ADULT-GERONTOLOGY ACUTE CARE

Transcription

1 ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER CERTIFICATION REVIEW/ CLINICAL UPDATE CONTINUING EDUCATION COURSE Barkley & Associates 1

2 by Barkley & Associates Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from Barkley & Associates. 2

3 Providing the Nation s BEST Nurse Practitioner Continuing Education Courses 3

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5 Providing the Nation s BEST Nurse Practitioner Continuing Education Course Online Streaming Video (OSV) Chapters Evidence-Based Cultural Considerations....1 Additional Special Considerations in Gerontology....1 a. Issues in Aging....1 b. Health Assessment....1 c. Atypical Disease Presentations....1 d. Pharmacology Considerations in Gerontology e. Select Geriatric Syndromes....1 f. Additional Special Considerations in Gerontology...1 References... 5

6 ANCC: Adult-Gerontology Acute Care Nurse Practitioner Board Certification Exam Content Outline Advanced Health/Physical Assessment Advanced Physiology/Pathophysiology Advanced Pharmacology Scope of Practice Patient/Family-Centered Care Ethical and Legal Concepts Evidence-based Practice Diagnosis of Complex/Acute/Critical/Chronic Illness Restorative Care Health Promotion and Health Protection Health Care Policy and Delivery Quality Improvement and Safety 6

7 BARKLEY & ASSOCIATES ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER CERTIFICATION REVIEW/CLINICAL UPDATE CONTINUING EDUCATION COURSE Principles of Instruction ISSUES, TRENDS, AND HEALTH POLICY PART I 1. Mentoring/coaching a. Instructing patients in how to successfully manage their own conditions Instructing patients with asthma on how to manage exacerbations Instructing patients with diabetes mellitus on how to control blood glucose via diet and exercise 2. Role modeling a. Instructing patient through examples of health care processes in action May be done through NP instructing patient in healthy behavior or through role modeling examples in other patients 3. Counseling a. Instructing patients in how to responsibly manage medications, conditions, and courses of treatment Health Literacy 1. The degree to which health care professionals have the capacity to obtain, process, and understand basic health care information and services necessary to make appropriate health care decisions 2. Health literacy: considered to be the single best predictor of one s health status 3. Average adult in America reads at an eighth-grade level 4. Medical/health information literature should be written at no higher of a grade level than 6 th to 8 th grade. Legislative and Regulatory Processes 1. Accreditation guidelines a. Often laid out by the Joint Commission 2. Joint Commission also lays out National Patient Safety Goals and areas of concern for health care professionals in accredited institutions. 3. Goals in acute/critical care: a. Proper identification of patients and relevant health data (e.g., blood types) b. Proper staff communication c. Safe use of medications Proper labeling Proper care and mindfulness when treating patients taking anticoagulants Proper knowledge and patient counseling on medication, including maintaining list of current agents and checking for possible interactions 7

8 d. Ensuring alarms are easily heard and responded to in time e. Prevention of infection Maintaining set standards of hygiene, including hand cleaning Use of proven guidelines to treat resistant infections Use of proven guidelines to prevent infection of blood from central lines Use of proven guidelines to prevent infection after surgery Use of proven guidelines to prevent UTI from catheter f. Prevention of mistakes in surgery via proper marking of surgical area and pausing to evaluate process 4. Institutional bylaws a. Rules laid out by the institution that may provide further qualifications and restrictions on the role of healthcare staff (e.g., the duties, responsibility, and privileges of AGACNPs) Economics 1. Resource utilization involves: a. How consumers use health care resources and services b. How patients interact with health care providers c. Special concerns in acute care: Lengths of stay Top reasons for hospitalization Preventable hospitalizations Long-term care Emergency room and primary care clinic utilization Multidisciplinary Response Teams (MRTs) 1. Team of multiple health care professionals across various disciplines, assembled to deal with emergency situations 2. Rapid Response Team: deals with rapid deterioration in health, such as respiratory distress or cardiac arrest a. Physician/AGACNP b. Nurse c. Respiratory therapist d. Others per institutional protocol 3. Institutional disaster: a mass casualty event which MRTs frequently train to intervene a. Pandemic b. Terrorist attack/mass shooting c. Natural disaster d. Large chemical exposures e. Large fires/explosions 8

9 Integrating Health Information Technology 1. Utilizing healthcare technology and databases to optimize course of treatment 2. Electronic Medical Record (EMR): integrated database that allows NPs real time access to patient health information 3. Meaningful Use (MU): using EMR technology to: a. Improve quality, efficiency, and safety b. Reduce healthcare disparities c. Engage patients and family members in course of care d. Improve care coordination e. Maintain privacy and safety of patient health information Quality Improvement (QI) Principles 1. QI is a management process of monitoring, evaluating, continuously reviewing, and improving both the quality of health care delivery and the health status of target populations. 2. Quality and Safety Education for Nurses (QSEN) Initiative a. An initiative aimed at providing future nurses with the knowledge, skills, and attitude necessary to ensure continuous improvement in quality and safety of their respective healthcare systems. b. Identifies, funds, and promotes education across six key competencies: Patient-centered care Teamwork and collaboration Evidence-based practice (EBP) QI Safety Informatics Evaluating Safety Initiatives 1. Uses multi cause variable systems such as root cause analysis 2. Effective systems of evaluation should answer the following questions: a. Are we providing safe care? b. How safe was this care in the past? c. How safe will we be in the future? d. Can our process and health system reliably deliver safer care? e. How can we be sure that we are getting better? Standardized Assessment Tools 1. Mental Health a. General Patient Stress Questionnaire 1) Used in primary care to screen for behavioral health symptoms 2) Assesses symptoms of depression, anxiety, trauma, and alcohol use 9

10 b. Depression Patient Health Questionnaire (PHQ-9) 1) Most common screening tool for depression 2) Patient self-ranks 9 signs and symptoms over the last 2 weeks on a scale of 0 to 3, with 3 indicating nearly every day. a. 1 to 4 = Minimal depression b. 5 to 9 = Mild depression c. 10 to 14 = Moderate depression d. 15 to 19 = Moderately severe depression e. 20 to 27 = Severe depression c. Anxiety Disorders Generalized Anxiety Disorder-7 (GAD-7) 1) Self-administered screening tool that identifies whether a complete assessment for anxiety is indicated 2) Patient ranks 7 signs and symptoms over the last 2 weeks on a scale of 0 to 3, with 3 indicating nearly every day a. 5 to 9 = Mild anxiety b. 10 to 14 = Moderate anxiety c. 15 to 21 = Severe anxiety d. of generalized anxiety disorder d. Drug and Alcohol Use CAGE-AID 1) Self-report questionnaire designed to quickly assess whether an alcohol or drug assessment is needed 2) Answering yes to two or more questions warrants a complete assessment a. C: Have you ever felt that you ought to cut down on your drinking or drug use? b. A: Have people annoyed you by criticizing your drinking or drug use? c. G: Have you ever felt bad or guilty about your drinking or drug use? d. E: Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover? (e.g., eye opener) 2. Pain a. Wong-Baker FACES Pain Rating Scale Self-assessment tool Patient rates pain by choosing among six faces, ranging in expression from smiling to crying b. Ramsay Sedation Scale Assesses conscious state of a patient If awake: 1) Ramsey 1: anxious, agitated, restless 2) Ramsey 2: cooperative, oriented, tranquil 3) Ramsey 3: responsive to commands only 10