Foundation of nursing CHAPTER 2

Medicare

The federal government health insurance program for people older than 65 or those with certain disabilities or conditions

Managed Care

A system of healthcare delivery and managing the cost and quality of access to healthcare

Case management

patient care approach and coordinating the care of patients who are vulnerable at risk or cost intensive so that their specific needs are met in the most cost efficient manner while still bringing them the optimum health

Medicaid

A federally and state funded health insurance program for individuals who are poor and medically indigent, pregnant women were individuals with disabilities and children meeting income level requirements

Third party payer

The insurance company that finances health care provided to a beneficiary

Health maintenance organization

A cost containment program featuring a primary care physician as a gatekeeper to eliminate unnecessary testing and procedures

Diagnosis-related group

A classification of illnesses and diseases that is then used to determine the amount of money paid to a hospital by Medicare

Preferred provider organization

A group of healthcare providers who contract with a health insurance company to provide services to a specific group of patient on a discounted basis

Point of service-

A type of insurance program where a primary care physician serves as a gatekeeper but the members are not capitated insured people can see care from healthcare providers who are both in and out of the net work

Primary care physician

The gate keeper for access to medical services

When a person stays overnight or longer in a healthcare facility he or she is referred to as

Inpatient

_____ can be one or many types of health or medical services provided to patient in their home because they are confined to their home by an illness or disability.

-Home health care

____ is a medically directed nurse coordinated program providing a continuum of home and inpatient care for the patient who is terminally ill and his or her family

-Hospice

Empowering the patient to take control of and manage their care is called?

• client centered care

When patient care is provided by different individuals who perform tasks based on their skills education and licensure is called ___?

Team nursing

In ___ One nurse is responsible for all aspects of nursing care for their assigned patient

-primary care nursing

When a primary care physician cannot successfully treat a patient's condition they will ____ to a specialist

-referral

When care is provided to a person without admitting them to a healthcare facility the person is referred to as an___

-outpatient

A facility that specializes in intense physical occupational and speech therapy is called?

-rehabilitation

At what age are people eligible for Medicare?

65

Insurance companies will only pay cost when a procedure is deemed medically necessary by medically necessary they mean?

-The procedure has to be a reasonable intervention given the patient's diagnosis

-The procedure has to treat an illness or injury

A 58-year-old patient is in a ICU step down unit at an acute care hospital after having a Stroke with right sided weakness. He is medically stable but needs assistance with all activities of daily living. The doctor thinks he may be able to regain all of his formal level of function. The appropriate level of care at this point in the patient progress is?

-rehabilitation facility

Which of the following is a criterion for admission to a skilled nursing facility?

-The patient has been hospitalized within the last 30 days

Which of the following can be considered a disadvantage of team nursing?

-care can be fragmented unless there is good communication among team members

An LPN is the team leader for all other LPN and certified nursing assistance, all of whom are caring for 10 patients in a long-term care facility. The second LPN applies a pressure ulcer dressing incorrectly. Which of the following is the best response for the team leader to make when she discovers the error.

-you did a good job with this dressing change I see one step here that you may have overlooked tell me how you did it so we can figure out if it was done according to the procedure

Explain why team leaders must have good communication skills?

-so the patient can get the best patient care, keeping team moral high, the team leader shows respect for all team members

Explain why patient should know the details of their insurance plan?

• so that they avoid incurring expenses that they must pay out-of-pocket

Give one reason why patient or cared for by a team of healthcare professionals from different specialty areas?

• because each practitioner brings a unique skill set that helps provide the patient with holistic care

Which are true statements about the affordable act care?

-it makes some services such as preventative care and vaccinations free to patients

-it requires everyone to have health insurance or else pay a special tax

-mini insurers are no longer offering insurance coverage through the exchange

Nurse practitioner

certified in a specific area of practice carries an advanced practice license and can diagnose illnesses prescribe medication and order treatments

RN

practice is nursing within a defined scope under the direction of a physician provides direct patient care managers department and supervisors other nurses in assistive personnel

LPN/LVN

practices within a defined scope under the supervision of a physician dentist or RN provides direct patient care and supervisors assistive personnel

CNA

performed patient care duties and assist nursing staff performs more complicated task including sterile procedure some states

Physicians assistant

Employed by physicians or hospitals to work closely with physicians and assist in directing patient care

Medical social worker

provides psychosocial support to patient families or vulnerable populations advises caregivers counseled patient plans for patient needs after discharge and arranges for needed care such as home health

The personnel who help patients with disabilities to develop new skills, recover lost skills, or maintain functional skills so that they can perform activities of daily living are called?

-occupational therapist or certified occupational

The personnel who help diagnose swallowing difficulties are called?

-speech and language therapist

What are the two most important factors in economic decision about patient care?

-medical necessities an appropriate level of care

Healthcare provided by various companies and purchased by the individual or an employer is called?

-private insurance

One important consideration in managing cost is making sure the patient is placed in which of the following?

-appropriate level of care

Which of the following is the major difference between an assisted living facility in a independent living facility?

-independent living facilities do not provide nursing care

An 81-year-old woman had a total hip replacement one month ago but has had difficulty swallowing related to an injury from the breathing tube. Three weeks ago she had a feeding tube placed through her abdominal wall directly into her stomach to help her get enough calories and for administering medication. She has been improving and has just started a thickened liquid diet. Which of the following would be the appropriate level of care for her?

-skilled nursing facility

Describe three types of rehabilitation facilities?

1-physical

2-drug

3-alcohol

A 48-year-old male patient has been hospitalized for six weeks in an acute care facility after being involved in a car accident. He was driving while intoxicated and admitted to being an alcoholic. He went through alcohol withdrawal while he was recovering from his injuries and has received some information about alcoholism treatment for Psychologist. He has his own business, he's married, has four children, and has adequate health insurance. What care options are the best for him?

-inpatient drug and alcohol rehabilitation facility

Which of the following represents the desired outcomes of a cardiac rehabilitation?

-to prevent worsening heart disease new cardiac events and premature death

Which of the following statements are true regarding health departments?

1-they are funded by all levels of government

2- they provide immunizations

3- they track and treat communicable diseases

4-they run the women, infants, and children health program WIC

What is the role of the social worker in home health care?

• provide psychosocial support

-helps families prepare for the patient's needs after discharge

-arranges for community services such as meals on wheels or transportation to and from office visits

Which of the following represents a benefit of home health care?

-allows people to stay in their homes instead of being in a facility

-it is more cost-effective than inpatient care

Which of the following services can be provided through home health care?

-infusion therapy

-occupational therapy

-physical therapy

-wound therapy

For Medicare to pay for home health services, which of the following two criteria must be met?

-skilled services required patient is homebound

Although there's no hard and fast rule, when is the appropriate time to initiate hospice care?

-when the patient is expected to live six months or less

The national hospice organization definition of hospice states that hospice?

-provides a continuum of home and inpatient care

-it is coordinated by nurses

-cares for the patient and family

Fragmentation of care is more likely to occur with team nursing them with primary nursing

TRUE

Delegation skills are helpful when leading a nursing care team but not essential because each team member knows his or her level of expertise

FALSE

Team leaders probably know more about each patient in his or her care because they have other staff to help them

FALSE

As a member of a nursing care team but not the leader it is important for a nurse to have good communication skills

TRUE

In client centered care of patients are encouraged to have a voice and goal setting and in deciding how the goal will be met

TRUE

In client centered care the nurse make sure other members of the healthcare team such as the phlebotomist EKG technician and respiratory therapist perform their tasks in a timely manner

FALSE

Cross training of staff is more important in primary care than it is in client centered care

FALSE

Primary care nursing means one nurse does all the care for one patient

TRUE

Primary care works best on general care floors not intensive care units

FALSE

Primary care must be performed by an RN

FALSE

The main goal of a case management is to make sure patient at high risk get the care they need at the least cost to the facility

TRUE

The nurse case manager usually provides direct hand on care

FALSE

A case managers main function is to coordinate and facilitate the care of several different patients concurrently

TRUE

Collaboration and teamwork are closely associated with patient safety

TRUE

Multidisciplinary teams work especially well for patient with multiple and complex health problems

TRUE

___ is a government run insurance plan for people older than a certain age

-medicare

____ it's a government run insurance program for poor people and some people who are disabled

-medicaid

Diagnosis related groups are classifications of illnesses or procedures used to?

-standardize the amount the government will pay for a specific illness

Blue Cross Blue Shield Aetna or examples of ___ Insurance programs

• private

A primary care physician acting as a gatekeeper to illuminate unnecessary testing and procedures is a feature of _____?

-Health maintenance organization