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L&E Chapter 001 Lo
- 1. Lesson 1.1 Chapter 1 Caring for Medical-Surgical Patients
- 2. Learning Objectives 1.Identify 10 sites of employment for licensed practical/vocational nurses (LPN/LVNs) in medical-surgical nursing. 2. Describe each of the roles of the LPN/LVN. 3. Explain the difference between a health maintenance organization (HMO) and a preferred provider organization (PPO). 4. Differentiate between Medicare and Medicaid in the areas of eligibility and services provided. 5. Describe how hospitals are reimbursed under the diagnosis-related group (DRG) system of Medicare. 6. Discuss four factors that contribute to rising health care costs. 7. Explain how Healthy People 2010 could decrease health care costs as a health promotion and prevention of illness strategy. 8. Define and explain the importance of holistic care. 9. Explain how the nurse-patient relationship is established. 10. Discuss how psychological, social, cultural, and spiritual needs are incor- porated in the LPN/LVN’s plan of care. 11. Provide a general description of depressed and manipulative behavior. 12. Identify the relationship of unmet needs to withdrawn, dependent, hostile, and manipulative behavior. 13. Describe two nursing interventions to meet needs of patients exhibiting each of the following types of behavior: dependent, withdrawn, depressed, hostile, and manipulative.
- 3. Employment Opportunities ofLPN/LVN in Medical-Surgical Nursing Acuity State’s nurse practice act (NPA) Scope of practice
- 4. Roles of theLPN/LVN Uphold clinical standards. Provide safe patient care. Teach patients. Communicate effectively. Be a collaborative member of the health care team. Advocate for the patient.
- 5. Expanded Role ofLPN/LVN Charge Nurse/Manager of Care Delegating and Assigning Right Task Right Circumstances Right Person Right Direction/Communication Right Supervision
- 6. Delegating Transfer tocompetent unlicensed assistive personnel (UAP) the responsibility to perform a selected nursing task/activity in a selected patient situation that is within the job description of the LPN/LVN.
- 7. Assigning Distribution ofwork = Directing a UAP to do nursing tasks/activities within his/her job description.
- 8. Assigning and Delegatingby the LPN/LVN Charge Nurse Are tasks/activities in nursing assistant's job description? May nursing assistant refuse nursing task/activity? What accountability is held for nursing task/activity?
- 9. When the LPN/LVNCharge Nurse Delegates Provide unlicensed personnel with the necessary information, assistance, equipment, and monitoring to safely carry out the delegated task/activity. The charge nurse is ultimately responsible for deciding if and when to delegate, what to delegate, to whom , and under what circumstances .
- 10. When the LPN/LVNCharge Nurse Delegates Ask unlicensed personnel to do part of the job to free you up to perform other responsibilities with the goal of improving resident care and meeting resident goals (outcomes). Remember these personnel must voluntarily accept the delegation.
- 11. Health Care FinancingTypes of Health Care Financing Deductible Copayment Co-insurance Capitation
- 12. How Patients Payfor Health Care Services Group health insurance Managed care Health maintenance organization (HMO) Preferred provider organization (PPO)
- 13. Health Maintenance Organization (HMO) Prepaid fee for comprehensive care Exclusive buildings and physicians Practice of preventive medicine Discourages excessive diagnostic tests and treatments Limited option of choosing physician Point of service (POS)
- 14. Preferred Provider Organization(PPO ) Alternative to the strict utilization review system Fee-for-service Negotiated discount fees Better health coverage with preferred providers in the network Physicians engage in both private practice and PPO
- 15. Medicare Part A Helps pay for inpatient hospital care Available without cost to eligible individuals Helps pay for inpatient hospital care: drugs, supplies, laboratory tests, radiology, and intensive care unit Covers 20 days posthospitalization for skilled nursing facility care for rehabilitation services, home health care services under certain conditions, and hospice care Does not pay for nursing home custodial services, private rooms, telephones, or televisions provided by hospitals or skilled nursing facilities
- 16. Medicare Part BRequires a deductible and pays 80% of most covered charges The patient is responsible for the remaining 20% For medically necessary health services Does not pay for most prescription drugs, routine physicals, services not related to treatment of illness or injury, dental care, dentures, cosmetic surgery, routine foot care, hearing aids, eye examinations, or glasses
- 17. Medicare Part CMedicare Advantage plans, such as HMOs or regional PPOs Provides Parts A, B, and D benefits to people who elect this type of coverage instead of the original fee-for-service program
- 18. Medicare Part DOutpatient prescription drug benefit Available to all Medicare enrollees in the original fee-for-service program for an additional monthly fee
- 19. The Medicaid ProgramState Children’s Health Insurance Program (SCHIP) supplements Medicaid for children of low-income families Primary source for low-income individuals with disabilities or chronic illnesses and those who need mental health services and substance abuse treatment Does not cover low-income Medicare beneficiaries, including for long-term care and vision and dental care Dual eligible
- 20. Goals for HealthCare Need for cost containment Healthy People 2010 and health promotion Holistic care of medical-surgical patients
- 21. Healthy People 2010: Ten Leading Health Indicators Physical activity Overweight and obesity Tobacco use Substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality Immunization Access to health care
- 22. Goals for HealthCare: Psychological Needs Nurse-Patient Relationship Show empathy Establish therapeutic relationship Establish trust Use therapeutic communication skills Maintain patients’ self-esteem Display nursing competence Display compassion
- 23. The Patient withDependent Behavior Spend time with the patient Establish trust Anticipate needs and wants Assure patient that needs will be met if not medically contraindicated Focus on the patient’s abilities Encourage independence Praise matter-of-factly Set limits
- 24. The Patient withWithdrawn Behavior Provide a consistent routine of care Reduce environmental stress Limit the number of health care providers with whom the patient must interact Be alert to personal space needs Avoid whispering, secretive behavior, teasing, and joking
- 25. The Patient withDepressed Behavior Sit quietly next to the patient Encourage and assist patient engagement in activities of daily living Be aware that the pace of work will be slower Give directions for diagnostic tests one at a time
- 26. The Patient withDepressed Behavior Offer patient sincere feedback Sincerely emphasize patient’s good qualities Avoid stories that illustrate that the patient’s situation could be worse Avoid being bright and cheerful in the patient’s presence Take threat of suicide seriously
- 27. The Patient withHostile Behavior Talk to the patient Listen and intervene as appropriate Allow patient who is hostile to make reasonable suggestions and choices about his/her care Meet appropriate patient suggestions Avoid empty promises
- 28. The Patient withManipulative Behavior Avoid being flattered by compliments Tell patient to ask directly when they need something Assure the patient that all direct, reasonable requests will be considered
- 29. The Patient withManipulative Behavior Make plans with the patient Take any threat of suicide seriously Avoid becoming defensive Avoid trying to impress upon the patient how busy you are with other responsibilities
- 30. Goals for HealthCare Social needs Cultural needs: Nonjudgmental Stereotypes Biomedicine Spiritual needs
Editor's Notes
- #4 How does acuity increase the demand for more nurses in the health care environment ? What is the difference between the scope of practice of an RN and an LVN ? Where do you get a copy of the scope of practice for an LVN/LPN ?
- #5 How are these roles indicated in the state’s scope of practice for the licensed practical/vocational nurse? What is the role of the LPN/LVN regarding working with other health care providers, such as nursing aides, registered nurses, physical therapists? How does the LVN/LPN advocate for the patient in your specific work environment?
- #6 Give examples of how the LVN/LPN can delegate a specific task. Give examples of how the LVN/LPN can assign a specific task. Can an LVN/LPN become a charge nurse? Under what circumstances?
- #7 Based on the five rights of delegation, identify a specific task that the LVN/LPN can delegate to the nursing assistant. How do you ensure that the task delegated is completed? Can an LVN/LPN delegate to another LVN/LPN? Can an LVN/LPN delegate to a registered nurse?
- #8 What are some of the considerations in making patient assignments in your work setting? How are disputes regarding patient assignments resolved in the work settings? Identify specific situations that warrant a change in patient assignment during the shift.
- #9 What is included in the job description of the nursing assistant in the work setting? If a patient states that the morning bath really isn’t wanted right now, what are some of the appropriate actions by the nursing assistant? The nursing assistant assists with personal hygiene, performs ordered treatments, initiates nursing interventions, and administers medications. The LVN/LPN would question which action by the nursing assistant?
- #10 Differentiate delegation from assignment? Delegation is transferring to competent unlicensed assistive personnel (UAP) the authority to perform a selected nursing task/activity in a selected patient situation that is within the job description of the LPN/LVN. To assign is to direct a UAP to do nursing tasks/activities within his/her job description.
- #11 Delegation is a voluntary function. Not all states allow LPN/LVNs to delegate nursing tasks/activities and state nurse practice acts (NPAs) vary greatly concerning delegation.
- #12 Provider = A licensed health care provider such as a physician, dentist, or nurse practitioner whose health care services are covered by a health insurance plan Compare and contrast deductible, co-payment, and co-insurance? Deductible = The yearly amount an insured person must spend out-of-pocket for health care services before a health insurance policy will begin to pay its share Co-payment = The amount an insured person must pay at the time of an office visit, prescription, or hospital service Co-insurance = Once a deductible is met, the percent of the total bill paid by the insured person. The insurance company pays the remainder Capitation = An alternative for fee-for-service payment; it involves a set monthly fee charged by the provider of health care services for each member of the insurance group for a specific set of health care services
- #13 Explain: “The young and the healthy generally subsidize (support) the sick and older persons in the health insurance group.” What is “third-party coverage”? Third-party coverage = A financial middleman who pays the individual's health care bills What is the utilization review system? How is it utilized to manage health care costs?
- #14 Point of service (POS) option allows a member to go outside the HMO to see a desired physician for an extra fee . List the advantages and disadvantages of the health maintenance organization. Is this a cost-effective system?
- #15 List the advantages and disadvantages of the preferred provider organization. Is this a cost-effective system?
- #16 Medicare Federal program that helps to partially finance health care for all persons over age 65 years (and their spouses), who have at least a 10-year (40 quarters) record in Medicare-covered employment Citizens or permanent residents of the United States Under age 65 who are victims of end-stage renal disease or who are permanently and totally disabled What are the ethical implications of Medicare?
- #17 What is a deductible? What are the advantages and disadvantages of prescription drug coverage?
- #18 What is a “fee-for-service” program? What are the advantages and disadvantages of extended health coverage?
- #20 Define “dual eligible.” Medicaid = State budgets and covers over 39 million low-income children and parents in working families Compare and contrast Medicare and Medicaid.
- #21 What are the ethical implications of cost-containment? What is Healthy People 2010? Healthy People 2010 is a nationwide health promotion and disease prevention agenda to improve the health of all Americans in the United States during the first decade of the 21st century. It includes a set of health objectives based on best scientific knowledge. Healthy People 2010 has the potential to affect the health of all Americans and reduce health care costs. What is holistic care? Holistic care involves dealing with the total person. Nurses need to be aware of the physiologic, psychological, social, cultural, and spiritual needs of patients.
- #22 How can the nurse help achieve the ten leading health indicators?
- #23 Empathy means the nurse accurately perceives the patient’s current feelings and their meanings but does not experience the emotion with them. Differentiate between a therapeutic nurse-patient relationship with a social relationship. The focus of the nurse-patient relationship is the patient and his/her problems and needs. The relationship is therapeutic because it provides the help needed for healing or return to wellness of the patient. A social relationship is not goal-directed, exists primarily for pleasure, and meets the needs of each person in the relationship. What is the importance of nurse competence? Nurses, who are competent in their skills, build patient’s confidence and this decreases patient anxiety.
- #24 What are the characteristics of a patient with dependent behavior? Unreasonably demanding of the nurse's time and attention Show little or no initiative in performing the simplest of self‑care activities Exhibit flirtatious behavior to attract attention to self
- #25 What are the characteristics of the patient with withdrawn behavior? May exhibit silence Failure to make eye contact Recoiling from touch Superficial conversation without any self‑disclosure or sharing of feelings Denial of feelings Denial of reality such as their own illness and its effects on their lives
- #26 What are the characteristics of the patient with depressed behavior? Loss of appetite, fatigue Vague aches and pains Insomnia Poor posture Gazing into space and difficulty making decisions
- #27 A nursing assistant demonstrates upbeat behavior while dealing with a patient with depressed behavior. How would you approach the situation to provide a therapeutic environment for the patient? How would you determine the seriousness of a patient’s threat of suicide? A patient was diagnosed with a terminal disease. How would you approach the patient?
- #28 What are the characteristics of a patient with hostile behavior? The patient with hostile behavior may shout, criticize, threaten to "report" the nurse, and constantly complain about the care provided. Some may strike out physically. Some may turn anger towards themselves and may attempt to hurt themselves. A nurse indicated that the patient with hostile behavior would be discharged by the physician before the end-of-the shift. As an incoming nurse, you realized that the physician opted to keep the patient for at least one more night. How would you approach the patient? The family expressed dissatisfaction with the care of their loved one. How would you, the nurse, help alleviate the mounting frustration and potential for a hostile reaction by a family member?
- #29 What are the characteristics of patients with manipulative behavior? A patient compliments the nurse for being attentive to the patient’s needs. List appropriate nursing actions. A patient reminds you of someone you know personally. How would this affect your nursing care?
- #30 The nurse is beginning to demonstrate defensive behaviors toward the patient. List appropriate nursing actions to alleviate the nurse’s mounting frustration or anger. While juggling admissions and discharges during a busy shift, how could a nurse meet the needs of the patient with manipulative behavior? The patient said, “If you do not do this for me, I will kill myself.” What are appropriate nursing actions?
- #31 Discuss how the nurse meets the social, cultural, and spiritual needs of the patients in an acute care setting. Give examples of judgmental behaviors you observed during your clinical rotations. Define “stereotype.” A stereotype is a simplification used to describe all members of a specific group without exception. Compare and contrast spirituality and religion.