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Aka speech therapist, helps the client with a speech disorder
to learn to communicate and helps family members learn new
communication techniques:
also aids with SWALLOWING PROBLEMS - ANSWER-speech-
language pathologist
Method used by nurses in facilities to plan and deliver care to
clients Purpose: to meet the clients needs for care/support -
ANSWER-Care planning process (nursing process)
Occurs through the evaluation of information collected about
the client through
observation, reflection, communication - ANSWER-
Assessment
Social worker, nurse, or caseworker who does the assessment
(only a nurse or
physician can assess physical health) - ANSWER-
team leader
Statement describing a health problem that is treated by
nursing measures (ex-
,low self esteem, high risk aspiration, etc) -
ANSWER-Nursing Dx
Made by a physician and is the identification of a disease or
condition (ex-
pneumonia, cancer, CVA, bipolar, diabetes) -
ANSWER-medical dx
Involves establishing goals, priorities, and developing
measures or actions to
help pt meet these goals - ANSWER-
Planning
Goals are ____ If pt doesn't reach goals by the set date
- ANSWER-
Reassessed
Action or measure taken by the health care team to help the
client meet a goal—does not need a doctors order but CAME
FROM ONE (ex—doctor suggests client walks 200m daily and
nurse adds this to careplan) – ANSWER-intervention
The _____ is NOT A FINISHED DOCUMENT— revised
continually depending
on needs, condition, progress -
ANSWER-Careplan
The document that details the care and services the pt must
receive during
,each shift - ANSWER-
Careplan
The ____ contains: dx, goals, interventions - ANSWER-Careplan
1) lists care/services patient must receive
2) ensures consistent client care no matter who the worker is
3) enables health care team to effectively communication details
about client care - ANSWER-Functions of the careplan:
... considers the entire families wellbeing and the case
manager decides what
services are needed and assess for safe home
environment
Case manager SCHEDULES all outside services and
ARRANGES FINANCES
for them; multiple needs means multiple services
involved - ANSWER-
Community care
planning
When reporting, use clients ___ ____, and be precise/accurate,
DO NOT
INTERPRET/MAKE ASSUMPTIONS—-observations are
sufficient! – ANSWER-exact words
, Aka signs; information you gather with your senses - ANSWER-
objective data
Aka symptoms; information reported by a client but not
directly observed by
others - ANSWER-
subjective data
Permanent and legal document required to record a client's
condition, signs, and symptoms of any illness, the care and
treatment given to the client and the clients responses to care -
ANSWER-Chart (record)
Admission to discharge or death, and if filed for min 5yrs in
Ontario - ANSWER-
Records are kept
from..
-communication
-planning client care
-currency
-accountability
-continuity of care
-quality assurance
-education and research
-funding - ANSWER-Reasons for charting...