cueto, cunanan, dadgardoust, daguman, damo, david h.l., david h.a., de guzman j., de guzman r., de...
TRANSCRIPT
Cueto, Cunanan, Dadgardoust, Daguman, Damo, David H.L., David H.A., De
Guzman J. , De Guzman R., De Leon, De Mesa, De Vera, Dela Cruz C., Dela Cruz F., Dela Cruz I.,
Dela Rosa, H., Delos Santos K.
HOME CARE
Home Care• Provision of comprehensive health services
to individuals and families in their own residence -promote, maintaine or restore health
- Minimize the effect of illness and disability
• Being prepared to become a member of the team caring for a chronically-ill or terminally-ill patient at home
• More people-oriented
Services Offered in a Home Care Program
Medical CareRehabilitationCounseling and health educationWellness programDiagnostic and therapeutic proceduresNursing careSpiritual careSupport groupCommunity resourcesTransportationBereavement and respite careFirst aid
Therapeutic Procedures Transferred at HomeParenteral nutritionHome enteral nutrition (nasogastric tube)Intravenous antibioticsBlood transfusionsRespiratory therapyRenal and peritoneal dialysis
Home care services must be able to provide comfortable transition to home, maintenance of optimal clinical condition, ongoing health education and reinforcement of learning and continuity of care
Role of the PhysicianManager
Acquisition of appropriate home care assessment skills
Assessment of the adequacy of family caregivers and resources
Knowledge of community resourcesKnowledge of home care technologyIntegration of home and hospital care for
patientsAbility to lead the home care team.
Preparations for Home Care
MultifacetedAssessment and
preparation of both patient and home environment – facilitate safest and smoothest transition
Sharing information about diagnosis being considered
Discussion of treatment plans and therapeutic options
Assessment includes:Evaluation of physical
conditionsFunctioning of
extremitiesSensory components Excretory functionsSocial factors
Prior to discharge, physical functioning must be enhanced by:Elimination
unnecessary bed rest Physical activity must
be encouragedCaregivers (trained)Safety measuresCareful planning of
mobility for bathroom, doors, and stairs
Organizing a Home Care Program
a. Get manpowerHome care team consists of:
Primary care physicianNurseTherapistSocial workerVolunteers
Effective Cost-saving manner to the patient
b. Train staff
Assess hazards in the homeConduct functional assessmentMonitor medicationsAssess caregivers
c. Prepare a home care program
Includes the various services offered mechanics of implementationSet policiesIssues on reimbursement or fees
d. Establish networking and linkagesHelp people deal with health and social
problemsEstablish good lines of communication
(agencies, communities, etc)Awareness of what they offer
e. Implement the program• Diagnosis and prognosis should be clear• Verify if the patient & family is informed
about the referral• Clarifications: Call the attending physician• Meet and establish rapport, know their
expectations, Do goal setting.• Schedule-frequency of visits• Checklist of gadgets and equipments• Financial agreement
f. Evaluate the programMonthly health management meetingDetermine if the planned care is effectively
achieving its expected outcomeAdjustments to be done
Guidelines for Home VisitPreparationPlanningCoordination
Guidelines for Home VisitPrior to home care:Patient selection
Admission criteriaReview medical records – goal for a patientTake notes, form questions, make hypothesis
Schedule visit
Guidelines for Home VisitPrepare a home care plan
MedicalPsychosocialWellnessEconomicEnvironmentalIncluding short and long term goals for the
patient and his family
Guidelines for Home VisitDuring the visit:Establish rapportBrief review of medical historyExploration of psychosocial issuesLiving conditionsSelect a primary caregiver appraise his capabilities
Guidelines for Home VisitDuring post-visit: • Write the report of visit– Problem list– Specific interventions performed
• Schedule follow-up visits– Check compliance– Render continuing care
• Refer to other disciplines and coordinate with them, if needed.
COMMON HOME CARE PROCEDURES AND
INTERVENTIONS
NGT (Nasogastric Tube) Insertion
Source: http://emprocedures.com/ngt
NGT (Nasogastric Tube) Insertion
1. Gloves, protective gown, and face shield2. Nasogastric tube3. 2% lidocaine jelly4. Phenylephrine nasal spray 5. Atomized lidocaine or benzocaine spray6. Cup of water with straw 7. Emesis basin8. Towels, chux9. 60cc catheter tip syringe10. Stethoscope11. Tape12. Suction
Source: http://emprocedures.com/ngt
NGT (Nasogastric Tube) Insertion INDICATIONS:
a)Aspiration of stomach contents for either diagnostic or therapeutic reasons
b)Feedingc)Administration of therapeutic substances
Source: The Filipino Physician Today, 2nd Edition, Maglonzo
CONTRAINDICATIONS:
a)Esophageal stricturesb)Facial fracturec)Comatose patients with unprotected
airwaysd)Penetrating cervical wounds
Source: The Filipino Physician Today, 2nd Edition, Maglonzo
Mechanical Ventilation• Indication: respiratory failure
• Recommendations– VT = 10-15 mL/kg– Rate = 60-80 breaths/min– FiO2 = 0.40– Ventilator mode: assisted control– Inspiratory flow = 50%– Peak pressure = 50 cm H2O– I:E ratio = 1:2– Humidifier temperature = 35˚C
3. Tracheostomy Tube Suctioning and Cleaning
Tracheostomy tube consists of: inner canula, obturator, ties and fenestrations
Remove accumulated secretions to:facilitate patient comfortincrease respiratory efficiencydecrease risk of complete airway obstructiondecrease the risk of infection
Clean the inner cannula- done twice a day- done by immersing it in hydrogen peroxide and then rinse with normal saline
Clean tracheostomy site with sterile cotton buds and normal saline
Replace soiled ties
Catheter InsertionFemale
Catheterization• Half the catheter must
be inserted before inflating the balloon.
• Place it in the urethral meatus.
• From the urethral meatus, catheter advances towards the bladder as it proceeds in a slightly upward direction.
Catheter InsertionMale Catheterization• Insert at least 24cm
before inflating the balloon.
• Place the distal urethra in a slight stretch straight up to straighten the urethra.
• Catheter then needs only a single curve on its way to the bladder.
Intravenous (IV) Intravenous (IV) MedicationsMedications enter the patient’s bloodstream directly by
way of a veinAppropriate when:
rapid effect is requiredMedications are too irritating to tissues to be
given by other routes
Take note!Assess caregiver’s eyesight & manual
dexterityCheck appearance of medication and
expiration dateKnow which medications are unsuitable for
IV administrationObserve patients for any adverse reactions
Home Care
IV InfusionIV InfusionFor shortened hospital stays and the need
to cut costsPeripheral IV lines are used for the
maintenance of fluid balance, administration of medications and nutrition.
The butterfly or catheter set may be used. Then it is connected to the tubing of the intravenous system.
Home Care
IV InfusionIV InfusionPermanent access
Long-term or home parenteral nutritionAchieved by placement of a catheter with a
subcutaneous part for access, by tunneling a catheter w/ a substantial subcutaneous length, or threading a long catheter through the basilic or cephalic vein into the SVC.
Temporary/ Short-term accessAchieved w/ 16- gauge, percutaneous catheter
inserted into a subclavian/ IJV and threaded into the SVC
Nursing Care
Includes:• Positioning and moving the patient in bed• Perineal care• Oral care• Bed bath• Transfers
Nursing care
Positioning and moving the patient in bed
Nursing Care
Perineal care
Oral Care
Nursing Care
Bed Bath
Nursing Care
Patient transfers
Immunizations Most cost-effective form of disease control and the only
form effective against many viruses 2 types: Active immunization occurs by administration of antigen,
and requires an immune response. Passive immunization occurs by transfer of preformed
immunoglobulin. “Booster” immunizations generate secondary responses
and increase the strength of immunological memory. Home vaccination are provided by physicians
themselves, including a pre-assessment Several factors needed to be considered before any
patient is vaccinated: susceptibility of the patient, the risk of exposure to the disease, the risk from the disease, and the benefits and risks of the immunization.
Wound Dressing• One of the most common services provided• Wounds that are difficult to heal, usually because of
underlying disease processes, anemia, poor nutrition, wound contamination, chemical irritants and other factors
• Chronic wounds: basic wound care including frequency of dressing change, type of dressing used, cleaning solutions, and topical medications, is generally determined by the physician
• Wound treatment and management include the following:– Prevention of further tissue destruction– Prevention of infection– Planning treatments as appropriate for the type of
wound, condition and size of the wound
Lab Screening• Yearly physical examination and home
laboratory screening for undetected diseases at the confines of your home
• Complete with interpretation by a fully licensed physician
• Cholesterol screening, Blood pressure screening, Obesity screening, Diabetes mellitus screening
• Cancer screening tests
Ancillary ProceduresMobile x-raysUltrasound
Caregiver TrainingModules are designed to train family
members, informal household carers, and caregivers on the proper management of patients
Treatment plan that addresses needs of caregiver and the patient. Identification of caregiver burn-out or stress.
Issues in Home Care
LEGAL ISSUESHome care policies must be properly drafted
to avoid medicolegal riskIncludes documentation of all examinations,
conversations and care rendered Constant surveillance and attention to quality
of care are the best preventive measures
Ethical IssuesThere must be an informed consent
All risks regarding the procedure must be explained to the patient
There must be an agreement before a procedure can be started
If the patient is not competent to make a decision, the guardian or any family member can give the consent
Financial Issues
The Philippine Health Care Insurance System does not have any provisions for reimbursement in the home care setting.Before entering the home care, the patient’s
family should be informed regarding the financial agreement.
Legal Issues and Considerations on Home Care
Legalities of Home Carelegal documents and formalities for
completionDone ASAPInclude the person/patient involve and his/her
family in the decision makingOnly a very close friend or family member with
no conflicting motives should be given these powers.
Letters of Instruction• A letter of instruction provides important
information and instructions a caretaker may need.
• It includes – the contact information for close family
and friends, – a list of assets and liabilities, a list of
insurance policies – and information on all financial
accounts.
WillA will designates who will receive major
assets after a person dies.. It also includes guardianship of any children
under the age of 18. Smaller items such as heirlooms, furniture
and other household goods, should be addressed in a separate testamentary letter.
This letter should be referenced in the will.
Living WillsA living will is a clear statement about
wishes regarding artificial life support. If a person's brain is dead yet the body
remains functioning only with the help of life support, a living will directs attendants in what choice to make - to keep the machines functioning or turn them off.
Power of AttorneyIf the people under your care are unable to
make decisions for themselves because they are somehow incapacitated, you will need to have power of attorney to make these decisions for them. Of course, they will need to create powers of attorney before they are actually needed
Two Types of Powers of AttorneyDurable Power of AttorneyHealthcare Power of Attorney
Durable Power of Attorneygives a person, or people, authority to
manage finances and other legal affairs if the person needing care is not capable of managing these.
It can be long-term or short-term. Allows the party that has power of attorney
to use money to provide care, sign tax returns, handle investments and other important matters.
Healthcare Power of AttorneyAllows the person designated to make
healthcare decisions if the person being cared for is unable to make these himself or herself.
For example, someone holding power of attorney may be able to decide against dangerous surgery if he or she feels that is in the patient's best interest.
Trust• Establish financial resources for family
members, especially for those who cannot easily do so themselves, or for those with a disability
• To protect assets in the event of an older person requiring residential care
• Organise your personal financial affairs• Provide a form of protection for various
beneficiaries• Protection of assets against creditors• Establish a Trust for charitable purposes
THANK YOU!