Admission Orders

Question 1

definition of inpatient

Answer 1

someone expected to stay more than 2 midnights

Question 2

definition of outpatient

Answer 2

occurs within 1 day, no overnight stay

- usually occurs in a surgery center, eye center, or special procedures

Question 3

define observation admissions

Answer 3

needs hospital care but expected to stay only 1 midnight, can transition to inpatient admission if meets criteria

Question 4

defined skilled nursing care

Answer 4

occurs in a nursing home but particular beds are set aside for “post-acute care”

Question 5

when should you transfer a patient to a skilled nursing facility (SNiF)

Answer 5

when they have surgeries or illnesses that cause significant debilitation where they are not ready to go home within 3-4 days

Question 6

compare hospice care and home health

Answer 6

hospice care: denotes palliative care w/ hospice at end of life

home health: needs skilled care at home

Question 7

what is the ADC VANDALISMM pneumonic (used to write complete admit orders for patients)

Answer 7

Admit
Diagnosis
Condition
Vitals
Activity
Nursing
Diet
Allergies
Lab and Diagnostics
IV fluids
Specialists/Consultants
Medications
Monitoring

Question 8

What parts of the ADC VANDALISM pneumonic correlate with “conditions for admission” of a patient

Answer 8

(ADCAM)
Admit
Diagnosis
Condition
Allergies
Medications

Question 9

What parts of the ADC VANDALISM pneumonic correlate with “diagnostic processes” of a patient

Answer 9

(VANDLISM)
Vitals
Activity
Nursing
Diet
Lab and Diagnostics
IV Fluids
Specialists and Consultants
Mediations

Question 10

What parts of the ADC VANDALISM pneumonic correlate with “safety” of a patient

Answer 10

(MM)
Medications
Monitoring

Question 11

what must you specify in an admission order

Answer 11

• the service (ex: medicine)
• the attending (ex: Dr. Snow)
• a particular unit (ex: medical, step-down)
• whether this patient will need cardiac monitoring (telemetry)

Question 12

what patients should be admitted to the ICU

Answer 12

Those who:

• requiring advanced respiratory support
• requiring support of 2+ organs
• chronic impairment of 1+ organ systems who also require support for acute reversible failure of another organ

Question 13

define “support” when talking about admission to the ICU

Answer 13

care that cannot be addresses on another unit due to:

1) medication intensity
2) need for close monitoring
3) high risk of decline in condition

Question 14

how to document a diagnosis on an admission order

Answer 14

1) list primary diagnosis (do NOT list signs and sx)
2) list in order of priority
3) break them into two groups (acute and chronic - first acute, then chronic)

Question 15

define “stable” when referring to a patient

Answer 15

implies patient has stable vita signs and is in no life-threatening duress
(“good” denotes the same)

Question 16

define “fair” when referring to a patient

Answer 16

implies pt is experiencing a condition whereby they are not doing well and will need monitoring
- may be due to pain issues or other mild circumstances w/ minimal impairment of pt safety
(“ill-appearing” denotes the same)

Question 17

define “guarded” when referring to a patient

Answer 17

pts that need to be monitored closely

• vital signs possibly labile
• mentation could be altered
• they could be in a category of “toxic” as in sepsis
• multiple injuries from trauma

Question 18

define “critical” when referring to a patient

Answer 18

pts going to intensive care as they are potentially unstable or have been unstable prior to admission
- pt is stabilized enough to be transferred

Question 19

define “expectant” when referring to a patient

Answer 19

pts that have been placed on palliative care or are pending hospice consultation
- presentation prior to admission deems them likely to die within 72 hours
- pt likely needs inpatient palliative care
(“poor prognosis” or “poor” denotes the same)
- sx of impeding death such as low BP, bradycardia, agonal respirations, hypoxia, comatose state

Question 20

what should you document regarding vitals on an admission order

Answer 20

frequency of vital signs you prefer

Question 21

what is the usual frequency of vital signs on an admitted pt

Answer 21

every 4-8 hours

- sometimes you want them every 2 hours for 8 hours (4x), then move to every 4 hours

Question 22

vital signs parameters that require notifying a physician on an admitted pt

Answer 22

SBP: <90 or >150
HR: <60
RR: <10
T: >38.3 (100.9F)

Question 23

define “up ad lib” as a direction for admitted patients

Answer 23

patient can get up when they want to usually w/o help

Question 24

define “bedrest w/ assistance” as a direction for admitted patients

Answer 24

patient stays in bed and only gets up with help

Question 25

define “bathroom privileges” as a direction for admitted patients

Answer 25

patient can get up and go to the bathroom unassisted

- “with help” can be added

Question 26

define “bedrest” as a direction for admitted patients

Answer 26

pt should not get up at all

Question 27

orders like “turn, cough, deep breathe exercises every 2 hours”, “routine oral care”, and “routine hygiene” that are not completed by the physician are referred to as what

Answer 27

nursing orders

Question 28

list examples of respiratory nursing orders

Answer 28

• updrafts (nebulizer tx)
• endotracheal suctioning
• spirometry
• incentive spirometer

Question 29

list examples of wound care nursing orders

Answer 29

• dressing changes

- DVT stockings

Question 30

list examples of precautionary measure nursing orders

Answer 30

• aspiration precautions
• fall prevention
• seizure precautions

Question 31

list examples of general health nursing orders

Answer 31

• strict inputs/outputs
• daily weights
• foley to gravity
• O2 requirement
• 1:1 observation

Question 32

list examples of neurological nursing orders

Answer 32

neurocheck q4h

Question 33

list examples of nursing order protocols

Answer 33

• hypoglycemia protocol
• bedsore prevention
• incentive spirometer

Question 34

define “carbohydrate consistent” diet for an admitted pt and what pts are normally prescribed it

Answer 34

usually done for diabetics

- can specify calories per day and the nutrition center will calculate the carbs for you, eg 1600, 1800, 2000/day

Question 35

define “clear liquid” diet for an admitted pt and what pts are normally prescribed it

Answer 35

done for pre-procedure patients or in the face of persistent nausea and vomiting
- pts only get broth, jello, coffee, water

Question 36

define “full liquid” diet for an admitted pt and what pts are normally prescribed it

Answer 36

used for a slow advance to regular diet after surgery or other illnesses causing decreased oral intake
- ice cream, milk, cream of “whatever” soup, certain juices

Question 37

define “NPO” diet for an admitted pt and what pts are normally prescribed it

Answer 37

means “nil per os” which means “nothing by mouth”

• pre-operative order that goes into place at midnight before date of surgery or at least 6 hours before a procedure
• or if there is persistent nausea and vomiting
• or if they have dx of acute pancreatitis or bowel obstruction –> NPO will facilitate “bowel rest”

Question 38

most important feature of admission orders

Answer 38

medications