#1 study guide questions Flashcards
Record review and resident interviews revealed that the supper meal and breakfast were served 14 hours apart. The CNAs deliver a nourishing snack at night. Would this be considered deficient practice?
It is not a deficient practice. There must be no more than 14 hours between an evening meal and breakfast the following day, except when a nourishing snack is served at bedtime, up to 16 hours may elapse. In our case, a CNA is also providing a nourishing snack at night. If more than 14 hours between evening and morning meals, cite F809.
During medication observation the surveyor observed one resident receive two ibuprofen 200 mg tables, Mounjaro 5 mg injection, and fluoxetine 20 mg. How many opportunities did the surveyor observe?
The surveyor observed three med opportunities.
When evaluating a resident’s nutritional status, the surveyor noted that the most recent hemoglobin value was 8.5 g/di. What medications could contribute to the low hemoglobin level?
Several medications can contribute to decreased hemoglobin levels. These include:
1. Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Long-term use of NSAIDs, such as ibuprofen and aspirin, can cause gastrointestinal bleeding, leading to chronic blood loss and anemia.
2. Chemotherapy drugs: Many chemotherapy agents can cause bone marrow suppression, leading to reduced production of red blood cells.
3. Antibiotics: Certain antibiotics like penicillin and sulfonamides or rifampin can cause hemolytic anemia in some individuals.
4. Antiepileptic drugs: Medications such as phenytoin and valproic acid can lead to bone marrow suppression and anemia.
A residents current weight is 150 pounds. If estimating protein requirements as one gram of protein per kilogram of body weight (1 kg. of body weight = 2.2 lbs) What would be the residents protein requirement?
150:2.2x1= 68 gr
What areas of the facility should emergency electrical power be supplied?
Emergency Lighting: Hallways, stairwells, exits, and other critical areas to ensure safe evacuation and movement within the facility.
(Also, Medical Equipment: Power for critical medical equipment such as ventilators, oxygen concentrators, dialysis machines, and other life-sustaining devices.
Fire Safety Systems: Fire alarms, smoke detectors, sprinkler systems, and emergency communication systems.
Refrigeration Units: For the storage of medications, vaccines, and other perishable medical supplies that need to be kept at specific temperatures.
Kitchen and Food Storage Areas: To ensure food preparation and storage can continue, preventing spoilage and maintaining food safety.
HVAC Systems: Heating, ventilation, and air conditioning systems to maintain a safe and comfortable environment for residents.
Water Supply and sewage and waste disposal)
A Surveyor observes a resident start uncontrollably shaking. Record review revealed the resident has a history of seizures. How should the surveyor write this observation?
Observation on xx/xx/xxxx at xx am/pm of R **in his room (or whatever location he was) revealed R * began experiencing involuntary shaking, characterized by rapid, rhythmic, and uncontrollable movements of the limbs. This shaking onset was sudden and was not triggered by any apparent external stimuli. (Or, if there are any possible triggers that preceded the onset of shaking, I would mention those activities or events.) I would also include additional details to include for a more comprehensive description, such as duration: How long the shaking lasted, severity: intensity of the shakes (mild, moderate or severe); and if there any other symptoms present, such as confusion or sweating. R* was admitted to the facility on x/x/20xx with diagnoses including, but not limited to seizures.
What persons are allowed during the exit conference for the survey and how should the information related to the survey be communicated during the exit conference?
An exit conference with the facility administration is to inform the facility of the survey team’s observations and preliminary findings. Ask the Administrator to invite Medical Director. Invite the ombudsman and an officer of the organized resident’s group, if one exists. Also, invite one or two residents to attend.
The team may provide an abbreviated exit conference specifically for residents after completion of the normal facility exit conference. If two exit conferences are held, notify the ombudsman and invite the ombudsman to attend either or both conferences.
Do not discuss survey results in a manner that reveals the identity of an individual resident. Provide information in a manner that is understandable to those present. If the provider asks for the specific tag, you should provide this information, cautioning the facility that the tags are preliminary. Under no circumstances, should you provide the S/S for a given deficiency, unless it is an IJ.
Describe the team’s preliminary deficiency findings to the facility and let them know they will receive a report of the survey that will contain any deficiencies that have been cited.
During the exit conference, provide the facility with the opportunity to discuss and supply additional information that they believe is pertinent to the findings.
During record review it was identified that a resident had a severe infection and was to receive start antibiotics two days prior that had not been started. The resident is currently not eating or drinking, is lethargic, with very little urine output. This was confirmed via observation. What should the surveyors concern be?
I would speak with the TC immediately about possible an IJ situation. My concern should be the significant delay in starting the antibiotics for the resident with a severe infection. This delay in treatment has likely contributed to the resident’s current deteriorating condition, which includes:
* Not eating or drinking
* Lethargy
* Very little urine output
These symptoms suggest the resident’s infection may have worsened and could potentially lead to more serious complications, including sepsis or organ failure and require immediate medical attention.
I would investigate why the antibiotics were not started as prescribed two days ago.
1. Potential Systemic Issues: Whether this delay is indicative of broader issues in the facility’s medication administration and monitoring processes.
2. Risk of Serious Complications: The possibility that the resident could develop or may already be developing severe complications due to the untreated infection.
What are acceptable clinical reasons for the use of a Foley catheter?
Acceptable clinical reasons for the use of a Foley catheter include:
1. Urinary Retention: Inability to empty the bladder naturally, which can be due to an obstruction, nerve problems, or post-surgery complications.
2. Monitoring Urine Output: Especially important in critically ill patients, those undergoing major surgery, or those with conditions like heart failure or severe infections.
3. Severe Incontinence: When other methods of managing incontinence have failed, and the incontinence is causing skin breakdown or other complications.
4. Surgical Procedures: During and after certain surgeries, particularly those involving the lower abdomen, pelvis, bladder, or urethra.
5. Wounds or Pressure Ulcers: To prevent contamination of wounds or pressure ulcers in the perineal area.
6. Comfort for End-of-Life Care: To reduce discomfort and manage incontinence in terminally ill patients.
7. Immobility: When a patient is immobilized for an extended period due to fractures, critical illness, or other conditions.
8. Severe Trauma: In cases of significant injury to the lower body where bladder control is affected.
It’s important to regularly assess the necessity of a Foley catheter and remove it as soon as it is no longer clinically necessary to reduce the risk of complications such as urinary tract infections.
During a tour of a long-term care facility, the survey team notes that no water pitchers or cups are available at the residents’ bedside. What should the survey team do?
If the survey team notes that no water pitchers or cups are available at residents’ bedsides in a long-term care facility, they should follow these steps:
1. Assess Hydration Policies: Review the facility’s hydration policies and procedures to determine how residents’ fluid intake is managed. The absence of water pitchers could indicate an alternative system for providing fluids.
2. Observe Resident Hydration: Check whether residents are receiving adequate fluids through other means, such as staff offering drinks at regular intervals, especially for residents with mobility or cognitive impairments.
3. Interview Staff and Residents: Speak with staff and residents to understand how hydration is monitored and maintained. Ask about access to water and how frequently it is offered.
4. Check for Special Needs: Verify if the absence of water pitchers is due to specific resident needs (e.g., risk of spills or choking). Some residents might require assistance or alternative methods of hydration.
5. Document Findings: If the survey team finds that residents’ hydration needs are not being adequately met, document the findings and cite deficiencies based on their findings, especially if there is a failure to provide access to fluids or monitor hydration adequately.
The F-tag related to hydration in long-term care facilities is F692.
F692 addresses the facility’s responsibility to ensure that residents receive adequate hydration to maintain proper health. It covers both ensuring access to fluids and monitoring residents for signs of dehydration. If a survey team finds deficiencies related to hydration, such as residents not having access to water or fluids not being properly provided, this tag could be cited under a failure to meet regulatory standards.
Facilities must ensure that they have proper systems in place to meet each resident’s hydration needs, as dehydration can lead to serious health complications.
What are concerns related to the tube feeding?
There are many concerns, considerations, and aspects related to tube feeding. For a full explanation see tag F693 or F694.
* Physical complications (aspiration, leaking around the insertion site, intestinal perforation, abdominal wall abscess or erosion at the insertion site);
* Implementing interventions to minimize the negative psychosocial impact that may occur as a result of tube feeding;
* Providing mouth care, including teeth, gums, and tongue;
* Checking that the tubing remains in the correct location consistent with facility protocols;
* Properly positioning the resident consistent with the resident’s individual needs;
* Using universal precautions and clean technique and following the manufacturer’s recommendations when stopping, starting, flushing, and giving medications through the feeding tube;
* Ensuring the cleanliness of the feeding tube, insertion site, dressing (if present) and nutritional product;
* Providing the type, rate, volume and duration of the feeding as ordered by the practitioner and consistent with the manufacturer’s recommendations.
* Do tube feeding orders include a sufficient amount of free water, and are the water and feeding are being administered in accordance with physician orders?
As a surveyor, per Federal Regulations, what would you expect to see a facility do after a resident had an unwitnessed fall with and/or without injury?
Report within 2 hrs…/24 hrs…
1. Evaluate and monitor resident for 72 hours after the fall.
2. Investigate and record circumstances, resident outcome and staff response.
3. Complete fall assessment.
4. FAX and/or notify primary care provider. Notify family
5. Implement immediate intervention within first 24 hours.
6. Update plan of care.
7. Monitor staff compliance and resident response.
A resident is admitted to a facility. The resident is blind. What would you expect the facility to do for the resident?
The facility has a responsibility to provide comprehensive care for blind residents, ensuring their safety, comfort, and quality of life. Some key considerations and actions that should be taken:
1. Environmental Modifications: Clear Pathways: Ensure that hallways and rooms free of obstacles to prevent falls and injuries. Consistent Layout: consistent furniture arrangement to help the resident navigate their environment more easily. Braille Labels: Use Braille labels on doors, appliances, and personal items to aid identification. Lighting: Ensure adequate and appropriate lighting, even though the resident is blind, for any residual vision they may have.
2. Assistance and Support: Provide training to help the resident navigate the facility independently, including the use of a cane or other mobility aids. Escort Services: Offer assistance for moving around the facility, especially in unfamiliar areas, taking residents for needed medical appointments etc. Accessible Communication: Use large print, Braille, or audio formats for written communication, such as menus, activity schedules, and important notices.
3. Daily Living Activities: Offer help with ADLs as needed.
4. Engagement and Activities: Sensory Activities: Provide activities that engage other senses, such as listening to music, tactile arts and crafts, and aromatherapy. Social Interaction: Encourage participation in social activities and facilitate interaction with other residents.
5.Adaptive Technology: Provide access to technology designed for the visually impaired, such as screen readers, talking clocks, and adaptive computer software.
6.Staff Training: Train staff on how to effectively assist and communicate with blind residents.
7. Emergency Preparedness: Emergency Plans: Develop and practice emergency plans that include specific instructions for assisting blind residents during evacuations or other emergencies. Alert Systems: Use alert systems that accommodate the needs of blind residents, such as vibrating or auditory alarms.
A resident with right-sided weakness has a right-hand brace. A specially styled spoon can be attached to the brace. How would you expect to see the facility position the residents tray On the resident’s right or left side?
Right side
What would be the concern if a surveyor observed a resident receive a regular diet instead of the pureed food that the physician had ordered? What should the surveyor do?
Resident requiring a pureed diet may have difficulties with chewing or swallowing (dysphagia). Providing a regular diet could lead to choking, aspiration, and other serious complications. To protect the resident and mitigate any immediate risk, the surveyor should intervene at the last moment, once it is clear the intention was for facility staff to provide the incorrect diet.
Then the surveyor should examine the resident’s medical records, dietary orders, and care plans to verify the prescribed diet and to identify any gaps in communication or documentation. Check the facility’s policies and procedures related to dietary management and compliance with physician orders. The surveyor would document the incident thoroughly, including the specific observations, the resident’s condition, and any immediate corrective actions taken by the staff. Then conduct interviews with the resident, if possible, staff responsible for meal preparation and delivery, and /or nursing staff to understand why the mistake occurred.
Would a resident with conjunctivitis be placed on standard precautions? Would enhanced barrier precautions be used?
Yes. The standard precautions would include hand hygiene, selection and use of PPE (e.g., gloves, facemasks, eye protection), environmental cleaning and disinfection, and reprocessing of reusable resident medical equipment.
