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NSG 308 Adult Health
Chronic Illness/Rehabilitation/Home Care Nursing
| Question | Answer |
|---|---|
| Chronic Illness (Definition) | - health problem requiring long term management 3+ months - requires patients to learn how to live with symptom/disability, come to terms with disease, medication management |
| Acute illness characteristics | - rapid onset + short duration - Self limiting (usually) - Responds readily to treatment w/ infrequent complication - Returns to previous level of functioning after illness |
| Chronic illness characteristics | 3+ month, does not resolve spontaneously and not cured completely - Permanent impairment/deviation from normal - Irreversible pathologic changes - residual disability + need for special rehabilitation - Long term medical and/or nursing management |
| Factors influencing development of chronic illness | - Increasing age (but differentiate between aging/illness) - Socioeconomic status (healthcare access, nutrition, lifestyle) - Impaired healthcare management (support systems, education, economics, culture) |
| Levels of limitations for Chronic Illness | 1 - Minimal impact on activity (independent) 2 - Moderate limitation (some assistance needed) 3 - Significant dependence (Tech + support) 4 - Complete dependence (eg. terminal dementia) |
| Phases of Trajectory for Chronic Illness | Pre-Trajectory Trajectory Onset Stable Unstable Acute Crisis Comeback Downward Dying |
| Pretrajectory phase | Stage 1 At risk w/o symptoms |
| Trajectory onset phase | Stage 2 Onset of symptoms/disability |
| Stable phase | Stage 3 Symptoms/disabilities are managed |
| Unstable Phase | Stage 4 Symptom exacerbations, complications, illness reactivate from remission |
| Acute Phase | Stage 5 Sudden severe symptom (hospitalization) |
| Crisis phase | Stage 6 Critical/Life-threatening situation |
| Comeback phase | Stage 7 Recovery after acute episode |
| Downward phase | Stage 8 Symptoms/disability worsen despite treatment Home community care |
| Dying phase | Stage 9 Gradual/rapid decline despite treatment Hospice care |
| What contributes to chronic illness | - Medical/pharmacological advancements + longevity = age related illness - Lifestyle changes (smoking/stress/sedentary living) - Early detection - Workplace safety |
| Common issue in Chronic Illness | - Decreased mobility (not necessarily bedbound) - Chronic pain - Fatigue - Depression |
| PERSON Framework | Protection Elimination Rest/Sleep/Activity Self Concept Oxygenation Nutrition For altered mobility |
| Types of Chronic pain | MSK Neuropathic Disease process |
| Fatigue considerations | Space activities out around what matters to patients |
| Psychological adaptations (Nurse Role) | Listen w/o fixing + explore options + support patients in their own process - Patients w/ grief + loss -> transition from "sick" to "impaired" role - Pt will use previous coping mechanism - Reaction based on understanding/perception of impact |
| Western Cultural Attitude to Illness | "Cure" oriented -> less attn to incurable disease - treatment over management - Less funding for chronic condition - System geared to acute care episode |
| Other cultural attitude to Illness | - Stoicism -> illness to be accepted not treated - Punishment -> punishment for sins + no seeking help/self-care - Authority figure -> told what to do + no patient input - Society should care -> no self care, family refuse active involvement |
| Familial/Social issues for Chronic Illness | - Workplace role -> impaired employment ability = role change/income loss - Social isolation - Familial impact -> role/relationship change = familial caretaker - Caregiver strain -> physical/emotional exhaustion of family (assess and refer to support) |
| Nursing Consideration for Chronic Care | - Pt/family more knowledgeable about managing their illness - DO NOT assume pt is educated abt illness - Well informed patients seek out early intervention - Consider psychological/social state -> readiness/ability to learn/phase of illness/coping - Anticipatory counseling - Patient autonomy ` |
| HCP difficulties | - Decisions rest with patient - Complementary/Alternative Medicine use (respect it) - Incurable illness -> change mindset from cure-focused to QoL |
| Rehabilitation process | dynamic/health oriented process assisting ill/disabled people and improve physical/mental/social/economic function realistically |
| Principles of Rehab | - Work with patient (only assist with activities if they need it) - Goal = max independence + QoL - Assess for coping mechanism - Educate self care + management - LISTEN w/o FIXING |
| Types of rehab care | - Chest physiotherapy - PT for teaching walker/crutch + improve strength/balance/gait - Formal programs 3 days x 6 weeks (COPD/cardiac) - Stroke program - Bladder/bowel train - OT for home environment - SLP eval for post intubation/stroke |
| Nursing rehab action in acute care/home setting | - Teach foot/leg exercise - Educate expected progress - Develop plan for progressive ambulation/activity - Add rehab goal to UAP assignment - Discharge planning |
| Rehab settings | 1. Acute care 2. General Rehab Center 3. Nursing Home 4. Specialty Rehab Center 5. Home |
| Rehab Team | - Physiatrist (rehabilitation medicine, leads the plan) - Physical therapist (MSK/neuro issues -> strength/gait/balance) - Occupational Therapist (ADL train, provide adaptive device, fine motor coordination) - Speech Therapist (speech/communication/swallow) - Nurse (Central coordination 24/7) |
| Nurse Role of Rehab Team | - Prioritize/coordinate care - Collaborate with team - Patient advocacy - Educate patients on prescribed rehab to follow 24/7 - Delegate goals to UAP purposefully - Discharge planning |
| Rehab Nursing Process | - Assess -> Head to toe assessment and social/psychological status - Plan -> set goals with time frames for patients; short term goals -> long term goals for patient - Implement -> educate and implement goals (eg. energy conservation/increase mobility, orthotics use) - Evaluate -> day by day evaluation, review plan/adjust before patient mental status decline |
| Home health care payers | - MCR - Federal funded, previously HCFA (Healthcare Financing Administration) now CMS Center for MCR/MCD - MCD - State funded, needs based (CMS and state admin) - Private - HMOs with coverage varying by plan |
| 1965 | Medicare funding for homecare Criteria: needs MD orders, is homebound, intermittent skilled nursing, unstable condition, measurable goals, ceritifed agencies |
| Visiting Nurse Services | Voluntary organizations - not state/tax dollar dependent - Donations/patient insurance funded |
| Hospital based home care | - To benefit from reimbursement - Integrated with acute care systems |
| Proprietary Agencies | - For profits, specializes in 1 area eg. IV, peds, dialysis, private duty nurses, HHA, home attendants |
| Public Health Dept | - Prevention/Health promotion for immunizations, screening, education, medical clinics, epidemiology, OB/NB health |
| Nurse role/Competency in Home Care | - Autonomous practice - Patient education (most important intervention) - Skilled assessments - Documentation (measurable details eg. walks 8 ft w/o dyspnea) - Coordination/Collaboration (coordinate all care) - Reimbursement awareness (know criteria/reimbursable plans of care) |
| Ethical/Legal concerns for Home Care | - Confidentiality when involving family and getting resources - Cost management - Avoiding legal risk for self/agency |
| Patient safety challenges for Home Care | - Cords, cooking, refrigeration, heating, cleanliness, scatter rugs (fall/fire hazards, social determinants of health) - Transportation, financial concerns (food/rent) - Family safety -> must be removed if unsafe |
| One on one challenges for Home care | - advance directive - Informed consent - Who pays/amount - Sexuality |
| Emergency preparedness challenges for Home care | - Agency disaster plan + patient preparedness - Patient specific risk assessment (eg. vent/O2) - Network, kit, evacuation route - How to deliver care during emergency |
| Developing Plan of Care (POC) | - Appropriate/time limited - Reimbursement - Documentation on every MEASURABLE detail (eg. walks 8 ft w/o dyspnea) - OASIS tool (on admission, every 60 days, and discharge -> e-submit to CMS) |
| OASIS tool | Outcome and Assessment Information Set - to be reported to CMS on admission, Q60 days, and on discharge |
| Key concepts of Home Care | - Safety (patient/home, auxiliary staff, RN) - Confidentiality (HIPAA law) - Infection control (aseptic technique in uncontrolled home environment) - Risk management (documentation, agency policies) |
Created by:
sleepingbear