CDI Foundations

Question 1

7 D’s of CDI

Answer 1

Definition, Diagnosis, Documentation (providers); Deciphering, Delineation, Deployment (CDI/coders); Defense (everyone, w/audits)

Question 2

Principal Diagnosis

Answer 2

The condition found after study to be chiefly responsible for occasioning the inpatient admission. *based on circumstances of admission, dx approach, treatment rendered

Question 3

What is heart failure?

Answer 3

Inability of heart to effectively pump blood out with each beat.

Question 4

What are the clinical indicators of heart failure?

Answer 4

Increased BNP, sx of pulmonary or systemic congestion (wheezing/resp distress, edema, weight gain, HTN, arrhythmias, JVD, decreased SpO2)

Question 5

How do you know if a diagnosis is present or a “history of”?

Answer 5

History of = no longer present, no longer treated. Present = may be treated (meds, therapies, etc), but can be more or less asymptomatic d/t being well controlled. Ie breast cancer pt on tamoxifen, still “has” breast cancer d/t ongoing tx.

Question 6

What is HF with reduced EF or preserved EF?

Answer 6

Reduced EF (systolic HF) = < 50% EF; Preserved EF (diastolic HF) = > 50% EF

Question 7

What defines heart failure being “decompensated”?

Answer 7

Requiring urgent, unplanned/unscheduled care to manage. IE IV diuretics, increased monitoring, etc.

Question 8

What are the different types of altered mental status?

Answer 8

Delirium: acute change in arousal and content
Depression: chronic change in arousal
Dementia: chronic change in arousal and content
Coma: dysfunction of arousal and content
Psychosis: acute change

Question 9

Can you explain underlying causes of different types of altered mental states?

Answer 9

Possibilities: primary intercranial disease(s), systemic diseases affecting the CNS, exogenous toxins (toxic encephalopathies), drug withdrawal.
Consider: hypoglycemia, hypoxia, infection/sepsis,

Question 10

Toxic vs metabolic encephalopathy

Answer 10

Toxic: usually d/t (external) toxic exposure; worksite neurotoxins, drugs, alcohol, CO2, hydrogen sulfide, cyanide, heavy metals
Metabolic: usually d/t internal factors; hypoglycemia, ischemia, hypoxia, hypercapnia, vitamin deficiencies, d/t peripheral organ dysfunction (hepatic, uremic/dialysis)

Question 11

PATIO

Answer 11

Present at the time of inpatient (admission) order

Question 12

What is sepsis?

Answer 12

The body’s systemic inflammatory response TO infection (not an infection itself).

Question 13

Sepsis-2

Answer 13

Systemic Inflammatory Response to Infection.
clinical indicators = pt “looks” septic
organ dysfunction not required

Question 14

Sepsis-3

Answer 14

Dysregulated host response to infection resulting in organ dysfunction.
requires documentation of “severe sepsis” or “septic shock” to be coded as sepsis-3

Question 15

Septic shock

Answer 15

Patients who require vasopressors to maintain MAP > 65 mmHg or greater and lactate > 2 mmol/L in the absence of hypovolemia.

Question 16

Sepsis vs cytokine release syndrome

Answer 16

Sepsis: body’s response to infection, Interferon rarely elevated, IL-6 and ferritin levels often very high
CKS: not d/t infection

Question 17

Which conditions may present like sepsis but not be due to infection?

Answer 17

Anaphylaxis, aspiration pneumonitis, adrenal insufficiency, SBO, DKA, heat emergencies, hypovolemia, PE, pancreatitis, intestinal ischemia, thyroid disease (thyrotoxicosis/thyroid storm), toxicity (ODs) and withdrawals, malignant hyperthermia, neuroleptic malignant syndrome, vasculitis

Question 18

Recommended anti-infective tx for adults with CAP and no concerns for Psuedo or MRSA:

Answer 18

Combination therapy: beta-lactam (ampicillin, rocephin, cefotaxime) AND macrolide (azithromycin or clarithromycin).
Monotherapy: respiratory flouroquinolone (levofloxacin)

Question 19

Recommended anti-infective tx for adults with CAP and concerns for MRSA:

Answer 19

Vanco or Zyvox (linezolid)

Question 20

Recommended anti-infective tx for adults with CAP and concerns for Pseudomonas Aeruginosa:

Answer 20

Zosyn (piperacillin-tazobactam), Cefepime, ceftazidime, aztreonam, meropenem, imipenem

Question 21

Respiratory insufficiency

Answer 21

Shortness of breath

Question 22

Respiratory distress

Answer 22

labored, difficult breathing

Question 23

Respiratory failure

Answer 23

Failure to ventilate or oxygenate (hypoxia, hypercapnia) AEB elevated PCO2 or decreased O2.

Question 24

How to differentiate between acute and chronic hypercapnic respiratory failure?

Answer 24

Acute: pH < 7.33
Chronic: pH > 7.33 (compensated)

Question 25

What is shock?

Answer 25

life-threatening circulatory failure that leads to tissue hypoperfusion and tissue dysoxia (abnormal tissue oxygen utilization)

Question 26

What are the 4 classifications of shock?

Answer 26

Cardiogenic, Distributive (septic, vasodilatory), Hypovolemic, Obstructive (think large PE blocking pulm artery and left ventricle)

Question 27

Clinical indicators of shock

Answer 27

sx of poor peripheral perfusion - cold, clammy skin, delayed cap refill, mottling
tachycardia
urine output
abnormal BPs
altered level of consciousness

Question 28

Lab values supporting shock dx

Answer 28

lactate levels (#1 cause of elevated lactate = shock, but not the only cause)

Question 29

What makes a debridement excisional vs non-excisional?

Answer 29

Excisional debridements are done by scalpel only. Other sharp instruments (scissors, curette, etc) do not apply to excisional debridements.

Question 30

Essentials of a condition: M.U.S.I.C.

Answer 30

Manifestation
Underlying Cause
Severity/Specificity - organism?
Instigating cause - what precipitated?
Consequences?