Ambulatory Chronic Disease Exam 2

What is the focus for chronic disease management in the in-patient setting?

Stabilize & symptom management

How does managment of chronic conditions in ambulatory nursing care differ from in patient?

Self care, self management, improving quality of life, and preventing hospitalizations

What 3 cardiac conditions commonly lead to readmissions?

HF, MI, S/P CABG

What 2 respiratory conditions commonly lead to readmissions?

COPD, pneumonia

What 2 ortho conditions commonly lead to readmission?

TKA, THA (Total knee and hip replacement)

Returning to the hospital within how many days is considered a readmission?

30 days

What patients should not go to cardiac rehab?

High risk for arrythmias, decompensation of HF, unstable angina

What patients should go to cardiac rehab? 

HF, s/p MI, angina, and cardiac surgery like stents, CABG, valve repair and heart transplants; sometimes congenital  

Who pays for cardiac rehab?

Medicare (up to 20%)

How long does cardiac rehab last in the medical gym?

2 weeks - 1 month

How long does cardaic rehab last in the outpatient rehab? 

Up to 12 weeks 

In cardiac rehab, what nutritional counseling will we have to emphasize?

Fluid and sodium levels

Why do we measure weights daily during rehab?

To assess fluid retention?

When is the best time to weigh a patient?

At the same time in the morning

What is the most common co morbidity 

Diabetes 

What LDL cholesterol levels are we aiming for?

<100

What HDL cholesterol level should we aim for?

60-80

Medicare part c

medicare advantage, comes with an extra cost but helps to supplement services not covered by standard medicare

What does medicare c offer? 

free or reduced gym memberships 

Medicare part D

Comes with C but is for medication

A comprehensive program for frail, community dwelling individuals, 55 and older who are nursing home eligible; 90% dual eligible

PACE program

What are your 2 most common tests to diagnose diabetes?

HGB A1C and fasting plasma glucose

How long should you be NPO before a fasting plasma glucose test? 

8-12 hours 

How many fasting glucose tests are recommended to diagnose a patient with diabetes?

2 tests

• Canes

• Crutches

• wheelchairs

• walkers

• oxygen equipment

• Hospital beds

• Blood sugar monitors

  • Continuous glucose monitors

DME covered by medicare part b

The nurse is teaching a client who has left-sided weakness how to use a cane. Which statement by the client indicates understanding of proper cane use?

“I should hold the cane on my right side and move it forward with my left leg.” 

The nurse is evaluating a clients understanding of how to safely navigate stairs with a cane. Which client action requires further teaching?

Going up stairs by moving the cane and affected leg first

Which leg goes up first? (Stronger or weaker) 

Stronger 

Which leg goes down first? (Stronger or weaker)

Weaker

When you turn the high flow oxygen up past 4L/min what is recommended?

Humidification

What is the most commonly prescribed chemo agent? 

Xeloda 

Alzhemers is listed as the ____ cause of death in the US

6th

What is the main cause of death with Alzhemers’s dementia?

Pneumonia