NU 430 Community MIDTERM
Flint Crisis: Other Issues and Outcomes
--Legionnaires Disease (bacterial pneumonia): Largest outbreak in US history: at least 90 ill with 12 reported fatalities. Delay in notifying Public of Risk --E.coli outbreak --Fertility rates dropped by 12% and miscarriages increased --Increased need for Head Start --Home values drop --8 government officials charged, mostly plea deals or charges dropped. Spoke of new investigation, Bill introduced to extend statute of limitations in criminal misconduct cases involving public officials (2019) --Two businesses charged --Right to submit Civil suits against state and local officials upheld by Supreme Court. "Qualified Immunity" not a protection --Spike in students needing Special Education more than twice the national average. Lawsuits to gain needed services --$97 million in Concerned Pastor's suit settlement --Pipe inspections and replacements 90% complete; Millions$$; construction halted in March2020 due to Covid, restarted in June --Michigan to pay $600 million to victims --Faith and trust is government lost
Asset-based assessment
-attention is directed to community strengths and resources as a primary approach to community assessment •A community asset (or resource) is anything that can be used to improve the quality of community life ( person, physical structure or place, community service) •Empowers community, improves relationships, can change perspective, philosophical approach
Rate definition
-the primary measurement used to describe the occurrence and existence (quantity) of a state of health in a specific group of people in a given time period -Rates measure the PROBABILITY that an event will occur again. Used as predictor.
Environmental health definition
A field of public health science that focuses on how the environment influences human health
ADLs vs IADLs
ADL: Basic activities of daily living that allow the patient to care for themselves. Ex: Dressing, Eating, Toileting, Bathing, Grooming, Mobility IADL: Build upon ADLs, more complex that help get the patient back to normal life. Ex: Managing finances, Cooking and meal preparation, Medical management, Transportation
Other Services
Adult Day Care: provides nursing care, personal care, nutrition, podiatry, socialization Social Day Care: provides supervision, socialization, nutrition Congregate Housing (Senior Housing) Assisted Living: provides personal care, nursing care, meals, homemaking
Pandemic
An epidemic that affects several countries or continents
Epizootic
An excess over the expected occurrence of a disease in an animal population, Disease transmits from animal to human (more of whats expected in animals that also spread to humans)
Epidemic
An increase over the usual occurrence of a disease in a geographical area (more of what's usually expected)
Flint Water Crisis
April 2014-- Flint's water source changed from Lake Huron to Flint River so a new pipe supply could be made for Lake Huron. The Flint water was not treated for corrosion and it caused the lead to leech out from the pipes and into the water. October 2015-- water supply switched back to Lake Huron, but the damage was done. Use water bottles only now. Estimated 100,000 residents affected (57% black, 31% white, 4% latinx) and 41% of city residents live in poverty The number of children with dangerously high lead levels in their blood has doubled since the water supply was switched.
Diabetes Self-Management
Assess blood glucose, vital signs, heart and lung sounds Teach self-management of: Insulin injection/medications, Glucose monitoring/log, Diet and portion control, Foot care, Exercise Assess and teach: Signs/symptoms of hypo/hyperglycemia Assess for complications Teach annual screenings
Roles of the Coordinator of Care
Assess for need for ADL assist and establish plan of care (bathing, grooming, dressing, med reminder, simple exercises, weigh, vs, report and change) Orient and supervise HHA Assess and refer for PT, OT, SPT, medical social worker Order durable medical equipment Assess need for assist with IADLs Refer for homemaker Knowledge of community resources, how to refer (Transportation, Food stamps, Fuel assistance)
Environmental Justice
Belief that no group of people should bear a disproportionate share of negative environmental health consequences regardless of race, culture, or income. Issues of political and economic power Healthy homes, schools, communities Vulnerability to environment
Obesogenic environment
Circumstances in which a person lives, works, and plays that promote the overconsumption of calories and discourage physical activity and calorie expenditure. It encourages people to make bad decisions and lack access to healthy lifestyle (junk food more predominantly displayed, no local gyms etc)
Medication Management
Complex medication regimes: Polypharmacy Teach medication regime, assess understanding (teach-back) and ability to take meds (show me) Provide written instructions Have patient/family maintain a current list of meds Have patient bring all meds to MD appointments Establish pre-fill, administration, and storage process Assess effectiveness of meds Teach and assess side effects Advocate for simplification
Factors of Community Assessment
Demographic- distribution and stats of age, gender, ethnic data, education level, race, income levels, etc Biological- morbidity and mortality stats, top 10 major illness or injuries in this community , leading causes of death Social and cultural-- racial and ethnic groups, languages spoke, cultural beliefs/values/events, how to people get along, norms and acceptable behavior Physical- the boundaries of the community, bodies of water, neighboring towns and cities, topography Environmental- housing market (occupied vs unoccupied, type of housing, cost), businesses present, air and water quality, safety (sidewalks, playground, bike paths, crossing signs), gyms, access to food, type of grocery and convenient stores)
Web of Causation
Emphasizes multiple causes while de-emphasizing the role of agents to explain illness. Looks at what existed prior or came before an illness. Provides multiple points of entry to a given illness that could both influence the development of an illness and prevent a given illness. Emphasizes the status of health before the causative agent and how it can be a catalyst to illness
Teach-Back
Ensuring agreement and understanding about the care plan is essential to achieving adherence "I want to make sure I explained it correctly. Can you tell me in your words how you understand the plan?"Can you tell me what the medicine is for? Some evidence that use of teach-back is associated with better diabetes control
Patient Education: Assessment
Essential learning needs for self-care: Current knowledge/understanding Assess: Readiness to learn, Motivation, Cognitive ability, Age, Treatment goals, Anxiety/stress, Cultural issues Targeted questions/conversation
Patient Education: Evaluation
Evaluate understanding of information and ability to perform skills Teach-back Show Me: Demonstration Revision of education plan Use of different resources Involve family members
Health Inequities
Examples like poverty, income and wealth inequality, poor quality of life, racism, sex discrimination, and low socioeconomic conditions are the major risk factors for ill health and health inequities... conditions such as polluted environments, inadequate housing, absence of mass transportation, lack of educational and employment opportunities, and unsafe working conditions are implicated in producing inequitable health outcomes
Determining Health Impact
Exposure estimate: attempt to determine a person's level of exposure (Exposure depends on how long? How often? And dose of contaminant?) Duration, Frequency, and Bioavailability of contaminant Bioavailability is the amount of a substance that is absorbed or becomes available at the site of physiological activity. Helps determine the "dose" of a certain contaminant that will cause a health effect. Exposure estimate compared to health guideline, if level is above guideline, there's a chance exposure could cause health effect
Patient education: Planning and Implementation
Goals and objectives: clear and simple Knowledge Psychomotor skill Educational Resources: readability Includes Content, Literacy demand, Graphics, Layout and type, Learning stimulation and motivation, Cultural appropriateness
The Epidemiologic Triad
Host --> Agent --> Environment Environment is how the host and agent interact This model is limiting when you have more complex causative factors Host: age, sex, race, genetic profile, previous diseases, immune status, religion, customs, occupation, marital status, family background Agent: Biologic (bacteria, viruses), Chemical (poison, alcohol, smoke), Physical (trauma, radiation, fire), Nutritional (lack, excess) Environment: temperature, humidity, altitude, crowding, housing, neighborhood, water, milk, food, radiation, pollution, noise
Assessment of Environmental Health: IPREPARE
I= Investigate potential exposures P=Present work (exposures, protective equip, MSDS) R=Residence (age of home, heating, recent remodeling, chemical storage, water) E=Environmental concerns (air, water, soil, industries, waste site or landfill nearby) P=Past work (exposures, farm work, military, volunteer, seasonal, length of work) A=Activities (hobbies, gardening, fishing, hunting, smoldering, pesticides, melting, burning, food eaten R= Referrals and resources (EPA, Agency for Toxic Substance & Disease Registry, OSHA, CDC, local health dept, poison control E=Educate (risk reduction, prevention, follow-up
Precautionary principle definition
If something has the potential to cause harm to humans or the environment, then precautionary measures should be taken even if there is a lack of scientific evidence
5 Phases of the Home Visit
Initiating the Visit: Assessing referral, contacting the patient, scheduling the visit within 24 hours Preparation: Paperwork, equipment, directions, personal safety Actual Visit: establishing a relationship (need to be welcomed back), consider cultural factors, assessment, oral and written instructions, assess home safety, assess meds, fall risk, abuse and neglect, collaboratively establish POC Terminating the Visit: Assess understanding of all teaching/instructions, discuss any referrals, schedule next visit, review emergency plan and how to contact health care providers, emergency #s at phone Post-visit Planning/Documentation: Complete any referrals, all documentation, planning for future visits, obtain any needed prior approvals
Salutogenic environment
It is an environment that reduce vulnerability to illness and promote enhanced levels of well-being. (Salutogenesis is a scholarly orientation focusing attention on the study of the origins of health, contra the origins of disease and risk factors)
Medication Reconciliation
Many discrepancies at transition points (14.1-94% clients at least one discrepancy) Discrepancies can lead to adverse events and patient harm Process of comparing a patient's medication orders to all the meds that patient has been taking Done to avoid med errors such as omissions, duplications, dosing errors or drug interactions Should be done at every transition in care
Home Safety Assessment
Medication Safety Fall Prevention Fire safety Assess all rooms in the house Security (Locks, windows) Complete Safety Checklist Assess for Abuse or Neglect
Medicare Criteria for Home Health Services
Nursing, PT and SPT can begin independently OT, Medical Social Service, and HHA can only begin if Nursing, PT or SPT are already providing care. OT can continue (if needed) even if Nursing, PT and SPT have ended. (cannot begin alone, but can end alone) Medical Social Service and HHA must discontinue if no other skilled service remains (cannot begin or end alone) You must be under the care of a doctor (have been seen recently) who establishes and reviews the plan of care (POC), which is agency generated using the Outcome and Assessment Information Set (OASIS). POC covers 60 days and then must renew and re-certify POC Initial orders come on referral from hospital, quality varies MD must certify that the client needs at least one of the covered skilled services (needed and reasonable) The need for skilled service must be part-time and intermittent (24 hour care not covered, difficult to get coverage for daily visits) 2-3x/week for 1-2hours The client must be certified by MD as homebound, meaning it's a taxing effort to leave the house and only leaves fro medical appointments or short, infrequent non-medical reasons, such as religious services, hair appointment, family holiday. Clients going to adult daycare are still eligible for home health services
Interdisciplinary Team
Nursing: Registered nurses with varied specialty backgrounds Social Worker: help client cope with the medical, functional, emotional, personal relationships, environmental and financial challenges of living in their own homes. Provide counseling and access to community services Home Health Aide (HHA); assists with ADLs (simple exercises, vital signs, med reminder etc) Rehabilitation --Physical Therapist: help restore strength, flexibility, ambulation, coordination, gross motor function of clients disabled by an accident or illness --Occupational Therapist: work with clients to help them regain skills they need to function in their day-to-day activities (bathing, grooming, dressing, meal prep), advise on use of adaptive equipment, fine motor skills --Speech Therapists: Help clients regain their ability to produce and understand speech, facilitate communication and swallowing skills
Components of Community Assessment
People Demographic (US census, city or nationwide data on the internet; secondary sources) Biological factors Social factors Cultural Factors Place or Environment Physical factors Environmental factors Social Systems Health, economic, education, religious, welfare, political, recreation, transportation, legal, communication, resources, structure of governance, activism, crime rates, communication between community services (health department, police, fire, etc)
Level of Prevention Examples (Interventions)
Primary (health promotion): health education, screening, immunizations Secondary (early detection/ prompt treatment): screenings, regular check-ups, glycemic control Tertiary (rehab/ maximize function/ prevent decline/ improve QOL): rehab programs, support groups, ongoing treatment
Types of Interventions
Primary prevention protects against risks to health. Keeps problem from occurring. Immunizations Secondary preventions detects and treats problems in their early stages. Implemented after problem has begun. Screening Tertiary prevention limits further negative effects from a problem. Keeps existing problem from getting worse. Implemented after disease or injury has occurred. Focuses on rehab and recovery to optimal level of functioning Cardia Rehab, Substance use disorder Rehab, Support Groups
Area Agencies on Aging (AAA)
Principal responsibility is to provide a collection of supportive services designed to help older adults remain independent and in their own homes Services: Non-Skilled side: IADLs and ADLS Information and Referral: Entitlement programs (food stamps, fuel assistance, MassHealth, Assisted Living, Nursing home Case managers: Social workers Assessment and intervention with Cases of Older Adult Abuse and Neglect Homemakers Nurse assess and supervise PCA (not as skilled as HHAs)s PCAs/companions Congregate meal sites Home delivered meals
Characteristics of Public Health Nursing (PHN)
Public health nurses focus on improving population health in the environments where people live, work, learn, and play. 1) a focus on the health needs of an entire population, including inequities and the unique needs of sub-populations 2) assessment of population health using a comprehensive, systematic approach; 3) attention to multiple determinants of health 4) an emphasis on primary prevention 5) application of interventions at all levels—individuals, families, communities, and the systems that impact their health.
Definition of Public Health Nursing (PHN)
Public health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences. It's a specialty practice within nursing and public health. It focuses on improving population health by emphasizing prevention, and attending to multiple determinants of health. Often used interchangeably with community health nursing, this nursing practice includes advocacy, policy development, and planning, which addresses issues of social justice. With a multi-level view of health, public health nursing action occurs through community applications of theory, evidence, and a commitment to health equity. Made up of nursing health, public health, and social health.
Assessment of Contaminants
Risk Assessment: Process to determine the likelihood or probability that adverse effects will occur in a group of people because of exposure to an environmental contaminant. RISK= Hazard + EXPOSURE (If hazard present but exposure blocked, there is no risk) EXPOSURE PATHWAY: A process by which someone is exposed to a contaminant that originates from a specific source. (If the pathway is not complete, or it can be disrupted, the contaminant of concern should not affect human health.)
Program of All-Inclusive Care for the Elderly (PACE)
Setting: PACE serves enrollees in day centers and clinics, their homes, hospitals and nursing homes. Long-term care and financing innovation focused on keeping older adult at home in their community Financed by Medicare and Medicaid (or Medicare and private pay) Must be 55 or older and certified by state as eligible for care in a nursing home, and live in the program's defined geographic area Provides comprehensive health and social services Interdisciplinary approach Adult day health center based Care management Primary and specialty care
Lead Poisoning
Sources: air, soil, water, homes, toys, ceramics, pipes, plumbing, solders, gasoline, cosmetics Health Impacts: behavior and learning problems, lower IQ, hyperactivity, anemia, hearing problems, slowed growth, premature birth, reduced growth of fetus, hypertension, decreased kidney function, reproductive problems. Lowering Exposure: Inspect maintain all painted surfaces, Keep home clean and dust-free, Use wet-moping and wiping, Use cold water to prepare food and drinks, Flush water outlets used for drinking and food prep, Wash children's hands, bottles, pacifiers and toys often, Check for recalls of toys and ceramics, Ensure well balanced diet, Children with healthy diets, Safe process for renovations and repairs: contractor lead-safe certified Diet to Reduce Lead Effect: Iron-rich foods (Chicken, Lean red meats, Iron-fortified cereals, Dried fruit (raisins, prunes) Calcium-rich foods (Milk, Yogurt, Cheese, Green leafy vegs (spinach, kale) Vit C-rich foods (Oranges, orange juice, Grapefruit grapefruit juice, Tomatoes, tomato juice, Green peppers)
Health Literacy Universal Precautions Approach
Structuring the delivery of care as if everyone may have limited health literacy You cannot tell by looking Higher literacy skills ≠ understanding Anxiety can reduce ability to manage health information Everyone benefits from clear communication
Epidemiology definition
Study of the distribution and determinants of states of health and illness in human populations; used both as a research methodology for studying states of health and illness, and as a body of knowledge that results from the study of a specific state of health or illness. Epidemiology studies health, disease, and injury and how to intervene to reduce the effect of these diseases etc (also maximizes state of health)
PHN Interventions
Surveillance: monitors health events through ongoing, systematic collection, analysis, and interpretation of health data for planning, implementing, and evaluating public health interventions Outreach: locates populations at risk, provides information, identifies possible actions, and identifies access to services Screening: identifies individuals with unrecognized risk factors or asymptomatic conditions ◦Mass: screen general population for a single risk (chol in a shopping mall) or multiple health risks (health fair at job site) ◦Targeted: process to promote screening to a discrete subgroup within the population (those at risk for HIV) ◦Periodic: process to screen a discrete but healthy subgroup of the population on a regular basis, over time, for predictable risks or problems (breast and cervical cancer screening, well-child) Case-finding: locates individuals and families with identified risk factors and connects them with resources Referral and follow-up: assists in identifying and accessing necessary resources to prevent or resolve problems
Home Health Care: Skilled services
Table 12.1 Pg 254 Assessment of lungs and weight of a client diagnosed with CHF Teaching diabetic how to fill insulin syringe or how to use insulin pen Manage care through speech therapy, PT, home health aide services Changing complicated wet-to-dry dressing
Home Health Services: Unskilled services
Table 12.1 Pg 254 Changing a dry dressing Teaching a client or spouse how to pay medical bills Managing care of home health aide after all healthcare skilled needs have been stabilized Pouring medications in plastic labeled container Visiting the client to decrease loneliness
Environmental justice definition
The belief that no group of people should bear a disproportionate share of negative environmental health consequences (regardless of race, culture, or income)
What is Health Literacy?
The degree to which individuals have the capacity to obtain, process and understand basic health information and services to make appropriate health decisions
relative risk ratio
The ratio of the incidence rate in the exposed group and the incidence rate in the non-exposed group Ex. the incidence rate of ppl with respiratory infection who have asthma vs those with resp. infection who don't have asthma
Care Management
The role differs depending on the setting -In-hospital Care management for discharge planning -Care management within insurance plans/HMOs -Care management in Home Health
Toxicology definition
The study of the adverse effects of chemical, biological agents on people, animals, and the environment
Endemic
The usual prevalence of a disease in a geographic area (whats usually expected)
Health Disparities
They are differences in the incidence and prevalence of health conditions and health status between groups Most health disparities affect groups marginalized because of socioeconomic status, race/ethnicity, sexual orientation, gender, disability status, geographic location, or some combination of these. People in such groups not only experience worse health but also tend to have less access to the social determinants or conditions (e.g., healthy food, good housing, good education, safe neighborhoods, freedom from racism and other forms of discrimination) that support health Health disparities are referred to as health inequities when they are the result of the systematic and unjust distribution of these critical conditions
Social Determinants of Health
They are the conditions in which people are born, grow, live, work, and age: They are life-enhancing resources, such as food supply, housing, economic and social relationships, transportation, education, and health care, whose distribution across populations effectively determines length and quality of life
Secondary data
Use of existing data as part of assessment: Aggregate data, Comparisons/trends/patterns, demographic census data, morbidity and mortality. Chamber of commerce, annual reports, health records, meeting minutes, prior health surveys
Fall Prevention
clear pathway, night lights, bright tape on edges of stairs etc, padded railings, slippery surfaces are non-slip stickers, mat in bathtub or shower, raised toilet seat, do not use towel rack for support self, cords should be taped down, no fluorescent bulbs bc it creates glares, no clutter
Wheel of Causation
de-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments Can have more than one or an unidentifiable agent
case fatality rate
death rate of a specific cause in the population that currently has that cause/disease (ex death from lung cancer in a population that is living with lung cancer)
Crude rate
measurement of the occurrence of the health problem or condition being investigated in the entire population (rate expressed for a total population)
Prevalece rate
measures the number of people in a given population who have an existing condition at a given point in time. Includes both new and existing cases Depends on incidence rate and duration of the disease (if incidence is low and duration high = high prevalence relative to incidence and vice versa) # of new cases over specific time period (numerator) / population at risk for same time period (denominator)
Rate calculation
rate = (# of conditions within specific period of time / population at risk during same time period) x base multiple of 10 Ex. influenza rate = (2,250/104,000) x 100,000 influenza rate = (0.0216346) x 100,000 influenza rate = 2,165.3 cases per 100,000 people
Outbreak
small geographic area or among a small group of people (increase among a smaller group of people)
Adjusted rate
statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another (removes difference within the population)
Healthy People 2030 5 new categories
•Health Conditions (20 conditions) (Addiction, Heart Disease and Stroke, Infectious Diseases) •Health Behaviors (14 behaviors) (Vaccination, Physical Activity, Health Communication •Populations (10 populations) (LGBT, Older Adults,People with Disabilities) • Setting and Systems (13 settings/systems) (Community, Public Health Infrastructure, Global Health) •Social Determinants of Health (5 SDoH) (Economic Stability, Neighborhood and Built Environment, Education Access and Quality)
Collaborative Model of Assessment
•Interdisciplinary approach •Teamwork, mutual group work •Community members have an active voice •"We can do it together approach" as opposed to we/they approach •Time consuming, needs pre-established systematic approach to maintain shared clarity and direction
Primary data
•Key Informant interviews: direct discussion of ideas and opinions •Community Forum: Open Public Meeting •Focus Group: Directed talk with representative sample •Surveys: Specific questions asked in written format •Participant Observation: Observe formal or informal community activities •Windshield Survey: Descriptive approach assesses several community components while driving or walking through a community
Incidence rate
•Measure of new cases over a given time period. Used as a probability when expressed as proportion or a rate. # of new cases over specific time period (numerator) / population at risk for same time period (denominator)
Why we use rates
•Measuring the magnitude or frequency of a state of health determines the characteristics of those who are at high risk. •Epidemiologic descriptive studies have determined measurable risk factors for major illnesses. •Calculation of rates provides the best indicators of the probability that a specific state of health will occur.
Specific rates
•Specific rates are more detailed rates and calculated according to smaller subgroups of the population in the denominator •Described by Three things: •Person (who is experiencing the illness/condition?) •Place (where is it occurring?) •Time (when does it appear?) •Then think about: •Differences in frequency of characteristics between groups •Areas of agreements where there are factors occurring frequently •Variations in data that might hold clues to prevention and/or control
Healthy People 2030 foundational principles
•The health and well-being of all people and communities is essential to a thriving, society. •Promoting health and well-being and preventing disease are linked efforts that encompass physical, mental, and social health dimensions. •Investing to achieve the full potential for health and wellbeing for all provides valuable benefits to society. •Achieving health and well-being requires eliminating health disparities, achieving health equity, and attaining health literacy. •Healthy physical, social, and economic environments strengthen the potential to achieve health and well-being. •Promoting and achieving health and well-being nationwide is a shared responsibility that is distributed across the national, state, tribal, and community levels, including the public, private, and not-for-profit sectors. •Working to attain the full potential for health and well-being of the population is a component of decision-making and policy formulation across all sectors.
Changes in Epidemiology
•Traditionally focused on infectious disease •Expansion as a result in improved public health practice •Emergence/increase of non-infectious disease (•Chronic disease, Psychosocial problems, Occupational injuries, Environmental effect) •Changes in diagnostics, therapies, and resulting strategies for prevention and control of disease -This change leads to increase in life expectancy, improvement in health (Health service planning and evaluation)
Multilevel Interventions
•Upstream: at the societal, environmental, or policy level •Mainstream: at the population or community level •Downstream: at the individual level
Heart Failure: Physical Activity
■ Discuss physical activity program & goals w/physician & patient. ■Refer to PT to establish exercise regimen to improve strength, duration, endurance & safety ■Refer to OT for energy conservation techniques & adaptive equipment ■ Teach simple exercises for limited mobility pts. ■Frequent movement (q hr), short duration, gradual increase ■Avoid fatigue ■ Consider referral to an outpatient cardiac rehabilitation program
Heart Failure: Asses at every visit
■- Vital signs, Lung sounds ■- Assess weight and edema ■- Request weight log to assess pt. ability to log daily weights ■- Cardiovascular assessment w/focus on HF signs & symptoms ■- Pain status ■- Changes in medication orders or usage ■- Pt knowledge of medications to avoid that exacerbate HF ■- Pt ability to manage co-morbid conditions (DM, COPD, depression) ■- Nutrition ■- Mental status/anxiety/depression ■- Any falls since last visit ■- Functional ability ■- Learning ability/readiness for change ■- Barriers to adherence ■- O2 saturation, safety & usage. ■- Advanced Planning & palliative care conversation if pt. appropriate
COPD: Assess every visit
■- Vital signs, Lung sounds ■- Assess weight loss ■- Request weight log to assess pt. ability to log weekly weights (COPD causes weight loss) ■-Respiratory assessment w/focus on COPD signs & symptoms ■- Ability to use inhalers/nebulizer ■- Changes in medication orders or usage ■- Pt ability to manage co-morbid conditions (DM, HF, CAD, depression) ■-Smoke Cessation ■- Nutrition: assess appetite and water intake (it thins secretions) ■- Mental status/anxiety/depression ■Infection control/avoidance measures ■- Any falls since last visit ■- Functional ability ■- Learning ability/readiness for change ■- Barriers to adherence ■- O2 saturation, safety & usage. ■- Advanced Planning & palliative care conversation if pt. appropriate Assess cough, frequency, type, mucus production and appearance, consistency change or odor, blood in sputum, teach them to document when nurse is not there too
COPD: Symptom Monitoring
■Assess COPD symptoms on each visit - vital signs, weight, dyspnea, lung sounds, fatigue, appetite, chest tightness or pain, SPO2, sleep disturbances, cough, mucus production, activity tolerance, fluid intake, dehydration (orthostatic hypotension) ■ Educate pts./caregivers to improve abilities to recognize, interpret & act on early symptoms. Use teach-back to assess learning ■Early detection of infection ■ Review Table 1 Fritz article, p. 580 ■Help pt./caregiver to identify 1-2 achievable goals
Heart Failure: Symptom Monitoring
■Assess HF symptoms on each visit - vital signs, weight, dyspnea, lung sounds, fatigue, appetite, peripheral & abdominal edema chest pain, SPO2, sleep disturbances, dry cough, activity tolerance, dehydration (orthostatic hypotension) ■ Educate pts./caregivers to improve abilities to recognize, interpret & act on early symptoms. Use teach-back to assess learning ■ Use Remote pt. Monitoring as tool for daily, repeated, serial assessments of specific symptoms ■Utilize Stoplight/Zone tools to help pts. interpret & act on symptom changes ■ Help pt./caregiver to identify 1-2 achievable goals
COPD: Intake
■Call/speak to pt. on day of dc from facility to ask: - Who is helping you at home? - Has your breathing changed since you got home or have you had any chest pain? - Were all of your prescribed medications obtained? Any questions about them? - Do you feel safe &/or do you need a visit today/this evening? _ Extent of family involvement; identified informal caregiver - Do you know who to call if your symptoms change?
Heart Failure: Intake Interventions
■Call/speak to pt. on day of discharge from facility to ask: - Who is helping you at home? - Has your breathing changed since you got home or have you had any chest pain? - Were all of your prescribed medications obtained? Any questions about them? - Do you feel safe &/or do you need a visit today/this evening? _ Extent of family involvement; identified informal caregiver - Do you know who to call if your symptoms change?
COPD: Physical Activity
■Discuss physical activity program & goals w/physician & patient. ■Refer to PT to establish exercise regimen to improve strength, duration, endurance & safety ■Refer to OT for energy conservation techniques & adaptive equipment ■ Teach simple exercises for limited mobility pts. ■Frequent movement (q hr), short duration, gradual increase ■Avoid fatigue
Heart Failure: Meds and Diet
■Medication management -Prescription and OTC (herbs) -Finances -Reminders -Self-administration system ■Sodium restriction -Reading labels -Food preparation (no extra salt on the table, no salt marination) ■Fluid restriction -How to measure, monitor, and document -Alcohol and caffeine consumption (limited or none- 3 or less/week)
COPD: Meds and Diet
■Medication management -Prescription and OTC (herbs), Steroids, Inhalers, antibiotics -Finances -Reminders -Self-administration system ■Diet Instructions -Small, frequent meals -Avoid spicy, fatty foods (GERD) ■Fluid Intake -How to measure, monitor, and document -Water intake -Alcohol and caffeine consumption
Heart Failure: Visit Planning
■Provide agency name & contact info. ■• Admit w/in 24 hours of facility discharge ■• Plan SN, Rehab & HHA schedule - Visit frequencies for weeks 1-4 -3 RN visits the 1st week (frontloading, consecutive visits best) then 1-3 times/week . The more visits able to make the better. -At least 1 in home visit in 1st week from each of ordered therapies, then 1-2 times/week ■- Phone contact on days in between visits ■• Implement Tele-health by 2nd day, if using ■• Physician follow-up/appt. made w/in 7-10 days of dc
