Chapter 16 Patient Care Settings

Answers CHAPTER 16 PATIENT CARE SETTINGS AUDIO CASE STUDY Shawn and Home Health Care 1. Consider each visit’s purpose—including timing of needed task, complexity, and required length of time—and location to make the best use of the time and mileage; consider if the visit is with a new patient or prior patient, as new patients take longer to meet. 2. Vegetables that are high in vitamin K, such as dark green leafy vegetables like spinach and broccoli should be eaten in consistent amounts rather than alternating amounts to prevent affecting the established therapeutic INR/PT level when on Warfarin therapy. Since vitamin K is the antidote for Warfarin, ingesting large amounts of it in vegetables could lower the therapeutic levels of INR/PT. 3. Using the Internet to map the addresses for the home visits, the nurse can identify dangerous areas and can review and implement safety checks. These checks include parking on the street rather than in a shared driveway, keeping car and tires in good repair with a full tank of gas, being aware of surroundings, carrying a map and a whistle, having cell phone battery charged, calling into agency before leaving the car to let them know the location, checking the location of the home’s exit doors and windows, and having car keys out when walking to and from the car. VOCABULARY 1. (6) 2. (4) 3. (5) 4. (3) 5. (7) 6. (2) 7. (8) 8. (10) 9. (1) 10. (9) 11. (14) 12. (15) 13. (13) 14. (11) 15. (12) HOME HEALTH CARE SERVICES 1. (3) 2. (5) 3. (4) 4. (2) 5. (1) 6. (8) 7. (6) 8. (7) PATIENT CARE SETTING LPN/LVN DUTIES 1. (4) 2. (1) 3. (5) 4. (3) 5. (4) 6. (3) 7. (1) 8. (5) 9. (2) 10. (1) 11. (3) 12. (6) 13. (2) 14. (4) 15. (2) CRITICAL THINKING 1. Four times per week for 4 weeks. 2. Dressing changes, reinforcement of medication teaching that includes relationship of medications to blood glucose monitoring and vital sign monitoring, and oxygen (O2) therapy precautions. 3. “No smoking” signs need to be posted because Mrs. Thompson is receiving O2 therapy. The environment needs to be checked for potential safety hazards, including long O2 tubing, scatter rugs, and inadequate lighting. Mrs. Thompson’s need for assistive devices should be identified. 4. Yes, including social services such as Meals on Wheels; occupational therapy and physical therapy for strength training and identification and instruction of assistive devices; and a home health aide for assistance with activities of daily living. 1 2 Chapter 16 Answers REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (1, 2, 3, 4, 6) are correct. (5) is incorrect. Lawyers are not part of the health care team. 2. (4) is correct. Patients are in control in their own homes. (1, 2, 3) are incorrect. Only the patient is in control. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 3. (1) is correct because it shows caring, understanding, and insight into the patient’s needs. (2, 3, 4) are incorrect. (2) is part of the process for making a visit but does not influence trust. (3) should be done as needed as part of providing nursing care but does not influence trust. (4) reflects confidentiality requirements, but others may be included with patient’s permission, such as family members and other health care team members involved in the patient’s care. 4. (4, 5, 6) are correct and are general safety measures for any person who is ambulating. (1, 2) are incorrect, as the patient may need to get out of bed or ambulate when others are not there; the means to do so safely should be provided. (3) is not a skilled nursing function. If there are concerns with housekeeping, it can be discussed with family and possibly addressed with other services. 5. (2) is correct. (1, 3, 4) are incorrect because they promote the risk of infection. 6. 0.8 mL is correct. 7. (2, 3, 4, 5) are correct to promote learning. (1) is incorrect because information should be provided in brief, organized concepts to allow learning and retention. 8. (1) is correct so that the registered nurse can perform an assessment and determine an appropriate plan of action. (2, 4) are not correct because it is inappropriate to direct the patient as to what to do in the patient’s own home, and washing the dishes is not the nurse’s function. (3) is not correct because this is an assumption that may not be true and requires assessment by the registered nurse. 9. (1, 3, 5, 6) are correct. (2) is not usually possible, so a time range should be given. (4) is not done for safety so that the nurse’s car is not blocked in. 10. (1, 2, 3, 5) are correct. The nurse should perform a complete patient assessment during each visit. Assess the home environment for potential safety hazards and need for devices to assist with care. (4) is incorrect. Collecting a urine sample is not ordered or necessary. 11. (2, 3, 5) are correct. Preparation and organization are essential to providing timely, excellent care. (1) is incorrect. There are differences between home health care and hospital nursing. Patients are in control in their own homes; in home health care, the nurse has more autonomy; and the same resources are not readily available. (4) is incorrect. Over time, the nurse will develop skills to adapt to variabilities found across homes. 12. (4) is correct, as the spouse is the patient’s caregiver. (1, 2, 3) are incorrect, as they affect the patient. 13. (2, 3, 4, 5, 6) are correct for medical office duties. (1) is incorrect, as the licensed practical nurse/licensed vocational nurse contributes rather than develops the plan of care; that is the role of the registered nurse. 14. (1, 2, 4, 5) are correct things the nurse must learn related to the special setting and patient population as well as institutional polices. (3) is not correct, as precertification, not postcertification, is a duty for the nurse. (6) is a skill that the nurse would already know and not learn during an orientation. 15. (1, 2, 3, 5, 6) are correct. Long-term care services can be provided in all of these settings. Most occur in the patient’s home. (4) is incorrect, as hospitals provide acute care. 16. (2) is correct. Reducing noise in the environment is important. (1) is incorrect, as adequate lighting is required for safety. (3) is incorrect because it would reduce sensory input, which can lead to delirium. (4) is incorrect, as that contributes to noise rather than reduces it. 17. (1, 2, 3, 4) are correct. They can all assist the patient to remain strong and therefore prevent falls. (5) is incorrect. Calcium should be increased to maintain strong bones and prevent falls.