How many violations of Medicare and Medicaid guidelines are ...

[tnt_battle]

How many violations of Medicare and Medicaid guidelines are evident in this documentation?
 
  Patient assaulted nurse in hall at 1730
 
  Staff provided verbal intervention, but patient continued to strike out. Patient placed in seclusion at 1745 . Observation instituted at hourly intervals. Order received from physician at 1930 . Patient sleeping soundly at 2100 . Patient released from seclusion at 2230 and returned to own room.
  a. Two
  b. Three
  c. Four
  d. Five

Question 2

The parent of an adopted infant tells the nurse, Our baby was abused before the adoption. I read an article online that said this experience causes problems as a child grows up. What we should be watching for? Select the nurse's best response.
 
  a. Early trauma sometimes causes learning difficulties, anxiety, and difficulty handling stress later in life.
  b. Early abuse causes the myelin covering of the nerves to overgrow, which leads to high anxiety and mood instability.
  c. Many individuals who experience early trauma and abuse develop symptoms of schizophrenia.
  d. Your child will be normal. Information in online articles is not reliable.

[pangili4]

Answer to Question 1

D
Constant observation of a secluded individual is necessary, with attention given at frequent intervals for safety and comfort interventions. No mention is made of providing fluids or bathroom privileges. Seclusion requires a written order posted within 1 hour. Seclusion must be terminated when patient behavior permits. If the patient is calm enough to sleep, the need for seclusion should be reevaluated. The patient should be debriefed after the seclusion.

Answer to Question 2

A
Stress increases cortisol levels. Excessive cortisol levels can cause hippocampal atrophy, leading to memory and learning difficulty. Elevated cortisol level is also associated with hypersensitivity of the hypothalamic-pituitary-adrenal (HPA) system, leading to overreaction to stress and possibly a propensity to depression and anxiety. Myelin continues to grow after birth, but overgrowth is not likely as a result of abuse. Stating that the individual is at risk for schizophrenia is incorrect. Online articles may or may not be reliable. The nurse should not give false reassurance about the child's development.