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NU665 Final exam Questions and Correct Answers, Exams of Nursing

Regis University Nursing

PCP as care coordinators ✓ ~~~ -These children require heath maintenance, illness prevention, and developmental surveillance ✓ -Traditional primary care needs - needed for routine vaccinations, common disease management, and family support and guidance

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NU665 Final exam Questions and Correct

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PCP as care coordinators

✓ ~~~ -These children require heath maintenance, illness prevention, and

developmental surveillance

✓ -Traditional primary care needs - needed for routine vaccinations, common disease

management, and family support and guidance

✓ -Collaboration among clinicians, case managers, family members, home care and

school professionals, clinics, hospitals, and community-based services

✓ -Gatekeeper and care coordinator - collaboration for all needs

✓ -PCHH - patient-centered health home - ideal model for managing complex health

care needs

Differences between CSHCN (children with special health care needs) and without

special needs

✓ ~~~ Table 7.1

✓ -Mental health problems - ADD, mood disorders, autism, tic disorders

✓ -Atopic and rheumatic disorders - asthma, JRA, lupus

✓ -Endocrine and metabolic diseases - growth disorders, adrenal disorders, disorders

of sex development, thyroid disorders, inborn errors of metabolism, DM, pituitary

disorders

✓ -Congenital, genetic, or chromosomal defects - rare genetic diseases/syndrome

✓ -Premature and/or very low birth weight infants

✓ -Severe injuries or burns

✓ -Static or progressive neurologic and neuromuscular disorders - CP, global

developmental delays, muscular dystrophy, spina bifida, seizure disorders

✓ -Respiratory disorders - cystic fibrosis

✓ -CV disorders - cardiac defects, long-term effects of acquired CV disease

✓ -GI disorders - IBD

✓ -Childhood cancers

✓ -Family psychosocial concerns - trauma/abuse, homelessness, undocumented

immigration status, overwhelming needs with limited resources

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NU665 Final exam Questions and Correct

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PCP as care coordinators ✓ ~~~ - These children require heath maintenance, illness prevention, and developmental surveillance ✓ - Traditional primary care needs - needed for routine vaccinations, common disease management, and family support and guidance ✓ - Collaboration among clinicians, case managers, family members, home care and school professionals, clinics, hospitals, and community-based services ✓ - Gatekeeper and care coordinator - collaboration for all needs ✓ - PCHH - patient-centered health home - ideal model for managing complex health care needs Differences between CSHCN (children with special health care needs) and without special needs ✓ ~~~ Table 7. ✓ - Mental health problems - ADD, mood disorders, autism, tic disorders ✓ - Atopic and rheumatic disorders - asthma, JRA, lupus ✓ - Endocrine and metabolic diseases - growth disorders, adrenal disorders, disorders of sex development, thyroid disorders, inborn errors of metabolism, DM, pituitary disorders ✓ - Congenital, genetic, or chromosomal defects - rare genetic diseases/syndrome ✓ - Premature and/or very low birth weight infants ✓ - Severe injuries or burns ✓ - Static or progressive neurologic and neuromuscular disorders - CP, global developmental delays, muscular dystrophy, spina bifida, seizure disorders ✓ - Respiratory disorders - cystic fibrosis ✓ - CV disorders - cardiac defects, long-term effects of acquired CV disease ✓ - GI disorders - IBD ✓ - Childhood cancers ✓ - Family psychosocial concerns - trauma/abuse, homelessness, undocumented immigration status, overwhelming needs with limited resources

Subspecialty care ✓ ~~~ - PCPs review notes and recommendations, looking for missing or duplicate items

May have an interdisciplinary clinic available Tertiary care ✓ ~~~ - PCP makes sure family has documentation of child's condition, medications, etc. and knowledge of when to go to a higher level of care Homecare and community services ✓ ~~~ - PCP in charge of arranging and recognizing the need for services Technology dependence and medication ✓ ~~~ - Complex equipment such as home ventilators, enteral feeding pumps, wheelchairs, hospital beds, and nerve stimulations may be needed
Low-tech supplies may include respiratory or feeding tubing, special formulas or diets, urinary catheters, and ostomy bags
Ongoing family education is essential to ensure the safe and effective use or all devices and to make sure that families know how to fix common complications without seeking urgent care
Medications - be aware of polypharmacy - this leads to an increased risk of drug interactions and confusion about dosing and administration
Ongoing review of medication necessity and limiting the use of medication to compounding pharmacies; PCPs can help find compounding pharmacies as many of these kids require liquid medications and cannot swallow pills

✓ ~~~ - From birth to age 3

May include developmental, speech, physical, and occupational therapy, audiology, assistive medical technology, family training assistance, social work services and service coordination
PCPs should refer any child with suspected disabilities or developmental delays to EI services for evaluation and therapy
Services are generally free, but other services may be billed so referral to social work may be needed
After age 3, CSHCN transition to services through the public school system - IDEA and section 504 ensures free, appropriate education in the least restrictive environment possible for all children
Children with disabilities receive educational support in either general or special education classrooms, therapies including speech and OT, health care services needed during the school day, and emotional, behavioral, and psychologic services
PCPs should encourage parents of children receiving EI to contact their school before third birthday - they may be eligible for a 504 or IEP IEP and 504 plans ✓ ~~~ - Children who do not meet criteria for an IEP may be eligible for 504 plan if they follow the curriculum without modification but require additional assistance in school settings such as physical, sensory, or mental support

504 plan

Simple accommodations or minor changes; easier, faster, more flexible

Eligibility - based on identification of psychologic or physical disorder that limits a major life activity (learning or behavior)
Evaluation - compiled by the school from a variety of sources to confirm assumption; no money to cover evaluation or support; can occur without parental knowledge or participation
Provisions - extra time to complete assignments, a copy of notes, providing a quiet place to take tests, or assistive technologies; no legal requirements for what is included, for parent involvement, or mandated reevaluation

IEP

Needs a wide range of services or protections
More involved with mandated parental participation
Eligibility - meet criteria of qualified disability - ADHD not included - developmental delays, emotional disturbances, or SLD that affects learning or behavior
Evaluation - a complete evaluation compiled by a team of professionals including testing and information from a variety of sources; federally funded; must have written consent to perform
Provisions - it describes the child's learning problems, details services to be provided, sets annual goals, and defines how progress will be measured; changes made only in meeting and in collaboration with team; special provisions if suspected or expelled; reevaluation every 3 years

Central record or database - pertinent medical information, including hospitalizations and specialty care; updated medical list; equipment, supplies, therapies with product information, suppliers, sizes
Care coordination - information-sharing among the child, family, and other providers; referrals to other health care providers, collaboration with agencies to obtain necessary services
Family support - support groups (online, national organization); parent-to-parent groups, social work, mental health services
Communication - information sharing among specialists and other professionals; families understanding of recommendations and treatment options, encouraging families to keep pertinent information and share this information with health care providers as needed Shared plan of care ✓ ~~~ - Comprehensive information compilation that, in partnership with the family, allows individualized care coordination
Determine needs and strengths of child/family - consider each family's situation and abilities, strengths and needs, medical conditions, psychosocial factors, child/family development, environmental issues; financial strengths and needs
Develop necessary partnerships - identify how providers, caregivers, and children work together; shared agreement on plan; account for family preferences and best practices

Develop a plan of care - identify roles and responsibilities of providers and families; include specific emergency care information; include fact sheets about rare conditions, legal documents about guardianship and/or health care decision making
Implement the plan of care - update the plan of care as needs change; evaluate and plan process at each encounter, assess progress towards goals and develop new goals as needed Respite care ✓ ~~~ - Provide breaks from time to time - This can take place in homes or in institutional settings

Some states have assess to federal funds to help support these services for families Support groups and services ✓ ~~~ - These services are available through community-based services, parent training groups, and national organizations
Families should seek out services and get involved in educational, advocacy, and other activities to alleviate stress and caregiver fatigue Transition of care ✓ ~~~ - Barriers - the diversity of clinical conditions makes standardization difficult; no adult providers qualified to treat what were once considered childhood diseases; complex process across locations or levels of care
Factors influencing successful transitions - timing, patient transition perceptions, preparation for the transition, posttransition patient outcomes, barrier identification, and transitions facilitating the identification of these factors

The amount of parental education and disease process, pharmacology, and other therapeutic treatments required for the at-home care of the child
How to best advocate for these children to access services through schools, state and community agencies, or special federally sponsored programs
Treatments or procedures that may be embarrassing, painful or time consuming
Unpredictability of the child's condition and the potential for complications, frequent medical visits, hospitalizations, and death
The developmental effect that chronic disease can have on a child, especially during adolescence and early adulthood (periods of increased vulnerability)
Acceptance by peers
Dealing with feelings (anger, sorrow) while attempting to cope with chronic illness
Problems of non-compliance Key indicators that affect treatment adherence in children and adolescents with acute illnesses or chronic conditions ✓ ~~~ 1. Illness

Severity
Length and prognosis
Effect of illness on functional and social activities of daily living

Management

Complexity of treatment plan

Length of time for each treatment, how often, and for what length
Visibility of assistive equipment

Family

Support network and size of family
Financial resources; knowledge base and the understanding of illness; overall cognitive skills; communication style
Coping ability and skills; problem-solving skills
Family's belief system and spiritual base

Child or teen

Age
Cognitive, social, and emotional level of development; temperament
Peer group; coping ability

Healthcare provider and environment

Communication style of PCP with child, family, and other healthcare providers; belief in empowerment of parent and child/teen
Organization of clinic or office setting to the child, teen, and family friendly, need for adaptive modifications in their environment
Number of healthcare providers involved in the child's care; team member collaboration and partnership among themselves and with the family
Open and "blame-free" approach when adherence issues arise

Good documentation and patient visit ✓ ~~~ 1. Be alert to a complaint or combination of complaints that are red flags for more serious illnesses - abdominal or chest pain, headache, syncope; note pertinent positives and negative history and physical findings relative to these complaints

Identify differential diagnoses and rule out serious or life-threatening illness first. Be sure to gather enough data to either rule in or out the diagnosis based on history, physical findings, and diagnostic studies; Rule outs are no longer acceptable by insurance providers. Providers must use medical terms such as RLQ pain rather than rule out appendicitis
Revisit an unresolved problem until it resolves. Reschedule a follow-up examination or use telephone or email contact with the family to determine if the complaint or illness resolved
Ensure there is a system in place to ensure that diagnostic studies were done, results received, and follow-up was done by the provider
Follow-up on referrals to other healthcare providers or agencies and document the recommendations or treatments from these referral sources
Document missed clinic appointments through chart audits, which should be a regular part of practice quality improvement. Look for such information omissions, whether problems identified in earlier visits were addressed at subsequent visits until resolved, and compliance with routine health maintenance screenings Triage questions

✓ ~~~ 1. Description - tell me about the problem; what signs and symptoms are present

Duration - how long has the problem been present
Clinical changes - how has the child's behavior or activity level changed - eating, sleeping, playing, interaction with others
Appetite - has there been a change in eating or drinking
Elimination - have there been changes in bowel or bladder habits
Sleep pattern - has there been a change in the child's sleeping habits
Cause - what does the parent believe ma be contributing to the condition
Management - what has the parent done and the effect
Feelings - does the parent feel anxious about the current condition Texting and e-mail ✓ ~~~ - HIPAA does not comment on messaging because the law was created before texting

As of 2013, all providers must have the ability to have secure healthcare communications with an encryption protection platform as part of their mobile device assuring that if there is a loss of a mobile device, the user can be disconnected from the system to avoid a data breach
PHI is not allowed to be stored on personal mobile devices if a personal mobile device is used on an open WIFI network
SMS are used to send appointment reminders, give educational messages, provide support to patients between visits, and track lab results

Relevant because they help identify individuals at increased risk for multifactorial disease Point mutations ✓ ~~~ - Single base pair changes - substitutions, deletions, or insertions, occurring at the level of the nucleotide and capable of changing the function of a gene or gene product
Responsible for single gene disorders, such as sickle cell anemia, cystic fibrosis
Different from SNPs
Deletions - section of DNA is lost or deleted; example - 22.q11.2 deletion syndrome, Duchenne MD and neurofibromatosis
Insertions - extra base pairs are inserted; Duchenne MD, Charcot-Marie-Tooth Type 1A **Single gene disorders Frameshift mutation ✓ ~~~ - Insertion and deletions - INDELS
Insertions and deletions in the codons can change the gene message so that it cannot be coded or it cannot be coded correctly - frameshift mutation
Tay-Sachs, many types of cancers, Crohn disease Chromosome mutations

✓ ~~~ - Occur when even larger segments of a chromosome are deleted, duplicated, rearranged, or translocated in such a way that there is a resulting alteration of the DNA sequence, a modification of the gene dosage, or a complete absence of a gene or several genes

Down syndrome Single-gene disorders ✓ ~~~ - Aka monogenetic disorders
Occur when the mutation affects one gene
The mutation may be present on one or both chromosomes, associated with one of three different Mendelian patterns of inheritance - dominant (just one of the two alleles), recessive (both alleles), or X linked (confined to X chromosome)
Examples - sickle cell disease, thalassemia, neurofibromatosis, hemophilia, Duchenne MD, CF, fragile X syndrome, polycystic kidney disease, Marfan syndrome, and Tay-Sachs disease Chromosome disorders ✓ ~~~ - Occur with changes in the number or structure of an entire chromosome, or large segments of it
Down syndrome (trisomy 21) is caused by an extra copy of chromosome 21
Prader-Willi syndrome is caused by the absence of a group of genes on chromosome 15
CML - translocation in which chromosome 9 and 22 are exchanged, resulting in a new abnormal gene
Also, cri-du-chat syndrome, Williams syndrome, DiGeorge syndrome

Autosomal dominant* ✓ ~~~ - This type of single gene disorder is characterized by the inheritance of a single copy of a mutated gene located on one of the autosomal chromosomes (1-22)

Passed on from one parent but results in an inherited disorder; the paired gene from the other parent is normal
The parent passing it on typically has the disorder
For the offspring, the chance of getting it is 50%
Without having the gene you cannot pass it on or have it
Huntingtons, Noonan syndrome, and neurofibromatosis type 1
The clinician should consider AD inheritance when a specific phenotype appears in a family generation after generation, both sexes can be affected, and male-to-male transmission occurs Autosomal recessive* ✓ ~~~ - This type of single gene disorder requires inheritance of two copies of a mutated gene (one from each parent) located on one of the autosomal chromosomes (1-22)
Offspring who inherit only one abnormal gene are carriers - they can pass it on to their children but are unaffected
For offspring of parents who both carry an AR mutation, there is a 25% chance of inheriting the mutation from both parents, thus developing the disorder, a 50% chance of inheriting one copy and becoming a carrier, and 25% chance of not inheriting either mutation

Cystic fibrosis, albinism, thalassemia, and sickle cell anemia
The clinician reviewing a child's history should consider AR inheritance when a specific phenotype affects multiple siblings and both sexes are affected, the phenotype is often not present generation after generation X-linked dominant ✓ ~~~ - When a disorder is classified this way, it means that a single abnormal gene on the X chromosome gives rise to the disease
If the father is affected and the mother is not, all of his female offspring will inherit the allele, but none of his male offspring, because daughters always inherit their father's X chromosome, whereas sons inherit their father's Y chromosome
If the mother is affected and the father is not, there is only a 50% chance that each daughter or son will inherit the disease causing allele and manifest the disorder, because mother's have two X chromosomes to pass on
Consider this when a specific phenotype affects both sexes in each generation, with slightly more females and the absence of male-to-male transmission
X-linked dominant disorders are often lethal in males
Rett syndrome, vitamin-D resistant rickets X-linked recessive ✓ ~~~ - This disorder will occur in males
Males only have one X chromosome, so a single, abnormal, recessive allele on that X chromosome is enough to cause the disease

NU665 Final exam Questions and Correct Answers, Exams of Nursing

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NU665 Final exam Questions and Correct

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