Unit 15 Study guide:



Unit 15: Nursing in a Variety of Settings:Chapter 96: Extended CareChapter 97: Rehabilitation NursingChapter 98: Home Care NursingChapter 99: Ambulatory NursingChapter 100: Hospice Nursing(References: Rosdahl, C. B, Kowalksi, M. T. ( 2017). Textbook of Basic Nursing ( 11th ed.). Wolters Kluwer / Summer Putt)Chapter 96: Extended CareExtended-Care Facilities:Extended-care facilities (ECFs)“Extend” or continue care started in the hospital ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Long-Term Care Facilities:The skilled nursing facility (SNF) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________The intermediate care facility (ICF) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Components of LTC Facilities:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Services Provided in Transitional Facilities:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Other Extended Care Options:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Goal of Quality Improvement Networks:Improve care, particularly for Medicare recipients___________________________________________________________Provide guidance for quality improvement for facility managers and staff (to improve care)___________________________________________________________Provide recommendations for training and/or certification of nonlicensed personnel Transitional Care:Transition of care (TOC) ______________________________________________________________________________________________________________Handover or handoff ______________________________________________________________________________________________________________The SBAR process______________________________________________________________________________________________________________Universal transfer form (UTF)Personal health record (PHR) SBAR Process:Situation: ___________________________________________________________Background: ___________________________________________________________Assessment: ___________________________________________________________Recommendations: ___________________________________________________________Ways to Prevent Rehospitalization:Ongoing education of clients and families about ___________________________________________________________Increasing the ability of clients/families to self-manage ___________________________________________________________Better discharge planning during ___________________________________________________________Medication reconciliationBetter communication between ___________________________________________________________Increased use of ___________________________________________________________Utilization of electronic medical records between facilities, ___________________________________________________________Better utilization of ___________________________________________________________Encouraging primary providers to be truthful with clients/families who have __________________________________________________________________________________________________________Chapter 97: Rehabilitation NursingRehabilitation:Rehabilitation__________________________________________________________________________________________________Long-term rehabilitation Short period of rehabilitation __________________________________________________________________________________________________Stages of Adjustment to a Disability:Early reactions______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Eventually, the client with permanent disability____________________________________________________________________________________________________________________________________________________________________________________________________The Rehabilitation Team:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Rehabilitation and Maslow Hierarchy of Needs:Principles of rehabilitation__________________________________________________________________________________________________Maslow hierarchy of needs______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Activities of Daily Living (ADLs):Paramount goal of rehabilitation____________________________________________________________________________________________________________________________________________________________________________________________________Functional ADLs (FADLs)__________________________________________________________________________________________________Nursing Considerations in Rehabilitation:Treatments to halt destructive processes and to repair body damagePrevents further injury and restores normal functions whenever possibleProvides clients with emotional supportScope of rehabilitation nursing practice__________________________________________________________________________________________________Skin Care:Risk for skin breakdown__________________________________________________________________________________________________Primary goal of all nursing care__________________________________________________________________________________________________A number of nursing measures related to skin care do not require a provider’s orderFall Assessment:A formal fall assessment should be done on each client on a regular basis, whether they are in a rehabilitation program or not The Hendrich Fall Risk Tool Elimination:Management of incontinence is a major factor in a person’s quality of lifeA person’s independence and ability to live at home, rather than being required to live in a healthcare facility, is directly related to the person’s ability to maintain continence____________________________________________________________________________________________________________________________________________________________________________________________________Some nurses specialize in continence care and set up programs for continence rehabilitationChapter 98: Home Nursing CareHome Care:Part-time, medically necessary skilled care ordered by a healthcare providerAssistance with activities of daily livingThe instrument/data collection tool (OASIS)__________________________________________________________________________________________________The National Association for Home Care (NAHC)__________________________________________________________________________________________________Types of Agencies and Services:Long-term home care__________________________________________________________________________________________________Children with special healthcare needs__________________________________________________________________________________________________Intermittent or short-term home care__________________________________________________________________________________________________Reasons for Home Care:To reduce unnecessary and avoidable rehospitalizations Quality indicators of home care__________________________________________________________________________________________________Avoidance of unnecessary rehospitalizations is vital for the home care agency to maintain its fundingFewer people are being admitted to hospitals, and those who are admitted are going home sooner, with more need for assistance at homeCharacteristics of Home Care:__________________________________________________________________________________________________New mothers may require assistance during the first few days at home.Some people receive their entire care at home.__________________________________________________________________________________________________Clients may not have family caregivers.__________________________________________________________________________________________________Telehealth; nurses use digital cameras to record information.Advantages of Home Care:__________________________________________________________________________________________________Nurses, support personnel, and primary caregivers can provide continuous care from hospital to home. __________________________________________________________________________________________________Home care agencies often provide hospice care.__________________________________________________________________________________________________The Role of the LV/LPN:Furnish services in accordance with agency policies.__________________________________________________________________________________________________Assist healthcare providers and RNs to perform specialized procedures.__________________________________________________________________________________________________Assist clients in learning appropriate self-care techniques.Chapter 99: Ambulatory NursingAmbulatory Healthcare:Ambulatory healthcare__________________________________________________________________________________________________Primary care provider (PCP)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________The Role of the Nurse:Routine client care Some of the other duties include ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Private Clinics:Private physicians or groups of physicians often practice in a clinic, which may be associated with hospitals or may be free-standing. Other professionals who work in these clinics include advance practice nurses, physicians’ assistants, general staff nurses (RNs, LPNs), and various specialists and office personnel. The Community/Family Health Center:The community/family health center (CHC or FHC)__________________________________________________________________________________________________Specialized populationsThe role of the advance practice nurse The Emergency Department and Emergi-Center:Emergency department (ED) or emergency room (ER) in hospitals__________________________________________________________________________________________________Urgent-care departments (urgi-centers)__________________________________________________________________________________________________Free-standing emergi-centers__________________________________________________________________________________________________Walk-in clinics not attached to hospitalsThe Same-Day Surgery or Ambulatory Surgery Center:Endoscopy, laser, fiberoptics, ultrasound, MRI, CT, and positron-emission tomography (PET/PETT) scans__________________________________________________________________________________________________Increased sophistication of local, spinal, and block anesthesia; client-managed pain-control pump systems __________________________________________________________________________________________________Specialized implant materials, joints or bone stabilization; external fixators, halo devices, and so onThe determination of candidates for ambulatory surgery is based on factors such as:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Benefits of same-day surgeryClient Criteria for Outpatient (Same-Day) Surgery:Class I__________________________________________________________________________________________________Class II__________________________________________________________________________________________________Class III__________________________________________________________________________________________________Electronic Health Record (EHR):The EHR greatly enhances communication between agencies and facilities. It improves client care and increases safety.Clients can access their own information and ask informed questions.__________________________________________________________________________________________________The EHR also allows clients to receive medications ordered by their provider when they are in a different part of the country, using a nationwide system, such as Walgreen’s.Chapter 100: Hospice NursingHospice:A philosophy of care__________________________________________________________________________________________________Physical and emotional comfort and quality of life __________________________________________________________________________________________________Goals of Hospice:Hospice care focuses on the human needs.__________________________________________________________________________________________________The goals of hospice are:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Characteristics of a Hospice:The hospice must be a centrally administered, autonomous program. __________________________________________________________________________________________________Team members should practice interdisciplinary care under a qualified healthcare provider’s direction, and consultation must be available at all times, day or night. __________________________________________________________________________________________________Hospice services must be extended to the family during the time of bereavement for at least 1 year; it must be based on a client’s needs.Respite Care:____________________________________________________________________________________________________________________________________________________________________________________________________Family caregivers should be encouraged to utilize respite services. In this way, they will be physically and emotionally better able to continue with the difficult task of caring for their loved one.Palliative Care: Symptom Management:Symptoms related to hospice care often span a longer period of time or require management different from that in other settings.______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________One philosophy of hospice is that suffering is not prolonged. Symptoms are managed as noninvasively as possible.Emotional Support:Fear of most clients____________________________________________________________________________________________________________________________________________________________________________________________________Hospice care______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Spiritual Support:Most hospice teams have chaplains available for consultation if clients are interested.Respect each client’s cultural and religious customs.Ask the client or family about desired procedures. Bereavement Care:Bereavement is part of the process of dealing with a loved one’s death.______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Support for Hospice Staff:Hospice staff members need emotional support when they regularly work with dying people. Support groups or other outlets must be available for team members to help deal with the loss of people for whom they have cared.Assisting the Hospice Client:Basic needs______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Insomnia and hypersomniaElimination__________________________________________________________________________________________________Personal care and comfort____________________________________________________________________________________________________________________________________________________________________________________________________Emotional concerns______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Pain Management:Evaluation of painPharmacologic therapy____________________________________________________________________________________________________________________________________________________________________________________________________Psychosocial and other nonpharmacologic modalities for pain managementPalliative radiation, medications, and surgeryChildren in Hospice Programs:Staff members must consider dying children in terms of their developmental levels and levels of understanding. Children usually understand what is happening, but need their questions answered truthfully. __________________________________________________________________________________________________Medication doses are adjusted according to a child’s size and reactions.When the Client Dies:Some nursing functions performed for a client who dies at home:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Summer Putt Study Guide (Need to Knows):UNIT 15: (Chapters 96, 97, 98, 99 & 100)What is a long-term care facility? What are some characteristics of LTC? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What services are provided in transitional facilities? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is SBAR? What does it stand for? What does it mean and how will you use it as a nurse?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How can we as nurses prevent rehospitalization? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is rehabilitation? Are there more than one time? Where can this take place?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How does Maslows hierarchy of needs play into rehab? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What does ADL stand for and what are ADL’s?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What are some nursing considerations with rehab? Skin Care? Fall assessment? Elimination?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is the role of the LPN in home care?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is the role of the LPN in ambulatory care?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What does EHR stand for and what is the EHR?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is hospice care? What is it based off of? When is care available? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is respite care? What is the purpose? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What does DNR, DNI and DNH mean? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How can you as a nurse offer emotional support? Spiritual support? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is bereavement care? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________In what ways can the nurse assist the hospice client? The basic needs…what are they? There are several…..________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What about children in hospice care? What is unique about children and hospice? How do you explain this to them? Does it matter to them? Developmental level is important….______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What are the nurses role/function when the client dies at home?___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ................
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