Chapter 11 -Timby's -Lecture on Admission, Discharge, Transfer, and Referrals

These flashcards cover key concepts related to the admission, discharge, transfer, and referral processes in health care, based on the provided lecture notes.

What is the admission process in healthcare?

The admission process involves entering a health care agency for nursing care and medical or surgical treatment.

What is included in the admission process?

Authorization from a physician, collection of billing information, completion of admission database, documentation of medical history, development of an initial nursing care plan, and initial medical orders.

What are the types of admissions?

Inpatient, Planned (nonurgent), Emergency Admission, Direct admission, Outpatient, and Observational.

What characterizes an inpatient admission?

Length of stay generally more than 24 hours.

Give an example of a planned (nonurgent) admission.

Elective surgery, such as a bladder suspension.

What is an emergency admission?

An unplanned admission where the patient is stabilized in the emergency department before being transferred to a nursing care unit.

What is direct admission?

An unplanned admission that bypasses the emergency department, going directly from the primary care physician's office to the nursing care unit.

What does outpatient admission typically involve?

A length of stay of less than 24 hours for minor surgeries, cancer therapy, or physical therapy.

Define observational admission.

A temporary admission where monitoring is required to determine the need for inpatient care, typically within 23 hours.

What common physiological responses are observed during client admission?

Responses may include anxiety, fear, stress, and situational low self-esteem.

What are common nursing diagnoses when patients are admitted?

Anxiety, fear, decisional conflict, powerlessness, social isolation, and ineffective self-health management.

What role do nurses play during the admission process?

Preparing the client's room, welcoming the client, orienting them, safeguarding valuables, and compiling a nursing database.

What is involved in the discharge process?

The termination of care from a healthcare agency, including discharge planning initiated at admission.

What is the purpose of discharge planning?

To ensure continuity of care and a smooth transition back to home or another care setting.

What are steps involved in the discharge process?

Obtaining a discharge order from the MD, completing discharge instructions, notifying the business office, and summarizing the client's condition.

What are key components of a discharge plan according to the method guide?

M-medications, E-environments, T-treatments, H-health teaching, O-out patient referral, and D-diet.

What must a nurse evaluate during discharge?

Ensure the client's health condition is stable and that they can paraphrase discharge instructions.

What defines a transfer in nursing care?

Discharging a client from one unit and admitting them to another without going home in between.

Why might a patient be transferred?

To provide more specialized care or to reduce healthcare costs.

What is Minimum Data Set (MDS)?

A standard assessment completed for nursing home residents that is updated regularly to inform the care plan.

What factors are assessed in the MDS?

Cognitive patterns, physical functioning, psychosocial well-being, and medication use.

How often is the MDS repeated?

Every three months or whenever there is a change in the client's condition.

What is involved in the referral process?

Sending clients to another person or agency for special services to ensure continuity of care.

What is the significance of home health care?

It allows for recovery at home, reducing hospital admissions and readmissions.

What factors increase demand for home health care?

Limitations imposed by Medicare and the growing number of chronically ill older adults.

How do older adults often respond to their symptoms?

They may minimize their symptoms, complicating assessment and response.

What is a common barrier to using community-based services?

Lack of finances or reluctance to acknowledge the need for services.

What must be included in discharge documentation?

Date and time of discharge, client's condition at discharge, and mode of transportation.

What nursing activities promote successful discharge?

Performing hand hygiene, assisting with clothing for discharge, and validating client understanding of discharge instructions.

What role does early discharge planning play for older adults?

It helps to facilitate a safe transition back to the home environment with proper community resources.

What nursing interventions can help reduce anxiety during admission?

Encouraging familiar methods, reducing stimuli, and establishing trust.

What is the significance of client valuables during admission?

They should be safeguarded and placed in the hospital's safe to prevent loss.

A nurse is admitting a client and explains that the process involves medical and surgical treatment followed by nursing care. What definition is the nurse referring to? A) Transfer process B) Admission process C) Discharge process D) Referral process

Correct Answer: B Rationale: The admission process is defined as entering a health care agency for nursing care and medical or surgical treatment.

Which action by the nurse represents the start of the admission process? A) Providing the client with a dinner tray B) Documenting a discharge order C) Collecting initial billing information D) Administering a final dose of medication

Correct Answer: C Rationale: The admission process includes authorization from a physician and the collection of billing information to initiate care.

A client is admitted for a length of stay that is expected to exceed 24 hours. How should the nurse categorize this admission? A) Outpatient B) Observational C) Inpatient D) Emergency

Correct Answer: C Rationale: Inpatient admissions are characterized by a length of stay generally more than 24 hours.

A client is scheduled for a bladder suspension surgery next week. What type of admission is this? A) Direct admission B) Planned (nonurgent) C) Observational D) Emergency

Correct Answer: B Rationale: A planned or nonurgent admission involves care scheduled in advance for non-life-threatening procedures like elective surgery.

A resident is brought to the hospital from a physician's office, bypassing the emergency department. Which term describes this admission? A) Direct admission B) Outpatient admission C) Inpatient admission D) Emergency admission

Correct Answer: A Rationale: A direct admission occurs when an unplanned admission bypasses the emergency department, going directly from a clinician's office to a nursing unit.

A patient is admitted for cancer therapy and will stay for less than 24 hours. Which classification does this fall under? A) Inpatient B) Long-term care C) Outpatient D) Tertiary care

Correct Answer: C Rationale: Outpatient admission typically involves a stay of less than 24 hours for treatments such as minor surgery or cancer therapy.

What is the primary purpose of an observational admission? A) To provide long-term recovery B) To perform major surgery C) To monitor the client to determine the need for inpatient care D) To facilitate end-of-life care

Correct Answer: C Rationale: Observational admissions are temporary and involve monitoring to decide if the patient requires inpatient status, usually within 23 hours.

The nurse notices a new client appearing restless and asking repetitive questions about the facility. What is the most likely physiological response? A) Elation B) Anxiety C) Apathy D) Aggression

Correct Answer: B Rationale: Anxiety is a common physiological response during client admission due to uncertainty and the new environment.

Which nursing diagnosis is most appropriate for a client admitted from a different state who expresses feeling alone? A) Social isolation B) Decisional conflict C) Ineffective airway clearance D) Imbalanced nutrition

Correct Answer: A Rationale: Social isolation is a common nursing diagnosis when patients are admitted and lack their usual support systems.

During admission, the nurse asks the client to sign over their gold watch for storage in the hospital safe. What is the nurse doing? A) Encouraging theft B) Safeguarding valuables C) Orienting the client D) Compiling a nursing database

Correct Answer: B Rationale: Nurses are responsible for safeguarding client valuables during admission by documenting them and keeping them in a secure hospital safe.

When should discharge planning ideally begin? A) The day of discharge B) Two days after admission C) At the time of admission D) After the doctor signs the order

Correct Answer: C Rationale: To ensure the best outcomes, discharge planning is initiated at the time of admission to prepare for a smooth transition.

A nurse is using the METHOD guide for discharge planning. What does the 'M' in the acronym stand for? A) Meals B) Medications C) Mobilization D) Mental state

Correct Answer: B Rationale: According to the METHOD guide, M stands for Medications, ensuring the client knows what they must take at home.

When assessing the 'Environment' (E) in the METHOD guide, what is the nurse's focus? A) Checking hospital lighting B) Ensuring the home environment is safe and accessible C) Cleaning the client's current room D) Planting trees in the garden

Correct Answer: B Rationale: The 'E' in METHOD refers to the environment, focusing on whether the client's home is suitable for their recovery.

Under the METHOD guide, what does the 'T' represent? A) Testing B) Teaching C) Treatments D) Transportation

Correct Answer: C Rationale: The 'T' in METHOD stands for Treatments, which helps the client understand any procedures they need to continue at home.

A nurse provides a client with a list of local physical therapy clinics during discharge. Which part of the METHOD guide is this? A) M B) E C) O D) D

Correct Answer: C Rationale: The 'O' stands for Outpatient referral, providing the client with external resources for continued care.

The 'H' in the METHOD guide refers to Health teaching. Which action by the nurse demonstrates this? A) Handing the client a bill B) Explaining how to change a surgical dressing C) Taking a final set of vitals D) Calling a taxi for the client

Correct Answer: B Rationale: Health teaching (H) involves educating the client on how to manage their condition and care for themselves after leaving the facility.

What is the 'D' in the METHOD guide primarily concerned with? A) Diagnosis B) Discharge date C) Diet D) Destination

Correct Answer: C Rationale: The 'D' in METHOD stands for Diet, ensuring the client understands any dietary restrictions or requirements for their health.

A client is being moved from the Intensive Care Unit (ICU) to a step-down medical unit. What is this process called? A) Referral B) Discharge C) Transfer D) Admission

Correct Answer: C Rationale: A transfer involves discharging a client from one unit and admitting them to another within the same or a different agency without going home.

What is the primary goal of the Minimum Data Set (MDS) assessment? A) To calculate hospital billing B) To inform and update the resident's care plan C) To determine the physician's salary D) To schedule staff vacations

Correct Answer: B Rationale: The MDS is a standard assessment for nursing home residents used to inform and regularly update the care plan.

How often is the MDS assessment repeated for a stable nursing home resident? A) Every month B) Every 3 months C) Yearly D) Once at admission

Correct Answer: B Rationale: The MDS is repeated every 3 months or whenever there is a significant change in the client's condition.

Which factor is NOT typically assessed in the MDS? A) Cognitive patterns B) Physical functioning C) Favorite television shows D) Medication use

Correct Answer: C Rationale: The MDS focuses on clinical factors like cognition, physical function, psychosocial well-trough, and medication use; personal hobbies are secondary.

A nurse sends a client to a specialized wound care clinic after discharge. This is an example of what? A) A transfer B) A referral C) A planned admission D) An emergency admission

Correct Answer: B Rationale: A referral is the process of sending a client to another person or agency for special services to ensure continuity of care.

Why has the demand for home health care increased in recent years? A) People prefer hospital food B) Limitations imposed by Medicare and higher numbers of chronically ill seniors C) Hospitals are closing down D) Physicians no longer see patients in offices

Correct Answer: B Rationale: Medicare limitations on hospital stays and a growing population of chronically ill older adults have increased the need for home-based care.

A nurse is discharging an older adult. Why might the nurse need to follow up more closely on the client's symptoms? A) Older adults often exaggerate symptoms B) Older adults may minimize symptoms or attribute them to aging C) Older adults have better memory than younger adults D) Older adults do not requires medication

Correct Answer: B Rationale: Older adults often minimize their symptoms, making it difficult for nurses to assess their health status accurately without careful evaluation.

What is the first step a nurse should take when a discharge order is received? A) Walk the client to the car B) Help the client pack their bags C) Verify the discharge order from the physician D) Call the client's family

Correct Answer: C Rationale: Obtaining or verifying a discharge order from the MD is the formal first step in the termination of care process.

A nurse asks a client to repeat the instructions for their new heart medication. What is the nurse evaluating? A) The client's speech pattern B) The client's ability to paraphrase and understand discharge instructions C) The nurse's own teaching style D) The hospital's pharmacy efficiency

Correct Answer: B Rationale: A critical part of discharge evaluation is ensuring the client can paraphrase instructions to prove they understand their care.

What documentation is required when a client leaves the facility? A) The names of all visitors the client had B) The date, time, and mode of transportation C) The current weather conditions D) The nurse's lunch break schedule

Correct Answer: B Rationale: Proper discharge documentation must include the date, time, the client's condition, and how they were transported (e.g., wheelchair to private car).

Which nursing action helps reduce a client's stress during admission? A) Speaking as quickly as possible B) Establishing trust and encouraging familiar routines C) Keeping the lights as bright as possible D) Avoiding eye contact

Correct Answer: B Rationale: Nurses can reduce admission stress by establishing trust, being supportive, and allowing the client to maintain familiar patterns.

What document provides a standardized assessment of cognitive and physical functioning in long-term care? A) The Physician's Progress Note B) The MDS (Minimum Data Set) C) The Billing Ledger D) The Discharge Summary

Correct Answer: B Rationale: The MDS is the standard tool used in nursing homes to assess cognition, function, and psychosocial well-being.

A nurse is preparing a room for a new admission. What should be done first? A) Order the client's first meal B) Ensure the bed is in the lowest position and the room is clean C) Call the insurance company D) Write a discharge plan

Correct Answer: B Rationale: Preparing the client's room, ensuring it is clean and safe, is a primary nursing responsibility during the admission process.

Why is a nursing database compiled during admission? A) To sell the data to researchers B) To establish a baseline and develop an initial nursing care plan C) To fill up the electronic health record D) To justify the cost of the room

Correct Answer: B Rationale: The nursing database provides the necessary information to assess the client's needs and create an effective initial care plan.

Which of the following is a barrier to patients using community-based services? A) Too much information B) Lack of finances C) Excessive hospital support D) High literacy rates

Correct Answer: B Rationale: Financial limitations and a reluctance to acknowledge the need for help are significant barriers to using community resources.

A patient is transferred to a specialized trauma center. What is the most likely reason for this? A) To save the hospital money B) To provide more specialized care not available at the current facility C) To make the patient move faster D) To change the nursing staff

Correct Answer: B Rationale: Transfers are often performed to move a client to a facility that can provide more specialized or higher-level medical care.

Which nursing diagnosis focuses on a client's decreased control over their environment during admission? A) Fear B) Anxiety C) Powerlessness D) Social Isolation

Correct Answer: C Rationale: Powerlessness occurs when a client feels they have lost control over their daily routines and environment due to being hospitalized.

What defines a 'planned' admission? A) Admission via the ambulance B) An elective procedure scheduled in advance C) A sudden heart attack D) A fall at home

Correct Answer: B Rationale: Planned admissions are scheduled in advance, such as for elective surgery, whereas emergency admissions are unplanned.

What is the purpose of the initial medical orders provided during admission? A) To document the client's address B) To provide immediate direction for medications and treatments C) To describe the hospital layout D) To list the nursing staff names

Correct Answer: B Rationale: Initial medical orders from the physician provide the necessary instructions to begin treatment and medication administration immediately.

When managing a transfer, the nurse must: A) Tell the patient to walk to the new unit B) Hand off a summary of the client's condition to the new nurse C) Cancel all previous medical records D) Ask the client to go home first

Correct Answer: B Rationale: A successful transfer requires a clear communication of the client's condition and needs to the receiving nurse to ensure continuity of care.

What is the primary benefit of home health care for the healthcare system? A) It is more expensive B) It increases hospital readmissions C) It helps reduce hospital admissions and readmissions D) It eliminates the need for doctors

Correct Answer: C Rationale: Home health care allows for recovery in a comfortable setting and is proven to reduce the frequency of hospital readmissions.

A nurse validates that a client understands their discharge diet. Which action by the client shows this? A) The client throws the diet sheet away B) The client explains which foods they should avoid and why C) The client asks for more salt D) The client refuses to speak

Correct Answer: B Rationale: Validation of understanding is best demonstrated when the client can explain the information in their own words (paraphrasing).

A client is admitted directly from the physician's office with severe chest pain. This is best described as: A) Planned admission B) Direct admission C) Outpatient admission D) Observational admission

Correct Answer: B Rationale: A direct admission occurs when the patient goes straight from the primary care office to a nursing unit, bypassing the emergency room, even if it is unplanned.