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Foundations of Nursing 6th ed. (Exam 8) ch.11 - Admission, Transfer, and Discharge

Terms in this set (43)

Admission
-entry of a patient into the health care facility
AMA (Against Medical Advice)
-when a patient leaves a health care facility without a physician's order for discharge.
-if the physician fails to convince the patient to remain in the facility, the physician will ask the patient to sign an AMA form, releasing the facility from legal responsibility for any medical problems the patient may experience after discharge.
Continuity of Care
-continuing of established patient care from one setting to another.
Discharge
-release of a patient from a health care facility.
Discharge Planning
-the systematic process of planning for patient care after discharge from the hospital. Begins shortly after admission.
Disorientation
-mental confusion characterized by inadequate or incorrect perception of place, time, and identity.
Empathy
-ability to recognize and , to some extent, share the emotions and states of mind to another and to understand the meaning and significance of that person's behavior.
Health Care Facility
-agency or institution that provides health care.
Home Health Agency
-an organization that provides health care in the home.
Separation Anxiety
-fears and apprehension caused by separation from familiar surroundings and significant people.
Third-party Payors
-entitles (people or elements) other than the giver or receiver of service responsible for payment, e.g. Medicare or insurance company.
Transfer
-moving a patient from one unit to another (intraagency transfer) or moving a patient from one health care facility to another (interagency transfer).
SPC
-Special Care Unit
ICU
Intensive Care Unit
CCU
Coronary Care Unit
Patient Self-Determination Act of 1991
-patients being admitted to a Medicare- and Medicaid-recipient facility are required to be made aware of their right to accept or refuse medical treatment and to receive information on advance directives.
HIPAA (Health Insurance Portability and Accountability Act)
-a federal mandate that ensures the privacy of the patient's protected health information (PHI)
-patients are informed of their privacy rights
-requires that facilities only use or disclose PHI for the purpose of treating and payment
-only health care providers directly involved in the care of patient are given info, at need-to-know basis
-patients have right to gain access to their records, request amendments to PHI, request restrictions or record of all PHI disclosures
Inter-agency
-transferring a patient from one facility to another facility
-ex. hospital to a nursing home
-inter= place/facility to a different place/facility
Intra-agency
-transferring a patient from one area with a facility to another are within the facility
-intra= unit/same facility to unit/same facility
Transferring a patient
-the patient transfer requires a thorough preparation and careful documentation before, during, and after a transfer to ensure continuity of care.
-preparation: explain transfer to patient and family, discuss the patients condition and plan of care with the staff of the receiving unit or facility, arrangements for transportation
-obtain a set of vital signs, assessment and give report to the person accepting the patient
Discharge planning instructions
-ideally, discharge planning begins shortly after admission
-teach the patient and family about the patients illness and its effect on his or her lifestyle
-provide instructions for home care
-communicate dietary or activity instructions
-explain the purpose, adverse effects and scheduling of medication to be taken
-complete a medication reconciliation form at the time of discharge
-often includes arranging transportation
-follow up care may be necessary
-coordinate outpatient or home care services
-the nurse assists the patient pack belongings and dress to go home.
Risk factors for discharge planning
-older adults
-multi-system disease process
-major surgical procedure (risk for infection)
-chronic or terminal disease
-emotional or mental disability
Discharge summary
-includes patients learning needs, how well they were met, patient teaching completed, short and long term goals of care, referrals made
Referrals for Health Care services
-a patient may require the services of various disciplines within a hospital
-a patient may require the services of outside healthcare agencies
-the nurse is often the first to recognize the patient's needs
-referrals should be made ASAP after the patients ned is identified
-a physicians order is needed for a referral

Various Health Disciplines:
-dietician
-social worker
-PT
-OT
-speech therapist
-clinical nurse specialist
-Home health care nurse
Maslow-Safety
-fear of the unknown, which causes insecurity
Maslow-belonginess & love
-separation anxiety & loneliness
Red Band
-alert personnel to patient allergies
Health History
-reason for admission: signs & symptoms
-past illnesses
-surgical procedures
-hospitalizations
-medications (prescriptive & non-prescriptive)
-allergies (food, medication, other)
-eating habits
-urinary & bowel patterns
-sleep routine
-activity & exercise habits & routine
-language spoken
-family members & significant others
-home situation, interest, abilities, ADLs, occupation
Initial assessment
-level of consciousness
-vital signs
-height & weight
-breath sounds
-bowel sounds
-range or motion
-condition of skin
-vision
-hearing
Critical Condition
-moved to special care areas (ICU & CCU)
Improved Condition
-moved from special care are to general care area or step-down unit
Transfer Preparation
-explanation of transfer to patient & family
-discussion of patient's condition & plan of care with the staff of the receiving unit or facility, arrangements for transportation
Discharge Purposes
-teach patient & family about patient's illness & effect on their life style
-provide instructions for home care
-communicate dietary or activity instructions
-explain purpose, adverse effects, scheduling of medication treatment
-include arranging for transportation, follow-up care, coordination of outpatient or home health care services
Good Discharge Planning
-involves patient form the beginning
-uses strengths of patient in planning, provide resources to meet the patient's limitations
-focused on improving the patient's long-term outcome
Transitional Specialist
-begins discharge planning & makes home visit before the patient is discharged
Discharge Summary
-includes patient's learning needs, how well they have been met, the patient teaching completed, short- and long-term goals of care, referrals made, and coordinated care plan to be implemented after discharged
Dietitian
-providers proper nutrient and food source requirements in patient's diets
-instructs patients on meal planning and diet restrictions
Social Worker
-provides counseling for major life crises (e.g.terminal illnesses, family problem)
-assists in finding community resources
-assists in finding financial resources to cover medical costs
Physical Therapist
-assists in the examination and treatment of physically disabled or handicapped people
-assists in rehabilitating patient sand restoring musculoskeletal function to a patient's greatest potential
Occupational Therapist
-teaches patients to adapt to physical handicaps by learning new vocationalist skills or ADLs
Speech Therapist
-assists patients with disorders affecting normal oral communication
Clinical Nurse Specialist
-consults with nursing staff on appropriate nursing interventions for complex nursing diagnoses
-provides instructions to patients and family members who will assume patient care
Home Health Care Nurse
-provides follow-up discharge visits to a patient's home for the delivery of nursing services
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