Ch.11 Admission, Discharge, Transfer, and Referrals

Question 1

List the major steps involved in the admission process

Answer 1

• Authorization from a physician that the person requires specialized care and treatment
• Collection of billing information by the admitting department of the health care agency
• Completion of the agency’s admission database by nursing personnel
• Documentation of the client’s medical history and findings from physical examination
• Development of an initial nursing care plan
• Initial medical orders for treatment

Question 2

Identify common psychosocial responses when clients are admitted to a health agency

Answer 2

Some common reactions of newly admitted clients are

• Anxiety
• Loneliness
• Potential for compromised privacy
• Loss of identity.

Question 3

List the major steps involved in the discharge process

Answer 3

METHOD discharging planning Guide

M: Medications: Instruct the client about drugs that will be self-administered.

E: Environment: Explore how the home environment can be modified to ensure the client’s safety.

T: Treatments: Demonstrate how to perform skills involved in self-care and provide opportunities for returning the demonstration.

H: Health teaching: Identify information that is necessary for maintaining or improving health.

O: Outpatient: Explain what community services are available that may ease the client’s transition to independent living.

D: Diet: Arrange for the dietitian to provide verbal and written instructions on modifying or restricting certain foods or suggestions for altering their methods of preparation.

Question 4

Give examples of the use of transfers in client care

Answer 4

A transfer (discharging a client from one unit or agency and admitting him or her to another without going home in the interim) may occur when a client’s condition improves or worsens.

Question 5

Describe the levels of care that nursing homes provide

Answer 5

Extended Care Facilities: (a health care agency that provides long-term care) is designed for people who do not meet the criteria for hospitalization.

Skilled Nursing Facilities: provides 24-hour nursing care under the direction of an RN.

Intermediate Care Facilities: This type of agency provides health-related care and services to people who, because of their mental or physical condition, require institutional care but not 24-hour nursing care.

Basic Care Facilities: An agency that provides extended custodial care. The emphasis is on providing shelter, food, and laundry services in a group setting.

Question 6

Discuss the purpose of a minimum data set (MDS)

Answer 6

The minimum Data Set (MDS) part of a federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes.

Question 7

Identify contributing factors to the increased demand for home health care

Answer 7

A wide range of health care services that can be provided in the home for an illness or injury; usually less expensive, more convenient, and just as effective as care in a hospital or skilled nursing facility

Question 8

The process of entering a health care agency for nursing care and medical or surgical treatment is called ____________.

Answer 8

Admission

Question 9

The envelope containing the secured valuables of the client should have the signature of the nurse, the security personnel, or the ____________.

Answer 9

Supervisor

Question 10

Termination of care from a health care agency is called ____________.

Answer 10

Discharge

Question 11

Activities involved in discharge planning ideally begin at the time of ____________.

Answer 11

Admission

Question 12

Discharging a client from one unit or agency and admitting them to another without going home in the interim is called ____________.

Answer 12

Transferring

Question 13

To qualify for Medicare benefits in a nursing home, a person must have been hospitalized for ____________ days or more within 30 days without needing skilled nursing care.

Answer 13

Three

Question 14

An ____________ care facility is a type of agency that provides health-related care and services to people who do not require 24-hour nursing.

Answer 14

Intermediate

Question 15

A ____________ is the process of sending someone to another person or agency for special services.

Answer 15

Referral

Question 16

A person on Medicare who needs skilled nursing care intermittently may vary from getting the nursing treatment every day to once every ____________ days.

Answer 16

60

Question 17

Identify what is occuring in the picture.

Answer 17

A Client is having an ID bracelet applied.

Question 18

What information can be found on the object identified?

Answer 18

The element contains information regarding the client’s name, an ID number, and in some cases, a barcode for computerized scanning purposes.

Question 19

What is this object used for?

Answer 19

The element is used to identify the client and ensure their safety.

Question 20

Feeling caused by insecurity that makes the client uncomfortable

Answer 20

Anxiety

Question 21

Leaving before the physician authorizes the discharge

Answer 21

Against medical advice

Question 22

Briefly writing the client’s current condition at the time of relocation

Answer 22

Transfer Summary

Question 23

Providing long-term health care

Answer 23

Extended Care Facility

Question 24

Providing extended custodial care

Answer 24

Basic Care Facility

Question 25

Presented here, in random order, are steps of the admission process. Write the correct sequence in the boxes provided.

1. Completion of the agency’s admission database
2. Documentation of the client’s medical history
3. Authorization from a physician
4. Developing the initial nursing care plan
5. Collection of billing information

Answer 25

3. Authorization from a physician
4. Collection of billing information
5. Completion of the agency’s admission database
6. Documentation of the client’s medical history
7. Developing the initial nursing care plan

Question 26

Presented here, in random order, are steps to be followed by a nurse when helping a client undress. Write the correct sequence in the boxes provided below.

1. Remove the client’s shoes.
2. Cover the client with a bath blanket.
3. Lift the client’s head to guide garments over it.
4. Release fasteners such as zippers and buttons.
5. Provide privacy.

Answer 26

5. Provide privacy.
6. Remove the client’s shoes.
7. Release fasteners such as zippers and buttons.
8. Lift the client’s head to guide garments over it.
9. Cover the client with a bath blanket.

Question 27

What is an initial nursing plan?

Answer 27

After all admission data are collected, the nurse develops an initial plan for the client’s care.

The initial plan generally identifies priority problems and may include the client’s projected needs for teaching and discharge planning.

Question 28

What nursing actions generally occur during the medical history and physical examination?

Answer 28

The medical history and physical examination generally include identifying data, reason for seeking care, history of current illness, personal history, past health history, family history, review of body systems, and conclusions.

Question 29

What actions occur during the discharge process?

Answer 29

The discharge process generally consists of discharge planning, obtaining a written medical order, completing discharge instructions, notifying the business office, helping the client leave the agency, writing a summary of the client’s condition at discharge, and requesting that the room be cleaned.

Question 30

When and why does a transfer process take place?

Answer 30

A transfer process may occur when a client’s condition improves or worsens.

Generally, a transfer has some advantage for the client.

It may facilitate more specialized care in a life-threatening situation or it may reduce health care costs.

Question 31

What is an extended care facility?

Answer 31

An extended care facility is a health care agency that provides long-term care.

It is designed for people who do not meet the criteria for hospitalization.

Examples of extended care facilities are group homes for assisted living, adult day care centers, senior residential communities, home health care agencies, and hospices.

Question 32

A nurse is caring for a client who is to be shifted from the cardiac care unit to the general nursing care unit within the facility.

1. What are the nurse’s responsibilities with regard to transfer of this client?

Answer 32

When transferring a client to a different nursing unit within the health care facility, the nurse Informs the client and family about the transfer

Completes a transfer summary briefly describing the client’s current condition and reason for transfer

Speaks with a nurse on the transfer unit to coordinate the transfer

Transports the client and their belongings, medications, nursing supplies, and chart to the other unit

Question 33

What information is provided in a transfer summary?

Answer 33

A transfer summary is a written review of the client’s current status that briefly describes the client’s current condition and reason for transfer.