Medicare - answersfor clients over age 65 and/or with permanent disabilities. premiums applied as insurance program
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reimburses providers based on DRGs. Premiums applied as Managed Care Organizations (MCOs) provide enrolled
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clients with comprehensive care overseen by a primary care provider. Is federally funded.
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Medicaid - answersfor clients with low income. is federally funded and individual states determine eligibility requiremen
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Traditional Insurance - answersreimburses for services on fee-for-service basis. mi mi mi mi mi mi mi mi
Managed Care Organizations (MCOs) - answerscomprehensive care is overseen by a primary care provider & focuses
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on prevention and health promotion
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Preferred Provider Organizations (PPOs) - answersclient chooses from a list of contracted providers. using non-
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contracted providers increases the client's out of pocket costs mi mi mi mi mi mi mi mi
Exclusive Provider Organizations (EPOs) - answersthe client chooses from a list of providers within a contracted
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organization
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Long-Term Care Insurance - answersprovides for long-term care expenses not covered by Medicare
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Preventive health care - answersfocuses on educating and equipping clients to reduce and control risk factors of diseas
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Examples include immunizations, stress management programs, and seat belt use
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Primary health care - answersemphasizes health promotion, and includes prenatal and well-baby care, nutrition
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counseling, and disease control. is based on a sustained partnership between client and provider. examples include
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office or clinic visits and scheduled school/work centered screenings (vision, hearing, obesity)
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Secondary health care - answersincludes the diagnosis and treatment of emergency, acute illness, or injury. examples
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include care given in hospital settings (inpatient and EDs), diagnostic centers, or emergent care centers
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Tertiary health care - answersinvolves the provision of specialized highly technical care. examples include oncology
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centers and burn centers
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Restorative health care - answersinvolves intermediate follow-up care for restoring health. examples include home
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health care, rehab centers, and skilled nursing facilities
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Continuing health care - answersdesigned to address long-term or chronic health care needs. examples include hospic
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adult day care, and in-home respite care
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Health care regulatory agencies include: - answers-US Dept of Health and Human Srvcs
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-US FDA mi
-State and local public health agencies
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-State licensing boards (to ensure providers & agencies comply with state regulations)
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-the Joint Commission/JCAHO (set quality standards for accreditation of health care facilities)
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,-Professional Standards Review Organizations (PSROs) mi mi mi mi
-Utilization review committees (monitor for appropriate diagnosis and treatment of hospitalized clients)
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Clergy - answersJob: provide spiritual care to client (pastors, rabbis, priests)
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Refer to when: the client requests communication or the family asks for prayer prior to client undergoing a procedure
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Registered dietitian - answersJob: assess, plan for, and educate the client reg. nutritional needs; direct care of nutrition
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aids
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Refer to when: ex- the client has low nutrient levels and/or experienced a recent unexplained weight loss
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Lab tech - answersJob: obtain specimens of the client's body fluids and perform the necessary diagnostic tests
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Refer to when: ex- the provider orders a CBC to be performed immediately
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Occupational therapist - answersJob: assess and plan for the client to regain ADLs, esp motor skills of the upper
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extremities; direct care of occupational therapy assistants
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Refer to when: ex- client has difficulties using an eating utensil with dominate hand following a stroke
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Pharmacist - answersJob: provide & monitor meds for the client as prescribed by the provider; supervises pharm techs
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states in which the practice is allowed
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Refer to when: client concerns over meds; dosage concerns; etc
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Physical Therapist - answersJob: assess and plan for client to increase musculoskeletal functions, esp of lower
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extremities, to maintain mobility; direct care of physical therapy assistants
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Refer to when: ex- following a hip replacement, a client requires assistance learning to ambulate and regain strength
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Provider - answersJob: assess, diagnose, and treat cllient for disease and/or injury; includes MDs, DOs, APNs, and PA
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Refer to when: ex- client experiences change in vital signs
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Rad Tech - answersJob: position client and perform x-rays and other imaging procedures for providers to review for
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diagnosis of disorders of various body parts
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Refer to when: ex- provider orders x-ray of client's hip after a fall
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Respiratory therapist - answersJob: evaluate resp status and provide prescribed resp treatments including O2 therapy
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chest physiotherapy, inhalation therapy, and artificial mechanical ventilation
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Refer to when: ex- client with resp disease experiences SOB and requests nebulizer treatment that is ordered PRN
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Social Worker - answersJob: work with client and client's family by coordinating inpatient and community resources to
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meet psychosocial and environmental needs that are necessary for recovery and/or discharge
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Refer to when: ex- client dying of cancer wishes to go home but is unable to perform ADLs; the spouse needs med
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equipment in the home to care for client
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,Speech therapist - answersJob: evaluate and make recommendations regarding the functions of speech, language, an
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swallowing impacted by various client disorders or injuries; teach client techniques and exercises to improve function
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when possible
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Refer to when: ex- a client is having difficulty swallowing a regular diet after trauma to the head and neck
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Registered Nurse (RN) - answers-Functions under state nurse practice laws mi mi mi mi mi mi mi mi mi
-Perform assessments; establish nursing diagnoses, goals, and interventions; conducts ongoing client evaluations
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-Participate in developing interdisciplinary plans for client care mi mi mi mi mi mi mi
-Share best practices; continuing education
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Licensed Practical Nurse (LPN) - answers-Works under supervision of the RN
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-Collaborate with other team members mi mi mi mi
-Possess technical knowledge and skills mi mi mi mi
-Participate in the delivery of nursing care, using the nursing process as a framework mi mi mi mi mi mi mi mi mi mi mi mi mi
Unlicensed Assistive Personnel (UAP) - answers-Includes CNAs, CMAs, and non-nursing personnel
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-Work under direct supervision of an RN or LPN
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-Specific tasks usually outlined in position description
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-Tasks may including feeding clients, preparing meals, lifting, basic care, measuring & recording vital signs, and
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ambulating clients
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The foundation of ethics is based on: - answersan expected behavior of a certain group in relation to what is considered
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right and wrong; it is the study of conduct and character
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Morals are: - answersthe values and beliefs held by people that guide their behaviors and decision making
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Ethical theory examines: - answersthe different principles, ideas, systems, and philosophies used to make judgments
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about what is right/wrong and good/bad
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Ethical principles - answersstandards of what is right/wrong with regard to important social values and norms
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Autonomy - answersability of client to make personal decisions, even when those decisions may not be in the client's be
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interest
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Beneficence - answersagreement that the care given is in the best interest of the client; taking positive actions to help
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others
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Fidelity - answersagreement to keep one's promise to the client about care that was offered
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Justice - answersfair treatment in matters related to physical and psychosocial care and use of resources
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Nonmaleficence - answersavoidance of harm or pain as much as possible when giving treatments mi mi mi mi mi mi mi mi mi mi mi mi mi
Hospital's ethics committee - answersmay meet to discuss/resolve unusual or complex ethical issues; not a legal entity
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Ethical dilemmas are: - answersproblems about which more than one choice can be made and the choice made is
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influenced by the values and beliefs of the decision makers
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,A problem is an ethical dilemma if: - answers-it cannot be solved solely by a review of scientific data
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-it involves a conflict between two moral imperatives
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-the answer will have a profound effect on the situation/client
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Steps in ethical decision making - answers-identify whether or not the issue is indeed an ethical dilemma
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-state the ethical dilemma including all surrounding issues and individuals involved
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-list and analyze all possible options for resolving the dilemma and review implications of each option
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-select option that is in concert with the ethical principle applicable to this situation, the decision maker's values and
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beliefs, and the profession's values set forth for client care; justify why chosen over other options
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-apply this decision to the dilemma and evaluate the outcomes
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Advocacy - answerssupport of the cause of the client regarding health, safety, and personal rights
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Responsibility - answerswillingness to respect obligations and follow through on promises mi mi mi mi mi mi mi mi mi mi
Accountability - answersability to answer for one's own actions mi mi mi mi mi mi mi mi
Confidentiality - answersprotection of privacy without diminishing access to quality care mi mi mi mi mi mi mi mi mi mi
According to the UDDA, death is determined by one of two criteria: - answers-an irreversible cessation of circulatory and
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respiratory functions
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-irreversible cessation of all functions of the entire brain, including the brain stem mi mi mi mi mi mi mi mi mi mi mi mi
A determination of death must be made: - answersin accordance with accordance with accepted medical standards
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Nurse's roles in ethical decision making include: - answers-agent for client facing an ethical decision: adolescent child
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debating on abortion; parent contemplating blood transfusion even when against religious beliefs
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-decision maker in regard to nursing practice: increasing staff load due to shift cuts; witnessing a surgeon discussion on
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surgical options without informing client of more conservative options
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Entities with codes of ethics that may be used to guide nursing practice include: - answers-the American Nurses
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Association (ANA)
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-the International Council of Nurses (ICN)mi mi mi mi mi
-the National Association for Practical Nurse Education and Services, Inc.
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By practicing nursing within the confines of the law, nurses are able to: - answers-shield oneself from liability
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-advocate for client's rights mi mi mi
-provide care that is within the nurse's scope of practice mi mi mi mi mi mi mi mi mi
-discern the responsibilities of nursing in relationship to the responsibilities of other members of the health care team
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-provide safe, competent care that is consistent with standards of care mi mi mi mi mi mi mi mi mi mi
Federal laws impacting nursing practice include: - answers-HIPAA mi mi mi mi mi mi mi
-ADA
-the Mental Health Parity Act (MHPA) mi mi mi mi mi
-the Patient Self-Determination Act (PSDA)mi mi mi mi
Criminal law: - answers-is a subsection of public law mi mi mi mi mi mi mi mi
-relates to the relationship of an individual with the government mi mi mi mi mi mi mi mi mi
-ex: a nurse falsifies a record to cover up a serious mistake may be found guilty of breaking a criminal law
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