Final exam Flashcards
What are the classic symptoms of ovarian cancer?
Bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary symptoms like frequency, urgency… Other symptoms= fatigue, indigestion, back pain, dyspareunia, constipation and menstrual irregularities. If these symptoms are experienced more than 12x/month and are unusual then the woman needs to see a gynecologist
Ovarian Cancer risk factors
personal or family hx of breast, colon, or ovarian cancer, increasing age, and nulliparity.
Factors associated with decreased risk of ovarian cancer include?
using oral contraceptives, having and breastfeeding children, and having a bilateral tubal ligation or hysterectomy or prophylactic oophorectomy.
Testing for ovarian cancer includes?
pelvic, vaginal, and rectal exams, transvaginal ultrasound, and CA 125 blood test. There is no reliable screening test for the early detection of ovarian cancer.
Disengagement theory
Theory that states aging adults will withdraw socially and psychologically from society. This withdrawal is a “mutual agreement process.” The biggest withdrawal is retirement and the problem is that the adult will become isolated. Withdrawal can be positive if adult is socially active.
Active Theory
Theory that older adults should continue to engage in similar activities that they enjoyed in middle adult and younger years. Activities should be with same aged adults and are dependent on physical/mental health
Continuity theory
theory that older adults maintain the same personality and behaviors as before, thus, their behaviors are predictable.
Self-efficacy theory
theory that hardy individuals will be successful in any situation b/c they believe they are in control of their own lives. The manage diseases better and are relatively unaffected by life changes.
Life-long Development theory
Theory that experiences of the past help plan for present and future experiences. This theory also insists that no part of development is better than another (ex- childhood development is not better than adult development)
Historical context and Development theory
Theory that development depends on culture and era one was born into. This theory insists that nurses assess individuals based on social/environmental factors in the era they were born.
Multidimensional/Multidirectional development theory
Theory that as older adults physically age, they use wisdom and expertise to develop strategies to stay at equilibrium and offset decline.
Pliable/Plastic Developmental theory
Theory that older adults can improve skills with training and practice to maintain their independence. ex- how to make shopping lists
Domain of Nursing
uses four paradigms to describe the beliefs and values that are at the core of nursing, and identify the needs of the p. and community through the nursing process. The paradigms are: person, environment, health, and the nurse.
Health paradigm of nursing
Describes health as not the absence of disease, nor an absolute state, but a dynamic state that changes daily. People can have chronic conditions and still have a functioning level of health b/c of medical regimens like diet, exercise…
Environment paradigm of nursing
includes the geographical location of the patient, the patient’s family and friends, schools, social activities, local gov’t, chemicals, and hazards. All factors have pos. or neg. effects on a person and their health.
Betty Neuman’s Systems theory
Theory that each individual strives for the highest level of potential and desires health. Health is defined as maintaining balance and equilibrium with lines of defense. Lines are broken by stressors in the environment and cause illness. The nurse helps the p. with stressors in the environment to maintain balance using preventative levels of health (primary, secondary, tert..)
Sister Callista Roy’s Adaptation Model
Theory that each person is an open system that responds to stimuli/stressors in the environment and must adapt to survive. Health is a state of adaptation resulting from coping w/stressors and how one copes/responds. Illness is an ineffective coping state The nurse helps the p. to adapt through setting goals and the NRS process. When the goal is met, the p. has adapted.
Dorothea Orem’s Self-Care model
theory that each person has a responsibility to care for himself and his dependents. Health is a state of independent functioning whereas illness is a deficit in self-care. The environment effects the person’s ability to care for himself. Nurses assess if a p. has a self-care deficit and if he fits the environment. Nurses also establish whether p. has a total compensatory self-care deficit or a partial compensatory self-care deficit and assist the client with care as needed.
Jean Watson’s Theory of human caring
theory that nursing needs to return to it’s original goal of taking care of people. Nurses should view their job as a profession/committment which should be personally gratifying and not just a job. Each person has ultimate responsibility over his health. Health= harmony b/w body, mind and soul whereas illness= lack of harmony. Nurses should understand the p’s meaning of life and should promote dignity, respect and integrity when caring.
Madeleine Leininger’s Culture Care theory
Theory that health is defined according to cultural practices and values of the group or individual and that individual is inseparable from his culture. Nurses provide the highest level of caring, and respect to p.s, when they integrate generic caring (folk practices based on culture of ethnic group) and professional caring.
Culture
patterns, beliefs, values, and practices shared by a grp that are past down from older generations and is resistant to change.
Cultural diversity
variability and differences in care beliefs, values and practices that makes each person unique. There is more diversity than universality among cultures which is why it is important to understand p’s beliefs/culture to provide culturally congruent care.
Nurses focus on what 3 factors when providing culturally congruent care?
1) Cultural care preservation/maintenance
2) cultural care accommodation/negotiation
3) cultural care repatterning/restructuring
Cultural Competence
understanding attitudes/knowledge and skills of cultural group and including them in nursing care. This provides a therapeutic relationship and effective communication.
Cultural Awareness
a self-reflection needed before one cares for a certain group;awareness of one’s own values/beliefs and beliefs toward another cultural group. Open-mindedness is the best quality for care b/c one is open to diff. beliefs/practices and adapts care for the p. based on their values
Cultural Knowledge
term referring to the idea that nurses should be aware of beliefs/practices of a cultural group before caring for a p. in that group. Knowledge shouldn’t be stereotypes or subjective.
Cultural skills
regarding and recognizing the patient’s/families perceptions of what is happening to their health so we do not judge them.
Cultural Encounter LEARN
L- listen with sympathy to p’s perception of problem. E- explain your perception of p’s problem. A-acknowledge differences and discuss. R-recommend Tx. N- negotiate a plan of care.
Ethnocentrism
tendency of person to view their culture as ideal and superior to all other cultures
Cultural imposition
tendency of person to impose beliefs of their culture onto another person
Cultural shock
uncomfortable feeling/anxiety when surrounded by people of another culture. Nurses and ps may have this, but ps usually have more
Cultural Care preservation/maintenance
NRS interventions that assist/support/facilitate actions and decisions of p. to preserve their care values. These will help maintain healthy healing from illness or prepare for death.
Cultural care accommodation/negotiation
NRS interventions that will help p. to achieve beneficial and satisfying outcomes. Nurse and p. must negotiate to develop optimal care plan.
Cultural care repatterning/restructuring
NRS interventions that assist the p. to change their lifestyle to become healthier. Exs- changing diets, creating exercise programs…
Cultural Assessment
the systematic exam of a p. or group in relation to their cultural beliefs/values/practices. Purpose is to determine the impact of these factors on health/illness and determine what interventions the nurse can plan/implement while still being culturally sensitive/congruent
Abuse–Violence
harming or threatening to harm the health or welfare of another person. Aggression is a learned behavior. Abusers may not recognize that they are the abuser.
Social factors influencing violence and abuse
stressful demands from work/income, education–stressors in classroom, household environment of children, media portrayal of violence, organized religion– remaining married, population–high density areas, poverty, and racial tension, and community facilities– places to go to cope and get rid of stress
Profile of the Abuser
The abuser is usually someone that has experienced abuse over time, may have low self esteem, want to control/overpower another person, may have a mental health problem, may be financially dependent on the abused person, may think that abuse is the only way to get what they want.
Homicide
Leading cause of death of children ages 1-9, leading cause of death for African american females, majority are husbands or ex husbands as perpetrator, child is usually a witness to homicide, females usually kill husbands out of self defense.
Physical Abuse
inflicting or threatening to inflict physical pain or injury on a person including hitting, kicking, shoving, striking, and restraints. S&S- bruising, black eye, welts, lacerations, open wounds, fractures, burns, scars, internal injury, inconsistency in how they obtain the injuries, lab findings of overdose on medication, p. c/o being deprived of basic needs,
Sexual abuse
infliction of non-consensual sexual contact of any kind and usually r/t violence and power. Types include- touching, sex assault, rape, molestation, incest, majority is male to female, females exp. PTSD, sex abuse in prisons- mostly male to male, usually unreported. S&S- bruising on chest and peri area, unexplained STDs, genital infection, vaginal infection, peri or anal bleeding, pregnancy, difficulty walking,
Emotional/psychological abuse
infliction of mental or emotional anguish or distress on another person that can be verbal or non-verbal. Includes verbal insults, threats, intimidations, harassment, sleep deprivation, and constant negative mood, constant family discord, treating an older person like an infant, isolating a person from family. S&S- agitation/upset, fearful around certain individuals, may w/draw or become apathetic, may suck thumb or rock back/forth, bite,
Criminal neglect
intentional refusal or failure by those responsible to provide adequate food, shelter, healthcare, or protection to a vulnerable person or older adult. S&S- pressure ulcers, prolonged periods of sitting in wet/soiled briefs, dehydration, malnutrition, untreated health conditions, not giving medications,
Unintentional neglect
type of neglect in which a person that is caring for someone needs assistance as well. This type is not a crime. S&S- pressure ulcers, prolonged periods of sitting in wet/soiled briefs, dehydration, malnutrition, altered mobility, untreated H. conditions, not given medications, unsafe environment.
Exploitation
illegal taking, misuse, concealment of funds, property or assets of a vulnerable person or an older adult. Can be a caregiver or an older adult, or an institution that has durable power of attorney over a patient. Problem is that person being exploited now has nothing to pay for food or medications
Signs of exploitation
life circumstances don’t match with the size of the estate, large w/drawals from bank accounts, switching bank accounts, switching names, signatures on checks don’t match, items are stolen from home, elderly may be deceived to sign a document, substandard care in home, hospital or nursing care, sudden appearance of uninvolved relatives.
Abandonment
When a recognized care giver has been giving regular and substantial care to a person and then willfully stops giving care to that person. Signs- desertion of elderly in hospital or NRS facility, or shopping center, departure of caregiver, no movement of older person, no telephone, elder reports they have been abandoned
Healthcare abuse
abuse by anyone taking care of a person in the healthcare perspective. includes- not providing the care but charging for it, overcharging, overmedicating or undermedicating, treating with a fraudulent medication so that the correct tx is not given, fraud with insurance companies.
Primary prevention with abuse
**can come out of tertiary prevention, when you have identified that abuse has happened you can go forward and do primary prevention. This includes strengthening the resistance of all persons to prevent abuse and violence in the future. exs- after school programs, parenting classes for new mother, providing coping strategies for frustration, support groups, anger management, conflict resolution,
Secondary prevention for abuse
to identify abuse through screening, nurses role is to get the p. out of the abusive situation. ex- Nurse asking a patient “in the past year, have you been kicked, punched, or hurt in other ways by someone close to you?” and performing physical exam
tertiary prevention for abuse
Includes rehabilitation and counseling when the abuse has already happened and now nurses are intervening. includes- providing names of shelters or safety, teaching that violence isnt the answer to frustration,
Wrap around services
Where a facility provides multiple services (medical and nursing care, social work,…) so a patient only needs to visit this facility instead of visiting multiple locations
HITS screening tool for abuse
H- have you been physically Hurt?
I- Have you been Insulted?
T- have you been Threatened with physical harm?
S- has someone Screamed at you or cursed you?
Vulnerability
refers to individuals who are more susceptible to the effects of risk factors than the remainder of the population. These people have decreased resilience or threshold to fight infection and have poor outcomes (chronic disease)
Epidemiology of Vulnerability
study of factors affecting the health/illness of populations which serves as a foundation for interventions in public health prevention.
Risk (r/t vulnerability)
refers to determinants that cause certain inds to have an increased probability of illness/disease/poor H. outcomes.
Epidemiological Triangle of Vulnerability
includes an agent, host, and the environment. The host is a group or ind. in a population that is at risk. The agent is the cause of illness/disease.
Risk Marker
risk factors that are modifiable or non-modifiable characteristics that place an ind. at risk. Includes Age, gender, race/genetics, stress, obesity, smoking, diet, exercise, environment.
Cumulative Risk (r/t vulnerability)
combination of risk factors that makes an individual even more susceptible to illness. exs- increasing age and smoking increases risk for lung cancer.
Differential Vulnerability Hypothesis
theory that individuals with multiple cumulative risk factors will be more sensitive to adverse effects and illness. Populations include- poverty, those that drink/smoke, those without transportation, elderly, female v. male gender, pregnant women with no resources.
Comorbidities
multiple health problems/chronic diseases that may be present within an ind. Exs- HTN, high cholesterol, obesity, CVD, diabetes. The more comorbidities present= the greater the stress on the immune system= the more interference with ability to develop a functioning health system.
Causes of vulnerability
poverty is the primary cause,
Federal poverty level
Annual income amount that marks the difference b/w the poor and the near poor. Poverty is a condition in which a person is deprived of or lacks essentials for minimum standard of well-being for life.
Federal poverty guideline
Poverty line that is calculated as 3x the amount needed for a nutritionally adequate diet per person. Individuals who have an annual income less than this amount are considered poor.
Social determinants of Health
the conditions in which people are born, grow, live, work, and age. These conditions are largely responsible for health disparities. Individuals who live in poverty or below that are offered gov’t assistance based on an annual income that is less than poverty guideline.
Medically indigent
people that cannot receive adequate H. care and can be uninsured or under-insured.
Working poor
those that work but still cannot afford health care or health insurance.
Disability
condition that restricts or prevents an individual from performing activities that are within the range considered normal given his/her age. Disability may prevent the person from having a job
Impairment
loss of psychological, physiological, or anatomical functioning or structure. ex- amputee.
Developmental disability
mental or physical impairment that occurs before age 22 that will last entire lifetime. The individual can’t perform own self-care, may have expressive aphasia, affective aphasia, memory problems, and decreased ability to live independently
Functional Limitation
describes a person that can’t perform self-care or normal activities. Includes people who have/had a stroke, arthritis, non-traumatic amputations (secondary to gangrene or ulcers)
Developmental stifling
Not a mental or physical condition. Pertains to a child that has an impairment and who is prevented, by their parents, from maintaining as much of a normal life as possible
How do shifting family dynamics relate to vulnerability?
Role changes within the family causes vulnerability. Includes single parent households, loss of jobs of both parents. Children are affected more so than parents b/c they do not understand what is happening.
health disparities
unequal treatment b/w groups or individuals that results from a lack of access to, or loss of, HC services.
health literacy
ability of an individual to read, comprehend, and respond to HC info. The elderly, ethnic groups, and people with chronic diseases tend to have poor health literacy.
Cycle of vulnerability
When a person develops stress and feelings of hopelessness b/c they cannot manage poverty or other areas of vulnerability and cannot get out of their situation. They will feel powerless and isolated socially which can lead to other factors like abuse.
Role of the nurse with vulnerability
work with groups so they can develop strategies to break the vulnerability cycle, eliminate factors and improve outcomes.
Abuse–Violence
harming or threatening to harm the health or welfare of another person. Aggression is a learned behavior. Abusers may not recognize that they are the abuser.
Social factors influencing violence and abuse
stressful demands from work/income, education–stressors in classroom, household environment of children, media portrayal of violence, organized religion– remaining married, population–high density areas, poverty, and racial tension, and community facilities– places to go to cope and get rid of stress
Profile of the Abuser
The abuser is usually someone that has experienced abuse over time, may have low self esteem, want to control/overpower another person, may have a mental health problem, may be financially dependent on the abused person, may think that abuse is the only way to get what they want.
Homicide
Leading cause of death of children ages 1-9, leading cause of death for African american females, majority are husbands or ex husbands as perpetrator, child is usually a witness to homicide, females usually kill husbands out of self defense.
Physical Abuse
inflicting or threatening to inflict physical pain or injury on a person including hitting, kicking, shoving, striking, and restraints. S&S- bruising, black eye, welts, lacerations, open wounds, fractures, burns, scars, internal injury, inconsistency in how they obtain the injuries, lab findings of overdose on medication, p. c/o being deprived of basic needs,
Sexual abuse
infliction of non-consensual sexual contact of any kind and usually r/t violence and power. Types include- touching, sex assault, rape, molestation, incest, majority is male to female, females exp. PTSD, sex abuse in prisons- mostly male to male, usually unreported. S&S- bruising on chest and peri area, unexplained STDs, genital infection, vaginal infection, peri or anal bleeding, pregnancy, difficulty walking,
Emotional/psychological abuse
infliction of mental or emotional anguish or distress on another person that can be verbal or non-verbal. Includes verbal insults, threats, intimidations, harassment, sleep deprivation, and constant negative mood, constant family discord, treating an older person like an infant, isolating a person from family. S&S- agitation/upset, fearful around certain individuals, may w/draw or become apathetic, may suck thumb or rock back/forth, bite,
Criminal neglect
intentional refusal or failure by those responsible to provide adequate food, shelter, healthcare, or protection to a vulnerable person or older adult. S&S- pressure ulcers, prolonged periods of sitting in wet/soiled briefs, dehydration, malnutrition, untreated health conditions, not giving medications,
Unintentional neglect
type of neglect in which a person that is caring for someone needs assistance as well. This type is not a crime. S&S- pressure ulcers, prolonged periods of sitting in wet/soiled briefs, dehydration, malnutrition, altered mobility, untreated H. conditions, not given medications, unsafe environment.
Exploitation
illegal taking, misuse, concealment of funds, property or assets of a vulnerable person or an older adult. Can be a caregiver or an older adult, or an institution that has durable power of attorney over a patient. Problem is that person being exploited now has nothing to pay for food or medications
Signs of exploitation
life circumstances don’t match with the size of the estate, large w/drawals from bank accounts, switching bank accounts, switching names, signatures on checks don’t match, items are stolen from home, elderly may be deceived to sign a document, substandard care in home, hospital or nursing care, sudden appearance of uninvolved relatives.
Abandonment
When a recognized care giver has been giving regular and substantial care to a person and then willfully stops giving care to that person. Signs- desertion of elderly in hospital or NRS facility, or shopping center, departure of caregiver, no movement of older person, no telephone, elder reports they have been abandoned
Healthcare abuse
abuse by anyone taking care of a person in the healthcare perspective. includes- not providing the care but charging for it, overcharging, overmedicating or undermedicating, treating with a fraudulent medication so that the correct tx is not given, fraud with insurance companies.
Primary prevention with abuse
**can come out of tertiary prevention, when you have identified that abuse has happened you can go forward and do primary prevention. This includes strengthening the resistance of all persons to prevent abuse and violence in the future. exs- after school programs, parenting classes for new mother, providing coping strategies for frustration, support groups, anger management, conflict resolution,
Secondary prevention for abuse
to identify abuse through screening, nurses role is to get the p. out of the abusive situation. ex- Nurse asking a patient “in the past year, have you been kicked, punched, or hurt in other ways by someone close to you?” and performing physical exam
tertiary prevention for abuse
Includes rehabilitation and counseling when the abuse has already happened and now nurses are intervening. includes- providing names of shelters or safety, teaching that violence isnt the answer to frustration,
Wrap around services
Where a facility provides multiple services (medical and nursing care, social work,…) so a patient only needs to visit this facility instead of visiting multiple locations
HITS screening tool for abuse
H- have you been physically Hurt?
I- Have you been Insulted?
T- have you been Threatened with physical harm?
S- has someone Screamed at you or cursed you?
Vulnerability
refers to individuals who are more susceptible to the effects of risk factors than the remainder of the population. These people have decreased resilience or threshold to fight infection and have poor outcomes (chronic disease)
Epidemiology of Vulnerability
study of factors affecting the health/illness of populations which serves as a foundation for interventions in public health prevention.
Risk (r/t vulnerability)
refers to determinants that cause certain inds to have an increased probability of illness/disease/poor H. outcomes.
Epidemiological Triangle of Vulnerability
includes an agent, host, and the environment. The host is a group or ind. in a population that is at risk. The agent is the cause of illness/disease.
Risk Marker
risk factors that are modifiable or non-modifiable characteristics that place an ind. at risk. Includes Age, gender, race/genetics, stress, obesity, smoking, diet, exercise, environment.
Cumulative Risk (r/t vulnerability)
combination of risk factors that makes an individual even more susceptible to illness. exs- increasing age and smoking increases risk for lung cancer.
Differential Vulnerability Hypothesis
theory that individuals with multiple cumulative risk factors will be more sensitive to adverse effects and illness. Populations include- poverty, those that drink/smoke, those without transportation, elderly, female v. male gender, pregnant women with no resources.
Comorbidities
multiple health problems/chronic diseases that may be present within an ind. Exs- HTN, high cholesterol, obesity, CVD, diabetes. The more comorbidities present= the greater the stress on the immune system= the more interference with ability to develop a functioning health system.
Causes of vulnerability
poverty is the primary cause,
Federal poverty level
Annual income amount that marks the difference b/w the poor and the near poor. Poverty is a condition in which a person is deprived of or lacks essentials for minimum standard of well-being for life.
Federal poverty guideline
Poverty line that is calculated as 3x the amount needed for a nutritionally adequate diet per person. Individuals who have an annual income less than this amount are considered poor.
Social determinants of Health
the conditions in which people are born, grow, live, work, and age. These conditions are largely responsible for health disparities. Individuals who live in poverty or below that are offered gov’t assistance based on an annual income that is less than poverty guideline.
Medically indigent
people that cannot receive adequate H. care and can be uninsured or under-insured.
Working poor
those that work but still cannot afford health care or health insurance.
Disability
condition that restricts or prevents an individual from performing activities that are within the range considered normal given his/her age. Disability may prevent the person from having a job
Impairment
loss of psychological, physiological, or anatomical functioning or structure. ex- amputee.
Developmental disability
mental or physical impairment that occurs before age 22 that will last entire lifetime. The individual can’t perform own self-care, may have expressive aphasia, affective aphasia, memory problems, and decreased ability to live independently
Functional Limitation
describes a person that can’t perform self-care or normal activities. Includes people who have/had a stroke, arthritis, non-traumatic amputations (secondary to gangrene or ulcers)
Developmental stifling
Not a mental or physical condition. Pertains to a child that has an impairment and who is prevented, by their parents, from maintaining as much of a normal life as possible
How do shifting family dynamics relate to vulnerability?
Role changes within the family causes vulnerability. Includes single parent households, loss of jobs of both parents. Children are affected more so than parents b/c they do not understand what is happening.
health disparities
unequal treatment b/w groups or individuals that results from a lack of access to, or loss of, HC services.
health literacy
ability of an individual to read, comprehend, and respond to HC info. The elderly, ethnic groups, and people with chronic diseases tend to have poor health literacy.
Cycle of vulnerability
When a person develops stress and feelings of hopelessness b/c they cannot manage poverty or other areas of vulnerability and cannot get out of their situation. They will feel powerless and isolated socially which can lead to other factors like abuse.
Role of the nurse with vulnerability
work with groups so they can develop strategies to break the vulnerability cycle, eliminate factors and improve outcomes.
What are things to assess for when considering vulnerability in a patient?
Physical health- health issues should be managed before other issues w/vulnerability are assessed. SE issues- money situation, transportation, in poverty? Biological issues- health assessment with family history. Psychological issues- communication, self-efficacy, self-perception, stress, disabilities? Lifestyle- drink, smoke, exercise, diet. Environment- home assesment. Education- health literate? community support the disabled?
Systems theory r/t vulnerability
Use this theory for the vulnerable population to identify stressors in the environment that are breaking the individual’s lines of defense and causing illness. Vulnerable groups will have multiple-overlapping stressors.
Adaptation model r/t vulnerability
Use this theory for the vulnerable population to help them adapt to stressors in the environment. The nurse helps individuals to identify their strengths so they can develop h. promotion strategies that improve their coping skills and prevent illness.
Self-Care deficit theory r/t vulnerability
Using this theory, nurses identify the self-care ability of vulnerable individuals/groups and then identify their self-care needs.
Outreach programs
programs that make resources available at certain locations where people can congregate, like churches, schools, workplaces, and community centers. This is where public h. nurses can present education, counseling and supportive services.
Case Finding (vulnerability)
Where the nurse goes out into the community to the vulnerable population. Often times this can happen with outreach programs as the nurse is actually with the people.
Comprehensive services
an agency that provides multiple/various HC services in one location. They offer a multidisciplinary focus for vulnerable families who require all of their needs met in one stop.
Safety net providers
clinics that provide HC and social services to vulnerable populations who have limited financial resources. Patients may receive services for free or at a rate they can afford.
Case management
where the nurse directly links the person/group to necessary services. The nurse may make referrals, do follow-up visits, provide counseling, screen for disease, or administer immunizations.
Primary prevention
interventions that prevent the development of disease, reduce or eliminate risk factors for health problems. Nurses promote health interventions through vaccines, counseling and education.
Secondary prevention
goal is to reverse or reduce the severity of the disease or to provide a cure- medication, wound care. This is when a disease is detected and treated early, often before symptoms are present which minimizes adverse outcomes. includes screening programs- mammography, PAP testing , prostate-specific antigen (PSA) testing
tertiary prevention
Interventions to prevent further loss of functioning when a disease is already present. Want to achieve highest level of function and maximize quality of life with rehabilitation. Includes rehab from heart attack or stroke, preventing complications of disabilities, and preventing bed sores among immobile individuals
What is the best way to improve care/outcomes for the patient?
To evaluate the patient’s overall satisfaction with the care provided
Social security act
beginning of federal gov’ts involvement in HC, 1935. The original goal was to guarantee that the elderly would have medical resources. Stated “if person was over 65 and a US citizen, then they would be given money to live on to prevent destitution, dependency and old age.” Also, people younger than 65 were eligible if disabled. The amount of money given was based on the average salary for the years that the ind. worked.
Public federally funded programs
includes medicaid and medicare. Medicaid is for p’s with low income where eligibility requirements are determined by each state. Medicare is for people over 65 or those disabled where premiums are either paid to insurance programs based on DRGs or to managed care organizations
Medicaid
started b/c of an increasing amount of low income inds w/limited resources. People are not eligible if they are just poor. Eligibility requirements include: low income, children/teens 18 years or younger, pregnant women married or single and children born while mother is on medicaid, children of parents with low income, elderly 65 years+, terminally ill and elderly in NRS homes, and blind/disabled of any age.
Medicare
for US citizens that have worked at least 5 years and are 65 years or older and for those permanently disabled. This program only covers what is medically necessary and the Dx/Tx must meet the criteria set by medicare. Has 4 different plans A, B, C, and D.
Managed care organizations (MCOs)
provide optimal care @ a controlled cost. Individual has to choose a primary care provider under a given network. MCOs include health maintenance organizations, preferred provider organizations, and point of service plans. Comprehensive care is overseen by a primary care provider and focuses on prevention and health promotion.
Health maintenance organizations
Organizations in which there is a contract b/w an individual and provider under a specific network of providers. Individuals will pay a fixed rate before being serviced. The goal of these organizations is to conserve costs and unnecessary tests
Preferred Provider Organizations
Organizations in which individuals can negotiate a fee, that is often discounted, with a contracted provider under a given network. Choosing a provider outside of the network increases the clients out of pocket costs.
Point of service plans
plans in which the primary care provider provides, arranges, authorizes and coordinates the care of the individual.
Medicare Part A
Plan in which a person is automatically eligible if 65 and meets all of the criteria. If the person has never worked, they can buy this plan. Covers: acute care (for 90 days, then p. can reapply), rehab, hospice, home HC, skilled NRS care, NRS home care for 100 days if p. was admitted w/in 3 days after hospital discharge.
Medicare Part B
Plan that an individual has to apply for, 3 days before they turn 65 and 4 months after they turn 65. This part is taxed based and locally controlled. Coverage includes: hospital, surgeries, lab tests, ER care, outpatient, dialysis, AMBULANCE fees (only paid for by part b), and preventive services (immunizations/tests)
Medicare part D
Only plan of medicare that will offer some coverage for prescriptions, but person still pays high out-of-pocket costs.
Supplemental Security Income
Offered to people who are 65+ years, blind, or disabled that can no longer work. They receive minimum income regardless of how long they worked and still pay high out-of-pocket costs b/c SSI is not an adequate income.
What was the goal of the Omnibus Budget Reconciliation Act of 1987?
To improve quality care given in nursing homes by developing minimum data sets (MDS) which are periodic assessments performed to verify is residents are receiving high quality care. If assessments are bad, government funding through medicare to the nursing home can stop.
Homelessness
an individual who does not have a permanent residence, address, or shelter. Homelessness is caused by multiple things- unemployment, drug addiction, domestic violence, veterans, deinstitutions, lack of social support, changes in the market, gentrification
Gentrification
Condemning of housing that is substandard, unsafe, and generally not occupied. This housing needs to be torn down. The problem is that poor/homeless people will live here and are forced out. They may be given little money in order to buy another house but the others are usually unaffordable
Neighborhood poverty
geographical area that is poor, usually with substandard housing, high drop out rates, single mothers in young age
Persistent poverty
poverty that lasts for generations
Primary, Secondary and Tertiary strategies provided to the poor/homeless
primary- prevent homelessness, refer for mental health Tx, various types of classes, needle exchange, safe sex education. Secondary- offering meals to the homeless and SOUP KITCHENS, alleviating factors of vulnerability that lead to disease. Tertiary- also includes needle exchange, and other interventions for people that have been homeless for a while.
