Nursing Chapter 11: Admission and Discharge

Questions and Answers

Which of these factors are important to assess for a safe patient transfer? (Select all that apply)

Upper arm strength (correct)

Cognitive status (correct)

Postural hypotension (correct)

Sensory status (correct)

Temperature

Pain level (correct)

What steps should be taken if a patient sustains an injury during transfer? (Select all that apply)

Evaluate the incident (correct)

Stay with the patient (correct)

Provide supportive care to the patient (correct)

Notify the healthcare provider (correct)

Complete an occurrence report per agency policy (correct)

Workers in and occupations suffer the most lost-time cases of general musculoskeletal pain and back pain.

nursing, support staff

The most effective way to prevent musculoskeletal injuries when positioning patients is to teach ___ and .

proper body mechanics, use of patient-handling equipment Signup and view all the answers

When admitting a patient to the hospital, the nurse observes that the patient is distracted and tense. This behavior suggests a common reaction to hospitalization, which is:

Fear of the unknown Signup and view all the answers

During the admission procedure, the nursing intervention that would best help reduce patient anxiety is:

Greet the patient by name Signup and view all the answers

An essential part of the admission procedure performed by the RN is to:

Obtain a health history Signup and view all the answers

Discharge planning should begin:

Shortly after admission Signup and view all the answers

To help the family of a patient find a source of financial aid to meet medical expenses, the nurse can make a referral to:

Social services Signup and view all the answers

When a patient demands to be discharged without a physician's order and is leaving the unit with his belongings, the nurse should ask the patient to sign a:

Discharge against medical advice form Signup and view all the answers

The nurse must be sensitive to an older adult patient experiencing separation anxiety when admitted to the hospital. A child will usually cry, whereas an older adult will often demonstrate:

Depression Signup and view all the answers

Upon admission, the nurse notes that a patient has a billfold filled with cash. Because there is no family member present, the nurse suggests that the money be:

Placed in the hospital safe Signup and view all the answers

If a patient has an order for an interagency transfer, the nurse explains that the patient will be moved from:

One facility to another Signup and view all the answers

Before the actual discharge, the nurse must ensure that the patient:

Understands the discharge instructions Signup and view all the answers

A patient who is alert and oriented is threatening to leave the hospital against medical advice (AMA). The nurse should:

Notify the physician that the patient is threatening to leave AMA Signup and view all the answers

The nurse demonstrates cultural sensitivity to a Haitian-American patient by:

Allowing the patient to keep leaves in her room Signup and view all the answers

A nurse is caring for a Haitian-American patient. The nurse demonstrates cultural sensitivity by:

Allowing the patient to walk out of the hospital when discharged Signup and view all the answers

How can the nurse help reduce the stress of a hospital admission? (Select all that apply)

Give a simple explanation of policies Signup and view all the answers

The nurse adheres to the discharge standards set by The Joint Commission (TJC), which include that patients will receive instruction regarding which aspect(s) of care? (Select all that apply)

Rehabilitation techniques Signup and view all the answers

The nurse completes thorough documentation before, during, and after a transfer to ensure _ of _.

continuity, care Signup and view all the answers

The nurse reminds the staff that the Haitian-American patient perceives a mystical and healing power in ________.

leaves Signup and view all the answers

Because of the stress caused by hospitalization, the nurse assesses a newly admitted older adult patient for ________________.

disorientation Signup and view all the answers

A patient's physical mobility is impaired because of paralysis of both lower extremities. Which is the best method for the nurse to use to place the patient in semi-Fowler's position?

Pull the patient to the head of the bed (HOB) using a drawsheet and then raise the HOB Signup and view all the answers

The nurse is caring for a patient after a motor vehicle accident and instructs the patient to avoid turning independently because the spine is unstable. Which explanation should the nurse use to explain the purpose of the safeguards in relation to the patient's injury?

They keep the neck and spine in straight alignment Signup and view all the answers

The nurse and an assistant are moving a dependent patient from the supine to the lateral position. Which should the nurse implement to begin repositioning?

Move the patient away from the center toward a side of the bed Signup and view all the answers

After 3 hours in the supine position, an older patient tells the nurse that he or she is stiff and too uncomfortable to move. Which is the best nursing intervention to maintain skin integrity?

Assess the patient's need for pain medication before repositioning Signup and view all the answers

The patient with hemiparesis is very hesitant to transfer from the bed to the chair with a new nurse's help. Which action should this nurse take first to accomplish the transfer?

Explain how the transfer of the patient will be done safely Signup and view all the answers

What should you ask the patient about transfers?

How the patient usually transfers. Signup and view all the answers

What should you document if the patient declines help for the transfer?

Document that the patient declined help for the transfer. Signup and view all the answers

What did the healthcare provider order regarding the patient?

A transfer. Signup and view all the answers

Which outcome statement for a patient with generalized postoperative weakness is best?

The patient transfers self safely from bed to chair 4 times daily within 2 days. Signup and view all the answers

Which is the first instruction that the nurse gives to the patient after properly positioning him or her with a transfer belt?

Rock to help stand while pushing up with your hands. Signup and view all the answers

What is the initial intervention for a nurse when a patient cannot get off the bed?

Return the patient to a safe position on the bed. Signup and view all the answers

What information is most vital for the nurse to include in the progress notes after a successful transfer?

A description of the patient's response to each transfer. Signup and view all the answers

What should the nurse do if a patient has difficulty following directions during a mechanical lift transfer?

Delay the transfer until help is found. Signup and view all the answers

Before leaving the patient's room after using a mechanical lift, what should the nurse ensure?

Secure the call bell within the patient's reach. Signup and view all the answers

What is the most critical action for a nurse before transferring a 225-pound unconscious patient?

Obtain a friction-reducing device and at least two other staff members. Signup and view all the answers

When placing a patient in a prone position, what should the nurse do?

Insert a pillow under the abdomen. Signup and view all the answers

What assessment data is expected for a patient who becomes fatigued rapidly during a transfer?

Increased pulse and increased respirations. Signup and view all the answers

Which intervention is likely to facilitate a weak patient's participation in ambulation?

Perform a quick assessment, including patient fatigue while talking. Signup and view all the answers

Which activity should be delegated to nursing assistive personnel (NAP) before transferring the patient?

Position the gait belt around the patient. Signup and view all the answers

Which concept should the nurse include in instructions for maintaining safety when lifting or moving patients?

Keep the patient close to the mover. Signup and view all the answers

Where should the caregiver place the chair for a patient with weakness on the right side?

Place the chair to the patient's left side after sitting the patient on the edge of the bed. Signup and view all the answers

Where should the third nurse be positioned when moving a patient onto a stretcher using a slide board?

On the side of the bed without the stretcher. Signup and view all the answers

Which of the following statements are correct steps in proper body mechanics? (Select all that apply)

Keep the weight close to the body. Signup and view all the answers

Which patients are at higher risk of complications from improper positioning? (Select all that apply)

The patient who is post hip fracture who has osteoarthritis. Signup and view all the answers

What is important to assess before transferring your patient from the bed to a chair after surgery?

Patient's stability and fatigue. Signup and view all the answers

Study Notes

Patient Admission Reactions

Common reaction to hospitalization includes fear of the unknown, leading to insecurity and anxiety.
Admission represents an anxious time for patients and families; the first contact with healthcare workers is critical.
Other common reactions: loss of identity, disorientation, separation anxiety, loneliness.
Maslow's hierarchy emphasizes the need for safety and security.

Importance of Greeting Patients

Greet patients by name to make them feel welcomed and reduce anxiety.
Introduce yourself with your name and title to convey concern and provide orientation about the new environment.

Admission Assessment

Essential part of admission procedure includes obtaining a health history performed by a registered nurse (RN).
The admission assessment must be completed within 24 hours, and data collection aspects can be delegated to Licensed Practical Nurses (LPNs).

Discharge Planning

Begins shortly after patient admission, encompassing education on illness, home care, medication, and follow-up care.
Key instructions include lifestyle changes, dietary restrictions, and arrangements for transportation and home health services.

Financial Aid Referrals

Nurses can refer patients or families to social services for assistance in finding financial help to cover medical expenses.
Social services provide support for major life crises, terminal illness, and family issues, as well as directing individuals to community resources.

Discharge Against Medical Advice (AMA)

When a patient insists on leaving without a physician's order, a discharge against medical advice form must be signed.
Nurses should document the incident thoroughly and notify the physician immediately.

Managing Separation Anxiety

Older adult patients may often exhibit depression instead of visible signs of anxiety, like crying observed in children.
Nurses should be aware of signs of disorientation commonly associated with hospitalization in older adults.

Handling Patient Valuables

Advise patients to secure valuables by placing them in the hospital safe to avoid loss, which could have legal implications.

Interagency Transfer

Defined as moving a patient from one healthcare facility to another, necessitating careful documentation to ensure continuity of care.

Patient Understanding of Discharge Instructions

It is crucial that patients fully understand discharge instructions, including medication, follow-up care, and key contact information, before leaving.

Cultural Sensitivity in Care

Cultural beliefs may influence patient perception of treatment; for example, Haitian-Americans may see leaves as having mystical healing properties.
Nurses should respect cultural practices and incorporate them into patient care whenever appropriate.

Reducing Admission Stress

Nurses can alleviate admission stress by demonstrating equipment use, explaining policies, and involving patients in their care plans.
Financial arrangements, however, should not be a primary focus of nursing responsibilities.

Joint Commission Discharge Standards

Patients must receive comprehensive education on medications, rehabilitation techniques, referrals to community agencies, and usage of medical equipment before discharge.

Documentation for Continuity of Care

Thorough documentation before, during, and after patient transfers ensures effective monitoring of patient conditions and continuity of care.

Assessing Patient Mobility and Safety

To assist patients with mobility issues, nurses should gather information on their usual transfer methods and address any concerns to facilitate a safe transfer.

Goal Setting for Patient Mobility

Establish clear, measurable goals for patients, such as transferring from bed to chair multiple times a day within a specified time frame, to promote successful postoperative recovery.### Postoperative Patient Transfer Goals
Goal: Safely transfer a patient four times a day within two days post-surgery.
Criteria for success: Specific, patient-oriented, measurable, and time-limited.
Importance: Improves patient ability and strength while decreasing fall risk.

Patient Transfer Techniques

Use a transfer belt for assistance when transferring a patient from bed to chair.
Initial instruction should encourage the patient to rock forward and push up with hands.
Ensure proper body mechanics to prevent injury to both the patient and nurse during transfers.

Initial Interventions for Transfer

If unable to transfer a patient to standing, prioritize returning them safely to bed.
Assess patient for weakness, fatigue, pain, and comprehension for future transfers.

Documentation and Patient Response

Document patient's response to each transfer, focusing on objective and subjective metrics.
Important details: breathing difficulties, dizziness, balance, muscle strength, and type of assistance required.

Mechanical Lift Guidelines

Delay transfer with a mechanical lift until an assistant is available if patient has difficulty following directions.
Position the base of the lift securely under the bed for stability.
Secure the call bell within reach after transferring to ensure patient safety.

Patient Safety During Transfers

For transferring a 225-pound unconscious patient, use a friction-reducing device and enlist at least two staff members.
Maintain patient observations during transfer; avoid obscuring with sheets.
When positioning a patient prone, place a pillow under the abdomen to reduce strain on the lower back.

Identifying Patient Fatigue

When transferring a bedridden patient, expect increased pulse and respiration rates as indicators of fatigue.
Perform a quick assessment for fatigue, especially when ambulating patients for the first time.

Task Delegation in Patient Transfers

Nursing Assistive Personnel (NAP) can assist by positioning the gait belt; more complex assessments should remain with nursing staff.

Proper Lifting Techniques

Teach caregivers to keep the patient close to the mover to stabilize the transfer and reduce injury risk.
Emphasize avoiding twisting while lifting and bending at the knees to maintain proper body mechanics.

Addressing Patient Weakness

Place the chair on the patient's strong side when assisting with transfers to enhance safety and support.

Slide Board Technique for Transfers

When using a slide board, ensure the third nurse is stationed on the side of the bed opposite the stretcher to assist effectively.

Assessment Prior to Transfer

Key assessments include sensory status, upper arm strength, postural hypotension, cognitive status, and pain level to ensure safe transfers.

Injury Protocol During Transfers

If a patient is injured during transfer: stay with them, notify the provider, complete an occurrence report, evaluate the incident, and provide supportive care.

Occupational Risks

Workers in nursing and support staff occupations experience the highest rates of musculoskeletal pain and injuries.
Prevention techniques include teaching proper body mechanics and utilizing patient-handling equipment.

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Description

Test your knowledge on the psychological reactions of patients during admission, transfer, and discharge processes in a healthcare setting. This quiz will help you understand key concepts and terminology that nurses need to be aware of when caring for patients. Dive into the emotional aspects of hospitalization and enhance your nursing skills.