus aureus or MRSA for short)

Viral Infection Treatment:

Antibiotics do not work on viral infections.  Viruses are difficult to treat since antibiotics do not work on them.  We have developed antivirals that reduce the length of infection.

Nosocomial Infections

are the result of infectious material carried by health care workers from one patient to another.  It is acquired during the process of receiving health care and the infection was not present during the time of admission.  This type of infections is increasing dramatically.  

Medical asepsis

(clean technique) decreases pathogens.  This kills some microorganisms to prevent them from spreading.  Used in doctor's offices

Surgical asepsis

(sterile technique) eliminates pathogens.  This completely kills and eliminates microorganisms. Used in hospitals.

Antiseptic-

kills/inhibits growth

of microorganisms on living beings

Disinfectant-

destroys most bacteria

and viruses on non-living things

Sterilization-

kills all microorganisms, used in professional settings such as hospitals

Body mechanics

the correct positioning of the body for a given task (lifting heavy objects or keyboarding)

Reaosn for using correct body mechanics

1. Muscles work best when used correctly

2. Correct use of muscles makes lifting, pulling,          and pushing easier

3. Prevents unnecessary fatigue, strain, and                saves energy

4. Prevents injury to self and others

5. Keep heavy objects close to your body

Health care workers perform body movements that can lead to injuries:

  1. lifting patients

       2.  medical transcriptionist keyboarding for many hours each 

            day

       3.  surgical technicians standing during long operations

Risk factors of injury:

poor posture

poor body mechanics

low level of fitness

obesity

stress, both mechanical and psychological

Repetitive Motion Injuries (RMIs)- 

injury based on the overuse of one part of the body.  Motions that are repeated over and over.

Examples:  carpal tunnel syndrome and tendonitis

How to Preventing RMIs:

• warm up and stretch after repetitive activities or lack of movement

• avoid staying in one position- move every 20-30 min

• change positions or stop whenever activities cause pain

• sit up straight at your desk

• set up computer workstations that fit your physical needs

Exertion Injuries-

injury caused by lifting, pulling, and pushing.  Back injury is the most common.

How to Preventing exertion injuries:

• Warm up before and after activities that require lifting, pushing, or pulling

• Avoid bending forward at the waist to lift an object

• Use the largest joints and muscles to do the work (use leg muscles instead of back when lifting heavy objects)

• Place feet 6 to 8 inches apart when lifting heavy objects

• Push heavy objects instead of pulling

Enviromental safety

Remain calm!!!!

 

Walk, never run

 

Always report unsafe conditions and accidents immediately!

 

Report any accidents or injuries immediately and complete an incident report. (written document that explains what happened)

Fire needs?

oxygen, fuel, and heat in order to start.

Major causes of fire:

• smoking

• matches

• misuse of electricity

• defects in heating

• spontaneous ignition

• improper rubbis disposal

• arson

RACE

Remove patients

  Activate alarm

  Contain the fire

  Extinguish the fire or Evacuate the area

 

**Always crawl along the floor

PASS

 Pull the pin

 Aim the nozzle at the base of the fire

 Squeeze the handle

 Sweep back and forth along the base of

  the fire.

 

Always aim the extinguisher at the base of the flames.

Material Safety Data Sheets (MSDS)

are guidelines that contain information of the potential hazards and how to work safely with the product.  Required by OSHA.

 

MSDS must contain:

1. Product information about the chemical

2. Protection or precautions that should be used when handling chemicals

3. Instructions for safe use of the chemical

4. Procedures for handling spills, cleanup, and disposal of chemicals

5. Emergency First Aid procedures

 ______ is what you should use to determine how to clean up.

Always rinse eyes that have chemicals in them for 15 minutes!

What is Health Insurance ?

A plan that helps the consumer pay for medical costs.

*No plan pays 100%

WHY do we need health insurance

We need insurance to help with the rising costs of healthcare.

Examples:

Coronary Artery Bypass Graft cost          $70,298

Knee Replacement cost                              $ 18,000

Can you afford to pay that?

EMTALA

• federal law requires that hospital emergency departments treat emergency condition of all patients regardless of their ability to pay.

• Law established no method of payment

• Government programs never fully reimburse for this mandated care

• Financial pressure on hospitals

• Patients cannot pay bill, escape into bankruptcy

What does COBRA stand for

Consolidated Omnibus Budget Reconciliation Act (1986) 

employee can pay to keep group health insurance for 18-36 months after leaving a job or losing health insurance

Patient Protection and Affordable Care Act:

• Often called Affordable Care Act (ACA) or Obamacare

• Law signed into law in 2010 by President Obama

What are the four goals of Patient Protection and Affordable Care Act

1. Make affordable health insurance available to more people

2. Expand Medicaid program to cover all adults with income below 138% Federal Poverty Level (FPL)

3. Support medical care delivery methods to help lower the cost of health care.

4. Access to insurance for those with pre-existing condition

Pre-existing condition

an illness already present when applying for a new insurance plan

Tort reform

  laws limiting medical malpractice suit payments

DRGs

• Diagnostic Related Groups – Medicare pays a set amount for specific classifications of diagnoses regardless of actual cost

Premium

• amount you pay to belong to a health plan

Deductible :

• amount you must pay each year before health plan begins paying

Co-insurance

• percent of medical costs a person must pay after meeting deductible  (ex:  20%)

Max Out of Pocket

• the amount you have to pay out of pocket before insurance pays 100%.

Co-pay

• set fee paid each time person receives medical care  (ex:  $10 per doctor visit)

• Group Insurance 

-Employer offers plan to workers

     - Share cost of premiums

• Individual Insurance 

  -Purchase plan directly from insurance company

     -Pay own premiums

• Fee- For- Service:  

Can choose any provider

- Deductible

      - Physicians set their own prices for services

     -  Has gotten too expensive for most people

• Managed Care Plans

A “network” of providers on the plan

     -  Provides incentive to providers to cut costs

- Costs lower if use network providers

- No insurance claim forms 

- Co-pays

HMO:

• Health Maintenance Organization

  - Receive most of care from primary care providers

      (PCP)   PCP coordinate health care needs of patients

        to help control costs

  - Specialists require a referral

  - Will only pay for network providers

  - Pays 100% for routine & preventative care

PPO: 

• Preferred Provider Organization

• More flexible than HMO, also more expensive

  - No referrals for specialists

  - Can use network or non-network providers

  - Pay more for non-network 

Medicare

- Federal

  - Health coverage for age 65 and older & people under 65 if they have end-stage renal disease or Amyotrophic Lateral Sclerosis (ALS)

  - Plan A :  hospital coverage / no premium

  - Plan B :  physician coverage, tests / premium / optional

      - Plan C: (Medicare Advantage) People with Plans A & B can 

        choose to receive all of their  health care services through a

        provider organization (HMO or PPO)

  - Plan D:  prescription drugs

Medicaid

- Federal

     - Administered by states

     - Covers those under 65 with low income (pregnant

        women and children), people who receive

        Supplemental Security Income (SSI) which 

        includes the disabled and the blind

  - Eligibility & benefits vary by state

• SCHIP / CHIP:

- State Children’s Health Insurance Program

   - State medical coverage for low income children who      do not qualify for Medicaid

• Worker’s Compensation

-Covers medical care for on-the-job injuries

-Covers part of wages lost due to injury

-Cost shared by state and employer

TRICARE

(formerly CHAMPUS:  Civilian Health and Medical Program U.S.)

-Federal medical plan for active duty and retired military personnel, their dependents, and survivors

1847

First group policy offered by Massachusetts Health Insurance of Boston

1890

• First individual policies covering disability & illness

1929

First modern group plan – group of Dallas teachers contracted with Baylor Hospital for medical services in exchange for a monthly fee

1932

• Non-profit organizations Blue Cross and Blue Shield offered group plans negotiated with doctors & hospitals in return for increased volume & prompt payment

1939-1945

 Government mandated wartime wage freezes accelerated the spread of group health care.  Unable by law to attract workers by paying more, employers improved their benefit packages by adding health care.

1940’s-1950’s –

 Unions bargained for better benefits, including tax-free employer-sponsored health insurance.

1954

Disability benefits were included in social security coverage.

1950’s-1960’s –

• Government programs to cover health care costs began to expand.

1965

Medicare and Medicaid programs created

1980’s-1990’s

Cost of healthcare rapidly rose; majority of employer-sponsored group plans switched from “fee-for-service” plans to cheaper “managed care plans”.

1995

 Individuals & companies paid for about half of the health care costs incurred by Americans with the government paying the other half (elderly, disabled, children, veterans, indigent)

Patient Protection and Affordable Care Act of 2010

Amended to be called the Affordable Care Act (Obamacare)

The law provides many rights and protections that make health coverage more fair and easy to understand.

Offers subsidies (premium tax credits) to make insurance more affordable

Allowed people with preexisting health problem to get affordable health insurance.

The Bill

• Hospitals and other providers charge 2, 3, 4 or more times what an insurance company will pay for treatment.

Billing practices

• Insurance companies have contracted rates with providers = discounted rates for patient volume and prompt payment

• Uninsured are billed full rate

• Some doctors bill 3 times what they expect to get; charge more in hope of getting more as they know they will not receive what they bill for.

• Patients who pay their inflated bills make up for those who cannot/do not pay.

Medical documentation

all notes and documents that health care professionals add to the medical record.  

Medical records

collection of all documents that are filed together and form a chronological health history of a particular patient.  Medical records are legal documents used in court.

Charting-

recording observations and informtion about patients.

Purpose of Medical Documentaton

• Improve continuity of care

• Provides health care providers with information they need to make decisions

• Helps enforce staff accountblity- accountable for what you write in medical record.

• More accurate vital statistics (death, disease outbreaks)

• Provides legal protection- records shows proof of what has taken place with the patient.

• Ensures compliance with regulatory agencies

• Improves cost control

• Decreases denials from insurance companies

• Provides data for investigation of errors and incidents

Medical History-

includes personal, family, and social history.  It should include the patient's past medical problems, surgeries, allergies, and current problems

Progress Notes-

chronological statements about a patient's care.  Each time a doctor see's a patient, they will make notes to update findings and plan the care of the patient.

How to fix an error:

1. Draw a single line through the error. Must be able to read the original entry.

2. Write in the correct information where there is space (above, below, or following the orignal entry)

3. Note the error as required by your facility 

Electronic Medical Records (EMRs)

are digital versions of paper records.

 

Benefits of EMRs

Medical records are entered into a computerized system.This helps with reduction of errors, easier access, improved communication and efficiency.

Challenges of EMRs

Cost of purchasing a system is very expensive.  Cybersecurity is another issue.  Health records can by compromised during a cyberattack.  HIPAA (Health Insurance Portability and Accountability Act) requires medical records to be kept private.

CYBERTHREATS

Biggest problem with  electronic health records??

Computers perform three major operations:

1. Store huge amounts of data

2. Calculate, manipulate, organize, and retrieve data quickly and accurately

3. Enable high-speed communication

Diagnostic tools are available due to the computers ability to manipulate data and perform high-speed calculations. Diagnostic Imaging

• Computer tomography (CT)

• Magnetic resonance imaging (MRI)

• Positron emission tomography (PET)

• Ultrasonography

• Electrical impedance tomography (EIT)

CT Scan

uses x-ray and computer to create detailed images of bones and soft tissue

How the MRI works

Uses large magnet, radio waves, and computer to created detailed images of organs and structures

PET Scan

Uses radioactive trace material to find diseased tissue to detect cancer.

Ultrasongraphy

Uses sound waves to create images of of organs in your body

Electrical Impedance Tomography

Measures electrical currents to detect differences in lung tissues

Steps of Electronic impendence Tomograhy

A= electrodes placed

 

B= EIT image where white indicates highest volume changes and dark blue is non ventilated regions of the lung

 

C=CT scan of someone with lung disease

Other uses for technology:

• New treatments including lasers (focused light rays)

• Pharmaceuticals- dispensing medications

• Rehabilitation- people with disabilities can live more independently and computer-aided design to improve prosthetic devices

• Research- keeping up to date with medical advances

• Education- offers ways to learn for students, health care professionals, and patients

• Electronic Mail (email)- is now a standard professional communication tool

• Telemedicine- treat patients remotely

Conditions favorable for growth

1. Warmth

2. Darkness

3. Food source

4. Moisture

Aerobic

Require oxygen

Anarerobic

Do not require oxygen

Chain of infection

1. Pathogen causes infection; causative agent

2. human body, animals, environmental; where it lives normally; resovoir

3. Pathogen leaves resovoir; portal of exit

4. how pathogen gets from resovoir to new host; mode of transmission

5. how pathogen gets into new host; portal of entry

6. someone who gets sick from pathogens; suseptible host

Carrier

someone who gets infected without sympotms