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transcript
Carrie L. Engelbright RN, MSN, CNEMid-State Technical College
Essentials of Certified Nursing Assisting
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Essentials of Certified Nursing Assisting, First EditionCarrie L. Engelbright RN, MSN, CNE
978-1-941626-05-4Published by August Learning SolutionsCleveland, OH
www.augustlearningsolutions.com
. 2014 August Learning Solutions. All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever, including but not limited to photocopying, scanning, digitizing, electronic storage or transmission, or in any other medium, without the express written permission of August Learning Solutions or its licensors.
Cover photo by Andrey_Kuzmin
Textbook activity answers, instructor resources, test bank questions, and workbook answer keys are available to professors from the author via email at Carrie.engelbright@mstc.edu
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This book is dedicated to all nursing assistant instructors and students. To my fellow instructors: Your work is so vitally important to our healthcare system. Without nursing assistants the healthcare industry could not function. Nursing assistants are the backbone of nursing care, sharing their roots with nurses in the environmental theory of Florence Nightingale’s canons. To my former students: You have taught me so much. To my future students: I am excited to learn even more from you. Nursing assistant programs can lead to a gratifying lifelong career or can be the entry point into any healthcare field that interests you. Please use this text as a platform from which to jump into the exciting world of healthcare.
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v
Brief Contents
Chapter 1 The History of Healthcare in the United States 3
Chapter 2 Responding to Emerging Trends in Healthcare 15
Chapter 3 Healthcare Settings and Governance 27
Chapter 4 The Nursing Assistant Role and Scope of Practice 41
Chapter 5 Communication 53
Chapter 6 Professionalism in Healthcare 71
Chapter 7 Legal and Ethical Issues 87
Chapter 8 Body Structures and Functioning Processes 103
Chapter 9 Common Diseases and Disorders 131
Chapter 10 Infection Control Practices 165
Chapter 11 Body Mechanics and Workplace Safety 193
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Chapter 12 Reducing Client Injury and Falls 209
Chapter 13 Restraints and Restraint Alternatives 223
Chapter 14 Basic First Aid Measures 235
Chapter 15 Stress Reduction and Management Techniques 253
Chapter 16 Holistic Care of Clients 271
Chapter 17 Client Room Environment 287
Chapter 18 Preventing Skin Breakdown 301
Chapter 19 Bedmaking 317
Chapter 20 Positioning Clients 335
Chapter 21 Moving, Transferring, and Transporting Clients 351
Chapter 22 Ambulation and Exercises for Clients 383
Chapter 23 Rehabilitation and Restorative Care 401
Chapter 24 Adaptive Equipment and Supportive Devices 411
Chapter 25 Vital Signs 423
Chapter 26 Bathing 451
Chapter 27 Grooming 487
vi Brief Contents
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Brief Contents� vii
Chapter 28 Nutrition 517
Chapter 29 Elimination 543
Chapter 30 Specimen Collection 575
Chapter 31 Oxygen Therapy and Respiratory Interventions 589
Chapter 32 Care for the Medical and Surgical Client 603
Chapter 33 Care for the Client With Communication Disorders 617
Chapter 34 Care for the Client With Cancer 625
Chapter 35 Care for the Client With a Positive HIV Status 639
Chapter 36 Care for the Client With Dementia 649
Chapter 37 End-of-Life Care 671
Chapter 38 Common Medications 685
Appendix A Common Medical Abbreviations and Directional Terminology 699
Appendix B ISMP List of Error-Prone Abbreviations 702
Appendix C Glossary 704
Index 711
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viii
A Note to Nursing Assistant Instructors xx
A Note to the Reader xxi
Acknowledgments xxii
About the Author xxiii
Chapter 1The History of Healthcare in the United States 3
LO 1.1 A Brief History of Healthcare in the United States 4
LO 1.2 The Beginning of Modern Healthcare 5
The Modernization of Medicine 6
LO 1.3 The Cost of Healthcare 7
LO 1.4 Healthcare Today 9
Summary of Learning Outcomes 11
Get Up and Think! 11
Reflect on This! 12
Let’s Review! 12
Multiple Choice Questions 12
References 13
Chapter 2Responding to Emerging Trends in Healthcare 15
LO 2.1 Who Is Your Client? 16
LO 2.2 Consumerism in America 16
LO 2.3 Home Healthcare Versus Facility Care 18
LO 2.4 Alternative Therapies 20
LO 2.5 Why the Nursing Assistant Needs to Know These Trends 21
Summary of Learning Outcomes 23
Get Up and Think! 23
Reflect on This! 24
Let’s Review! 24
Multiple Choice Questions 24
References 25
Chapter 3Healthcare Settings and Governance 27
LOs 3.1–3.4 Work Settings for the Nursing Assistant 28
Acute Care Settings 28Subacute or Rehabilitation Facility 30Long-Term Care 31Assisted-Living Communities 32Home Healthcare 33Hospice Services 34Respite Services 35
LO 3.5 Advanced Training and Opportunities 36
Summary of Learning Outcomes 37
Get Up and Think! 38
Reflect on This! 38
Contents
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Contents ix
Let’s Review! 38
Multiple Choice Questions 39
Chapter 4The Nursing Assistant Role and Scope of Practice 41
LO 4.1 Members of the Healthcare Team 42
LO 4.2 Scope of Practice for the Nursing Assistant 43
LO 4.3 Chain of Command 44
LO 4.4 Delegated Tasks 45
LO 4.5 Teaching Versus Reinforcing 47
LO 4.6 Time Management and Organization 48
Summary of Learning Outcomes 48
Get Up and Think! 49
Reflect on This! 49
Let’s Review! 50
Multiple Choice Questions 50
Reference 51
Chapter 5Communication 53
Communication in Healthcare 54
LO 5.1 Causes of Medical Errors 54
LO 5.2 Subjective Versus Objective Data 56
LO 5.3 Oral Reporting 58
LO 5.4 Written Documentation and the Nursing Assistant 58
LO 5.5 Verbal Versus Nonverbal Communication 62
Verbal Communication 62Nonverbal Communication 63
LO 5.6 Therapeutic Communication 64
LO 5.7 Confrontational Situations 66
Summary of Learning Outcomes 67
Get Up and Think! 67
Reflect on This! 68
Let’s Review! 68
Multiple Choice Questions 68
Reference 69
Chapter 6Professionalism in Healthcare 71
LO 6.1 Education and Certification 72Nurse Aide Registry 72Continuing Education 73
LO 6.2 Job Searching 73Applications 74Resume 75
LO 6.3 Interviewing 78
LO 6.4 Accepting and Resigning From a Position 79
LO 6.5 Acting Like a Professional 80Dependability 80Promptness 80Customer Service 80Flexibility 81Hygiene 81
Summary of Learning Outcomes 83
Get Up and Think! 83
Reflect on This! 84
Let’s Review! 84
Multiple Choice Questions 85
Chapter 7Legal and Ethical Issues 87
LO 7.1 Client Rights 88Health Insurance Portability and Accountability Act (HIPAA) 88Informed Consent 89
LO 7.2 Client Responsibilities 90
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LO 7.3 Employee Rights 90
LO 7.4 Employee Responsibilities 91Following the Care Plan 91Mandatory Reporting 92
LO 7.5 Laws 93Invasion of Privacy 94Misappropriation of Funds 95Negligence 95Abandonment 95False Imprisonment 96Neglect 96Assault and Battery 96Abuse 97
LO 7.6 Cultural Awareness 98
Summary of Learning Outcomes 99
Get Up and Think! 100
Reflect on This! 100
Let’s Review! 100
Multiple Choice Questions 101
Chapter 8Body Structures and Functioning Processes 103
LO 8.1 Basic Structures 104
LO 8.2 Tissue Types 104
LO 8.3 Body Systems 105Integumentary System 105Musculoskeletal System 106Respiratory System 109Cardiovascular System 111Nervous System 113Sensory Organs 115Endocrine System 118Digestive System 120Urinary System 123Reproductive System 124
Summary of Learning Outcomes 127
Get Up and Think! 128
Reflect on This! 128
Let’s Review! 129
Multiple Choice Questions 129
Chapter 9Common Diseases and Disorders 131
LO 9.1 Understanding Disease Processes 132
LO 9.2 Risk Factors 132
LO 9.3 Emergency Medical Services 132
LO 9.4 Common Diseases and Disorders 133
Integumentary System 133Musculoskeletal System 136Respiratory System 139Cardiovascular System 141Nervous System 144Sensory Organs 147Endocrine System 149Digestive System 153Urinary System 156Reproductive System 159
Summary of Learning Outcomes 160
Get Up and Think! 161
Reflect on This! 162
Let’s Review! 162
Multiple Choice Questions 163
Reference 163
Chapter 10Infection Control Practices 165
Introduction 166
LO 10.1 The Importance of Hand Washing 166
Germ Theory 166Global Society and Spread of Disease 167
LO 10.2 Chain of Infection 168
LO 10.3 Primary Prevention 169
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Contents xi
LO 10.4 Body Defense Mechanisms 170
LO 10.5 Hand Hygiene 172
LO 10.6 Standard Precautions 176Personal Protective Equipment (PPE) 176
LO 10.7 Specialty Precautions 180Airborne Precautions 180Droplet Precautions 180Contact Precautions 181Transporting a Client to and From an Isolation Room 181Blood Spill Kits 182Double-Bagging Technique 183
LO 10.8 Drug-Resistant Infections 184MRSA Infection 184VRE 184
Summary of Learning Outcomes 185
Get Up and Think! 186
Reflect on This! 186
Let’s Review! 187
Multiple Choice Questions 187
Skills 187
References 190
Chapter 11Body Mechanics and Workplace Safety 193
Introduction 194
LO 11.1 Exposure to Blood-Borne Pathogens and Chemicals 194
LO 11.2 Latex Allergies 196
LO 11.3 Injury Prevention 197Ergonomics 197Moving Clients 198Lifestyle Choices to Prevent Back Injuries 199Slips, Trips, and Falls 200
LO 11.4 Fire Safety 200
LO 11.5 Natural Disasters 201
LO 11.6 Bomb Threats 203
LO 11.7 Workplace Violence 203
Summary of Learning Outcomes 204
Get Up and Think! 205
Reflect on This! 206
Let’s Review! 206
Multiple Choice Questions 207
Chapter 12Reducing Client Injury and Falls 209
Introduction 210
LO 12.1 Why Falls and Immobility Are Dangerous 210
LO 12.2 Risk Factors for Falling 211
LO 12.3 Care During a Fall 212
LO 12.4 Care After a Fall 213
LO 12.5 How to Prevent Fall Injuries 214
LO 12.6 Alarm Systems 216
LO 12.7 Other Strategies 217
Summary of Learning Outcomes 217
Get Up and Think! 218
Reflect on This! 219
Let’s Review! 219
Multiple Choice Questions 219
Skills 220
Chapter 13Restraints and Restraint Alternatives 223
LO 13.1 Restraints 224
LO 13.2 Working With Restraints 224
LO 13.3 Types of Restraints 225
LO 13.4 Risks of Using Restraints 227
LO 13.5 Instances When Restraints Are Allowed 228
LO 13.6 Side Rails 229
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xii Contents
LO 13.7 Restraint Alternatives 229
Summary of Learning Outcomes 231
Get Up and Think! 231
Reflect on This! 232
Let’s Review! 232
Multiple Choice Questions 232
Reference 233
Skill 233
Chapter 14Basic First Aid Measures 235
Introduction 236
LO 14.1 Airway Obstruction 236
LO 14.2 Cardiac Arrest 237
LO 14.3 Syncope 238
LO 14.4 Seizures 239
LO 14.5 Hemorrhage 241
LO 14.6 Shock 242
LO 14.7 Burns 243
LO 14.8 Poisoning 244
Summary of Learning Outcomes 244
Get Up and Think! 245
Reflect on This! 246
Let’s Review! 246
Multiple Choice Questions 247
Skills 247
Chapter 15Stress Reduction and Management Techniques 253
LO 15.1 Why Is Healthcare So Stressful? 254
LO 15.2 Ways to Prevent Stress From Taking Charge 256
LO 15.3 Time-Management Techniques to Reduce Stress While at Work 257
LO 15.4 Preventing Stress and Promoting Job Satisfaction 258
Good General Health 258Yoga 259Meditation 259Pet Therapy 260Humor 260Journaling 261Visualization Techniques 261Breathing Exercises 262
LO 15.5 Client Stressors 263Pain 263Illness 263Sleep Deprivation 263Anxiety and Depression 264Grief 264Coach Your Clients 265
Summary of Learning Outcomes 265
Get Up and Think! 265
Reflect on This! 266
Let’s Review! 266
Multiple Choice Questions 267
Skills 267
Chapter 16Holistic Care of Clients 271
LO 16.1 Holistic Care 272
LO 16.2 Maslow’s Hierarchy of Needs 272
Human Needs 272Application of Maslow’s Hierarchy to Caregiving 274
LO 16.3 Growth and Development 275
LO 16.4 Quality of Life 277
LO 16.5 Meeting the Needs of Loved Ones 282
Summary of Learning Outcomes 283
Get Up and Think! 283
Reflect on This! 284
Let’s Review! 284
Multiple Choice Questions 284
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Contents xiii
Chapter 17Client Room Environment 287
Introduction 288
LO 17.1 Safety 288
LO 17.2 The Physical Environment 289
LO 17.3 Individual Room Requirements 290
LO 17.4 Noise and Odor Control 292Noise Control 292Odor Control and Cleanliness 293
LO 17.5 Transfers and Discharges 294
LO 17.6 Current Trends 295
Summary of Learning Outcomes 296
Get Up and Think! 297
Reflect on This! 297
Let’s Review! 298
Multiple Choice Questions 298
Reference 299
Chapter 18Preventing Skin Breakdown 301
LO 18.1 The Importance of Healthy Skin 302
LO 18.2 Types of Skin Breakdown 302Rashes 302Friction and Shearing 303Pressure Ulcers 303
LO 18.3 Stages of Pressure Ulcers 305
LO 18.4 Risk Factors for Developing Pressure Ulcers 307
LO 18.5 Interventions for Preventing Skin Breakdown 308
Inspection and Cleanliness 309Positioning and Turning 309Pressure-Relieving Devices 310Positioning Devices 311Incontinence Care 311Nutrition and Hydration 312Reducing the Microclimate 313
Summary of Learning Outcomes 313
Get Up and Think! 314
Reflect on This! 314
Let’s Review! 314
Multiple Choice Questions 315
Chapter 19Bedmaking 317
Introduction 318
LO 19.1 Linens 318
LO 19.2 Infection Control 320
LO 19.3 Body Mechanics 321
LO 19.4 The Closed Versus Open Bed 322
LO 19.5 Making the Unoccupied and Occupied Bed 324
Unoccupied Bed 324Occupied Bed 324
Summary of Learning Outcomes 327
Get Up and Think! 327
Reflect on This! 328
Let’s Review! 328
Multiple Choice Questions 329
Skills 329
Chapter 20Positioning Clients 335
Introduction 336
LO 20.1 Frequency of Repositioning Clients 336
LO 20.2 Basic Positions for Clients in Bed 337
LO 20.3 Position to Relieve Pressure Sores 338
Supine 338Fowler’s Position 338Prone Position 340Side-Lying Position 341
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Sims’s Position 342Tripod Position 342
LO 20.4 Wheelchair Positioning 343
Summary of Learning Outcomes 344
Get Up and Think! 344
Reflect on This! 344
Let’s Review! 345
Multiple Choice Questions 345
Skills 346
References 349
Chapter 21Moving, Transferring, and Transporting Clients 351
Introduction 352
LO 21.1 Moving a Client in Bed 352
LO 21.2 Preventing Friction and Shearing Injuries 353
LO 21.3 Log Rolling a Client 354
LO 21.4 Moving a Client From Bed to Stretcher 355
LO 21.5 Transferring the Client Using a One- and a Two-Assist Transfer 356
Dangling 356Footwear 356Gait Belt 356One- and Two-Assist Transfers 357Mechanical Devices Used for Transfers 359
LO 21.6 Transferring a Bariatric Client 361
LO 21.7 Transporting a Client in a Wheelchair 362
Summary of Learning Outcomes 364
Get Up and Think! 365
Reflect on This! 366
Let’s Review! 366
Multiple Choice Questions 366
Skills 367
References 381
Chapter 22Ambulation and Exercises for Clients 383
Introduction 384
LO 22.1 Why We Move 384Self-Esteem 384Effects on the Digestive System 384Effects on the Cardiovascular System 384Effects on the Integumentary System 385Effects on the Musculoskeletal System 385
LO 22.2 Levels of Assistance 385
LO 22.3 Safety Measures Used During Ambulation 387
LO 22.4 Assistive Devices for Ambulation 388
LO 22.5 Range-of-Motion Exercises 390
LO 22.6 Soothing Sore Muscles 391
Summary of Learning Outcomes 392
Get Up and Think! 393
Reflect on This! 393
Let’s Review! 394
Multiple Choice Questions 394
Skills 395
Chapter 23Rehabilitation and Restorative Care 401
LO 23.1 Therapy Services Overview 402
LO 23.2 Rehabilitation Therapy 402Physical Therapy 402Occupational Therapy 403Speech Therapy 404
LO 23.3 Activities Therapy 405
LO 23.4 Restorative Care 406
Summary of Learning Outcomes 407
Get Up and Think! 408
Reflect on This! 408
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Contents xv
Let’s Review! 409
Multiple Choice Questions 409
Chapter 24Adaptive Equipment and Supportive Devices 411
Introduction 412
LO 24.1 The Client With a Prosthesis 412Prosthesis Overview 412Types of Prostheses 414Care Measures 415
LO 24.2 The Client With an Orthosis 415Orthosis Overview 415Care Measures 415
LO 24.3 Adaptive Tools Used at Meal Times 416
LO 24.4 Adaptive Tools for Grooming and Other ADLs 418
Summary of Learning Outcomes 418
Get Up and Think! 419
Reflect on This! 419
Let’s Review! 420
Multiple Choice Questions 420
Chapter 25Vital Signs 423
LO 25.1 Introduction 424
LO 25.2 When Vital Signs Are Taken 424
LO 25.3 Infection Control 425
LO 25.4 Accurately Measuring Vital Signs 425
Temperature 425Pulse 428Respiration 429Pulse Oximetry 430Blood Pressure 431Height 435Weight 435
Summary of Learning Outcomes 437
Get Up and Think! 437
Reflect on This! 438
Let’s Review! 438
Multiple Choice Questions 438
Skills 439
References 449
Chapter 26Bathing 451
Introduction 452
LO 26.1 Routine Bathing 452
LO 26.2 Distressed Bathing 453Alternatives to Tub Bathing and Showering 454Easing Distressed Bathing 454
LO 26.3 Rinseless Systems 455
LO 26.4 Peri-Care 456
LO 26.5 Bed Baths 459Partial Bed Bath 459Complete Bed Bath 461
LO 26.6 Shower and Tub Baths 462Shower 462Whirlpool Tub Bath 464Hair Care 465
LO 26.7 Responsibilities on Bath Day 465
Summary of Learning Outcomes 466
Get Up and Think! 467
Reflect on This! 467
Let’s Review! 468
Multiple Choice Questions 468
Skills 469
Reference 485
Chapter 27Grooming 487
LO 27.1 Promoting Independence 488
LO 27.2 Dressing 488Dressing a Client With One-Sided Weakness 489
LO 27.3 Hair 489
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LO 27.4 Vision and Hearing 490Glasses and Contacts 490Hearing Aids 491
LO 27.5 Shaving 492
LO 27.6 Oral Care 494
LO 27.7 Nail and Foot Care 498Nail Care 498Foot Care 499
Summary of Learning Outcomes 500
Get Up and Think! 501
Reflect on This! 501
Let’s Review! 501
Multiple Choice Questions 502
Skills 502
Chapter 28Nutrition 517
Introduction 518
LO 28.1 MyPlate and MyPyramid 518
LO 28.2 Nutrients Essential for Life 519Calories 519Carbohydrates 519Proteins 519Fats 520Vitamins and Minerals 520
LO 28.3 Water and Fluid Needs 522
LO 28.4 Food Groups 523Grains 523Fruits 524Vegetables 524Dairy Products 525Protein 525
LO 28.5 Types of Diets 526Specialty Diets 526Mechanically Altered Diets and Fluids 529Thickened Fluids 530Diets for the Postsurgical Client 530Mechanical Feeding 531
LO 28.6 Problems With Digestion 532Nausea, Vomiting, and Diarrhea 532Malnutrition and Overeating 533
LO 28.7 Feeding Dependent Clients 534
Summary of Learning Outcomes 536
Get Up and Think! 537
Reflect on This! 538
Let’s Review! 538
Multiple Choice Questions 538
Skill 539
References 541
Chapter 29Elimination 543
Introduction 544
LO 29.1 Urinary Elimination via Catheter 544
Types of Catheters 544The Nursing Assistant’s Role in Care of the Client With a Catheter 545Cleaning the Catheter 546Changing the Collection Bag to a Leg Bag 547Positioning the Client With a Collection Bag 547Protecting the Privacy of the Client Who Uses a Catheter 548Emptying the Collection or Leg Bag 548Cleaning Collection and Leg Bags 548
LO 29.2 Urostomy 549
LO 29.3 Incontinence 549Care of the Client Who Is Incontinent 549Types of Incontinence Products 550
LO 29.4 Dialysis 551Hemodialysis 551Peritoneal Dialysis 551Care of the Client Who Is on Dialysis 552
LO 29.5 Bowel Elimination 552
LO 29.6 Ostomies 553
LO 29.7 Digestive Tract Bleeding 555
LO 29.8 Devices Used for Elimination 556
Summary of Learning Outcomes 558
Get Up and Think! 559
Reflect on This! 559
Let’s Review! 560
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Contents xvii
Multiple Choice Questions 560
Skills 561
Chapter 30Specimen Collection 575
Introduction 576
LO 30.1 Basic Principles of Collection and Transport 576
LO 30.2 Urine Specimens 577
LO 30.3 Straining for Kidney Stones 578
LO 30.4 Fecal Specimens 579
LO 30.5 Occult Blood 580
Summary of Learning Outcomes 581
Get Up and Think! 581
Reflect on This! 582
Let’s Review! 582
Multiple Choice Questions 583
Skills 583
Chapter 31Oxygen Therapy and Respiratory Interventions 589
LO 31.1 Why Supplemental Oxygen Is Needed 590
LO 31.2 The Nursing Assistant’s Role in Oxygen Therapy 590
LO 31.3 Delivery Routes 592
LO 31.4 Delivery Systems 593
LO 31.5 Interventions to Ease Anxiety Related to Breathing Difficulties 595
LO 31.6 Interventions to Aid Lung Function 595
Coughing and Deep Breathing Exercises 595Incentive Spirometry 596
Summary of Learning Outcomes 596
Get Up and Think! 597
Reflect on This! 597
Let’s Review! 598
Multiple Choice Questions 598
Skills 599
Chapter 32Care for the Medical and Surgical Client 603
Introduction 604
LO 32.1 The Medical Client 604
LO 32.2 The Postsurgical Client 605
LO 32.3 Diet for the Postsurgical Client 605
LO 32.4 Activity for the Postsurgical Client 606
LO 32.5 Weight-Bearing Status 607
LO 32.6 Respiratory Complications 607
LO 32.7 Cardiac Complications 608
LO 32.8 Intravenous Therapy 609
Summary of Learning Outcomes 610
Get Up and Think! 611
Reflect on This! 611
Let’s Review! 611
Multiple Choice Questions 612
Skills 612
Chapter 33Care for the Client With Communication Disorders 617
Introduction 618
LO 33.1 Hearing-Impaired Clients 618
LO 33.2 Speech-Impaired Clients 619
LO 33.3 Emotional Communication Deficits 621
Summary of Learning Outcomes 622
Get Up and Think! 622
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Reflect on This! 622
Let’s Review! 623
Multiple Choice Questions 623
Chapter 34Care for the Client With Cancer 625
Introduction 626
LO 34.1 What Is Cancer? 626
LO 34.2 What Causes Cancer? 627
LO 34.3 How Is Cancer Diagnosed? 629Staging Cancer 630
LO 34.4 Treatment Options 630
LO 34.5 Common Side Effects of Cancer and Treatment 632
LO 34.6 Palliative Care 634
Summary of Learning Outcomes 634
Get Up and Think! 635
Reflect on This! 635
Let’s Review! 636
Multiple Choice Questions 636
Reference 637
Chapter 35Care for the Client With a Positive HIV Status 639
LO 35.1 HIV Versus AIDS 640
LO 35.2 HIV Transmission 640
LO 35.3 Effects of HIV and AIDS 641
LO 35.4 Testing for HIV 642
LO 35.5 Preventing an HIV Infection 643
LO 35.6 Rights of Individuals With HIV/AIDS 645
Summary of Learning Outcomes 645
Get Up and Think! 646
Reflect on This! 646
Let’s Review! 647
Multiple Choice Questions 647
References 647
Chapter 36Care for the Client With Dementia 649
LO 36.1 Types of Dementia 650
LO 36.2 Risk Factors for Dementia 650
LO 36.3 Treatment of Dementia 651
LO 36.4 Diagnosing Dementia 651Stages of Dementia 652Common Signs, Symptoms, and Behaviors Associated With Dementia 653
LO 36.5 Managing the Behaviors Associated With Dementia 655
Meeting Unmet Needs of the Client 655Therapeutic Interventions 656Maintaining Function 658Approach to Specific Behaviors 658Improving Meal Time 659Managing Pain 660Sleep Disturbances 661Toileting Interventions 661Bathing Interventions 662Wandering and Elopement Safety Measures 663Discouraging Sexual Inappropriateness 664
LO 36.6 Remember the Families 664
LO 36.7 Caregiver Strain 665
Summary of Learning Outcomes 666
Get Up and Think! 667
Reflect on This! 667
Let’s Review! 668
Multiple Choice Questions 668
References 669
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Chapter 37End-of-Life Care 671
Introduction 672
LO 37.1 Body System Changes 672Respiratory Changes 672Cardiovascular Changes 673Nervous System and Sensory Organ Changes 673Digestive Changes 674Urinary Changes 675
LO 37.2 Special Care for the Dying Client 675
LO 37.3 Faith and Religion 676
LO 37.4 Care for the Family 677
LO 37.5 Post-Mortem Care 678
Summary of Learning Outcomes 679
Get Up and Think! 680
Reflect on This! 680
Let’s Review! 680
Multiple Choice Questions 681
Skill 681
Chapter 38Common Medications 685
LO 38.1 Scope of Practice 686
LO 38.2 Drug Names 687
LO 38.3 Actions of Medications 687Allergic Drug Reactions 687Drug Interactions 688
LO 38.4 Medication Classifications 689Analgesics 689Antibiotics 690Bronchodilators 691Antihypertensives 691Anti-Anginals 692
Cardiotonics 692Anticoagulants 693Diuretics 693Antidiabetics 694Medications to Relieve Constipation 694
Summary of Learning Outcomes 695
Get Up and Think! 696
Reflect on This! 696
Let’s Review! 697
Multiple Choice Questions 697
Appendix A: Common Medical Abbreviations and Directional Terminology 699
Common Medical Abbreviations 699
Directional Terms 701
Appendix B: ISMP List of Error-Prone Abbreviations 702
Appendix C: Glossary 704
Index 711
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Brief Contents
Adult learners have very specific traits and characteristics that need to be acknowledged by the instructor to optimize the learning process. In this textbook you will see various strategies to engage students and to improve upon the learning process.
To address auditory learner needs, your students will rely on your skillful classroom teaching techniques. For the visual learner you will note up-to-date photos and text boxes that incorporate major themes of the content in this textbook. For the kinesthetic learner, I incorporate “Get Up and Think” exercises throughout the chapters rather than traditional “Stop and Think” exercise boxes. These boxes encourage dyad learning and creative thinking skills. The exercises ask readers to stand up and walk through different areas of their classroom or school grounds to brainstorm new and creative problem-solving thought processes in relation to the content. The kinesthetic learner will benefit from partnered skill-based activities within the classroom as well.
Adult learners need to be challenged with materials yet also need to know why this content is applicable. Throughout the chapters I integrate reflection exercises to stimulate thinking and real-time application of content, and case studies to apply information learned to real-world scenarios to make the information applicable to that unique student. I incorporate prioritization exercises to help the student manage the large amount of information that is needed to function in the nursing assistant role.
This book details the care for not just the elderly population, but also populations that are gender specific, age based, and setting specific to address the changing face of our healthcare delivery. Consumers of healthcare want to look at alternative healthcare options, they want their care to be individualized to meet their specific demands and needs, and they want quality in the product they are purchasing. This book addresses these themes in relation to the changing caregiving standards of the nursing assistant.
A Note to Nursing Assistant Instructors
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You will be responsible for many things when working as a nursing assistant. One important aspect of caregiving is promoting independence. I describe in this book how to complete skills for someone who is completely dependent upon you for all care. You must keep in mind, though, that at every step of the way you must factor your client’s abilities into their care. This will keep them functioning at their highest capacity for the longest period of time. It will also give them more choices, which in turn will make them feel more in control of their situation and will help maintain their sense of identity and self-esteem. This will take more time, but it is worth it. Stop and think how you would like to be treated in any of these situations. That is how you should be giving care.
For each of these skills, common starting-up and finishing-up steps need to be done. I will outline these steps here and just cite starting-up and finishing-up steps within the chapters and each skill page.
Starting-Up Steps 1. Knock before entering, identify the client, and introduce yourself. 2. Complete hand hygiene. 3. Provide for privacy. 4. Explain to the client what you will be doing before you start doing it. 5. Assemble your supplies.6. Ensure that the bed is at a good working height and is locked; or, if the bed is not in use, that you are in an
ergonomically correct position to assist the client.
Finishing-Up Steps 1. Ensure that all of the client’s needs have been met and that the client is positioned as desired. 2. See to safety. Replace any alarms or positioning devices as indicated on the care plan or individual service
plan. The bed should be in the low position and locked. 3. Place the call light within easy reach. 4. Clean and replace equipment and return supplies to the designated place in the client’s room or facility
storage area. 5. Leave the room clean and in order. The bed should be made. Remove trash and dirty linens from the room. 6. Complete hand hygiene.7. Report and document as required by your facility.
A Note to the Reader
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Writing a textbook is a long and arduous yet rewarding journey. Without the support and understanding of many surrounding me, this monumental task could not have been achieved. First I would like to thank my loving husband and children for always understanding and accepting the immense time commitment required to write this book. I spent many evenings, Fridays, and weekends at a computer screen. Throughout this project, they not only supported me but also cheered me on all the way. It is with immeasurable gratitude that I give my love and many thanks for their understanding and patience. To my parents and family: you supported me, encouraged me, and believed in me throughout this entire process. It is because of you that I was instilled with the values of hard work and persistence. To Ken Kasee, who had the vision for this project and who believed in me enough to entrust me with this venture. To Jane Velker, who took my words, sentiments, and sometimes even my thoughts and molded them into this beautiful finished product. Many thanks to the Posey Company, the makers of Bathing Without a Battle, the Wy’East Medical Corporation, and the Institute for Safe Medication Practices (ISMP) for allowing their graphics, content, and ideas to be woven into the text. Thank you to the many reviewers who gave feedback throughout this project, and Cynthia Hintze, who was such an invaluable contributor. Finally I would like to thank those at Mid-State Technical College for their continued support in this venture, including administration and all the nursing assistant faculty who have given me inspiration, support, encouragement, ideas, and feedback throughout this endeavor; and Lisa Whitley and Candace Barth, who stepped outside of their comfort zone to author the accompanying workbook.
Acknowledgements
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About the Author
Carrie L. Engelbright RN, MSN, CNE is a registered nurse and Nursing Assistant Program Director at Mid-State Technical Col-lege in Wisconsin Rapids, Wisconsin. After receiving her associate’s degree in nursing from Mid-State Technical College, she received her bachelor’s degree in nursing from the University of Wisconsin Oshkosh. She cur-rently holds a master’s degree in nursing with an emphasis in education, graduating summa cum laude, from Bellin College of Nursing in Green Bay, Wisconsin. In the spring of 2007, she was inducted into the nursing honor society Sigma Theta Tau and in the spring of 2008 was inducted into the national scholars’ honors society Magna Cum Laude. In March of 2011 she became credentialed by the American Nurses Association as a Certified Nurse Educator. She is currently completing a doctorate in nurs-ing practice with an emphasis in system leadership focusing on rural food desert conditions.
Carrie started her career as a nursing assistant in long-term care. Enjoying healthcare, she continued on to work as a certified medication technician. After completing her nursing degree, she continued work-ing in long-term care as a staff nurse. Upon completion of her bachelor’s
degree in nursing, she worked for the Wood County Public Health Department in Wisconsin as a maternal child health nurse with emphases in children with special healthcare needs, childhood lead poisoning prevention, and prenatal health. Carrie has been employed at Mid-State Technical College in Wisconsin Rapids, Wisconsin, since 2007 as the nursing assistant program director, faculty in the gerontology program, and lead faculty in the health and wellness promotion program.
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Chapter 1
photos.com
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Learning Outcomes:
At the conclusion of this chapter, the learner will be able to:
1.1. Describe the history of healthcare in the United States.
1.2. Paraphrase the beginnings of modern healthcare.
1.3. Describe the causes of the rising cost of healthcare.
1.4. Identify funding sources for healthcare services today.
Jennifer, a 32-year-old woman, presents to the after-hours urgent-care clinic com-plaining of severe shortness of breath. She has a history of asthma. The shortness of breath has been a problem for about a week now but has progressively gotten
worse. She tells you she didn’t come in right away because she really can’t afford the deductible on her insurance plan. She didn’t go to her normal doctor or clinic during the week because she can’t afford to miss any work. That time would be unpaid. Because of this she tried treating her problems at home with an herbal rem-edy she read about on the Internet. The doctor orders a breathing treatment while Jennifer is at the clinic and gives her two new prescriptions to fill at the pharmacy. Her insurance doesn’t cover much for prescription medications. When leaving, she says to you, “You may as well throw these prescriptions away; I can’t afford to fill them. I’ll probably see you in a few days again for another breathing treatment.” What do you do?
The History of Healthcare in the United States
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4 Chapter 1 The History of Healthcare in the United States
LO 1.1 A Brief History of Healthcare in the United StatesWhat did Florence Nightingale feel was important in caregiving? How does that relate to nursing assistant work today?
Florence Nightingale is known as the founder of modern nursing (Figure 1–1). After working in a field hospital during the Crimean War, which took place in the 1850s, Nightingale used statistics to show the connection between sanitary conditions and the spread of infectious disease. In doing so, she helped establish the scientific basis of nursing. She portrayed the art of nursing through her compassionate care of the sick, injured, and poor, without regard to background, class, or wealth. She brought the basics of care to the nursing profession and to public health.
Nightingale felt that the nurse’s role was to help the individual make the full-est recovery possible. When giving care, she considered not only the person, but also the person’s environment. She felt that a stable and healthy environment was an essential part of care to help the patient regain his health.
It is through her work that we have the basics of your training as a nursing assistant! Aspects of the environment that Nightingale regarded as necessary for basic nursing practice, and for which today’s nursing assistants are responsible, include bedmaking; cleanliness of the patient; activities for physical, intellectual, and mental well-being; proper food and water intake; documentation; and cleanli-ness of the patient’s room. By taking care of these needs, in addition to addressing the illness itself, we can help the client make the fullest recovery possible. We can also make sure the quality of life for our client is the best it can be. Nursing assis-tants play a very large role in caring for the client!
Florence Nightingale’s nursing, infection control, and compassionate care-giving principles lay the foundation for many nursing assistant tasks today, including bedmaking; cleanliness of the patient; activities for physical, intel-lectual, and mental well-being; proper food and water intake; documenta-tion; and cleanliness of the patient’s room.
FigUre 1–1. Florence Nightingale, the founder of modern nursing. photos.com
How would Florence Nightingale help Jennifer?
What was healthcare delivery in the United States like before the formation of regulated medical colleges?
In the early years of the United States, there were no real medical schools as we think of them today. There was no standard training, and there were no licensing boards or regulating bodies overseeing medical schools or doctors. There were no tests to pass. Although some medical schools were established, would-be physicians didn’t need to attend school of any kind—not even high school! Doc-tors, as they called themselves, were often the local tailor, clergyman, barman, or barber (Figure 1–2). Early healthcare practices mostly involved the use of herbal and home remedies. Practices were quite basic at this time.
Payment for a doctor’s services was completely paid for by the individual or his family. If there was no community doctor, or if the patient could not pay for the services in some way, the sick were simply cared for by family members within the home.
FigUre 1–2. in the early years of the United States no formal training was required to be a physician. Many were barbers, clergymen, or tailors. photos.com
Reflect on Jennifer!
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LO 1.2 The Beginning of Modern Healthcare 5
There were no hospitals during this time either—only almshouses. Almshouses were places for the poor, the elderly, the homeless, and the insane to stay. Most often these establishments were operated by donations from the community or religious orders. As you might expect, illness would easily spread through these almshouses. If there was a medical school in the area, often the students worked at the almshouses as part of their training. The training mainly consisted of an apprenticeship with a doctor, who usually had no formal train-ing himself.
Doctors had very little training. Many were community barbers, clergymen, or tailors. There were very few medical schools or hospitals. Most people were cared for at home by family members or in almshouses.
Almshouses Places for the poor, the elderly, the homeless, and the insane to stay; early form of a hospital
Imagine how care would be different in an almshouse compared to the patient’s home. Who would be caring for the patient? What if an emergency happened? Would a patient be safer in his home or in an almshouse? Would there be access to more care and supplies in an almshouse or in the patient’s home?
LO 1.2 The Beginning of Modern HealthcareWhat changes occurred in the U.S. healthcare system that led to the preva-lence of chronic illness versus infectious illness?
The concept of public health began to take hold in the mid-1800s (Figure 1–3). The goal of public health is to educate groups of people (not simply an individ-ual) about healthy ways to live and how to prevent illness before it starts. Before the start of public health, it was common for raw sewage to flow in city streets. That raw sewage would then flow on to streams and rivers and pollute drink-ing water. An example of public health is to teach communities the importance of a working sewage system and a clean water supply to prevent illness.
What is infectious illness, and what are some examples of infectious illness?
Public health interventions helped to reduce the prevalence of infectious illness, which was the type of disease that most often affected Americans. An infectious illness occurs when a germ enters the body and causes sickness. Before public health plans were put into place, people were more likely to suffer and die from infectious ill-nesses, like smallpox or cholera.
Infectious illness occurs when a germ enters the body and causes sickness. Examples of
Infectious illness Occurs when a germ enters the body and causes sickness
FigUre 1–3. Public health efforts began in the mid-1800s. stocksnapper
Reflect on Settings!
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6 Chapter 1 The History of Healthcare in the United States
infectious illness include smallpox, cholera, strep throat, the common cold, tuberculosis (TB), and HIV.
What is chronic illness, and what are some examples of chronic illness?
As the number of individuals in America dying from infectious illness decreased, people began to live long enough to develop chronic illnesses. Chronic illness is a condition or disease that people live with for a long period of time. Examples of chronic illness include heart disease, asthma, and arthritis. The trend shifted in the United States from people dying primarily of infectious illness to people dying primarily of chronic illness (Table 1–1).
TABLe 1–1. examples of infectious and Chronic illnesses
Examples of Infectious Illness Examples of Chronic Illness
Smallpox Heart disease
Cholera Asthma
Strep throat Arthritis
The common cold Diabetes
Tuberculosis (TB) Osteoporosis
HIV Epilepsy
Chronic illness is a condition or disease that people live with for a long period of time. Examples of chronic illness can include heart disease, asthma, arthri-tis, diabetes, osteoporosis, and epilepsy.
Public health interventions helped reduce the occurrence of infectious illness. As the number of individuals dying from infectious illnesses at an early age decreased, people began to live long enough to develop chronic illnesses.
Chronic illness A condition or disease that people live with for a long period of time
Have you thought about exposure to other germs at the clinic that might make Jennifer even sicker? Explain what the risks are to her. What could you do to limit those risks?
The Modernization of MedicineIn the early 1900s, scientists were identifying causes of illness, how to keep people from becoming ill, and how to better treat them if they did fall ill. A scientific basis for the practice of medicine became established. Medical schools, as we now know them, began to emerge. Medical training was much more demanding, took longer amounts of time to complete, and involved scientific instruction rather than just an apprenticeship.
In the late 1900s medicine became very organized. Doctors now have exten-sive training. They are also licensed and regulated strictly. There is a rise in spe-cialty healthcare providers. Doctors are furthering their training in areas such
Reflect on Jennifer!
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LO 1.3 The Cost of Healthcare 7
as specialty surgery and cancer care. Because of the specialty training, jobs in physical therapy and occupational therapy expanded, and specialty nursing degrees evolved.
What would healthcare look like today if we did not have formal schooling and education for healthcare professionals? What would happen if you were a nursing assistant without any formal training? Do you think being certified as a nursing assistant will encourage your clients to trust you more? How does being certified raise the standard of care for your clients? Should nursing assistants have to con-tinue their education once training has been complete? If so, how much continu-ing education do you think would be appropriate?
LO 1.3 The Cost of HealthcareWhat made healthcare become so costly in the United States?
With the increased sophistication of healthcare, the fees for accessing healthcare services greatly increased also. Hospitals are now very organized entities. Some even specialize in treating certain groups of people, or specific diseases or injuries. For example, hospitals can specialize in treatment for burn victims, people with cancer, pediatrics, and many more areas (Figure 1–4).
FigUre 1–4. Many hospitals now specialize in a certain type of care based on the population served, or the disease or injury the patient has. VILevi
Reflect on Professionalism!
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8 Chapter 1 The History of Healthcare in the United States
Medicare Health insurance plan for the elderly and, in certain situa-tions, the disabled, funded through federal taxes
Medicaid Health insurance plan for low-income people and the disabled, funded through federal and state taxes
What sources of funding help pay for healthcare?
Healthcare is now a large part of our economy. It is very costly to access. People cannot pay for treatment outright; they need help to pay the mounting costs. Health insurance became a standard in American life following the Second World War. The model for healthcare insurance was based on the workers’ com-pensation plans offered by large manufacturing companies. Originally, workers’ compensation plans would pay the employee’s wages if an injury occurred at work and the employee was unable to come to work for a certain amount of time. Over the years, this evolved into paying not only for the lost wages but also for the healthcare costs. This system grew into our modern-day group insurance plans. Group insurance provided by the employer became a standard benefit for working people.
There was a problem, however. Individuals who did not or could not work did not have access to a group insurance plan. Because they did not work, most could not pay the out-of-pocket expenses for healthcare. In 1965, Congress created the Medicare and Medicaid programs. The Medicare plan gives access to health insur-ance to the elderly and to some younger people with certain disabilities. Medicare is funded through federal taxes. The Medicaid plan gives access to health insur-ance to eligible individuals and families, primarily the disabled and people with low incomes. The money for Medicaid comes from both federal and state taxes.
Until the 1980s, these methods of providing and paying for healthcare worked well. During this time, however, there were several factors that started to increase the costs of healthcare. These included the growing use of technology and pur-chasing those technologies for practice; paying for specialty services; a growing older population with more chronic illnesses; and research dollars needed to cre-ate new technologies, treatments, and drugs.
Healthcare has become so costly due to the growing use of technology and purchasing those technologies for practice; paying for specialty services; a growing older population with more chronic illnesses; and research dollars needed to create new technologies, treatments, and drugs.
How did managed care organizations (MCOs) keep healthcare costs down?
Because of these rising costs, managed care organizations (MCOs) became the insurance provider of choice to better control healthcare costs. MCOs changed the way doctors and other healthcare workers were paid for their ser-vices. These large organizations placed limits on how much money healthcare agencies and providers could charge for each service and dictated the amount and type of services healthcare consumers enrolled in these plans could access. There were also financial incentives for providers to treat and discharge patients from hospitals quickly.
The payment system initiated by MCOs is very important to understand. It leads us to where we are at today in our healthcare system. This is why we see a great increase in the number of outpatient versus inpatient surgeries. It is also why hospital stays are much shorter than they were in the past. And it is why consum-ers of healthcare in America have limited choices in where they access healthcare and from which providers they can receive services. In some situations, they are denied eligibility for certain types of care.
MCOs placed limits on how much money healthcare agencies and providers could charge for each service and dictated the amount and type of services healthcare consumers enrolled in these plans could access. There were also financial incentives for providers to treat and discharge patients from hospi-tals quickly.
Managed care organizations (MCOs) Insurance programs that worked to reduce the rising health-care costs in the United States in the late 1980s
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LO 1.4 Healthcare Today 9
Healthcare premium The cost that the individual must pay every month toward her healthcare plan; when the individual is employed, this amount is usually taken out of the employee’s paycheck
Co-pay A specific dollar amount or percentage that must be paid by the individual for each healthcare service received
Deductible A certain amount of money that the individual must pay for healthcare services before the insurance company will start to pay for any services used; this is renewed at the start of every year
LO 1.4 Healthcare TodayToday, the rate of healthcare costs is growing faster than that of inflation. It is becoming very expensive for employers to offer insurance as an employee ben-efit. Healthcare plan premiums may cost too much for a family or an individ-ual to afford. A healthcare premium is the cost that the individual must pay every month toward her healthcare plan. If the individual is employed, the amount of the premium is usually taken out of her paycheck. In addition to the insurance premium that is paid every month, individuals have other insurance- related expenses.
To try and keep the cost of the health insurance down, people pay more for services used (Figure 1–5). Most insurance plans have co-pays. A co-pay is a spe-cific dollar amount or percentage that must be paid by the individual for each healthcare service received. Deductibles are now widely used to control costs paid to the insurance company too. A deductible is a set amount of money that the individual must pay for healthcare services before the insurance company will start to pay for any services used. This is renewed at the start of every year. Often the deductible will be $1,000 or $2,500, or even $5,000.
What is preventing Jennifer from seeking medical care? Is she noncompliant, mean-ing that she just doesn’t follow the doctor’s orders? Or is there another reason?
FigUre 1–5. insurance helps the consumer of health care afford medical services. An individual often purchases insurance through an employer and pays a premium every month for coverage. alexskopje
Reflect on Jennifer!
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10 Chapter 1 The History of Healthcare in the United States
Over the years the number and types of people covered by national healthcare plans have increased. National healthcare plans now cover military veterans and their families. In some states, families just above the poverty level are now eligible for Medicaid. Services to those on Medicare have also increased. The most popular of these services is the addition of the Medicare prescription drug plan in 2006.
Some people may not have health insurance. Therefore, everyone pays more healthcare costs. If a person does not have insurance and needs an emergency sur-gery, most often all or part of the cost of that surgery and the associated care goes unpaid. That means the price of future surgeries goes up for everyone. This is how the hospital can recoup unpaid costs.
The Affordable Care Act was passed by Congress and signed into law in 2010. The Supreme Court upheld this law in 2012. The Affordable Care Act aims to increase access to insurance. Instead of needing a job to get health insurance, individuals can now access a marketplace to purchase individual health insurance policies. Some of these policies are subsidized by the federal government, meaning the government helps pay the premium. This makes insurance much more afford-able. Some of the major tenets of the Affordable Care Act are:
• Insurance companies can no longer refuse coverage due to preexisting conditions.
• Children can be carried under a parent’s insurance plan until the age of 26.• Preventive care and immunizations are covered at 100%.• Lifetime limits on coverage are eliminated.• Premiums must be spent primarily on healthcare costs rather than
administrative costs (80 cents out of every healthcare dollar must be spent on healthcare costs).
• Barriers to emergency services are removed.• Hospital readmission rates are targeted for reduction.
Since the implementation of the Affordable Care Act, healthcare costs have slowed. The rate of healthcare inflation has also slowed. New research indicates an improved quality of care since its implementation. The Affordable Care Act will continue to impact the future of health care in the United States.
Do you think it is good for Jennifer to have to keep treating an acute problem in urgent care? Is this cost effective?
Imagine you had a $1,000 deductible to meet. Would you miss work and go to the doctor if you knew you would not only lose your wages for the day but would also end up with a $300 bill? Or would you just go to work sick and potentially infect your coworkers and clients with the illness?
Reflect on Choices!
Reflect on Jennifer!
Healthcare services are funded by private insurance purchased by an individ-ual or by an employer for the employees; by out-of-pocket spending; and by government plans, such as veteran programs, Medicare, and Medicaid.
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Summary 11
Summary of Learning Outcomes
1.1. Describe the history of healthcare in the United States.
Florence Nightingale’s nursing, infection control, and compassionate caregiving principles lay the foundation for many nursing assistant tasks today, including bedmaking; cleanliness of the patient; activities for physical, intellec-tual, and mental well-being; proper food and water intake; documentation; and cleanliness of the patient’s room.
1.2. Paraphrase the beginnings of modern healthcare.
Doctors had very little training. Many were commu-nity barbers, clergymen, or tailors. There were very few medical schools or hospitals. Most people were cared for at home by family members or in almshouses before the establishment of regulated medical colleges. Public health interventions helped diminish the prevalence of infectious illness. As the number of individuals dying from infectious illness at an early age decreased, people began to live long enough to develop chronic illnesses.
1.3. Describe the causes of the rising cost of healthcare.
The growing use of technology and purchasing those technologies for practice; paying for specialty services; a growing older population with more chronic illnesses; and research dollars needed to create new technologies, treat-ments, and drugs all helped to create a costly healthcare system.
1.4. Identify funding sources for healthcare services today.
Private insurance purchased by an individual or by an employer for employees; out-of-pocket spending; and government plans, such as veteran programs, Medicare, and Medicaid all fund healthcare services.
get Up and Think!Find a partner, and both of you get up and think. Take along a piece of paper and pencil. Jot down your brainstorming thoughts to these questions as you walk. Bring back your thoughts to the class.
Beth has come to the community clinic with her two children. The chil-dren both have fevers and respiratory illness. She tells you that they have been sick for about 2 days now. She will have insurance soon; she is sit-ting out the 30-day waiting period from her new employer for it to be activated. Until then she will pay for everything out of pocket. She seems stressed out and upset. She tells you she has a new job and she just moved into a new house, and now the kids are sick. She starts to cry and states, “It’s just a little too much to handle right now; sorry I don’t usually dump my problems on strangers.”
• What is Beth feeling right now?• Explain the financial and emotional worries she has right now.• What can you do to help Beth? What specifically would you say to her?• How would you feel in this situation?• How would you handle this situation?
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12 Chapter 1 The History of Healthcare in the United States
reflect on This!Your mother has had a heart attack today. She just came out of bypass surgery and is doing fairly well. The doctor comes in to speak with her and says that she will be able to be discharged to go home tomorrow. You are enraged at the poor care this hospital gives and how quickly they want to shove your mother out the door! It must be because she has bad insurance! How are you going to treat the hospital staff that comes into her room after the doctor leaves? Are additional hospital days needed for her? What other services would be available for her? What should you have asked when the doctor was talking about discharge? How would you have asked these questions? Is your anger justified, and, if so, how? Who could you go to in order to get more information after the doctor leaves?
Let’s review!Prioritize these action items. 1. I seek medical services. 2. I pay my co-pay for medical services. 3. I become employed and sign up for the group health insurance plan. 4. I pay my premium.
Multiple Choice Questions 1. A healthcare premium is (LO 1.4):
a. a set amount of money that the individual must pay for healthcare services before the insurance company will start to pay for any services used.
b. a specific dollar amount or percentage that must be paid by the individ-ual for each healthcare service received.
c. the cost that the individual must pay every month toward her health-care plan.
d. the cost that the employer must pay every month toward a service used.
2. Florence Nightingale founded the basics of nursing care by focusing on (LO 1.1):a. the connection between sanitary conditions and the spread of infectious
disease.b. compassionate care of the sick, injured, and poor, without questioning
background, class, or monetary status.c. both A and B.d. neither A nor B.
3. This federally funded medical plan gives health insurance access to the elderly and some younger people with certain disabilities (LO 1.4):a. Medicaid.b. Medicare.c. private health insurance.d. MCOs.
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Summary 13
4. A stomach illness from drinking contaminated water, causing diarrhea for 2 days, would be an example of a(n) (LO 1.2):a. chronic illness.b. infectious illness.c. both A and B.d. neither A nor B.
5. Janice went to the doctor. The visit cost a total of $120. She had to pay $15 out of pocket for that visit. This payment is called a (LO 1.4):a. deductible.b. premium.c. insurance.d. co-pay.
referencesU.S. Department of Health and Human Services (US DHHS). (2014, July 24).
About the law. Retrieved from http://www.hhs.gov/healthcare/rights/index .html
Office of the White House. (2013, November). Trends in health care cost, growth and the role of the Affordable Care Act. November 2013. Retrieved from http://www.whitehouse.gov/sites/default/files/docs/healthcostreport _final_noembargo_v2.pdf
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