COPE Health Scholars Written Exam, questions and answers

COPE Health Scholars Written Exam, questions and answers What do you check for after log-rolling a patient? Bedsores Things to remember when ambulating a patient Check outside door for "High Fall Risk" sign. Check for yellow socks, indicating high fall risk. Ask 3 questions: Have you walked within the last 12 hours? Have you walked on this floor before? Where would you like to walk? Ask the patient if they are dizzy when you help them stand up from the bed. Report to the nurse the distance walked and the patient's overall mobility/speed. Things to remember when positioning a patient Never leave the bedside unattended without putting up the rails. Never have 4 rails up at a time, even for a second. Ask the CNA to put down a rail, and you should immediately put up your rail. When log-rolling the patient, ALWAYS check for bedsores. Things to remember when making an occupied bed Always change gloves before handling clean bed-sheets, pillow cases, etc. Always check for bedsores when log-rolling the patient. Wipe down the mattress and pillow with Sani-wipes, and leave for 2 minutes. Tuck clean linen UNDERNEATH dirty linen. Things to remember when toileting a patient Close the curtains to ensure patient privacy. Catch the filled bedpan when log-rolling the patient to prevent spillage. Wipe from front to back, with one wipe per swipe. Check for bedsores when log-rolling. Change the trash bag after depositing used wipes. Things to remember when bathing a patient Close the curtains. Ask the patient whether the water is too hot. Use the backhand technique when washing underneath the breasts. Always change wipes after washing the genitals, the legs, the back, and the anal area. Things to remember when transferring a patient from the bed to the wheelchair Wipe the wheelchair before and after use. Lock the wheelchair. Ask the patient if they're dizzy after doing the swivel technique and after helping them stand. Ask the patient if they have left any of their belongings in the room. Check out with the HUC on the floor. Mention the HCAHPS survey to the patient. Things to remember when transferring a patient from bed to gurney Make sure the bed and gurney are locked at the appropriate times. Make sure enough rails are up at the appropriate times. Always check for bedsores when log-rolling. Ask the patient to lift their head and legs during the transfer from bed to gurney. Things to remember when feeding a patient Check for an NPO sign outside the room. Check the patient's tray for their name. Look out for pockets of food and other signs of aspiration. Feed the patient slowly to avoid aspiration. Leave the patient upright for 30 minutes to aid in digestion. Report amount or percent of food and drink consumed by the patient. Ask the nurse if she would like to see the tray before disposing of its contents. Things to remember when taking a patient's vital signs The tubing of the blood pressure monitor should be along the inner arm. The tubing of the pulse ox should be on the top. The red light of the pulse ox should be on the top of the fingernail. The pulse ox should be placed on the opposite arm as the blood pressure monitor. Rolling machines should be wiped down, since they're transportable. The temporal thermometer should be wiped down with alcohol wipes. When the pain level is high, ask if it's a new pain and where it's located. AIDET ACKNOWLEDGE the patient. INTRODUCE yourself as a Health Scholar. DURATION of task should be communicated. EXPLAIN the task as you're doing it. THANK the patient. SKAHI SIGNS outside the door. KNOCK on the door. ASSESS patient surroundings to understand their state. HAND HYGIENE (gel and gloves). IDENTIFY the patient in 2 ways. HCAHPS Survey: Hospital Consumer Assessment of Healthcare Providers and Systems Measures: - Environment cleanliness* - Environment quietness* - Nurse communication - Physician communication - Communication about pain* - Communication about medications - Responsiveness of hospital staff* - Discharge information* - Transition of care - Overall hospital rating - Likely to recommend Program Manager number to report incidents Incident Unexpected or unanticipated event that needs to be reported. 1. Tell the charge nurse. 2. Call the program manager. Ex: patient/visitor fall Injury Any physical, mental, or emotional harm that you undergo at the hospital. 1. Tell charge nurse. 2. Get first aid. 3. Call Program Manager Ex: harassment, needle stick Mandatory reporting Reporting of suspicious events or behavior to authorities. Are Health Scholars mandatory reporters? Not according to law, but yes according to COPE policies. Report suspicious behavior to staff member or COPE staff member. What 4 things are Health Scholars required to report? Child abuse, domestic abuse, elderly abuse, harassment Where to report codes Dial 6464 Name, location/campus Code Gray Combative/disruptive patient confronting staff. Go to location of patient. Code White Child/ Pediatric CPR. Follow instructions from nurse Code Red Fire. Call code when you see smoke or fire. Close all doors. Follow RACE RACE RESCUE ALARM CONFINE EXTINGUISH Code Blue Adult medical emergency (14+). Follow instructions from nurse. Code Orange Hazardous material spill. Block off area. Do not clean. Code Pink Infant abduction. Guard entrance/exit. Look for suspicious items Nurses must use bassinets. Visitors must have badge. Code Purple Missing child patient. Report to security/public safety. Look for suspicious situations. Code Yellow Bomb threat. If called, get information about location, appearance, and when it will go off. Look for suspicious situations. Code Silver Person with weapon, or hostage situation. DO NOT go to location. Follow instructions from nurse. Triage Disaster internal -- hospital full Disaster external -- lots of incoming patientes RRT Rapid Response Team. Use when patient status changes quickly/significantly but Code Blue is not required. Code Jack Patient/visitor has fallen. If called, get as much information as possible. Class A Fire Ordinary combustibles (wood, etc.) Class B Fire Flammable liquids (gasoline, etc.) Class C Fire Electrical Class D Fire Combustible metals Class K Fire Cooking oils/greases PASS PULL pin out of extinguisher. AIM extinguisher at base of fire. SQUEEZE handle. SWEEP back and forth. CVA Cerebral Vascular Accident (aka stroke). Leading cause of serious long-term disability in U.S. Ischemic stroke Blockage of vessel to brain Hemorrhagic stroke Bursting of vessel in brain causing bleeding FAST FACE -- does one side droop when smiling? ARMS -- does one arm droop when both are raised? SPEECH -- is speech slurred or strange? TIME -- note when symptoms began, and quickly call nurse Tier I of Infection Prevention Standard Precautions: All bodily fluids are potentially infectious! Standard Precautions must be followed by ALL personnel at ALL times with ALL patients when there is potential for contact with bodily fluids. Are Health Scholars allowed to handle blood? We can only take blood samples to the lab. We cannot bring bags of blood back to the patient. Tier II of Infection Prevention Transmission-Based Precautions: Used when Standard Precautions may not be enough. Handwashing, PPE, environmental controls 3 types of precautions for transmission type (contact, droplet, airborne) Contact-based transmission precautions Can become infected from contact with: skin, bed, personal items, etc. Use: hand hygiene, gloves, gown, isolation protocol. Spore/enteric pathogens Contact-based. Do not eat in same room. Use: gloves, gown, NO hand sanitizer, bleach, orange-top wipes Ex: C. Difficile Droplet-based transmission precautions Can become infected from: coughing, talking, mucus, etc. Use: mask, hand hygiene Airborne-based transmission precautions Can become infected from: inhalation of air over long distance Use: N95 or PAPR mask, hand hygiene, etc. *Scholars are NEVER allowed to enter Airborne Isolation Rooms.* What types of isolation rooms are scholars allowed to enter? Contact isolation rooms Enteric contact isolation rooms Droplet isolation rooms Tier III of Infection Prevention Patient Protection Precautions: For immunocompromised patients -- PPE, mask, environmental cleaning, no flowers/fruit HIPAA Health Insurance Portability & Accountability Act Ensure privacy of information. Standardize healthcare. Insurance portability. HIPAA Rules Privacy Rule -- WHEN can PHI be disclosed? Security Rule -- safeguards to control WHO can access PHI Breach Notification Rule -- patient must be notified of breaches PHI Protected Health Information: - Health information - Payment methods - Care provided - Identifying information Minimum Necessary Rule Use the minimum amount of information required for your task. HIPAA Security Rule - Integrity: PHI is not destroyed or changed unless authorized - Availability: PHI must be available to patient upon request - Confidentiality: PHI is unavailable to unauthorized persons When can PHI be disclosed? For TPO purposes: Treatment (providing care) Payment (paying or being paid) Operations (legal, administrative, business, etc.) TPO Treatment, Payment & Operations Examples of HIPAA breaches? - Telling friends about hospital patients - Discussing private health information in public area - Posting or re-posting identifying information about patient on social media - Leaving PHI papers unattended Social media guidelines to avoid HIPAA breaches - Do not post identifying information about patients - Do not friend patients on social media - Do not take photos or videos with patient Neonates (1 month) and infants (1-12 months) are at high risk for what? Aspiration (choking) Suffocation Falls (infants) Toddlers (1-3 years) are at high risk for what? Choking Injury Infection Preschool and school-age children (4-12 years) are at high risk for what? Injury from falls Trauma from abuse Asthma Fluid/electrolyte imbalance from gastroenteritis Adolescents (13-18 years) are at high risk for what? Depression/suicide Sexually-transmitted diseases Substance abuse Young adults (18-40 years) are at high risk for what? Quarter-life crisis Midlife crisis Substance abuse Increased stress Middle adults (40-64 years) are at high risk for what? Late midlife crisis Hearing and eyesight decline Bone and joint pain Older adults (65+) are at high risk for what? Decreased skin integrity Aspiration (choking) Sleep disturbances, loss of sleep Falls Sensory/perceptual alterations (visual and auditory) What counts towards graduation hours? What doesn't? Does: - Initial training hours - Floor hours - Meeting hours - DST (department-specific training) hours - Recruitment of referred applicants - Projects - Pre-rotational shifts Doesn't: - Leaders - Shadowing a health professional What is the Scope of Service document? A document in each department that lists: - Green: things a scholar can do without supervision - Yellow: things a scholar can only do with supervision - Red: things a scholar cannot do at all How many hours must you complete in a rotation before moving onto a new rotation? 48 hours or more What is a rescheduled shift? A shift that has been rescheduled more than 48 hours prior. What is an excused missed shift? A missed shift where the scholar emails the Department Coordinator within 48 hours of the shift. What is an unexcused missed shift? A missed shift where the scholar does NOT email the Department Coordinator within 48 hours of the shift. How many rescheduled shifts are allowed? 3 per rotation. No more than 1 per month. How many excused missed shifts are allowed? 2 per rotation. No more than 1 per month. How many unexcused missed shifts are allowed? 0 What are Competency Checklists? When are they due? Documentation for the scholar's training for each department. Approved by an RN. They must be submitted to the Department Coordinator by the end of week 2 of the rotation. What happens if the Competency Checklist is not submitted? In Week 3, a warning email will be sent. In Week 4, a counseling session will be scheduled. By the end of Week 4, the scholar will be dismissed. How long can a Leave of Absence be? 14 - 180 days. A leave between 110-179 days requires re-training. What if a Leave of Absence is greater than 180 days? The scholar must re-apply to the program. How many days must the scholar work between Leaves of Absence? 90 days, or 48 floor hours How many days maximum can a scholar take in a Leave of Absence during their first rotation? 30 days max How far in advance should a scholar submit a Leave of Absence request? At least 2 weeks Who should the scholar submit a Leave of Absence request to? The Leave of Absence Coordinator (LOA Coordinator) What do you do when you are going to miss a shift? 1. Call Charge Nurse at least 15 minutes prior 2. Email the Department Coordinator at least 24 hours prior with a valid reason and a proposed make-up time 5 ways to identify a patient 1) nurse 2) wristband 3) patient's chart 4) whiteboard in nurses station 5) open ended question (what is your name/b'day?) 6) whiteboard in patient's room? What steps should you follow if a patient issues you a complaint? 1. Listen to the complaint 2. Assure them that you'll tell the appropriate people 3. Report the complaint to Leadership 4. Follow-up with the patient to say that you reported the complaint How to abide by professional boundaries - Do not connect on social media - Do not socialize outside of work - Do not give/receive gifts - Do not disclose sensitive personal information Are scholars allowed to operate mechanical lifting equipment? No Caudal Away from the head, towards the tail/hind parts Flexion Closing of a joint Trendelenburg position Lying on back with bed tilted so that the head is lower than the feet Used during insertion/removal of peripheral or jugular PICC lines Reverse Trendelenburg Position Lying on back with bed tilted so that the head is higher than the feet Used for head trauma patients (open wound) Fowler's position a semi-sitting position; the head of the bed is raised between 45 and 60 degrees Used after abdominal operations Semi-Fowler's Position Fowler's position but with knees flexed and supported by pillow Helps reduce pressure on back ACU Ambulatory Care Unit: Patients are able to walk, either assisted or unassisted ICU Intensive Care Unit Where unstable medical patients go for constant care NICU Neonatal Intensive Care Unit: Where premature and/or seriously ill or unstable babies are treated PACU Post-Anesthesia Care Unit: Provide care for patients recovering from anesthesia after undergoing surgery TKO to keep open; order to keep just enough flow through IV to keep vein open PO Per os: administer by mouth PR Per rectum: administer rectally PRN Pro Re Nata: Administer as needed Atherosclerosis Disease in which fatty material is deposited on the walls of the arteries MI Myocardial infarction: heart attack; loss of blood supply to the heart CHF Congestive heart failure: failure of the heart to pump blood effectively Stroke Brain attack; loss of blood supply to the brain Shock decreased perfusion of blood to body tissues Symptoms of myocardial infarction Severe retrosternal pain Pain in left arm or jaw Dyspnea (labored breathing) Diaphoresis (sweating) Pressure, heaviness, tightness Nausea, vomiting Risk factors for myocardial infarction Smoking, atherosclerosis, hypertension, hyperlipidemia Complications from myocardial infarction Arrhythmias, CHF, stroke Pneumonia inflammation of the lungs by any microorganism Tuberculosis infectious disease caused by mycobacterium tuberculosis Asthma Chronic condition characterized by airway inflammation, bronchoconstriction, and hypersecretion of mucus COPD chronic obstructive pulmonary disease. due to a variety of pulmonary conditions Emphysema Chronic expiratory airflow obstruction accompanied by permanent enlargement of the airspace (alveoli); subset of COPD Neoplasia uncontrolled, disorderly proliferation of cells Benign neoplasia does not metastasize; can still be harmful (e.g. compress adjacent tissues) Malignant neoplasia capable of invasion and metastasis; invasion = spread into adjacent areas; metastasis = implantation into non-adjacent sites Patient history chief complaint, history of present illness, past medical history CC Chief complaint: why is the patient currently seeking medical attention HPI history of present illness, detailed chronological account of the symptoms which prompted the patient to seek care; location, quality, quantity, severity, timing, aggravating/relieving factors PMH "past medical history" adult and childhood illnesses, injuries, hospitalizations, surgeries, immunizations, screening tests and psychiatric visits Stakeholders in US healthcare system Patients (care, goods) Providers Regulators (policy, compliance) Payers (government, private, uninsured) Community social determinants of health (SDOH) social determinants of health Education, screening, public health, food, transportation, medication PP ACA Patient Protection & Affordable Care Act ObamaCare Focuses on health coverage for all; spending on prevention; expanding public programs Patients in the inpatient setting complain about? Beds, food, service Patients in the outpatient setting complain about? Wait times, short time with provider, inability to ask clarifying questions, lack of follow-up the 6 vital signs are Temperature, pulse (heart rate), blood pressure, respiratory rate, oxygen saturation, pain level Can health scholars take vital signs of newly admitted patients? No. They can only take vitals signs of patients whose signs have been taken before. What can increase body temperature? Exercise, digestion, drinking a warm beverage, illness, stress, taking a warm bath, high progesterone after ovulation What can decrease body temperature? Sleeping, fainting, illness, drinking a cold beverage, dehydration, fasting, high estrogen before ovulation Normal pulse/heart rate 60-100 bpm adults 60-140 bpm children 100-190 bpm toddlers 100-205 bpm infants What vessel should be used to take the pulse when the patient is unconscious? Brachial artery What vessel should be used to take the pulse when the patient is conscious? Radial artery normal blood pressure 120/80 mmHg What increases blood pressure? Pain, immediate exercise, stress, obesity, age, ethnicity, family history, sodium What decreases blood pressure? Shock, rest, low sodium, exercise, stopping smoking Normal respiratory rate 12-20 breaths per minute adults 15-30 breaths per minute children 25-66 breaths per minute newborns Normal oxygen saturation 97-99% DNR (Do Not Resuscitate) An order that tells medical professionals not to perform CPR if patient goes into cardiac arrest Advanced directive a legal document prepared by a living, competent adult to provide guidance to the health care team if the individual should become unable to make decisions regarding his or her medical care because of a life-threatening scenario POLST Physician Orders for Life-Sustaining Treatment. A medical document completed by the patient that states the type of life-sustaining treatment(s) they may or may not want. An approach to end-of-life planning based on conversations between patients, loved ones, and healthcare providers. Signs of dying Lethargy, disorientation, incontinence, restlessness, reduced intake and output, temperature sensitivity, breathing changes Response to a dying patient Flexible -- allow more visitors into the room Accommodate -- increased staff support Communication -- more nonverbal than verbal, but increased communication overall Role of health scholar in death of patient Respect patient, show compassion towards family, assist staff in preparing body, assist staff in transport to morgue, be professional **Scholars will never be put in a situation in which they can cause a patient to lose their life. Donning PPE 1. Gown 2. Goggles 3. Mask 4. Gel 5. Gloves Doffing PPE Dirty to clean 1. Gloves 2. Gown 3. Gel 4. Mask 5. Gel Healthcare accreditation Measures organizational performance, focuses on providing quality care in safe environment, required to receive reimbursement from Medicare and Medicaid