Test 5 Study Guide Flashcards
Reviewing the patient’s complete medication regimen at the time of admission, transfer, and discharge and comparing it with the regimen being considered for the new setting of care
Medication reconciliation
Key uses for medical record
- Describe information pertinent to the patient.
- Provide for continuity in information about patient treatment.
- Act as a method for evaluating quality of care.
- Serve as a basis for reimbursement.
- Function as a tool for evaluating resource allocation.
- Serve as a legal document.
Elements of a patient medical record (14)
- Progress Notes
- Physician Orders
- Discharge Summary
- Flow/Graph Sheets
- Lab reports
- Medication Administration
- Digital images/recordings
- Radiology Reports
- Monitoring Strips
- Admissions Sheet
- History/Physical Examination
- Consultation Sheet
- Consent Forms
- Surgical Records
Five characteristics that are consistent within HROs
(1) Their preoccupation with failure.
* (2) Reluctance to simplify interpretations.
* (3) Sensitivity to operations.
* (4) Commitment to resilience.
* (5) Deference to expertise.
National Patient Safety Goals (6)
- Identify patients correctly
- Improve staff communication
- Use medications safely
- Use alarms safely
- Prevent infections
- Identify patient safety risks
Patient confidentiality is protected by ____
Heath Insurance Portability and
Accountability Act (HIPPA)
Intended to ensure the privacy and protection of personal records and
data in an environment of electronic medical records and third-party insurance
payers.
HIPPA
provides a uniform set of guidelines that apply to all providers and
organizations
HIPPA
designed to intervene during the critical prearrest
period when patients often demonstrate clinical warning signs of pending
demise.
Rapid Response Team
Goals of rapid response team
Preventing intensive care unit transfer
* Preventing cardiac arrest
* Preventing death
should be conducted immediately before starting the procedure.
Time out
- During the time-out, the team members agree, at a minimum on:
The correct patient identity
* Correct site
* The procedure to be done.
a structured method
used to identify underlying problem issues or analyze
serious adverse events.
Root Cause Analysis (RCA)
The process was initially developed to help analyze industrial accidents but now is widely used in health
care to analyze errors.
Root Cause Analysis (RCA)
the most common complication of
hospital care
Healthcare-associated infections (HAIs)
How many deaths associated with HAI’s in the U.S. each year.
75,000
These Five infections together account for the majority of all HAI’s:
- Surgical site infections (SSI’s)
- Cather-associated urinary tract infections (CAUTI’s)
- Central line bloodstream infections (CRBSI’s)
- Pneumonia
- Gastrointestinal infections (Clostridium difficile associated disease (CDI))
On average, ___% of adults aged 65 and over have at least one chronic condition,
and ___% have at least two.
80% and 50%
Defined as the average number of years an individual is expected to live, either from birth
or the number of years remaining at any given age.
Life Expectancy
a multidimensional,
interdisciplinary diagnostic process to determine the medical, psychological,
and functional capabilities of a frail elderly person in order to develop a
coordinated and integrated treatment plan.
Comprehensive Geriatric
Assessment (CGA)
The elderly have a reduction in _____ gas exchange surface area
Alveolar
In the elderly, the alveoli ____, and Pores of Kohn become larger.
Dilate
Likely due to changes in elasticity in the parenchyma.
The central and peripheral chemoreceptors are less responsive to changes in
____ and ____
.
PaO2 and PaCO2
Response to low O2
or high CO2
in a 75 year-old is ____ that of a 25 year-old.
Half
The net effect is an overall decrease in ____, which increases the work of
breathing for older adults.
Compliance
- Such changes make breathing almost ___ as much work for a 70-year-old as for
a 20-year-old.
Twice
Respiratory _____ ____ also declines with age.
Muscle strength
Physical assessment findings in the
elderly
Increased A-P chest diameter:
* Lung and chest wall alterations.
* Decreased lung sounds:
* Natural restrictive process.
* Crackles in the bases:
* CHF, atelectasis.
* Increased pulse pressure:
* Atherosclerotic changes.
One unfortunate characteristic of patients with AD is that dementia robs them of
the ability to control their ____
Behavior
When AD begins to develop, the frontal part of the brains is damaged, and
subsequently destroyed, causing lack of ____ ____
Impulse Control
a noxious response to a medication that is unintended at doses usually
administered for diagnosis, prophylaxis, or treatment.
Adverse drug reaction
How to avoid adverse drug reactions
- Drugs which effectively treat a 40 year old, may not be indicated in an 80 year old.
- New drugs may be incompatible with the older adults current medications.
- The more medication a individual takes, the greater the risk for adverse reaction.
Health damaging lifestyle behaviors
- Tobacco use
- Excessive use of alcohol
- Limited physical activity
- Poor diet and nutrition
- Obesity
A report by the Department of Health and Human Services estimates that
___% of adults age 60 and older are taking two or more medications.
76%
____% of people use five or more prescription drugs.
37%
Issues related to geriatric pharmacotherapy
medication safety,
adverse drug events, inappropriate medication use, under- and
overprescribing, and the rising cost of drugs
Leading causes of mortality
- Cardiac
- Cerebrovascular
- Pulmonary diseases
- Musculoskeletal disorders
- Malignancies
The study of morality—careful
and systematic reflection on and analysis of moral decisions and behavior, whether
past, present or future
Ethics
“[A] preference or an inclination, especially one that inhibits
impartial judgment” or “an unfair act or policy stemming from prejudice
Bias
[A] judgment formed before due examination and
consideration of the facts—a premature or hasty judgment.”
Prejudice
based on duty and states that an act is right or wrong based on its intrinsic
character (duty) rather than on its consequences
Deontological theory
concerned with doing what is best, while also doing what is right
Deontological theory
means truth.
* This principle implies that therapists should tell patients the truth at all times.
Veracity
Remuneration, travel expenses, or honorariums one has received from vendors,
manufactures, or pharmaceutical companies must be disclosed.
These are examples of _____ ___ _____
Conflict of Interest relationships
ensures that the information entrusted to healthcare
professionals in the line of duty is not revealed to others except when
necessary to carry out their duties.
Confidentiality
both the most cherished and most violated of the ethical
principles and has become more difficult to maintain due to technologic
advances.
Confidentiality
based on consequences.
* The right or wrong of an action is based on the outcomes or consequences of
predicted outcomes.
Teleological theory
The most common consequential theory is _____ where one chooses
the act that brings about the best outcome.
Utilitarianism
Ethical Principles (8)
- Beneficence
- Capacity
- Nonmaleficence
- Veracity
- Autonomy
- Confidentiality
- Justice
- Role fidelity
one or more documents that are generally designed
by knowledgeable case managers, social workers, legal entities, or healthcare
agencies.
Advanced Directives
communicate a persons foresight and planning and
document their last wishes if they are unable to verbally direct their
treatment
Advanced Directives
Some things on an advanced directive
Medical treatment
* Resuscitation
* Nutritional support
* Other specifics related to their health and welfare.
Justice deals with fairness and equity in the distribution of scarce resources,
such as time, services, equipment, and money.
- How should limited healthcare resources be distributed?
Justice
states that all individuals should have equal access to goods
and services
Egalitarian theory of justice
states that the distribution of resources should be such that it
achieves the greatest good for the greatest number of individuals
Utilitarian theory of justice
means charity or mercy:
Imposes the responsibility to seek good for the patient under all
circumstances.
Beneficence
