Medicare ANS:for clients over age 65 and/or with permanent disabilities. premiums applied as insurance
program reimburses providers based on DRGs. Premiums applied as Managed Care Organizations
(MCOs) provide enrolled clients with comprehensive care overseen by a primary care provider. Is
federally funded.
Medicaid ANS:for clients with low income. is federally funded and individual states determine eligibility
requirements.
Traditional Insurance ANS:reimburses for services on fee-for-service basis.
Managed Care Organizations (MCOs) ANS:comprehensive care is overseen by a primary care provider &
focuses on prevention and health promotion
Preferred Provider Organizations (PPOs) ANS:client chooses from a list of contracted providers. using
non-contracted providers increases the client's out of pocket costs
Exclusive Provider Organizations (EPOs) ANS:the client chooses from a list of providers within a
contracted organization
Long-Term Care Insurance ANS:provides for long-term care expenses not covered by Medicare
Preventive health care ANS:focuses on educating and equipping clients to reduce and control risk factors
of disease. Examples include immunizations, stress management programs, and seat belt use
Primary health care ANS:emphasizes health promotion, and includes prenatal and well-baby care,
nutrition counseling, and disease control. is based on a sustained partnership between client and
provider. examples include office or clinic visits and scheduled school/work centered screenings (vision,
hearing, obesity)
Secondary health care ANS:includes the diagnosis and treatment of emergency, acute illness, or injury.
examples include care given in hospital settings (inpatient and EDs), diagnostic centers, or emergent
care centers
Tertiary health care ANS:involves the provision of specialized highly technical care. examples include
oncology centers and burn centers
Restorative health care ANS:involves intermediate follow-up care for restoring health. examples include
home health care, rehab centers, and skilled nursing facilities
Continuing health care ANS:designed to address long-term or chronic health care needs. examples
include hospice, adult day care, and in-home respite care
Health care regulatory agencies include: ANS:-US Dept of Health and Human Srvcs
,-US FDA
-State and local public health agencies
-State licensing boards (to ensure providers & agencies comply with state regulations)
-the Joint Commission/JCAHO (set quality standards for accreditation of health care facilities)
-Professional Standards Review Organizations (PSROs)
-Utilization review committees (monitor for appropriate diagnosis and treatment of hospitalized clients)
Clergy ANS:Job: provide spiritual care to client (pastors, rabbis, priests)
Refer to when: the client requests communication or the family asks for prayer prior to client
undergoing a procedure
Registered dietitian ANS:Job: assess, plan for, and educate the client reg. nutritional needs; direct care
of nutritional aids
Refer to when: ex- the client has low nutrient levels and/or experienced a recent unexplained weight
loss
Lab tech ANS:Job: obtain specimens of the client's body fluids and perform the necessary diagnostic
tests
Refer to when: ex- the provider orders a CBC to be performed immediately
Occupational therapist ANS:Job: assess and plan for the client to regain ADLs, esp motor skills of the
upper extremities; direct care of occupational therapy assistants
Refer to when: ex- client has difficulties using an eating utensil with dominate hand following a stroke
Pharmacist ANS:Job: provide & monitor meds for the client as prescribed by the provider; supervises
pharm techs in states in which the practice is allowed
Refer to when: client concerns over meds; dosage concerns; etc
,Physical Therapist ANS:Job: assess and plan for client to increase musculoskeletal functions, esp of lower
extremities, to maintain mobility; direct care of physical therapy assistants
Refer to when: ex- following a hip replacement, a client requires assistance learning to ambulate and
regain strength
Provider ANS:Job: assess, diagnose, and treat cllient for disease and/or injury; includes MDs, DOs, APNs,
and PAs
Refer to when: ex- client experiences change in vital signs
Rad Tech ANS:Job: position client and perform x-rays and other imaging procedures for providers to
review for diagnosis of disorders of various body parts
Refer to when: ex- provider orders x-ray of client's hip after a fall
Respiratory therapist ANS:Job: evaluate resp status and provide prescribed resp treatments including O2
therapy, chest physiotherapy, inhalation therapy, and artificial mechanical ventilation
Refer to when: ex- client with resp disease experiences SOB and requests nebulizer treatment that is
ordered PRN
Social Worker ANS:Job: work with client and client's family by coordinating inpatient and community
resources to meet psychosocial and environmental needs that are necessary for recovery and/or
discharge
Refer to when: ex- client dying of cancer wishes to go home but is unable to perform ADLs; the spouse
needs med equipment in the home to care for client
Speech therapist ANS:Job: evaluate and make recommendations regarding the functions of speech,
language, and swallowing impacted by various client disorders or injuries; teach client techniques and
exercises to improve function when possible
Refer to when: ex- a client is having difficulty swallowing a regular diet after trauma to the head and
neck
, Registered Nurse (RN) ANS:-Functions under state nurse practice laws
-Perform assessments; establish nursing diagnoses, goals, and interventions; conducts ongoing client
evaluations
-Participate in developing interdisciplinary plans for client care
-Share best practices; continuing education
Licensed Practical Nurse (LPN) ANS:-Works under supervision of the RN
-Collaborate with other team members
-Possess technical knowledge and skills
-Participate in the delivery of nursing care, using the nursing process as a framework
Unlicensed Assistive Personnel (UAP) ANS:-Includes CNAs, CMAs, and non-nursing personnel
-Work under direct supervision of an RN or LPN
-Specific tasks usually outlined in position description
-Tasks may including feeding clients, preparing meals, lifting, basic care, measuring & recording vital
signs, and ambulating clients
The foundation of ethics is based on: ANS:an expected behavior of a certain group in relation to what is
considered right and wrong; it is the study of conduct and character
Morals are: ANS:the values and beliefs held by people that guide their behaviors and decision making
Ethical theory examines: ANS:the different principles, ideas, systems, and philosophies used to make
judgments about what is right/wrong and good/bad
Ethical principles ANS:standards of what is right/wrong with regard to important social values and
norms
Autonomy ANS:ability of client to make personal decisions, even when those decisions may not be in the
client's best interest
Beneficence ANS:agreement that the care given is in the best interest of the client; taking positive
actions to help others
Fidelity ANS:agreement to keep one's promise to the client about care that was offered
Justice ANS:fair treatment in matters related to physical and psychosocial care and use of resources
Nonmaleficence ANS:avoidance of harm or pain as much as possible when giving treatments