AGACNP review- Practice Issues

6th-8th grade reading level

Medical and health information literature should be written no higher than

MRT

Multidisciplinary Response Team Ex: Rapid response team

health literacy

Single best predictor of one's health status

How to prepare for future mass casuality

Pre-enroll in disaster and response organizations such as american red cross

MU

Meaningful Use; healthcare providers' use of certified EHR technology in ways that can be measured in quality and in quantity.

Root cause analysis

deep investigation into a sentinel event to determine why the event occurred, and exploring the circumstances that led to it to determine where improvements can be made

process that is part of an effort to build a culture of safety beyond the culture of blame

Patient Health Questionnaire (PHQ-9)

1-4 minimal

5-9 Mild depression

10-14 Moderate Depression

15-19 Moderate Severe Depression

20-27 Severe Depression

A brief 9-item self-report questionnaire used as a screening tool to assess severity of depression; widely used by health care providers, in validity is well established, particularly for identifying severe depression.

generalized anxiety disorder-7 (GAD-7)

5-9 Mild

10-14 Moderate

15-21 Severe

>\= 10 probable positive diagnosis

patient self ranks 7 s/s over the last 2 weeks on a scale of 0-3 with 3 indicating nearly every day

CAGE-AID

Self-report questionnaire designed to quickly assess whether an alcohol or drug assessment is needed

(C=cut down, A=annoy, G=guilty, E=Eye-opener, AID=altered to include drugs

Wong-Baker FACES scale

a pain assessment tool that asks patients (often children) to select one of several faces indicating expressions that convey a range from no pain through the worst pain (from smiling to crying)

Brief Pain Inventory (BPI)

Used with patients with pain from chronic diseases or acute conditions, assesses severity of pain and impact of pain on daily functions by asking patient to fill out a survey - rates severity of pain and impact of pain on daily function, as well as location of pain, pain meds, and amount of pain relief

Richmond Agitation Sedation Scale (RASS)

+4 combative

+3 very agitated

+2 agitated

+1 restless

0 alert and calm

-1 drowsy

-2 light sedation

-3 moderate sedation

-4 deep sedation

-5 unarousable

Critical Care Pain Observation Tool (CPOT)

Tool design to be sued for critical care unit to assess pain, assesses 4 behavioral categories: facial expression, body movements, muscle tension, compliance with the ventilator or vocalization (extubated patients) Total score ranges from 0-8

Confusion Assessment Method (CAM) for ICU

Tool designed for CC to assess for delirium. 4 features:

acute onset of AMS

inattention

disorganized thinking

altered LOC

Should be conducted every day/shift with ICU

Mini-Mental State Examination (MMSE)

Brief 30-point questionnaire test that is used to screen for cognitive impairment; commonly used to screen for dementia.

Clock Drawing test

The client is asked to reproduce the face of a clock set to a specific time. This test may detect difficulties with visuospatial skills, visual perception, selective attention, memory, abstract thinking, and executive functioning. The clock is scored 1-6, with a score of >/- 3 representing cognitive deficit

Geriatric Depression Scale (GDS)

A screening instrument used in clinical settings to assess depression in older people. It uses a yes and no answer format. 15 yes/no questions

A score of 5+ is suggestive of depression and should warrant a follow-up comprehensive assessment.

A score 10+ is indicative of depression

Katz ADL

Katz Index of Independence in Activities of Daily Living, tool measures activities of daily living: bathing, dressing, toileting, transferring, continence, and feeding

Get up and Go test

Short tests that measures patient's risk of falling. Rated 1-5, score >3, risk of falling

Pain assessment in advanced dementia scale

5 behaviors are observed: breathing, vocalization, facial expression, body language, and consolability. rated 1-10

1-3: mild

4-6 Moderate

7-10: severe

Durable Medical Equipment (DME)

Not usually useful to someone who is not sick or injured. Medicare will only pay one time for these.

Hearing aids

medicare doesn't cover

Light therapy

Used for seasonal affective disorder and contraindicated in glaucoma, retinal problems, and eye problems

Benchmarking

comparison against other national healthcare organizations. Four core principles:

maintaining quality

improving customer satisfaction

improving patient safety

Continuous improvement

Establishing rapport and professional therapeutic relationships

non-judgemental approach

mutual trust

professional boundaries

confidentiality

cultural competency (respect and spiritual needs)

Asian culture

no eye contact shows respect

Thai culture

"yes, yes, yes" doesnt mean they understand

Latin and middle east

Think you can look at someone and case a spell, reversible

Islam/muslim

fam cleans body and turns towards mecca, may not want to take of hijab especially with men present

Crisis intervention

Ensure your safety first, no police on exam, call security

Title I of HIPAA

COBRA: protects health insurance coverage for workers and their families when they lose or change jobs

Title II of HIPAA

The Administrative Simplification provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.

Covered entities of HIPAA

- health plans, healthcare providers, and healthcare clearinghouses

- NOT employers, worker comp carriers, non-health plans, child protection agency

Patient Safety and Quality Improvement Act

allows certain disclosures of patient safety data

Initiating change

Start local, work outward and upward

In treating patients

Medical conditions are always treated first before psychosocial conditions

strongest method to evaluate teaching

returned demonstration

Tertiary facility

specialties of all types, trauma equipped. Transfer if pt has major maxillofacial injuries or severe Le Fort fractures of the skull

Le Fort fractures of the skull

Le Fort 1: floating palate

Le Fort 2: floating maxilla

Le Fort 3: floating face

Subjective data

most powerful data collected from a patient

Healthy people 2030 goals

increase quality and years of health life

eliminate health disparities among americans

Report to health department

HIV, TB, Gonorrhea, Chlamydia, Syphilis (GCS)

Report to department of health and human services

Animal bites

Report domestic violence

In some states, not legally required to report

Domestic violence you are ALWAYS required to report

Elder and Child Abuse

report to police

Criminal acts and injury from a dangerous weapon (I.e. can tell police about trauma patient's condition and injuries)

Medicare

Sets standards for reimbursements and cutting costs

Expanded problem focused

A limited examination is made of the affected body area or organ system and other symptomatic or related body area(s)/organ system(s). Ex: sinusitis, EENT and Resp exam

Detailed

An extended examination is made of the affected body area(s) and other symptomatic or related organ system(s). Ex: Pelvic pain, GI, GU, and GYN

Medicare A

Inpatient/hospitalization

Skilled nursing faculty

Home health care

Hospice associated with inpatient care

Benefits at 65 yrs of age and those with severe disability no matter income level, or those with ESRD

Medicare B

Covers physician services, outpatient hospital services and diabetic supplies, DME (durable medical equipment), patients on long term disabilities, X-rays, dialysis, vaccines, and respiratory nebulizers, some home health

Supplemental insurance, recipients must pay premium

NPs and CNS receive 85% reimbursement of services

Medicare covers 80% of bill, patient pays 20%,

Medicare C

A + B = C, medicare advantage

Can pick provider or provider organization (HMO and PPO)

Medicare D

Prescription drug coverage

Incident to billing

Medicare regulation which permitted billing Medicare under the physician's billing number for ancillary personnel services when those services were "incident to" a service performed by a physician.

Not allowed in hospital setting

Medicaid

A federal and state assistance program that pays for health care services for people who cannot afford them. Benefits vary from state to state.

QSEN competencies

1. Patient-centered care

2. Teamwork and collaboration

3. Evidence-based practice

4. Quality improvement

5. Safety

6. Informatics

State practice acts

Dictate level of prescriptive authority, scope of practice, and disciplinary grounds

Credentials

education + license + certification, establish minimal levels of acceptable performance. Take the ANCC certification test, awarded AGACNP-BC credentials

Licensure

establishes a person is qualified to perform a particular professional role, granted by rules and regulations set forth by a governmental regulatory body. Once take boards, State of Alabama Board of Nursing recognizes you as a licensed CRNP

Certification

Granted by nongovernmental agencies such as AACN, ANCC

credentialing with hospital privileges is granted by...

hospital credentialing committee

Quantitative futility

Where the likelihood that an intervention will benefit the patient is extremely poor

qualitative futility

Where the quality of the benefit an intervention will produce is extremely poor

Nonmaleficence

do no harm

Utilitarianism

the doctrine that actions are right if they are useful or for the benefit of a majority.

beneficence

duty to prevent harm, promote good

Justice

duty to be fair

Fidelity

duty to be faithful

veracity

duty to be truthful

Autonomy

duty to respect an individual's thoughts and actions

Type 1 error

rejecting the null hypothesis when it is true (false positive)

type 2 error

Accepting null hypothesis when you should have rejected it (false negative)

Levels of evidence

Meta-analysis or systematic reviews of multiple well-designed controlled studies

Well-designed randomized controlled trials

Well-designed nonrandomized controlled trials (quasi-experimental)

Observational studies with controls (qualitative cohort studies)

Systematic review of descriptive and qualitative studies

Single descriptive or qualitative study (case controlled studies)

Opinions of authorities and/or reports of expert committees

Cronbach's alpha

a correlation-based statistic that measures a scale's internal reliability (optimal >70)

T test

a statistical test used to evaluate the differences in means between two groups

Sensitivity

True positive

Specificity

true negative

Incidence

The number or rate of new cases of a particular condition during a specific time.

Prevalence

The number or proportion of cases of a particular disease or condition present in a population at a given time.

Primary prevention

Efforts to prevent an injury or illness from ever occurring. (vaccines, wearing seat belts)

PRIOR

Secondary prevention

-focuses on early identification of individuals or communities experiencing illness, providing treatment, and conducting activities that are geared to prevent worsening health status

-examples: communicable disease screening and case finding; early detection and treatment of diabetes; exercise programs for older adult clients who are frail

SCREENING

Tertiary prevention

rehabilitation of a patient after detection of disease

Ex: 81 mg ASA to prevent another MI

Major causes of death adolescents

accidents, homicides, suicide, malignancy, CV disease

major cause of death young adult

MVC, homicide, suicide, injuries, heart disease, AIDS

Major cause of death middle aged adult

heart disease, accidents, lung cancer, CVAs, breast and colorectal cancer, COPD

Major cause of death elderly

heart disease, CVA, COPD, pneumonia/influenza, lung and colorectal cancer

Live vaccines

MMR and varicella, flu mist

Protein requirements

0.8-1 g/kg/day

5 types of negligence

Contributory and comparative negligence: won't be on test!!!

Gross negligence: willfully providing inadequate care

Negligent conduct: individual fails to provide reasonable care (ex: did not check blood cultures on nursing home pt admission, pt got septic and died, AKA did not perform standards of care)