Smoking Core Measures
Smoking or tobacco use, hands down, is the greatest cause of disease in the United States – even the whole world. Annually, it causes about 435,000 deaths.
Apart from causing heart disease, stroke, cancer and chronic obstructive pulmonary disease (among many others,) it puts a heavy burden to the individuals. A staggering $96 billion is lost due to smoking-related urgent care expenses, while $97 billion are lost in productivity gains because of tobacco use.
Because of its huge impact to the society, the Joint Commission has drafted a core measure set that addresses the perils of tobacco use. The statutes are:
Tobacco Use: Screening
Generally, patients aged 18 years and above are candidates for the screening process. As part of your nursing history, you need to calculate the patient age, which is the admission date minus the birthdate. If the patient is aged 18 years or older, proceed with the calculation of the length of hospital stay. If the length of stay exceeds one day, proceed with checking the patient’s cognitive impairment. If the patient demonstrates cognitive impairment, go ahead and check the patient’s smoking/tobacco use status.
Tobacco Use: Treatment Provided or Offered
Once you have established the patient’s smoking history (use of cigarettes, smokeless tobacco, cigars or pipes within the last 30 days,) the registered nurse’s responsibility is to discuss tobacco treatment, or at least make a referral for the patient’s treatment.
At the same time, you should encourage the patient regarding the many benefits of smoking cessation. Should the client refuse the treatment options, make sure to document the reason behind his non-acceptance.
Tobacco Use: Treatment Provided or Offered at Discharge
Patients can be addicted to smoking, that is why it is important to provide or offer treatment upon discharge. Before the patient is sent home from the medical center, the nurse should make sure that the client receives a prescription for a FDA-approved medication. Examples include:
- Varenicline (Chantix). Blocks the effects of nicotine and reduces withdrawal symptoms.
- Bupropion (Wellbutrin or Zyban). A prescription pill that reduces smoking nicotine cravings.
- Nicotine Replacement Therapies. Available in patches, gums, inhalers, nasal sprays and lozenges.
A referral to an outpatient counseling center should be sent as well.
Apart from documenting the nursing process, the nurse should educate the client regarding the benefits of smoking cessation.
Tobacco Use: Assessing Status after Discharge
Even after discharge, the nurse should help monitor the patient’s status. The officer in-charge should contact the client 15 to 30 days after release. Follow-up information should be gathered throughout the call. Questions that need to be asked include:
- Whether smoking counseling was received
- If medication was received
- If he has quit smoking or using other tobacco products
Although the nurse has no role in follow-up, he can help improve follow-up rates. He can do so by encouraging the patient to attend counseling, as well as telling him about the evils of smoking.
Fact: Obama Care levies an additional 50% to smokers because of “tobacco surcharge.” Do your part in eradicating this health care burden by learning more about the smoking core measures – available here at nclexpreceptor.com.
Childhood Asthma Core Measures
Childhood Asthma is the most common chronic condition in kids. It is one of the biggest reasons why children are sent to the hospital, with confinement cases amounting to 200,000 yearly.
With childhood asthma racking up to $3 billion in medical costs every year, the Joint Commission has released a core measure set to lessen such cases. These are proven-effective interventions which can decrease lost school time for children. At the same time, it can reduce Obama care hospitalization bills.
Use of Relievers for Inpatient Childhood Asthma
According to numerous studies, bronchodilators and short-acting beta agonists (SABA) are the best medications for patients. They bring about acute, urgent care relief of childhood asthma symptoms. Examples of such medications are Albuterol, Albuterol Sulfate, Albuterol/Ipratropium, Epinephrine, Ipratropium Bromide, Levabuterol Hydrochloride, Metaproterenol, Pirbuterol Acetate and Terbutaline.
As a nurse, it is your duty to educate the child or the parent/caregiver regarding the proper use of these inhaler medications. Ask the child or parent/caregiver to demonstrate the use of the inhaler. Let them ask questions as needed.
Your foremost nursing consideration for this measure is to ask the patient/parent to report any of these symptoms:
- Allergic reactions
- Difficulty breathing
- Dizziness or severe headache
- Fast/irregular heartbeat
- Chest pain
- Pounding in the chest
- Ear pain
- Blistered, swollen, reddened or peeling skin
Use of Systemic Corticosteroids for Inpatient Childhood Asthma
Many studies also suggest the use of systemic corticosteroids, as they can control acute childhood asthma exacerbation. At the same time, they can reduce the severity of symptoms in kids with mild, moderate or severe childhood asthma. These meds bring immediate relief by decreasing bronchoconstriction activities.
Systemic corticosteroids that the registered nurse might administer to childhood asthma patients include Dexamethasone, Hydrocortisone, Methylprednisolone, Prednisolone and Prednisone.
While systemic corticosteroids have fewer side effects, they are used for a short time only. Prolonged use can lead to impaired growth, hyperglycemia, osteoporosis and immunosuppression.
Home Management Plan of Given to Parent/Caregiver
Health care education is an essential component for both parents and caregivers of kids with childhood asthma. Accordingly, this is considered the most challenging of the three measures. In order to meet the requirements of the Joint Commission, the patient’s home management plan should contain all of the following:
- A copy of the Home Management Plan, which should be attached to the chart.
- Parent/caregiver acknowledgement which proves that the plan was received.
- Follow-up arrangements and schedules.
- Triggers (environmental or other) that need to be addressed.
- The childhood asthma controllers that need to be used.
- The childhood asthma relievers that need to be used.
- The Home Management Plan that states the time and methods of rescue interventions.
Although chronic, exacerbation of childhood asthma can be controlled with medication compliance and the elimination of environmental triggers, to name a few. Learn more about life-changing core measures at nclexpreceptor.com.
Influenza Core Measures
Influenza is an acute and contagious infection affecting the respiratory organs (nose, throat and mouth.) Caused by influenza viruses, it is highly prevalent during the autumn and winter months.
Affecting an estimated 1 out of 5 persons during the flu season, it results in the hospitalization of 226,000 Americans annually. With the staggering rates of flu-related complications and deaths, the Joint Commission has developed the immunization core measure for Influenza.
Prevention is better than cure, so goes the old adage. To protect the masses from the flu epidemic, hospitals and medical centers are required to administer flu vaccines from September to November. After all, the flu shot is the most effective way to prevent influenza and its life-threatening complications.
Traditional flu vaccines – also known as trivalent vaccines – protect the individual from three strains: influenza A (H1N1), influenza A (H3N2) and influenza B. Another type of vaccine – the quadrivalent shot – protects the receiver from the aforementioned strains, as well as another type of Influenza B.
Only a handful of people can be excluded from the screening and the vaccination process. They are patients less than 6 months old, and clients who have received organ transplantation during his confinement.
Patients discharged from October 1 through March 31 are excluded as well, since the vaccination orders are still underway during this period.
As a registered nurse, it is your responsibility to make sure that patients aged 6 months and above are screened for influenza vaccination prior to discharge. Individuals who were admitted to urgent care centers, following a flu shot this year, have to be tested as well.
Apart from administering the vaccine, the nurse should document all the important information related to the immunization. Make sure that these items are included in your nursing documentation:
- The fact that the patient received his influenza immunization for the corresponding flu season.
- The declination of the vaccine, should the patient refuse to receive it.
- Why the vaccine was not given, due to the presence of the following contraindications:
- Hypersensitivity or allergy to the vaccine.
- Hypersensitivity to eggs and other components of the vaccine, which could hinder the effectiveness of the shot. History of Guillain-Barre syndrome that occurred 6 weeks after a previous flu shot.
- Bone marrow transplant performed within the last 6 months.
- Allergy to latex materials (gloves, condoms.)
After administering the shot, you should inform the receiver about the expected side effects, which include injection site soreness and runny nose, if a nasal spray was given. These are generally mild side effects, which dissipate after a day or two.
Influenza is a contagious disease that can easily be contained with vaccination. Do your part for the Obama care program by mastering the flu core measures, available here at nclexpreceptor.com.
Heart Attack Core Measures
Heart attack – also known as Acute Myocardial Infarction (AMI) – is the leading cause of death in the United States. It occurs when the blood supply to the heart muscles is stopped or slowed down. Without the adequate oxygen and nutrient that it needs, the affected heart tissue will die. Because of the prevalence of heart attack, registered nurses – with the entire health team – should provide urgent care measures to AMI patients. In order to further improve the quality of life of these individuals, the Joint Commission has drafted several life-saving core measures.
Administering Aspirin Upon Hospital Arrival
Throughout years of research, Aspirin has shown the most benefits with regards to reducing heart attack-caused mortality. The effects manifest quickly, and persist throughout therapy. In order to actualize the benefits of the drug, Aspirin 325 milligrams should be given immediately to the patient. The nurse should administer the drug once the signs and symptoms of heart attack have been recognized. He should document the time it was given, or why it was contraindicated/not given.
Aspirin Prescribed at Hospital Discharge
As it has been said, Aspirin is efficient in reducing heart attack mortality. It remains effective with long-term use, even at doses of 75 milligrams per day. In order to prevent heart attack re-occurrence, the medical doctor should prescribe Aspirin upon the patient’s discharge. The nurse should then ensure that this is included in the patient’s take-home medication list. He should also educate the client about the importance of compliance. Other important nursing teaching points for post-heart attack patients include:
- Taking the drug with food if stomach upset occurs.
- Avoiding the intake of other over-the-counter meds, unless prescribed by the doctor.
- Knowing the side effects of Aspirin, which are stomach upset, nausea, heartburn, gum bleeding and easy bruising.
- Not crushing, chewing or cutting SR products.
Appropriate Usage of ACE Inhibitors/ ARBs
Studies show that the survival and quality of life of heart attack patients are enhanced with certain blood pressure-lowering drugs. These meds, in particular, are ACE Inhibitors and Angiotensin-Receptor Blockers. They can prevent future heart attack problems by blocking hormones that lead to blood vessel constriction, which then results to hypertension.
Beta Blocking Medications Prescribed at Hospital Discharge
Another blood pressure-lowering medication – the Beta-Blocker– has been proven effective in decreasing mortality during and after a heart attack. It does so by slowing the heart rate, decreasing heart stress and lowering the risk of abnormal heart rhythms. The nurse’s responsibility for this health care measure is to ensure that the medication is included in the list. Additionally, he should educate the client regarding the proper intake of the drug, as well as its side effects.
PCI Within 90 Minutes of Hospital Arrival
Percutaneous coronary intervention or PCI should be administered to the heart attack patient within 90 minutes of his arrival. In this procedure, the interventional cardiologist inserts a balloon, which is inflated at the blocked artery. A stent is then placed to permanently open the vessel, establishing normal blood flow. Apart from ensuring that this procedure is done, the nurse should place the patient on complete bed rest right after. The nurse should also place the patient on a cardiac monitor. He should check the vital signs frequently as well. The limb used for PCI should also be monitored for signs of poor circulation.
In order to meet the goals of Obama care, the nurse should make sure that the heart attack core measures are followed. Know more about other nursing best practices by parsing through nclexpreceptor.com.
NCLEX Cardiovascular Study Questions and Tips
Here is an example of a NCLEX cardiovascular question. You are working the night shift on a telemetry unit. You are caring for a 58 year old male admitted for anxiety. Which of the following actions is the first priority of care for a client exhibiting signs and symptoms of coronary artery disease?
- Decrease anxiety
- Enhance myocardial oxygenation
- Administer sublingual nitroglycerin
- Educate the client about his symptoms
In order for you to answer this NCLEX cardiovascular question you must know the signs and symptoms of coronary artery disease. Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn’t the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised.
NCLEX Cardiovascular questions will often ask about Coronary artery disease (CAD). CAD is the most common type of heart disease. CAD is often tested in the NCLEX Cardiovascular section. It is the leading cause of death in the United States in both men and women.
To test well in the NCLEX Cardiovascular section know how to assess and recognize signs and symptoms of CAD.
CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through the arteries. As a result, the heart muscle can’t get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the hearts’ blood supply, causing permanent heart damage. Nurses must be able to apply the nursing process to answer NCLEX cardiovascular questions correctly.
Over time, CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias. Heart failure means the heart can’t pump blood well to the rest of the body. Arrhythmias are changes in the normal beating rhythm of the heart. You can pass the NCLEX cardiovascular section by knowing about CAD.