NR 511 Final Exam Study Guide 1 PDF

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NR511 Final Exam Study Guide

Week 1
1. Define diagnostic reasoning
a. Involves critical thinking in a way that evaluates new data to support the hypothesis and reduce alternative hypothesis. This is done by evaluating all the avenues to reach a conclusion that gives the best...

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NR511 Final Exam Study Guide Week 1 1. Define diagnostic reasoning a. Involves critical thinking in a way that evaluates new data to support the hypothesis and reduce alternative hypothesis. This is done by evaluating all the avenues to reach a conclusion that gives the best evidence to support the main theory or hypothesis. b. Examples of diagnostic reasoning are problem solving, health promotion, and screening for disease or illness. All of these will require sensitivity, complexity, contest, and a sense of probability and uncertainty. 2. Discuss and identify subjective & objective data a. Subjective- what the patient reports as the CC and the responses to the questions in the interview. Includes ROS, CC, and HPI b. Objective – Information gained through exam, labs, imaging and other diagnostic tests. 3. Discuss and identify the components of the HPI a. Describes the reason the patient came in and include information using the acronym OLDCARTS i. Onset ii. Location iii. Duration iv. Characteristics v. Aggravating factors vi. Relieving Factors vii. Treatments tried viii. Severity of the level of pain 4. Describe the differences between medical billing and medical coding a. Medical billing is the process of submitting and following up on claims made to a payer in order to receive payment for medical services rendered by a healthcare provider. b. Medical coding is the use of code to communicate with payers about the procedures performed and why. 5. Compare and contrast the 2 coding classification systems that are currently used in the US healthcare system – The two systems need to be in line i.e. the CPT code for the activity performed should be followed with a relevant Diagnosis for the procedure performed. a. ICD 10- the newest version of shorthand for the patients diagnosis. It is necessary for all diagnosis and procedures performed. b. CPT- common procedural terminology represented by a 5 digit code that provides a uniform language to describe medical, surgical, and diagnostic services. Allows for tracking of treatments, trend and outcomes. Therer is 3 levels of CPT codes: Category I- used in contemporary medical practice, Category II

-tracking codes used for new or performance measurement, and Category III- Temporary coding used for new procedures, technology and services. i. Catergory I has six sections

1. Evaluation and Management 2. Anesthesiology 3. Surgery 4. Radiology 5. Pathology 6. Medicine 6. Discuss how specificity, sensitivity & predictive value contribute to the usefulness of the diagnostic data a. Specificity of a test = greater when it has few false

positives no. of true negatives specificity = no. of all tested indiv, who do not have the dz b. Sensitivity of a test = greater when it has few false negatives no. of the true positives sensitivity = no. of tested indiv that have the dz c. Predictive value = is in part dependent on the prevalence of the condition true + positive predictive value = ----------all + true Negative predictive value = ---------all – False positive - when a pt that does not have the condition has a positive reading False negative - when a pt that does have the condition but has a negative reading 7. Discuss the elements that need to be considered when developing a plan a. Diagnostic testing-what tests need to be conducted to clarify assessment b. Education-specific problems being managed c. Follow-up: when will the patient be seen again d. Be honest e. Negotiate what to cover 8. Describe the components of Medical Decision Making in E&M coding a. There is three key components the determine risk-based E&M codes i. History ii. Physical iii. Medical Decision Making- a way of quantifying the complexity of the thinking that is required for the visit. And gives credit for the excess work involved in management of a more complex patient. 1. Complexity of a visit is based on a. Risk b. Data

c. diagnosis b. Reason for consultation c. HPI d. ROS e. Physical exam f. Recommendation for testing and treatment 9. Correctly order the E&M office visit codes based on complexity from least to most complex a. New: i. 99201 (minimal/RN visit) ii. 992022 (Problem-focused) iii. 99203 (Expanded problem- focused) iv. 99204 (detailed) v. 99215 (comprehensive) b. Established: i. 99211 (minimal/RN visit) ii. 99212 (problem- focused) iii. 99213 (expanded problem focused) iv. 99214 (detailed) v. 99215 (comprehensive) 10.Discuss a minimum of three purposes of the written history and physical in relation to the importance of documentation a. Provides documentation about the findings in the history and physical exam b. Provides an outline for addressing the issues that prompted the visit. c. Form of communication about care involved in patients. d. Medical legal document e. Essential for accurately coding and billing for services. 11.Accurately document why every procedure code must have a corresponding diagnosis code a. Every procedure code needs a diagnosis to explain the necessity whether the code represents an actual procedure performed or a nonprocedural encounter like an office visit. 12.Correctly identify a patient as new or established given the historical information a. New patient- who has not received services from the provider before or who has not seen the provider/ group for over 3 years b. Established patient- has been seen within the last 3 years, 13.Identify the 3 components required in determining an outpatient, office visit E&M code a. Place of service b. Type of Service c. Patient status 14.Describe the components of Medical Decision Making in E&M coding a. Risk b. Data c. Diagnosis 15.Correctly order the E&M office visit codes based on complexity from least to most complex

a. New Pt: 99201 least complex -99205 most complex

b. Established patient: 99211 least complex - 99215 most complex 16.Explain what a “well rounded” clinical experience means a. Experience in a varied amount of paitnets across the lifespan i. 15% pediatrics ii. 15 % women’s health 17.State the maximum number of hours that time can be spent “rounding” in a facility a. 25% of total practicum hours for that course i. Rounding is permitted under the following circumstance 1. Your course instructor must be made aware that you’ll be rounding 2. The preceptor has facility privileges where the rounding will occur 3. Patients seen in a facility are patients of the provider’s outpatient practice 4. The student actively participated in the patients care (no observing) 18.State 9 things that must be documented when inputting data into clinical encounter a. Date of service b. Age c. Gender and ethnicity d. Visit E&M code e. Chief concern f. Procedures g. Test performed or ordered h. Diagnoses i. Level of involvement 19.Identify and explain each part of the acronym SNAPPS

a. S = summarize - present the pt’s hx and physical exam findings b. N = narrow - narrow your differential down - find the top 2-3 diagnosis c. A = analyze - analyze the differential - compare and contrast the H&P + physical exam findings for each of the dif that you have, coming down to 1 diagn. d. P = probe - ask the preceptor questions about what you are not sure e. P = plan - management plan, as specific as possible f. S = self-directed learning - opportunity to investigate more about the topics you are not sure Week 2 1. Identify the most common type of pathogen responsible for acute gastroenteritis a. Viral most common for adults b. Rotavirus leading cause for children c. Bacterial (30-80%)i. Campylobacter jejuni- most common in kids ii. Salmenella- most common cause of food borne illness in US

2. Recognize that assessing for prior antibiotic use is a critical part of the history in patients presenting with diarrhea a. C-diff is common after use of fluoroquinolones and clindamycin

3. Describe the difference between Irritable Bowel Disease (IBS) and Inflammatory Bowel Disorder (IBD) a. Irritable Bowel Syndrome (IBS)- A functional gastrointestinal disorder that is characterized by abdominal pain and discomfort. i. S&S: abdominal pain, discomfort that is relieved by defecation, change in stool frequency, change in stool appearance, frequent stools (more than 3 a day) or fewer stools (less than 3 per week), passing mucus, feelings of straining, urgency or incomplete evacuation, flatulence, and abdominal distention. b. Inflammatory Bowel Disease (IBD)- Chronic immunological disease that manifests in intestinal inflammation. i. Causes 1. Ulcerative Colitis 2. Crohn’s Disease ii. S&S- exacerbations and remissions that are experiences throughout and individuals lifetime and therefore results in significant disruption in the quality of life. 4. Discuss two common Inflammatory Bowel Diseases a. Ulcerative Colitis i. Involved only the mucosal surface of the colon. Occur in the rectosigmoid area but can be in the entire colon. More common in males. ii. S&S: Bleeding and friability, erosions b. Crohn’s Disease i. Also known as regional enteritis. Has areas of normal mucosa followed by areas of lesions. Can involve all or any layers of the bowel wall and any portion or the gastrointestinal tract from the mouth to the anus. Onset between age 15-30 years old, although it may occur at any age. More common in females. 5. Discuss the diagnosis of diverticulitis, risk factors, and treatments a. Inflammatory changes to the diverticular mucosa of the intestine. b. Risk factors- Older than age 40, low- fiber diet, previous diverticulitis and number of diverticula present in the colon. c. Treatments- High fiber diet, addition of fiber supplement with psyllium, rest, oral antibiotics, and a clear liquid diet. i. Antibiotic will depend on the extent of the inflammatory process 1. Metronidazole (Flagyl) 500mg TID and Ciprofloxacin (Cipro) 500 mg BID 2. Trimethoprim/sulfamethoxale (Bactrim DS) 160/800 mg BID x 7-10 days ii. Pain treatment is due to spasms and can be managed by antispasmodics 1. Hyoscyamine (Levsin) 0.125mg q4hrs 2. Dicyclomine (Bentyl) 20-40 mg 4 time a day 3. Buspirone (BuSpar) 15-30mg/day and or meperidine (Demerol) 100-150 mg per day in divided doses 6. Identify the significance of Barrett’s esophagus a. The effect of repeated exposer to gastric contents and inflammation of the esophageal mucosa. Blood floe increases and erosion occurs causing the normal

squamous epithelium to be replaced with metaplastic columnar epithelium containing goblet and columnar cells. These cells are more resistant to acid and supports esophageal healing. However, this tissue is premalignant tissue. 7. Discuss the diagnosis of GERD, risk factors, and treatments a. Diagnosis i. History; sensitivity of 80% ii. If symptoms are unclear or patient doesn’t respond to 4 weeks of empiric treatment. Ambulatory esophageal pH monitoring with a pH...