Page 190 - Saunders Comprehensive Review For NCLEX-RN

remaining 20% is the client's
responsibility and a supplemental
insurance needs to be obtained
c. Part C: a health plan offered by a
private insurance agency that contracts
with Medicare to supplement coverage
d. Part D: covers prescription medication
needs
6. Medicaid is a joint federal and state program that
provides health benefits to eligible low-income adults,
children, pregnant women, elderly individuals, and
people with disabilities. A concern associated with
these programs is fraud and abuse; a case manager
needs to know how to complete insurance, state, and
federal applications and be astute enough to know if
an individual is reporting incorrect information.
E. Critical pathway
1. A critical pathway is a clinical management care plan
for providing client-centered care and for planning
and monitoring the client’s progress within an
established time frame; interprofessional
collaboration and teamwork ensure shared decision
making and quality client care.
2. Critical pathways are based on evidence-based
practice and include evidence-based medical practice,
budgetary, organizational, and systems-wide
information.
3. Variation analysis is a continuous process that the case
manager and other caregivers conduct by comparing
the specific client outcomes with the expected
outcomes described on the critical pathway.
4. The goal of a critical pathway is to anticipate and
recognize negative variance (i.e., client problems)
early so that appropriate action can be taken and
positive client outcomes can result.
5. Critical pathways are used to ensure medical care is
consistent within budget constraints and to allow
providers to care for more complex clients. For
example, some ambulatory practices have critical
pathways for certain conditions such as blood
pressure monitoring or urinary tract infections.

F. Nursing Care Plan

1. A nursing care plan is a written guideline and
communication tool that identifies the client’s
pertinent assessment data, problems and nursing
diagnoses, goals, interventions, and expected
outcomes.

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