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Fundamentals · chapter 8 · Admission, Transfer, and Discharge

Patient Admission

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 4 practice questions with the reasoning.

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Key points

  1. Nurse role in admission

    Nurses play a vital role as the initial point of entry into the healthcare system because they are responsible for the initial assessment, evaluation, and documentation of a patient’s healthcare status, needs, and concerns.

  2. Admission information importance

    The information gained through the admission process sets the stage for the patient’s course of care.

  3. Changing admission level

    Admission placements can change quickly; for example, an admission to an ambulatory clinic for monitoring during administration of a medication can become emergent if the patient’s vitals become unstable.

  4. Escalation advocacy

    Nurses must understand the different types of admissions, assess their patients’ situations accurately, and advocate for escalation to a higher level of care when necessary.

  5. Acute care risk

    Their medical situation has been assessed as one that could potentially endanger their life if the problem is left unaddressed.

  6. Emergency triage system

    Emergency department nurses that assess patients for acute care admission employ a prioritization system called triage.

  7. Admission nursing responsibilities

    The admission process also involves additional nursing responsibilities including completing an admission history, performing a physical assessment, completing a medication reconciliation, developing the care plan, and documenting a belonging inventory.

  8. Observation admission purpose

    Observational admissions are typically one- or two-night stays where the patient needs to be closely monitored by a professional for a limited amount of time.

  9. Inpatient decline risk

    These patients have the potential to decline to a life-threatening level if not monitored by a healthcare professional.

  10. Unplanned admission response

    Admitting an unplanned patient requires rapid assessment and action on the part of the entire healthcare team.

  11. Planned admission structure

    Because these admissions are planned, the patient’s entry into the system is generally organized and structured.

  12. Thirty-day readmissions

    Admissions to the hospital that happen within thirty days of a prior admission are monitored by the Centers for Medicare and Medicaid Services (CMS).

  13. Ambulatory handoff safety

    Reports that are organized and structured help ensure the patient’s safe transition to a higher level of care.

  14. RN admission assessment

    The TJC standard is that each patient’s need for admission must be assessed by a registered nurse (RN).

Terms to know

acute care
The acute care is for patients who require inpatient monitoring and medical care under professionally trained healthcare providers.
triage
When a nurse evaluates patients according to the severity of their symptoms and ensures that those with the most serious and potentially life-threatening symptoms are seen first it is called triage.
Observational admissions
Observational admissions are typically one- or two-night stays where the patient needs to be closely monitored by a professional for a limited amount of time.
Inpatient admissions
Inpatient admissions are for problems that require more than just observation.
ambulatory care
The ambulatory care is care given in outpatient settings, which includes doctor’s offices, clinics, and outpatient surgery centers.
long-term acute care (LTAC) facility
A long-term acute care (LTAC) facility is very similar to acute care facilities in that it will take on acute patient tasks such as ventilator weaning, wound care, and/or intravenous (IV) antibiotics.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. The triage nurse is assessing two patients who arrive at the emergency department at the same time. Patient A has asthma with mild wheezing and stable vital signs. Patient B reports mild chest pain and has very unstable vital signs. Which patient should the nurse prioritize for evaluation and treatment?

    1. Patient B only after Patient A receives a complete admission history
    2. Patient A, because wheezing always requires immediate treatment before chest pain
    3. Patient B, because unstable vital signs with chest pain have greater potential to become life-threatening
    4. Patient A, because asthma is a chronic condition that should be treated before new symptoms

    Answer: Patient B, because unstable vital signs with chest pain have greater potential to become life-threatening

    Triage prioritizes patients based on severity and potential for life-threatening decline. In this situation, chest pain with very unstable vital signs is the higher priority even if another patient also needs care.

  2. A nurse is completing an acute care admission after a patient is brought from the emergency department to an inpatient unit. Which admission responsibilities should the nurse complete? Select all that apply.

    1. Complete a medication reconciliation
    2. Skip the belongings inventory until discharge
    3. Develop the care plan
    4. Complete an admission history
    5. Perform a physical assessment

    Answer: Complete a medication reconciliation, Develop the care plan, Complete an admission history, Perform a physical assessment

    The admission process includes collecting health information, assessing the patient, reconciling medications, developing the care plan, and documenting belongings. Skipping the belongings inventory until discharge does not match the admission responsibilities described in the section.

  3. A patient has a procedure with sedation in an outpatient setting and needs close professional monitoring overnight before likely discharge home. Which admission type best matches this situation?

    1. Long-term acute care admission
    2. Inpatient admission
    3. Thirty-day readmission
    4. Observational admission

    Answer: Observational admission

    Observation is appropriate when the patient needs close monitoring for a limited time, such as after sedation. Inpatient admission is for problems requiring more than observation, and long-term acute care is for longer-term acute needs.

  4. A patient comes to a clinic for a routine appointment. During assessment, the nurse finds the patient’s vital signs are unstable. What is the best nursing action?

    1. Wait for diagnostic test results before notifying anyone
    2. Call an ambulance or 911 to escalate the patient to a higher level of care
    3. Send the patient home with instructions to return if symptoms worsen
    4. Continue the routine appointment because the patient was scheduled for outpatient care

    Answer: Call an ambulance or 911 to escalate the patient to a higher level of care

    Unstable vital signs during a clinic visit can require escalation from ambulatory care to acute care. The section states that clinic staff should call an ambulance or 911 when unstable vitals are found during a routine appointment.

Where every quote comes from

Section 8.1 Patient Admission of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.