NR 511 Week 4 Midterm Study Guide

▪ veterans administration ▪ auto liability • Payment of NPs by Centers for Medicare and Medicaid Services (CMS) o NPs are reimbursed by CMS at 85% of the physician’s fee, with the patient still paying a 20% share (NP fees are typically 15% lower than that of physicians • Assistance for patients on Medicare to help with pay out of pocket expenses. o Most patients on the traditional Medicare plan acquire a secondary insurance plan to cover the 20% patient out-of-pocket expense. • Medicare Part A and B (what each pays) o Part A – inpatient hospital stay, skilled nursing care, hospice, home care o Part B – outpatient services, provider visits, surgery, lab tests, medical equipment, preventative exams o Part C – wellness services, vision exams, hearing exams, eye glasses, hearing aids o Part D – prescription drugs • The purpose of Medicare Advantage Plans o Medicare advantage plans = medicare MCOs (alternative carrier for medicare beneficiaries) o They offer all of the benefits of Medicare and usually offer additional benefits and lower co-payments. o These carriers offer traditional CMS services in addition to other health services at a lower cost. (CMS = centers for medicare and Medicaid services) o They are able to lower costs mainly due to economic efficiencies realized by their volume of commercial business relationships. o But, bc of the high medical utilization of and greater health-care costs incurred by their beneficiaries, many Medicare Advantage plans have found this market to be less financially viable WEEK TWO Chapter 10 Infectious and Inflammatory Neurological Disorders (p. 131-134) • Assessment and diagnosis of herpes zoster o AKA shingles o Unexplained pain, intermittent/tingling/stabbing 48-72 hours before rash ▪ Pain worsens at night & with temp changes o Painful rash with blisters o Unilateral vesicular rash along a dermatome, mostly thoracic or lumbar ▪ Reddish purple generalized macular and papular rash ▪ Lesions start on the head (face, behind the ears) and spread down the body within 48 hrs ▪ Diff dx: drug reaction, toxic shock, other viral exanthems ▪ Dx testing: reverse-transcriptase polymerase chain reaction (RT PCR) / IgG / IgM ▪ Must report all + cases ▪ High risk pts: pregnant, immunocompromised, younger than 5 or older than 20 ▪ Complications: pneumonia, bronchitis, myocarditis, encephalitis, premature / low birth weight ▪ Tx: pain relievers. ▪ Infectious 4 days before rash onset and 4 days after rash onset – return to school after rash subsides o Rubella (German measles/3 day measles) ▪ spread from respiratory droplets ▪ Rash starts 2 weeks after exposure ▪ Low grade fever, headache, sore throat, rhinorrhea, malaise, eye pain, myalgia ▪ Rose pink macules and papules that first start at the head and progress down the body ▪ Rash fades 1-2 days in same order lesions appeared ▪ Diff dx: hypersensitivity rxn, contact dermatitis, scarlet fever ▪ Tx: Tylenol and NSAIDs and rest ▪ Myalgias may last weeks after the virus ▪ Infectious 4-7 days before rash and can return to work after