bledsoe et al., essentials of paramedic care: division v © 2006 by pearson education, inc. upper...

Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Division 5Special Considerations/

Operations


Chapter 46Acute Interventions for the

Chronic-Care Patient


Topics

Home Health Care

Home Care Providers

ALS Support for Home Care Patients

Hospice


Introduction

A major trend in health care involves the shifting of patients out of the hospital and back into their homes as soon as possible.

The result has been a huge increase in home health care services.


History of Home Care

A number of factors have promoted the growth of home care in recent years. They include:– Enactment of Medicare in 1965– The advent of HMOs– Improved medical technology– Changes in the attitudes of doctors and

patients toward hospital care


In 1992…

Almost 75% of home care patients were age 65 or older.

Of the elderly home care patients, almost two-thirds were female.


The home care provider is an important source of information.


A number of situations may involve youin the treatment of a home care patient:

Equipment failure

Unexpected complications

Absence of a caregiver

Need for transport

Inability to operate a device


Many of the pathologies that you will encounter in a home care setting are the same as others. You must always keep in

mind that the home care patient is in a more fragile state.

Typical Responses– Airway complications– Respiratory failure– Cardiac decompensation– Alterations in peripheral circulation– Altered mental status– GI/GU crises– Infections/septic complications


Pressure sores are classified by the depth of tissue destruction.


Common medical devices for the chronic-care patient


General System Pathophysiology, Assessment,

and Management


Assessment

Assessment of the home care patient follows the same basic steps as any other patient.

The one thing home care calls have in common is their diversity.

Try to ascertain from the primary care provider the patient’s baseline health status.


Tailor your questions tothe home care setting.


Common Acute Home Health Situations (1 of 2)

Respiratory disorders– COPD– Bronchitis– Asthma– CHF– Cystic fibrosis– Bronchopulmonary dysplasia


Common Acute Home Health Situations (2 of 2)

Neuromuscular degenerative diseases– Muscular dystrophy– Poliomyelitis– Guillain-Barré syndrome– Myasthenia gravis

Sleep apnea

Patients awaiting lung transplants


Medical Therapy Found inthe Home Setting

Home oxygen therapy

Artificial airways/tracheostomies

Vascular access devices


Common Technical Problems with Oxygen

Systems


Artificial ventilation in a patientwith a tracheostomy tube


Use of continuous positive airway pressure—CPAP—

for sleep apnea patients


Vascular Access Devices

Hickman, Broviac, Groshong

Peripherally inserted central catheters

Surgically implanted medication delivery systems

Dialysis shunts


An A-V shunt is used in home carepatients requiring dialysis.


Vascular Access

Never access a surgically implanted port unless protocols allow you to do so—and you have the training/ equipment.

Avoid vascular access and blood pressure in the extremity of a shunt.


GI/GU Crisis

Devices to support GI/GU function are common.

Be familiar with the various devices and their complications.


An external urinary tract device


An internal urinary catheter with balloon


A nasogastric feeding tube


A gastrostomy feeding tube


Examples of colostomy stoma locations


Maternal and Newborn Care

Many women who deliver their babies in the hospital will be discharged in 24 hours or less.

ALS providers may be called upon to assist new parents in caring for newborns or post-partum complications.


Postpartum bleeding and embolusare common complications.

Management includes:– Massage of uterus– Administration of fluids– Administration of Pitocin– Rapid transport, if necessary


Common Infant/Child Complications

Signs/symptoms of cardiorespiratory insufficiency include:

Cyanosis

Bradycardia

Crackles (rales)

Respiratory distress


Commonly found medical therapiesfor children who are home care

patients include:

Mechanical ventilators

IV medications

Oxygen therapy

Tracheostomies

Feeding tubes

Pulse oximeters

Apnea monitors


Hospice

More than 2,250 hospices provide support for the terminally ill and their families.

The goal of hospice care is to provide palliative or comfort care rather than curative care.


Percentage of Hospice Patients by Age


Children with AIDS or HIV infectionin a hospice setting


Summary

Home Health Care

Home Care Providers

ALS Support for Home Care Patients

Hospice