Transcript Wound Care
Chapter 13: Specialized Home Health Care Nursing Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Disease management is defined as: A. Including both health promotion and disease prevention activities B. An approach to delivering health care to persons with chronic illnesses that aims to improve patient outcomes while containing health care costs C. Not reimbursable service through Medicare D. All of the above Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. An approach to delivering health care to persons with chronic illnesses that aims to improve patient outcomes while containing health care costs Disease management programs encompass providers across the health care continuum, including home care. Disease management is based on the premise that coordinated, evidence-based interventions can be applied to clients with conditions that are high- cost and highvolume. The goal is to improve clinical outcomes and lower overall costs. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Telehealth (see Research in Community-Based Nursing Care 13-1) • What factors contribute to the receptiveness, use, and acceptance of videophones in the home setting by family caregivers of stroke patients? • What are the obstacles to receptiveness of family caregivers to this form of telehealth? • What do you believe are the advantages for the nurse using the type of telehealth described in the research? Of telehealth in general? • What are the disadvantages for the nurse using the type of telehealth described in the research? Of telehealth in general? Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Infusion Therapy • Home infusion therapy includes chemotherapy, pain management, fluid replacement therapy, immunosuppressive drug therapy, and blood and platelet transfusion. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nurse Descriptions of the Realities of Infusion Therapy • I have to kneel and work from the floor. The equipment box is on the floor. The antibiotic-loaded syringes have been left in William’s refrigerator. I go to get one. Give the push dose with no problems. Flush the cannula, prime a new line, and attach the line to the cannula. A coat hanger is hung from a ceiling fan. The minibag is then hung from it. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nurse Descriptions of the Realities of Infusion Therapy (cont’d) • I load the minibag with the drug and set up the minipack. All this time Stacey (the client) is watching silently. Occasionally she chats about her work and sick leave. The minipack is attached to a coat hanger and suspended from the light fitting (light is on). Stacey and I joke about the light bulb warming the solution. (Sexton, J. S., & Seldomridge, L. [2002, May/June]. The characteristics and clinical practices of nurses who perform home infusion therapies. Journal of Infusion Nursing, 25[3], 176–181, 196–200.) Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Wound Care • Preparation for the first visit requires that the nurse be acquainted with: • Type of wound, wound care orders, cleaning method, frequency of dressing change, dietary and activity restriction, and medications • Mobility enhancement and pain assessment • The rules of scrupulous documentation (OASIS) Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question What skills are important for the nurse who is a wound care specialist? A. Technical skills related to infusion of medication B. Ongoing evaluation of the wound and any particular risk factors for healing C. Ability and comfort in educating the client and caregivers about wound care skills D. Choices B and C Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. Choices B and C In wound care, the role involves on ongoing evaluation of the wound and any particular risk factors for healing. It is important that the nurse is comfortable educating the client and caregivers in wound care skills. Lay caregivers must become competent in several aspects of wound care, as they often are the main care providers. They need to be able to describe and demonstrate wound care and signs and symptoms of infection. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Trends in Wound Care • Care conferencing • Telemedicine • Telewound care on the Internet – From the clinic – From the home Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Maternal–Child Home Care • Which of the following services are available in your community? What are the advantages of providing these services in the home? – High-risk prenatal care – Postpartum/well baby home care – Pediatric home care Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Recipients of maternal–child home care fall into which main category? A. Pregnant women and newborns B. Technology-dependent children C. High-risk pregnant women, high-risk infants, and high-risk children D. Children receiving hospice care Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. High-risk pregnant women, high-risk infants, and high-risk children Recipients of maternal–child home care fall into three main categories: high-risk pregnant women, highrisk infants, and high-risk children. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Barriers to Pain Management in Home Care Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is not a trend in pain management in home care? A. The increasing use of complementary therapies B. Hospitalization for pain management C. Focus on approaches to the management of acute low back pain D. Focus on developing pain medications that take advantage of the body’s natural ability to block or interrupt pain signals Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Hospitalization for pain management Trends include complementary approaches to the management of acute low back pain (standard care versus chiropractic, acupuncture, or massage therapy). There is a great deal of work focusing on the role of medication in pain management, including pain medications that take advantage of the body’s natural ability to block or interrupt pain signals (National Institute of Neurological Disorders and Stroke, 2006). Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Hospice Care • Hospice care focuses on palliative care to the terminally ill. • Most hospice clients have a diagnosis of cancer, AIDS, COPD, terminal heart conditions, or neurologic conditions. • Hospice care is provided in the home, hospital, or free-standing agency. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Role of the Nurse in Hospice • To shift the focus of care to palliative care and strengthen the client’s and family’s quality of life as the client faces death • To control pain at the end of life • To intervene according to the client’s diagnosis and the wishes of the client and family • To focus on quick thinking and immediate decision making • Specific role varies according to the client’s diagnosis and wishes of the client and family. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Role of the Nurse in Hospice (cont’d) • Therapeutic communication and responding to psychological responses are important, as the client and family members are vulnerable at this time. • Sharp assessment skills are needed to determine necessary delegated medical functions and comfort measures, as the client commonly experiences anxiety, depression, and delirium at the end of life as a result of the primary disease, concurrent physical conditions, inadequate pain management, medication side effects, or a combination of all of these. • Knowledge about various types of pain management techniques is imperative. Anticipating medication needs is an important role. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medicare Eligibility for Hospice Care • Must have life expectancy of 6 months or less • Must not be undergoing active treatment for the condition • Must agree to forgo resuscitative measures at the time of death Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins