preventive medicine members: epetia-erestain-esguerra-esmael-eugenio-evangelista e, evangelista k,...
TRANSCRIPT
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Preventive MedicinePreventive Medicine
Members: Epetia-Erestain-Esguerra-Esmael-Eugenio-Evangelista Members: Epetia-Erestain-Esguerra-Esmael-Eugenio-Evangelista E, Evangelista K, Facton, Fajardo, Fang, Florendo, Fontano, E, Evangelista K, Facton, Fajardo, Fang, Florendo, Fontano,
Francsico, Gabuat, Gaffud, Gagtan, Gallardo, GaranFrancsico, Gabuat, Gaffud, Gagtan, Gallardo, GaranSection BSection B
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HOME CAREHOME CARE
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It is the provision of health care in the patient’s It is the provision of health care in the patient’s home to promote, maintain, and restore health or home to promote, maintain, and restore health or minimize the effects of illness and disabilityminimize the effects of illness and disability
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formal careformal care
skilled careskilled care
informal careinformal care
non-medical carenon-medical care or or custodial carecustodial care
home health carehome health care
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To get betterTo get better
To become independentTo become independent
To become self-sufficientTo become self-sufficient
to maintain your highest level of ability or health, to maintain your highest level of ability or health, and help you learn to live with your illness or and help you learn to live with your illness or disabilitydisability
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Older people unable to care for themselvesOlder people unable to care for themselves
Disabled peopleDisabled people
w/ Chronic illnessesw/ Chronic illnesses
w/ Acute episodic illnessesw/ Acute episodic illnesses
Discharged patients requiring medical supervision or Discharged patients requiring medical supervision or rehabilitationrehabilitation
Terminally ill patientsTerminally ill patients
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ASPECTS OF HOME ASPECTS OF HOME CARECARE
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PREVENTIVEPREVENTIVE Health promotionHealth promotion
Maintenance for each family memberMaintenance for each family member
Screening in the home for undetected diseasesScreening in the home for undetected diseases
DIAGNOSTIC• Includes laboratory and ancillary procedures in the management of the patient and their family members
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THERAPEUTICTHERAPEUTIC Pharmacologic and non-pharmacologic Pharmacologic and non-pharmacologic
management of the patient’s illness as well as management of the patient’s illness as well as that of their familythat of their family
REHABILITATIVE
• various exercises and rehabilitation measures
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LONG TERM MAINTENANCELONG TERM MAINTENANCE
Sustaining the care of the chronically or Sustaining the care of the chronically or terminally-ill patientsterminally-ill patients
PSYCHOSOCIAL CARE• addressing the psychological, emotional and social needs of the patients and their families
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Preparation for Home Preparation for Home CareCare
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Preparation for Home Preparation for Home CareCare
Planning includes :Planning includes :
Assessment and preparation of the Assessment and preparation of the patientpatient and and the the home environmenthome environment
facilitate the safest and smoothest facilitate the safest and smoothest transitiontransition
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I. Preparing the PatientI. Preparing the Patient
1.1. Sharing information about the Sharing information about the diagnosis diagnosis considered.considered.
2.2. Treatment plans Treatment plans and and therapeutic options therapeutic options are are also discussed.also discussed.
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II. Patient AssessmentII. Patient Assessment
Includes the evaluation of the patient’s :Includes the evaluation of the patient’s :
1.1. physical conditionphysical condition
2.2. Functioning of extremitiesFunctioning of extremities
3.3. Sensory componentsSensory components
4.4. Excretory functionsExcretory functions
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Prior to Discharge :Prior to Discharge :
Physical Functioning Physical Functioning must be enhanced by :must be enhanced by :
1.1. Eliminating unnecessary bed rest in the Eliminating unnecessary bed rest in the hospital.hospital.
2.2. Physical activity must be encouragedPhysical activity must be encouraged
appropriate limit of tolerance will be appropriate limit of tolerance will be reached.reached.
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III. Preparation of the III. Preparation of the Physical Environment at Physical Environment at
HomeHome
Done with the help of the caregiversDone with the help of the caregivers
Caregivers should be trainedCaregivers should be trained
Safety measures Safety measures and and mobilitymobility for the for the bathroom, bedroom, doors and stairs should bathroom, bedroom, doors and stairs should be planned.be planned.
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ConclusionConclusion
The patient’s The patient’s QUALITY OF LIFE QUALITY OF LIFE must be the must be the concern of the physician.concern of the physician.
With With proper coordination and planningproper coordination and planning, the , the patient could be relegated to an independent patient could be relegated to an independent life.life.
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Organizing a Home Organizing a Home Care ProgramCare Program
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Organizing a home care Organizing a home care programprogram
Get manpowerGet manpower
Train staffTrain staff
Prepare a home care programPrepare a home care program
Do networking and linkagesDo networking and linkages
Implement the programImplement the program
Evaluate the programEvaluate the program
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1. Get manpower1. Get manpower
Home care team consist ofHome care team consist of Primary care physicianPrimary care physician NurseNurse TherapistTherapist Social workerSocial worker volunteersvolunteers
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1. Get manpower1. Get manpower
The home care team works togetherThe home care team works together
Blend their skills and servicesBlend their skills and services
Meets the needs of the patients and familyMeets the needs of the patients and family
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2. Train staff2. Train staff
Staff must be trained inStaff must be trained in Assessing hazards of homeAssessing hazards of home Conducting functional assessmentConducting functional assessment Monitoring medicationsMonitoring medications Assessing caregiversAssessing caregivers
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3. Prepare a home care 3. Prepare a home care programprogram
Various servicesVarious services
Mechanics of implementationMechanics of implementation
Policies and fees including reimbursementsPolicies and fees including reimbursements
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4. Do networking and 4. Do networking and linkageslinkages
Communications with various agenciesCommunications with various agencies
Community resourcesCommunity resources
Awareness of what they have to offerAwareness of what they have to offer
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5. Implement the 5. Implement the programprogram
Meet the patient and establish rapportMeet the patient and establish rapport
Know their expectations and do goal settingKnow their expectations and do goal setting
Assess educational and clinical needsAssess educational and clinical needs
Schedule visitsSchedule visits
Checklist of gadgets and equipmentsChecklist of gadgets and equipments
Financial agreementsFinancial agreements
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6. Evaluate the 6. Evaluate the programprogram
Monthly health management meetingMonthly health management meeting
Adjustments are done depending on the Adjustments are done depending on the results of the evaluationresults of the evaluation
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Guidelines for Home Guidelines for Home VisitVisit
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Guidelines for home Guidelines for home visitvisit
Enables the physician to identify problems Enables the physician to identify problems hidden during clinic visitshidden during clinic visits
family interactionfamily interaction
family role in illnessfamily role in illness
role in healingrole in healing
Home visits can deepen the physicians Home visits can deepen the physicians understanding of the familyunderstanding of the family
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Guidelines for home Guidelines for home visitvisit
Preparation Preparation
PlanningPlanning
CoordinationCoordination
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Guidelines for home Guidelines for home visitvisit
Select the patient and schedule the visitSelect the patient and schedule the visit Review medical recordsReview medical records Background regarding the disease is warrantedBackground regarding the disease is warranted REVIEW LITERATUREREVIEW LITERATURE Prepare home care planPrepare home care plan
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Guidelines for home Guidelines for home visitvisit
During the visitDuring the visit Necessary instrumentsNecessary instruments Develop rapportDevelop rapport History and psychosocial issuesHistory and psychosocial issues Living conditionsLiving conditions Cleanliness and safetyCleanliness and safety
It is important to select a PRIMARY CAREGIVERIt is important to select a PRIMARY CAREGIVER
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Guidelines for home Guidelines for home visitvisit
During the post visitDuring the post visit Write the reportWrite the report Problem list Problem list Intervention performedIntervention performed Schedule follow up visitsSchedule follow up visits Coordinate if referral is neededCoordinate if referral is needed
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Home Care Technique: Home Care Technique: NGT insertionNGT insertion
1.1. Lubricate NGT with water soluble jelly Lubricate NGT with water soluble jelly for 3-4 inches at the dital end.for 3-4 inches at the dital end.
2.2. Introduce lubricated tube along the floor Introduce lubricated tube along the floor of the nose with the patient sitting and of the nose with the patient sitting and the head supported to prevent reflex the head supported to prevent reflex withrawal.withrawal.
3.3. Advance the tube towards nasopharynx Advance the tube towards nasopharynx then to esophagus.then to esophagus.
4.4. The gastroesophageal junction is The gastroesophageal junction is reached typically at 40 cm.reached typically at 40 cm.
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Technique:Technique:5. Once the tube has been passed, confirm 5. Once the tube has been passed, confirm
if placement is correct by:if placement is correct by:
a. open end of the tube placed in a glass of water. a. open end of the tube placed in a glass of water.
Air bubbles = tube in bronchi or tracheaAir bubbles = tube in bronchi or trachea
b. patient asked to hum or talk. b. patient asked to hum or talk.
Not possible = tube in larynx. Withraw Not possible = tube in larynx. Withraw tube.tube.
c. a 60ml syringe with air is connected to the c. a 60ml syringe with air is connected to the suction lumen of the NGT. The examiner suction lumen of the NGT. The examiner auscultates the stomach while an assistant auscultates the stomach while an assistant empties the syringe slowly.empties the syringe slowly.
whooshing sound of borborygmi produced whooshing sound of borborygmi produced only at 10-20ml of air = tube is in the stomachonly at 10-20ml of air = tube is in the stomach
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Technique:Technique:
6. Secure the tube by anchoring it into the nose 6. Secure the tube by anchoring it into the nose with a hypoallergenic tape.with a hypoallergenic tape.
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Mechanical VentilationMechanical Ventilation Indicated for respiratory failure.Indicated for respiratory failure.
Recommended Set-upRecommended Set-up Tidal volume – 60-80 breaths/minTidal volume – 60-80 breaths/min FiO2 0.40FiO2 0.40 Ventilator mode – assisted controlVentilator mode – assisted control Inspiratory flow – 50%Inspiratory flow – 50% Peak P – 50cm HPeak P – 50cm H2200 I:E ratio – 1:2I:E ratio – 1:2 Humidifier T – 35Humidifier T – 3500CC
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Tracheostomy Tube Suctioning and Tracheostomy Tube Suctioning and CleaningCleaning
Removal of accumulated secretions facilitates:Removal of accumulated secretions facilitates:
patient comfortpatient comfort
increases respiratory frequencyincreases respiratory frequency
decreases risk of complete airway obstruction with decreases risk of complete airway obstruction with secretionssecretions
decreases risk of infection.decreases risk of infection.
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Tracheostomy Tube Suctioning and Tracheostomy Tube Suctioning and CleaningCleaning
Suctioning ProcedureSuctioning Procedure
1.1. Wash hands.Wash hands.
2.2. Position patient in a semi-sitting position.Position patient in a semi-sitting position.
3.3. Prepare materials.Prepare materials.
4.4. Attach catheter to suction tubing.Attach catheter to suction tubing.
5.5. Suction the sterile saline to moisten the Suction the sterile saline to moisten the catheter.catheter.
6.6. Cover the suction port with thumb while Cover the suction port with thumb while inserting the catheter and rotating it inserting the catheter and rotating it between the thumb and forefinger. between the thumb and forefinger. Periodically release the suction pressure for Periodically release the suction pressure for a brief second.a brief second.
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Tracheostomy Tube Suctioning and Tracheostomy Tube Suctioning and CleaningCleaning
Suctioning ProcedureSuctioning Procedure
Inner canula – soaked in Inner canula – soaked in hydrogen peroxide then hydrogen peroxide then rinse with normal saline.rinse with normal saline.
Tracheostomy site – cleaned Tracheostomy site – cleaned with sterile cotton buds and with sterile cotton buds and normal saline.normal saline.
7. Allow the patient to breath or cough between 7. Allow the patient to breath or cough between suctioning.suctioning.
8. Observe for sign of respiratory distress. Use manual 8. Observe for sign of respiratory distress. Use manual amby bagging if needed.amby bagging if needed.
9. Flush catheter with saline.9. Flush catheter with saline.
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Catheter InsertionCatheter Insertion
FemalesFemales – half of the catheter must be inserted before inflating – half of the catheter must be inserted before inflating the balloon. Place it in the urethral meatus to the urethra then the balloon. Place it in the urethral meatus to the urethra then upwards towards the bladder.upwards towards the bladder.
MalesMales – catheter inserted at least 24 cm before inflating the – catheter inserted at least 24 cm before inflating the balloon. balloon.
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IV insertionIV insertionPeripheral Iv lines are Peripheral Iv lines are
used for used for maintenance of fluid maintenance of fluid balance, balance, administration of administration of drugs and nutrition.drugs and nutrition.
Butterfly or catheter Butterfly or catheter may be used.may be used.
Connected to the Connected to the tubing of the IV tubing of the IV system.system.
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Nursing CareNursing Care
Positioning of the patient in the bedPositioning of the patient in the bed
Moving patient in bedMoving patient in bed
Perineal CarePerineal Care
Oral CareOral Care
Bed bathBed bath
TransfersTransfers
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ExercisesExercises
ROM exercises – to maintain muscle tone and ROM exercises – to maintain muscle tone and joint mobilityjoint mobility
Types of ROM:Types of ROM: Active in which patient performs movements on Active in which patient performs movements on
a non-functioning jointa non-functioning joint Active-assisted – patient and care-giver Active-assisted – patient and care-giver
participatesparticipates Passive – exercise performed by the caregiver.Passive – exercise performed by the caregiver.
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Common geriatric Common geriatric problems in the homeproblems in the homeHome care of a stroke patientsHome care of a stroke patients
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Home care of Stroke Home care of Stroke PatientsPatients
IMMOBILITYIMMOBILITY
PEPE Sitting balanceSitting balance
Neck turningNeck turning Ability to rise from a Ability to rise from a
sitting positionsitting position Evaluate ROM of all Evaluate ROM of all
joints and contractures joints and contractures notenote
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Home care of Stroke Home care of Stroke PatientsPatients
consequences of consequences of immobilityimmobility↓↓CV fitnessCV fitnessJoint stiffness and Joint stiffness and
contracturescontracturesMuscle wastingMuscle wastingAccelerated Accelerated
osteoporosisosteoporosisPneumoniaPneumoniaVenous stasisVenous stasisPulmonary emboliPulmonary emboliDecubitus ulcerDecubitus ulcer
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Home care of Stroke Home care of Stroke PatientsPatients
Treatment goal: Treatment goal: Maintain ADLMaintain ADL Achieve functional Achieve functional
independenceindependence
Non pharmacologicNon pharmacologic First approachFirst approach Patient’s educationPatient’s education Avoid complete bed restAvoid complete bed rest PhysiotherapyPhysiotherapy Occupational therapyOccupational therapy
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Home care of Stroke Home care of Stroke PatientsPatients
ROM exercises without ROM exercises without excess stressexcess stress Flexibility Flexibility Avoid contracturesAvoid contractures
Progressive work Progressive work programsprograms Promote CV fitnessPromote CV fitness
Assistive devices- Assistive devices- enhancement of ADLenhancement of ADL CrutchesCrutches CanesCanes Contour pillowContour pillow
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Home care of Stroke Home care of Stroke PatientsPatients
Analgesic- pain and anti-Analgesic- pain and anti-inflammatory effectinflammatory effect
TENS- painful shoulderTENS- painful shoulder
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Home care of Stroke Home care of Stroke PatientsPatients
INCONTINENCEINCONTINENCE
5 clinical classification5 clinical classification UrgeUrge StressStress OverflowOverflow ReflexReflex FunctionalFunctional
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Home care of Stroke Home care of Stroke PatientsPatientsHistory PE
Funtional Inability to reach bathroom in time
Confused, immobile
Urge Frequent sensation of need to urinate
Abnormal gait, Motor and sensory deficits
reflex No sensation of need to urinate
Abnormal gait, Motor and sensory deficits
Overflow ↓ force of stream, dribbling, necessity to strain
Palpable bladder and Fecal impaction
Stress dyspareunia Signs of estrogen lack
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Home care of Stroke Home care of Stroke PatientsPatients
Management of incontinence
cause treatment
Spastic bladder Bladder retrainingDisposable undergarmentsImipramineOxybutinepropantheline
Hypotonic bladder Frequent voidingIntermittent catheterizationDisposable undergarmentsBethanecolphrnoxymebenzamine
Urethral insufficiency Weight loss and pelvic exercisePessaryEstrogen and imipramine
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Home care of Stroke Home care of Stroke PatientsPatients
SKIN PROBLEMSSKIN PROBLEMS
a.a. Positioning of the patientPositioning of the patient
b.b. Sensory level and skin careSensory level and skin care
c.c. Pressure reliefPressure relief
d.d. Wound managementWound management
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Home care of Stroke Home care of Stroke PatientsPatients
Nutritional problemsNutritional problems
evaluate nutritional status and requirementsevaluate nutritional status and requirements Dietary prescription Dietary prescription
Nutrients, electrolyte, volume Nutrients, electrolyte, volume Parenteral, enteral or oralParenteral, enteral or oral
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Home care of Stroke Home care of Stroke PatientsPatients
BP CONTROLBP CONTROL Low saltLow salt Low fatLow fat MedicationsMedications activityactivity
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Home care of Stroke Home care of Stroke PatientsPatients
THROMBOSISTHROMBOSIS Antiplatelet drugAntiplatelet drug
Prevent further aggregation →thrombosisPrevent further aggregation →thrombosis AspirinAspirin TiclopidineTiclopidine dipyridamoledipyridamole
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Home care of Stroke Home care of Stroke PatientsPatients
WELLNESS PROGRAMWELLNESS PROGRAM Health maintenance plan Health maintenance plan
for all the family for all the family membersmembers
Periodic PE, screening Periodic PE, screening tests and developmental tests and developmental monitoringmonitoring
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Home care of Stroke Home care of Stroke PatientsPatients
Physician as social mobilizerPhysician as social mobilizer Preparing for home while in the hospitalPreparing for home while in the hospital Facilitation of referralsFacilitation of referrals Coordinating with other agenciesCoordinating with other agencies Facilitation of community resourcesFacilitation of community resources
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Home care of Stroke Home care of Stroke PatientsPatients
Physician as counselor and Physician as counselor and educatoreducator Educating the patient: Educating the patient:
treatment, medications, treatment, medications, supportive measures and supportive measures and course of diseasecourse of disease
Training of caregiversTraining of caregivers Counseling family members if Counseling family members if
they are stressedthey are stressed
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Home care of Stroke Home care of Stroke PatientsPatients
Physician as a managerPhysician as a manager Coordinate the home environmentCoordinate the home environment Home care needsHome care needs
Modifying home for accessibilityModifying home for accessibility safetysafety
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Home care of Stroke Home care of Stroke PatientsPatients
BEDROOMBEDROOM Large Large Bed should be at the Bed should be at the
height level with the height level with the wheelchairwheelchair
Electrical outletsElectrical outlets
BATHROOMBATHROOM Minimum of 3 feetMinimum of 3 feet Minimum of 30 inchesMinimum of 30 inches Toilet barsToilet bars Raised toilet seatRaised toilet seat Rubber matRubber mat Hand held showersHand held showers
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Home care of Stroke Home care of Stroke PatientsPatients
DOORSDOORS Lever type handleLever type handle Automatic doorAutomatic door Door peephole must be Door peephole must be
lowered to the eye lowered to the eye
FURNITUREFURNITURE Unobstructed Unobstructed
passagewaypassageway
KITCHENKITCHEN Refrigerator, sink and Refrigerator, sink and
range should be range should be accessibleaccessible
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Home Care Of COPD Home Care Of COPD PatientsPatients
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Chronic Obstructive Chronic Obstructive Pulmonary DiseasePulmonary Disease
Common among geriatricsCommon among geriatrics
One of the leading causes of permanent One of the leading causes of permanent disabilitydisability
Treatment not known to decrease morbidity Treatment not known to decrease morbidity or mortalityor mortality
Goal: improve quality of lifeGoal: improve quality of life Pulmonary rehabilitationPulmonary rehabilitation
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Evaluation of Pulmonary Evaluation of Pulmonary Function and DisabilityFunction and Disability
Class IClass I Normal Activities: not significantly restrictedNormal Activities: not significantly restricted EmployableEmployable DyspneaDyspnea
Unusually strenuous activityUnusually strenuous activity
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Evaluation of Pulmonary Evaluation of Pulmonary Function and DisabilityFunction and Disability
Class IIClass II Independent in essential activities of daily Independent in essential activities of daily
livingliving Restricted in other activitiesRestricted in other activities Employable if job is sedentaryEmployable if job is sedentary DyspneaDyspnea
Climbing stairsClimbing stairs
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Evaluation of Pulmonary Evaluation of Pulmonary Function and DisabilityFunction and Disability
Class IIIClass III Does not require physical assistanceDoes not require physical assistance Probably not employableProbably not employable DyspneaDyspnea
Absent at restAbsent at rest During usual activitiesDuring usual activities
ShoweringShowering DressingDressing
Can walk at own pace but cannot keep up with Can walk at own pace but cannot keep up with othersothers
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Evaluation of Pulmonary Evaluation of Pulmonary Function and DisabilityFunction and Disability
Class IVClass IV Some help in performing essential activities of Some help in performing essential activities of
daily livingdaily living Restricted to home if living aloneRestricted to home if living alone DyspneaDyspnea
Minimal exertionMinimal exertion Pausing after one flight of stairsPausing after one flight of stairs Walking more than 100 yardsWalking more than 100 yards Dressing upDressing up
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Evaluation of Pulmonary Evaluation of Pulmonary Function and DisabilityFunction and Disability
Class VClass V Dependent on help of most needsDependent on help of most needs Entirely restricted to homeEntirely restricted to home Activity limited to bed and chairActivity limited to bed and chair Dyspnea at restDyspnea at rest
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Evaluation of Pulmonary Evaluation of Pulmonary Function and DisabilityFunction and Disability
Goals and modalitiesGoals and modalities Prevention of exacerbationPrevention of exacerbation Relief of bronchospasmRelief of bronchospasm Reduction of secretionsReduction of secretions Breathing restrainingBreathing restraining
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Evaluation of Pulmonary Evaluation of Pulmonary Function and DisabilityFunction and Disability
Goals and modalitiesGoals and modalities Exercise conditioningExercise conditioning Oxygen therapyOxygen therapy Educating the patientEducating the patient Family psychosocial managementFamily psychosocial management
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Home Care of Cancer Home Care of Cancer PatientsPatients
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Home Care of Cancer Home Care of Cancer PatientsPatients
Natural course of the diseaseNatural course of the disease Advancing diseaseAdvancing disease Terminal phaseTerminal phase
Primary goalPrimary goal Symptomatic treatmentSymptomatic treatment
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Home Care of Cancer Home Care of Cancer PatientsPatients
QuestionsQuestions Are there adequate resources at home?Are there adequate resources at home? What are the expected morbidities of cancer What are the expected morbidities of cancer
treatment?treatment? Will the family be willing to act as caregivers?Will the family be willing to act as caregivers? Where will the patient die?Where will the patient die?
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Home Care of Cancer Home Care of Cancer PatientsPatients
Needs of the patientNeeds of the patient MedicalMedical PsychosocialPsychosocial EnvironmentalEnvironmental SpiritualSpiritual
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Home Care of Cancer Home Care of Cancer PatientsPatients
PhysicianPhysician EducationEducation
Key service to both patient and familyKey service to both patient and family Patients needsPatients needs Anticipation of deathAnticipation of death
Counseling and supportCounseling and support FamilyFamily FriendsFriends
Prevented from caregiver strainPrevented from caregiver strain
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Home Care of Cancer Home Care of Cancer PatientsPatients
CounselingCounseling Set of techniques, skills and attitudes to help Set of techniques, skills and attitudes to help
people manage their own problems using their people manage their own problems using their own resourcesown resources
ObjectivesObjectives Symptom reliefSymptom relief Behavioral changeBehavioral change Self-sightSelf-sight
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Function of Family Function of Family CounselingCounseling
EducationEducation
PreventionPrevention
SupportSupport
ChallengeChallenge