HLTC22H3 Lecture 9: Lecture 9

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beigewhale523

1 Mar 2011

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Govt aging in place (program) to help assess the functioning in elderly. We have a fear of aging fear of unknown what awaits us in the end. Commercial aircraft with 131 passengers made an emergency landing in winnpeg after a woman t ried to open the emergency hatch plane was on route to halifax from calgary . 47 yr old assaulted a 77 yr old passenger loretta mortim was arrested and faces several charges. could be because canada has been very slow to implement electronic record systems. dont really use electronic records don"t have info readily available in computerized form. Waiting, time, preventive, care and procedures cannot use electronic means about warning their paitents about adverse drug reactions when they find out about them. australia, new zealand, the uk, germany and the netherlands all did better than canada. study at st mikes showed that yojunger owmen than 45 are less likelt to see a specialiost.

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Pam Jenkins recently married Josh Brock. Pam continues to work as a sales representative for a clothing manufacturer, and her monthly income has averaged $2,840 a month over the past year. Josh is employed as a computer programmer and earns $3,000 a month. Their combined monthly income allows them to live comfortably. Yet they have been unable to save any money for emergencies. According to Josh, "It's hard to believe, but we don't even have a savings account because we spend almost everything we make." Every month, they deposit each of their paychecks in separate checking accounts. Josh pays the rent and makes the car payment. Pam buys the groceries and pays the utilities. They use the money left over to purchase new clothes and the other "necessities" for enjoying life. In an effort to make wise use of credit, the Brocks have examined various sources that could serve their current and future financial needs. In the assessment process, they compared the APR along with various fees and potential charges. Josh and Pam are also learning about various actions that might be useful if they encounter credit troubles. Their discussions with friends and money management advisers provided expanded knowledge of credit counseling and bankruptcy alternatives. Questions Q1. What is the minimum amount that the Brocks should have in an emergency fund? What actions might be taken to increase the amount in this fund? Q2. What other money management and financial planning activities would you recommend for the Brocks? Q3. List other actions that the Brocks might consider to reduce the cost of using credit. Q4. What information sources might be useful when comparing various sources of credit?

Read the Thomas article, Squeeze Play, and discuss how long you think the emerging upstart airline carriers in Asia that are featured can continue their competitive role in the face of changing travel patterns and consumer behavior brought on by low cost carriers, the Internet and rising G.D.P.s

IT HARDLY IS NEWS THAT THE EMERGENCE IN THE ASIA/PACIFIC REGION of multinational low-cost carriers modeled on the leading LCCs in North America and Europe has transformed and reinvigorated the inter-Asia travel market. But while most of the attention is focused on the impact these upstarts are having on major network/flag carriers, a less public battle is going on as Asia's niche airlines - SilkAir, Nok Air and Bangkok Airways, for example - find their space being challenged by the low-fare wave as well.

Neither full-service nor LCC, this band of carriers has fulfilled a role somewhat analogous to the holiday and charter airline segment in Europe, albeit on a much smaller scale. Some are standalone entities plying short-haul routes with turboprop and small jet aircraft. Others exist as part of a major airline organization, flying the last leg of a transcontinental journey into an Asia/Pacific vacation destination. The question is how long they can continue in their role in the face of changing travel patterns and consumer behavior brought on by LCCs, the Internet and rising GDPs.

A key year for them is 2015, when Southeast Asia's Open Sky Agreement comes into effect, allowing unlimited flights to all 10 ASEAN members: Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam. Any protections they enjoy from restrictive bilaterals will disappear and they will be fully exposed to aggressive competition from today's batch of LCCs and future new entrants.

Perhaps Thailand presents the best microcosm of the wider challenges facing niche airlines. When Thai AirAsia was launched in 2004 with the political support of the government, Thai International Airways, itself government-owned, responded by establishing Nok Air, in which it holds a controlling 39% stake. But as so often happens in such situations (think British Airways and Go or Continental Airlines and CALite), Nok Air and its parent were more at war with each other than with the new entrant. While Thai AirAsia has come from nothing to operate a fleet of 19 new Airbus A320s serving 24 domestic and international destinations, Nok Air has just 10 aging Boeing 737-400s and two ATR 72s serving 17 domestic points.

The future for Nok may be a bit rosier. CEO Patee Sarasin told eTN in 2009 that the airline, which at the time was carrying fewer than 2 million passengers a year, had "buried the hatchet" with its owner and the two now had common goals. "It is true that we had difficulties in the past to cooperate as we lacked a common vision," he said. "We are now ready to cooperate again."
Prior to the makeup, Thai was considering selling its interest in Nok or assuming 100% control to make it a more effective competitor to Thai AirAsia, although in actuality a takeover might not have been possible owing to the refusal of other shareholders to sell. Part of the new agreement was a realignment of missions, with Nok shrinking its route network to only serve domestic destinations along with cooperation on schedules, distribution, marketing and loyalty programs.
The impact was immediate: Nok Air's 2010 passenger count was 3.1 million, with $128 million in revenue yielding a $20 million profit, according to data from the Centre for Asia Pacific Aviation. Although these figures are well behind Thai AirAsia, which carried 5.7 million passengers, generating revenues of $402 million and a $92.4 million net profit, they are improved significantly from Nok's 2009 results. For 2011 it is forecasting a further lift of 22% in passengers to 3.8 million and a 47% jump in revenue to $175 million. Growth and fleet renewal are now front and center.
The airline, which operates from Bangkok's old Don Muang Airport, added four new destinations in April. Last year it took over three routes from Thai. Also on the agenda is expansion later this year of the secondary regional network with the addition of four ATR 72-500s leased from Nordic Aviation Capital. It is discussing the lease of seven 737-800s from 2012 as part of a conversion program to phase out its -400 Classics.
With Nok Air and Thai at peace and the former looking after domestic destinations, the parent did a deal last August with Tiger Airways to form Thai Tiger Airways to compete head-to-head with Thai AirAsia on international routes.
Supply Chain
Bangkok Airways' niche strategy is to control as much as possible of the journeys of high-yield tourists brought in via partnerships with Air France, Air Berlin, Etihad Airways and EVA Air. International tourists make up 80% of the airline's business, and while it has shelved plans for long-haul international operations, it is looking at Australia along with a return to Japan and China in the near term. Closer to home, flights to Malaysia are on the agenda for 2012.
BW, whose origin dates back to 1968, has nine A320s and eight ATR 72-500s serving eight domestic and eight regional international destinations. India has become a near-term focus after ASEAN's free trade area agreement with that country in 2010. Operations to Bangalore started in April and Chennai will follow in 2012. Services have been increased to daily to Mumbai, and New Delhi is on the radar.
nterestingly, the carrier has built three airports in Thailand - Samui, opened in 1989, Sukhothai (1996) and Trat (2002). Its hubs are Bangkok and the exotic resort of Koh Samui. A private airline, it carried 2.6 million passengers in 2010 and posted a profit of $23.3 million on revenues of $276.6 million. This year it expects a far more bullish outcome with passenger numbers up 19% to 3.1 million and revenues growing 28.2% to $352 million.
With some upbeat results under its belt, an IPO is on the radar. Late last year, President Puttipong Prasarttong-Osoth told the Bangkok Post that "next year should be an exceptionally good one for us barring any detrimental events such as renewed political turmoil. There's no set timeframe for an IPO, but we're thinking maybe in three years, as we must show continued profitability to meet set prerequisites."
Another Thai carrier, Orient Thai Airlines, which has had mixed fortunes over the years, ordered 12 98-seat Sukhoi Superjets last November, apparently on extremely favorable terms, to better position itself to compete with LCCs and carve out a stronger niche for itself. The small airline has been in the spotlight over alleged safety deficiencies yet has managed to stay aloft. In September 2007 an MD-82 of subsidiary One-Two-Go crashed at Phuket in a storm, killing 89. In July 2008 Orient Thai and its subsidiaries were suspended from flying for 30 days owing to an alleged poor maintenance record, while the EU banned One-Two-Go from flying to Europe (the ban later was lifted). Its 10-aircraft fleet is made up of MD-80s and MD-90s along with 747-300s and -400s that perform domestic services and one international route to Hong Kong plus mainly Hajj charters.
Delivery of the first two Superjets will occur in November with all 12 in service by 2014. They will both replace older types and enable expansion, although that will not involve One-Two-Go, which was shut down by the parent last year.
The flightpath for SilkAir, a wholly owned subsidiary of Singapore Airlines, is brighter, according to Peter Harbison, executive chairman of Sydney-based CAPA. "SilkAir is doing very well as a regional feeder for Singapore Airlines with a premium product," he says. It has 18 A320s and will receive three more this year and a further three by the end of 2013. It serves 31 of 50 short-haul destinations for SIA Group and its average sector length is just 955 km. While this may be short, it does stretch its legs to Chengdu, Chongqing and Kunming in central China as well as Xiamen and Shenzhen north of Hong Kong. India is also a big destination with services to six southern cities.
Harbison believes that SilkAir, which operates from the same terminals as its parent at Changi rather than the LCC terminal, plays a vital role for the overall network as SIA has no single-aisle equipment. It flies to holiday destinations such as Phuket, Penang and Langkawi but also largely has replaced SIA on services to Kuala Lumpur since AirAsia entered the route.
Less clear is whether the dividing line between SilkAir and LCC Tiger Airways, in which SIA Group holds a 34.4% stake, can be maintained. Whether or not SIA has kept the cat on a short leash - both sides deny it - the fact is that Tiger operates just 15 A320s out of Singapore and a further 11 in Australia, although it has 43 on order. Its JV with Thai Airways and its purchase of a 33% stake in Philippines-based SEAir suggests it may be ready to roar.
Back Where It Started
In the birthplace of Asia's LCC movement, Kuala Lumpur, Malaysia Airlines finally is reacting by turning its niche regional airline Firefly into an aggressive low-cost competitor to AirAsia. Firefly, which launched in 2007, operates seven ATR 72s and three 737s and is based at Sultan Abdul Aziz Shah Airport in Subang just 30 min. from downtown Kuala Lumpur as well as having a series of secondary hubs such as Penang. Late last year it announced that it would acquire 30 737-800s over five years and concentrate more on services from Kuala Lumpur International to take on AirAsia. Nonetheless, it has used its downtown location well and operates flights to Singapore seven times daily with ATR 72s and to Penang 11 times daily. In all it serves 19 destinations in Malaysia, Indonesia, Thailand and Singapore.
Is it possible that niche airlines in the region can find a peaceful coexistence with LCCs? Possibly, but the experience in North America, Australia and Europe suggests it will be difficult. Following deregulation, most US charter carriers folded as travelers and tour organizers found fares just as low on the major network airlines. Wardair, a popular Canadian charter carrier, tried to address the problem after Canadian deregulation by entering the scheduled market but could not make the transition. Australia's East West Airlines did not survive deregulation in the 1990s, caught as it was between Ansett and Australian/Qantas and without a clearly defined market.
The steady growth of US LCCs contributed greatly to the demise of Midwest Express (now part of Republic Airways Holdings' Frontier subsidiary). In Europe, the holiday/charter segment has taken its knocks from the likes of Ryanair and easyJet but continues to hold a large share of the market, although nothing like it enjoyed 20 years ago.
The answer, if one exists, is to identify a new market or find a fresh way to serve an existing one, as Allegiant Air has done in the US. With a route network focused on flying from smaller cites to major vacation destinations with very limited frequency and rock-bottom costs, Allegiant avoids the pitfalls of trying to compete head-on with either the network or LCC segment. Time will tell if such opportunities exist in Asia.

Q37 Research indicates more than 90 % of the deaths occur in older adult 65 and older due to lack of appropriate immunizations on which annual vaccination should the nurse first instruct the patient?

A Pneumonia

B Varicella

C TDAP

D influenza

Q38 which strategies of care would be least likely to enhance the physical function of older adult choose? Choose 2 answers

A weight control

B hearing and vision screening

C smoking cessation

D illness management

E forcing them to attend all activities

Q39 what are common risk factors that contribute to functional decline in the older adult population?

A physical inactivity

B tobacco use

C low sodium dietary intake

D having small families

Q40 what principle is least related to promoting health and preventing certain disabilities in older adults?

A continue activities of daily life (ADLs)

B Maintain as active a lifestyle as possible and desired

C Monitor illnesses through annual health screening ( AHS)

D keep up on assistive and information technology and other tools

Q41 Which focusing on the psychosocial needs of older adults, authorVirginia satir recommends that Healthcare providers get back to the basic communication. whatare the five basic principles satir describes?

A invite

B follow through

C respect personal space

D maximize understanding

E Arrange environment

F maximize attention levels

G trust

H maximize communication

Q42 how do electronic health records facilitate better care coordination? Choose 2 answers

A saving time typing rather than writing

B increasing the accuracy of diagnosis and health outcomes

C preventing an increase in the number of medical errors

D improving communication among health providers

Q43 Rick a 91 year old male, hasa history of chronic otitis media and is experiencing mild hearing loss in hisright ear,what type of assistive technology would Rick use to improve communicative function?

A icon communication board

B behind the ear ( BTE) hearing aid

C Augmentive and alternative communication ( AAC)

D completely in the canal ( CIC) hearing aid

Q 44 An elderly patient has suffered a stroke and is currently in the process of transitioning out of the hospital and into an assisted living facility. The patient's primary diffulty after the stroke is dealing with dysarthria, whichhas limited the patient's ability to speak. whatcommunication technology would appropriately promote an optimal transition of care for the patient?

A an over the ear (OTE) hearing aid

B an augmentation and alternative communication ( AAC) device

C an assistive listening device ( ALD)

D an analog technology to amplify sound

Q45 what must the nurse inform the patient and family or caregivers about assistive devices? Choose 2 answers

A may lessen the importance of ongoing communication with healthcare providers.

B they may result in complete recovery from chronic illness

C they may limit complications of an illness or disability.

D they may enable independent performance and reduce risk of injury.

Q46 An 81 year old Patient has multiple chronic conditions including uncontrolled hypertension and peripheral artery disease and agrees to try assertive devices for monitoring blood pressure and improving circulation provided by a home health agency. Choose 2 answers

A allowing the patient enough time and opportunity for repetition

B only presenting the most relevant content to the patient.

C refraining from suggesting mnemonic devices to Aid the patients use of Technology

D having an outside educator provide several hours of detailed device instructions

Q47 A goal of the National Health Initiative healthy people 2010 is to increase the quality and extend the years of healthy life. What are two ways that this initiative can achieve its goal? Choose 2 answers

A by pressuring older adults who are lonely to move to nursing homes at younger ages

B By encouraging people to have more children so that the children can help their parents as they grow older

C by helping people overcome views of denial and foreboding as old age approaches

D by trying to spread the view that aging is natural and need not include illness and disease

Q48 match each government program with its description. Answer options may be used more than once or not at all

A provide health insurance for low-income families

B bases basic benefits on a workers average indexed monthly earnings in covered employment

C offers a payment system for long-term care ( LTC) foreligible older Americans and persons with disabilities

D is the health insurance program for those 65 or other people with disabilities

Q49 a senior is being cared for by her daughter. The daughter works a full-time job and is only able to care for her mother before she goes to work. On her lunch break, andafter she gets off work. thesenior expresses to a nurse that she gets lonely during the day and sometimes cannot perform tasks by herself.which community resource should the nurse recommend looking into?

A a local Health Clinic

B Day Care Services for Seniors

C a medication assistance program

D Meals on Wheels.

Q50 the Independence at home demonstration was created by the Affordable Care Act. Which statement is true regarding Primary Care teams participating in this initiative?

A the teams are led by a licensed administrator

B the teams must serve at least 500 Medicare beneficiaries.

C the teams be led by a physician.

D the teams can be lead by a nurse practitioner.

Q51 which important facts about Medicare should nurses know? Choose 2 answers

A Medicare requires income assessment in order to qualify for coverage

B Medicare cover assisted living services for Americans in extreme poverty.

C Medicare recipients range from those simply needing Wellness services to those who are profoundly Frail.

D Medicare covers certain disabled Americans who have not reached age eligibility.

Q52 what is a common preventable error that can occur during the transition of care for older adults?

A unhelpful Hospital staff B inaccurate medication reconciliation.

C disorganized dosing schedule

D lost nursing equipment.

Q53 how is communication further facilitated? Choose 2 answers

A through communication to between and among the patients family caregivers and health care providers

B through active engagement of patients and family caregivers with a focus on meeting the patients goals

C through reliance on use of text messages that are less disruptive to the patient and family.

D through Healthcare Providers conversing with the patient and allowing the patient speak with the family.

Q54 what are appropriate evaluation measures related to successful transitions of care? Choose 2 answers

A emotional and social domains of quality of life.

B all clinical indicators related to Chronic conditions.

C functional status

D exclusion of nursing sensitive measures.

Q55 a critical competency in geriatric nursing is the ability to assess family knowledge of the skills necessary in the care of older adults. What Broad caregiver competencies are included in this assessment?

A knowing the science behind the scenes of geriatrics

B allowing the active participation of the patient in all aspects of care.

C balancing the patient autonomy with safety

D knowing how to safely start an IV.

Q56 what Communications techniques promote safe transition of care in patients with aphasia?

A respond in the affirmative when a question is asked

B speak softer so as to never have a harsh tone

C give the patient time to speak

D use non-verbal gestures to communicate.

Q57 what roles of the nurse protect the patient from harm in a care transition?

A symptom manager,educator, collaborator, carecoordinator.

B medication manager screener educator listener

C liasson with Hospital decision maker collaborator coordinator

D decision maker Symptom Manager care coordinator.

Q58 which statements are true regarding health-related quality of life? Choose 2 answers

A cannot be measured in persons with chronic illness

B is measured by and object Observer, basedon the number of times an individual emits both verbal signs of happiness and well-being

C is measured by individuals perceived healthy days per month.

D can be measured by an instrument developed by the center of Disease Control (CDC)

Q59 several options are available as a care approaches to chronic illness care. Which method best describes palliative care?

A care that is only delivered by family or other personal caregivers

B end-of-life care that suspends active treatment

C a combination of active treatment and comfort measures

D a continued focus on here rather than comfort and quality of life.

Q60 A nurse caring for people at the end of their lives knows that Dysnea is relatively common and interferes with patients'comfort and rest. What is the evidence based intervention for shortness of breath?

A liquid morphine at starting dose of 10 mg every 4 hours and titrating dose upward until dyspnea is relieved.

B administer O2 at least 5 liters per minute

C 5 mg of liquid morphine every 4 hours,along with lorazepam 0.5-2.0 mg every 4-6 hours PRN for anxiety and restlessness.

D elevate the head of the bed no more than 20 degrees.

Q61 what do dying persons typically experience grief over?

A loss of bodily function and independence that occurs as illness becomes more prevalent

B loss ability to give and receive love

C loss of basic beliefs,values and faith.

D the feeling that nobody cares that the person is dying.

Q62 which of the following is often the biggest barrier to overcome in crucial conversations to death and dying?

A mistrust of healthcare providers

B lack of energy

C societal attitudes about death

D cost of care

Q63 The End of life Nursing Education consortium (ELNEC) is a resource targeted to nurse providing end of life care that supports evidence based care of dying patients and their families,as well as self care that lessens stress and anxiety and sustains nurse in providing excellent end of life care. Which of the following are self care principles? Choose 2 answers

A maintaining professional boundaries and relationships with patients and families, by tightly controlling feelings and empathy

B. Making good use of the expertise and support of the interprofessional care team

C. Diminishing attention on maintaining an active personal life since end-of-life care is a callings of sorts

D. Developing expertise in symptom management, which not only helps patients and their families, but increases satisfaction and lessens anxiety among professional caregivers

Q64. In addition to a living will, advanced directives may also include a durable power of attorney that encompasses health care related decision making. Which two of the following are accurate so statements regarding the legal instrument known as the durable power of attorney?

A. The alternative decision maker must be a close relative of a dying persons in order to understand his or her wishes.

B. It allows for an alternative decision maker in the event that the dying persons is incapacitated and no longer able to make health care decision

C. The living will remains a useful tool in providing direction to the alternate decision maker.

D. A durable power of attorney for health care decision also enables the alternative decision maker to also handle finances and other legal matters.

HLTC22H3 Lecture 9: Lecture 9

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