Author Question: The patient has been in the hospital for a hip replacement. According to his critical pathway, he ... (Read 14 times)

waynest · **on:** Jul 24, 2018

The patient has been in the hospital for a hip replacement. According to his critical pathway, he should have his Foley catheter discontinued on the fourth day after surgery.

Instead, the patient has it removed on the third day and is voiding normally with no problems. This would be a sign of: a. a negative variance.
b. positive case management.
c. a positive variance.
d. use of SBAR.

Question 2

The nurse receives orders for an Acapella device on several patients. The nurse should question the order on the patient with which condition?

a. Chronic bronchitis
b. Asthma
c. Cystic fibrosis (CF)
d. Pleural effusion

cdmart10 · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

C
Variances are unexpected occurrences, unmet goals, and interventions not specified within the critical pathway time frame that reflect a positive or negative change. A positive variance occurs when a patient progresses more rapidly than is anticipated in the case management plan (e.g., use of a Foley catheter is discontinued a day early). A negative variance occurs when activities on the critical pathway do not happen as predicted, or outcomes are unmet (e.g., oxygen therapy is necessary for a new-onset breathing problem). Case management is a delivery model that coordinates and links health care services to patients and families while streamlining costs and maintaining quality. SBAR is a technique that provides a framework for communication between members of the health care team about a patient's condition. SBAR is a concrete mechanism used for framing conversations, especially critical ones, requiring a nurse's immediate attention and action.

Answer to Question 2

D
The Acapella device is a respiratory rehabilitation device designed to aid sputum clearance. Patients with chronic conditions such as cystic fibrosis, chronic bronchitis, and asthma appear to receive the greatest benefit from this type of treatment. CPT is contraindicated in patients with pleural effusion.