Chapter 9: Care Coordination and Continuity in Health Care Settings and the Community

Which type of home healthcare agency is a local health department?

Official or public agency

Lately there have been many significant changes in the healthcare delivery system; earlier hospital discharges is one of them. What is one result of earlier hospital discharges?

Patients with high home care needs are being discharged into the community.

Which of the following measures should a home health care nurse implement into his or her practice to minimize the potential for lawsuits?

Perform thorough, accurate, and timely documentation.

On admission to the hospital, patients are asked if they have a living will or a durable power of attorney. If not, the admitting staff person will provide a sample form to the patient if they want it. The purpose of this inquiry is to determine:

if they have a document describing their wishes for care when they are no longer able to make their own decisions.

Public health nursing is the branch of nursing that:

provides healthcare for the community.

Client education is a major nursing responsibility. The education that the nurse must accomplish prior to discharge includes what?

• A review of appointment schedule for follow-up care. • When to take medications, purpose, side effects, and appropriate administration. • A family member's practice of dressing changes. • information about home care/physical therapy with appropriate phone numbers.

Which of the following is the largest single source of reimbursement for home health care services?

Medicare

A 16-year-old girl has been injured in an accident and is receiving home care due to fractures and multiple trauma related injuries. She states, "I don't know why I survived and not my best friend." It is most important to

Communicate her feelings to family and friends

Which role is the home health nurse exhibiting when demonstrating how to suction the oropharynx of the client?

Educator

A registered nurse is providing community-based health care for a client and family. Which of the following would be most important for the nurse to do?

Encourage active participation of the client and family in health care decisions.

The nurse is assigned to care for a middle-aged client who is very agitated and wants to go home. The client states that he does not have time to waste in the hospital, and no one is doing anything anyway. Which action by the nurse is most appropriate if the client insists on leaving the hospital against medical advice (AMA)?

Have the client sign the AMA form.

A client is having an increasing amount of difficulty caring for herself in her home alone. She states to the nurse, "I need more help. What am I going to do?" What would it be important for the nurse to do?

Have the social worker visit to discuss care options

A woman living alone has degenerative joint disease, hypertension, and neuropathy. It is difficult for her to bathe herself, and her blood pressure is unstable. What type of care would this client benefit from most?

Home care

In preparation for discharge, the nurse is reviewing information related to new dietary guidelines with the patient. This is an example of which step in discharge planning?

Providing patient teaching

A client visits the healthcare facility, where the nurse provides primary healthcare. Which of the following services would the nurse most likely provide?

Screening

Nurses now have the option to practice in a variety of settings. One of the fastest growing venues of practice for the nurse in today's health care climate is home health care. What is the basis for the growth in this health care setting?

The discharge home of patients who are more critically ill.

It is important for home healthcare nurses to remember which point?

The nurse is the guest in the patient's home.

A home care nurse has completed a home assessment. Of the following findings, which should be reported to service providers immediately?

The smell of natural gas

A nurse is caring for a 17-year-old pregnant woman who needs to obtain assistance with essential baby items, such as a crib. The client mentions that she does not have any income from a job. The nurse should encourage the client to go to a

social welfare office.

The nurse is assigned to care for an elderly stroke client who will soon be going home. When the nurse is actually doing the discharge planning, what it the nursing priority?

• Plan reachable goals with the client and family.

A nurse is using the ISBARQ (introduction, situation, background, assessment, recommendation, and question and answer) framework for handoff communication. Which examples accurately represent this process? (Select all that apply.)

• The individuals involved in the process identify themselves, their roles, and their jobs. • The nurse reports the patient's vital signs, mental and code status, medications, and lab results • The nurse explains the patient's chief complaint, diagnosis, treatment plan, and patient wants and needs. • The nurse reports the current provider's assessment of the patient and need for further services.

A nurse working in a hospital setting is responsible for transferring patients. Which recommended nursing actions would the nurse perform during this process? (Select all that apply.)

• The nurse asks the family of a patient moved to a critical care unit to take home the patient's personal belongings. • The nurse carefully packs the belongings of a patient being discharged and sends them to the new facility. • The hospital nurse prepares a detailed assessment and care plan to send to the long-term facility to which a patient is transferred.

You are assigned to care for an elderly stroke patient who will soon be going home. Discharge planning is accomplished best when the nurse:

• assesses the needs of the patient and family throughout the hospitalization. • collaborates with the healthcare team to obtain referrals the patient will need. • teaches the patient and family about medications and treatments. • supports the caregivers as they adjust to the discharge

The admission of the patient includes a health history and complete assessment. The admission data is entered into the patient's health record. Objective assessment information includes:

• vital signs, height, and weight. • abdomen soft to palpation.