CH 19 professional issues part A Flashcards by Darlena Thach

Nurse Practice Act

rules in each state for nurses
-qualifcations for licensure
-nursing titles (NP) that are allowed to be used
-scope of practice (vary state to state! if practice state A and have full practice authority don’t need doc collab. if move to state B, can u practice like state A? need to check state B practice act to know what to do in that state

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If i have full practice authority (don’t need doc collab) & I move to state B, can u practice like state A?

need to check state B practice act to know what to do in that state

have 54 different practice acts to fully autonomous to highly restrictive

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process of credentialing

-confirms HCP meets regulations in the state where practice is located
-investigates NP’s background is well investigated
-provides practice authority in given healthcare setting
-enables insurance reimbursements
-defines clinical, hospital privileges

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NP credentialing process

education
certification
licensure
criminal backvround check (CORI, SORI)
work hx, employment background
natioanl practitioner data bank (malpractice or other actions against NP)
status of clinical or hospital privileges a/s with former employment

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DEA number

needed to prescribe controlled substances
schedule 1-5 substances ranked

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DEA number

needed to prescribe controlled substances
schedule 1-5 substances ranked

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schedule 1 controlled substances

ILLEGAL
no one has this license
herone, MDMA, PCP

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schedule 2 controlled substances

legal to prescribe BUT significant abuse potential
morphine, fentanyl, methadone, oxycodone, methylpenidate, anabolic steroids

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schedule 3 controlled substances

less abuse potential
teststerone, butalbital (Fioricet) etc

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schedule 4 controlled substances

low abuse potential
common sleeping aids (zolpidem (Ambien), short acting benzos, phentermine

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schedule 5controlled substances

low abuse relative to schedule 4
few meds like antidiarrheals diphenoxylate/atropine (Lomotil)

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beneficence

PCP obligation to help people in need

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nonmaleficence

do no harm with or w/o intention
if harm is unavoidable, must minimize harm

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autonomy

right of competent person to choose a personal plan of life, action by exercising rights of self determination, independence and freedom
-put my opinions away and provide unbiased info risks and benefits of tx
-i respect pt’s well informed decision

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goals of autonomy

-avoid paternalism such as forcing my choice to the pt when given 2 options

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autonomy is not an absolute right because

if it interferes with the rights and wellbeing of others
ie: someone has TB in the hospital and refuses to get tx for it. they can be sued and forced to get tx bc they can expose the nurse

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if impaired cognitive impaired person, decision making can be deferred to

health care proxy
need sig impairment

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competency

ability to exercise rights to give or refuse informed consent

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justice

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utilitarianism

utility = working well for the most good

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-ie: vaccines to avoid illness

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veracity

HONEST!

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B! fair and unbiased manner

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denying antibiotics!!!!!

if give antib, and gets complication like c diff and adverse effects and didn’t need it, can get sued

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A. beneficence = helping ppl in need

veracity - to tell the truth

autonomy

informed consent pt side

disclosing info to competent pt who can voluntary choice -DISCUSS DIRECTLY TO THE PT WHAT HAPPENS IF NO TX HAPPENS

informed consent PCP side

is consent ever presumed?

components of competency

i provide info and make sure pt understands or they can sue

who can declare if someone is competent or not?

only court can but if family, HC proxy agree pt cannot make informed decision

pt needs dialysis but reports wrong date, time, president.

she demonstrates competency and wishes should be followed. and said 'i guess ill die' she understands its a machine and is old.

advanced directives

durable statements of intent based on pts wishes -living will is 1 type

5 wishes document

a willl that meets requiremnts of AD -WHO makes decisions when unable -how pt wants ppl to tx person and what they want love ones to know

healthcare proxy/agent

healthcare surrogate or attorney -18 years and older -speaks FOR pt if anesthesia or unable to voice -usu spouses is "de facto" proxy if none other

daughter of 88 man calls about me. shes asking about his meds.. do u tell her?

assume compentency unless mentioned otherwise! tell her no she can only speak to pt

culture

culture sensitivity

culture knowledge

culture competence

if mentions a "Croation" or ethnicity, just cross it out and answer the q with any culture competence answer

ask the pt's father if he has any q's with son's are -only ask if pts father to leave if STD but if son brings father on purpose -

common in asian cultures head nodding means he understands - only go to his son ONLY if he's not competent and thats his proxy

Mal de Ojo

Evil eye folk belief in hex (mediter, latino,muslin, etc) - stronger or powerful person (adult) gazes at a weaker person -gaze can be inadvertent ( no ill intent) or intentional

the malignant gazer could be

jelaously coveting the baby (curse) amulet protects

the gazer could be admiring a lovely baby

ask permission to look at the baby then offer congrats and god bless baby and her, in most cultures removes hex on the baby. the mom counteract and say it's not that beautiful

illnesses as a result of evil eye

usu in younger kids - headache fever diarrhea distuebed sleep incr fussiness

protection from evil eye

diffs culture to culture

tx for evil eye

tradtional healer -support with healthcare -using raw egg to rub child

say you are concerned he will get sick if ppl look at him? -pose as question to info gathering bc ppl LOOK at him. directing back to ask for more info

malpractice

failure of PCP to exercise care as reasonable prudent PCP under the same or similar circumstances what would your peers do under same situation?

compontents of malpractice

duty: relationship b/t me and pt breach of duty: I violate standards when rendering care

if i refill a rx for a neighbor she is now my pt T/F

true

proximate cause

plaintiff establishes a relationship b/t breach and the injuries

make sure to educate about medication and side effects explain WHY ur going on this antibiotic and likely will recover in a few days. the neg are diarrhea, candida, vaginitis. i can give u a cream u can buy OTC to help so they are WELL INFORMED. most women don't need to but just be aware

2 types of liability insurance policies

1. occurance basis 2. claims made

occurance basis policy

i get sued 3 years from now but my policy was in place during that time

claims made policy

I have this in place 2 yrs ago but stopped practice 1 yr ago. this year, someone sue me based on an encounter 2 years ago. I'm covered for this claim since it carries a "tail" policy

Medicare

fed sponsored insurance for: -65 and older -under 65 with disabilities -End stage renal dz (dialysis or transplant)

medicare part A

medicare part B

NP skill level, not RN lvl to be reimbursed

medicare Advantage (Part C)

medicare part D

"incident to" is a billing MEDICARE term that allows

100% reimbursement at MD rate

"incident to" rules

if we are more independent/np only practice, we get reimbursed 85% but if we practice with a MD, we get 100% -we get paid more when practicing independently

medicaid

-low income

medicaird requirements

-US national, citizen, permanent resident -low or v low income -blind, dissabled, elder, pregnant, children with disability or resp of kids if under 19 yrs old

true for all.

true false

HIPPA purpose

who is a covered entity?

HC providers who electronically transmit health info in connection with a standard transaction