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Screen and intervene

Depression's effect on CHF readmission

doi: 10.1097/01.NUMA.0000511081.11598.c4
CE Connection
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GENERAL PURPOSE: To provide information about a research study on the importance of adequate depression screening in hospitalized patients with CHF. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing-education activity, you should be able to: 1. Discuss the influence of depression on acute care readmission rates for CHF patients. 2. Describe the significant elements of the research study and their implications for nurse managers.

  1. Which statement about CHF and depression is accurate?
    1. The incidence of CHF is stable in the United States.
    2. Complications from CHF are increased in depressed patients.
    3. Fewer CHF patients experience depression than patients with other chronic diseases.
  2. Complications of CHF
    1. may increase the cost of treatment by 215% by 2030.
    2. are predicted to increase due to the aging population.
    3. rarely result in readmission.
  3. Which factor is most predictive of success in lifestyle modifications?
    1. adoption of a prescribed exercise program
    2. adherence to the medication protocol
    3. the patient's willingness to change
  4. Which factor was identified by McGuire et as not related to the underdiagnosis of depression?
    1. ineffective care planning related to lack of continuity between shifts
    2. experience level of staff in identifying patient depression
    3. patients unable to identify their feelings as depression
  5. Best practice for depression screening in cardiac patients is
    1. a two-step process at multiple intervals.
    2. use of a depression screening tool at the time of diagnosis.
    3. screening for depression at the first readmission.
  6. This research study attempted to
    1. reduce morbidity through clinical intervention.
    2. improve clinical outcomes by treating depression.
    3. identify a link between positive depression screening and readmission.
  7. The provided literature review revealed that depression rates identified by screening tools were
    1. reduced using liberal criteria.
    2. lower using strict criteria.
    3. artificially high using strict criteria.
  8. Under the NYHA functional status scale, a patient with class III heart failure is how likely to have depression?
    1. 20%
    2. 38%
    3. 42%
  9. Depressed patients with CHF are more likely to be readmitted because
    1. they're less likely to adhere to treatment recommendations.
    2. they realize that they're approaching the end of life.
    3. antidepressant medications increase the severity of CHF.
  10. Which CHF patient would be included in the study?
    1. a 95-year-old who died in the second month of the study
    2. a 72-year-old who was readmitted to a different acute care facility within 60 days
    3. a 22-year-old with secondary CHF
  11. Depression screening using the PHQ-9 tool was
    1. more accurate when administered by the primary care provider.
    2. not required for inclusion in the study.
    3. included only for the initial admission.
  12. Which describes the most common CHF patient included in this research?
    1. married female age 74 with minimal depression
    2. widowed male age 69 with severe depression
    3. divorced female age 60 with moderate depression
  13. Which conclusion wasn't supported by the study results?
    1. Readmission rates correlate with level of depression.
    2. Readmission rates for depressed patients were higher than for nondepressed patients.
    3. First readmission between 31 and 60 days occurred in 16% of the patients.
  14. Results of depression screening by RNs at admission revealed that
    1. the process was ineffective in measuring depression.
    2. 83% of patients had at least mild depression.
    3. most patients had significant depression.
  15. Screening for depression is
    1. most beneficial upon admission.
    2. most accurate upon readmission.
    3. a critical step of care planning in the hospital.
  16. An inpatient with a positive depression screening score should
    1. be referred to his or her primary care provider for assessment.
    2. be evaluated for risk of harm while in the hospital.
    3. have testing repeated for validation.
  17. The authors recommend that hospital policies require all the following except
    1. scheduling an appointment with an outpatient social worker before discharge.
    2. assigning a depression score for all patients with chronic disease.
    3. inclusion of depression on the patient's problem list for billing/reimbursement purposes.
  18. Comprehensive depression screening education
    1. is known to impact patient depression scores.
    2. should be focused on all unit staff, not just RNs.
    3. should be completed before repeating this study.
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