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NUR 212 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Insurance company pays provider set amount of money each month to provide a defined set of Healthcare Services

A

Capitation

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2
Q

Reimbursement for healthcare services based on predetermined fixed Price–per–case/ diagnosis

A

DRGs

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3
Q

Providers reimbursement based on the patient’s diagnosis; most common method of payment in today’s healthcare system

A

Perspective payment system

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4
Q

Method of reimbursing healthcare providers based on each individual service provided; a.k.a. Fee-for-service.

A

Retrospective payment system

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5
Q

What is the impact of rising healthcare costs on families?

A

–rely on home remedies/ OTC’s

–skipped dental care

–postponed needed healthcare

–skip medication doses

–did not get prescriptions filled

–skipped recommended treatments/tests

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6
Q

Possible reasons for rising healthcare costs in US:

A

– aging population

–better technology= increased cost

–wasteful spending

–more chronic illnesses

–Pt’s A lower share of expenses

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7
Q

Method of reimbursing providers based on quality of care provided w/an emphasis on disease prevention and reduction of complications. Better patient outcomes= increased payment.

A

Pay-for-performance

Disadvantage: noncompliant patients= decreased reimbursement for provider

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8
Q

Medicare provides coverage for:

A

Persons over 65

Certain disabilities

end-stage renal disease

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9
Q

Joint Federal/State program to provide health insurance for impoverished families and people with certain disabilities.

Primary payer of LTC nationwide.

Fastest-growing component in most state budgets.

A

Medicaid

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10
Q

Federal entitlement program funded by wages from employees:

A

Medicare

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11
Q

Provider agrees to or is required by law to accept the Medicare approved amount as full payment for services.

A

Assignment

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12
Q

Neither Medicare A or B cover:

A

LTC (unless receiving dialysis)

Dental care/ dentures

cosmetic Sx

acupuncture

hearing aids/exams

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13
Q

Medicare A covers:

A

Hospitalization:

Inpatient in hospital/SNF

hospice care

Home healthcare

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14
Q

Medicare B covers:

A

Outpatient/MD services:

Ambulance services

preventative services

mental health inpatient/ outpatient

Pt pays premiums/ deductibles

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15
Q

Medicare D covers:

A

Prescription drugs:

Voluntary

Pt pays premium/ deductible

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16
Q

Medicare C/ medigap covers:

A

What Medicare A/B/D do not

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17
Q

Pricing discounts given to a Pt by the hospital they’re typically determined by income, Family size, and debt level:

A

Charity care:

Required for nonprofit hospitals

18
Q

Five major reasons people over 65 experience medication related problems:

A

Physiologic changes: altered Pharmokinetics

Polypharmacy: Often by Multi-provider

incorrect dosage/ med errors

self-medication/ nonadherence

19
Q

Any injury/Harm occurring during a patient’s therapy as a result of medications:

A

Adverse drug event

20
Q

And unforeseen/Unintended/Undesired effect of a drug that occurs during therapy:

A

Adverse drug reaction

21
Q

Any undesirable condition in a patient occurring as a result of treatment by a healthcare professional; pertaining to an illness or injury result from medication

A

Iatrogenic event

22
Q

Causes for polypharmacy:

A

Increased number of doctors

Increased number of pharmacists

increase number of chronic conditions

OTC not considered

Pt equate going to the doctor with getting pills

decreased knowledge about meds by Pt

sharing meds

inappropriate scripts/ underused Meds

23
Q

Reasons for adverse drug events in elderly:

A

Physiological change/ pharmokinetics

Drug absorption changes

drug distribution changes: reduced proteins/Albumin

slower drug metabolism

decrease drug elimination/GFR

24
Q

Creatinine levels decrease in the elderly d/t loss of lean body mass could appear normal d/t:

A

Decreased GFR:

Allows buildup of creatinine which could mask the reduced creatinine levels; normal indicator of renal dysfunction

25
Q

BUN levels: 10-20

??= dehydration

>??= renal

A low BUN, ??, & ?? may indicate malnourishment.

A

20-30s= dehydration

>30= Renal

Low BUN/Protein/Albumin

26
Q

Three essential nursing competencies needed to increase safety:

A

Critical thinking

Safety

teaching

27
Q

Collaboration with the interdisciplinary team:

A

Streamlines the decision-making process

Allows achievement of goals

ensures continuity

28
Q

An informal, achieved roll that has influence over others with no real authority; Part of every nurses responsibility

A

Leader

29
Q

Formal, designated role that helps others to develop and has authority over others; Improved by developing leadership skills

A

Manager

30
Q

Authority position of the unit responsible for developing healthcare professionals of delivering the highest quality of care compliance

A

Nurse manager

31
Q

What are the five major management functions?

A
  • Planning: defining goals/objectives; resource allocation
  • Organizing: coordinating people/time/work
  • Staffing: hiring/ training/Scheduling/Development
  • Directing: communicate/Delegate/Motivate/Manage conflict
  • Controlling: performance reviews monitoring financials and quality of care
32
Q

This type of allocation takes but the highest levels of administration policy a.k.a. government, and determines what funds to expand, Good to make available, and methods of distribution; Affects large numbers of people.

A

Macroallocation

33
Q

This type of allocation focuses on deciding who will be the recipient of scarce resources; often occurs at patients bedside.

A

Microallocation

34
Q

What are the four types of healthcare resources?

A

Labor: nurses/doctor/technicians

Capital: medical facilities/equipment/supplies

Land: property for the hospital/facilities

Entrepreneurship: vision and skill to manage the hospital as a business

35
Q

What are the three top chronic diseases?

A

Diabetes

Lung disease

Cardiovascular disease

36
Q

What are the four theories of justice?

A

Utilitarian: greatest good for the greatest number

Libertarian: fix the rights of each individual; citizens improve their own circumstances

Communitarian: places the community above individual, state, or nation

Egalitarian: promotes the idea of equal distribution amongst similarly situated people

37
Q

What is the six IOM quality aims?

A

STEEEP

Safe

timely

effective

efficient

equitable

patient-centered

38
Q

Community oriented nurse

VS

Community-based nurse

A

Community oriented: Focus on at risk people families and groups and community as a whole; works on the primary and secondary care levels.

Community-based: focuses on individuals and families illnesses, and management of acute/chronic conditions in settings were individuals/Families/Groups live; works on a tertiary care level

39
Q

Public health nursing

VS

Community health nursing

A

Public-health: promote/ maintain health through disease prevention of the whole community; focuses on disease prevention

Community health: promote/maintain the health of populations by the delivery of health services to individuals families and groups; delivery of health services

40
Q

Ocupational Health Prevention

Primary=??

Secondary=??

Tertiary=??

A

P= prevention/Immunizations/ protective equipment

S= ID-ing hazards/ early detection/ counseling and referrals

T= restoration/rehabilitation ex: Limited duty programs

41
Q

Primary=??

Secondary=??

Tertiary=??

A

p= prevents initial occurrence

s= early detection/ assessment

t= recovery/rehab

42
Q

Epidemiology

Agent:??

Host:??

Environment:??

A

a: animate or inanimate object that causes the disease
h: living being that is affected by the agent
e: setting or surrounding that sustains the host

NUR 212 (3 decks)

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