Community Exam 2 Study Guide PDF

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Katy Needle NUR443 Exam 2 Study Guide

Hospice and Home Health I. Home Healthcare  Home healthcare  focus is on primary, secondary, and tertiary prevention o This thereby decreases client’s vulnerability o In HHC, the nurse is generally the provider and the whole family is the client o Healthcare takes place in the client’s home (wherever/whatever that may be) o Allows individuals to stay at home rather than long-term hospitalizations  “Aging in place”  Purposes of Home Healthcare o 1. Meets the acute and chronic needs of the patient and family in the home patient centered  Home care provides all the disciplines of the hospital care to the client:  Nursing, registered dietitians, PT, OT, ST, SW and HHA’s.  Home care also includes hospice care  Hospice care: Client with prognosis of 6 month or less  Focus is on pain control, comfort of family/pt during the dying process; provide great amount of support.  SW in home care: care for issues directly related to the patient/family’s social and emotional needs directly related to the patient’s medical condition  Deal with housing, financing, caregiver concerns, counseling and longterm placements or arrangements. o 2. Ask any patient if he/she would rather be at home or in the hospital, (most will say home)  Home gives a sense of security, independence, comfort and protection  Patients do better at home feel better and feel more in control  Follow their schedule as far as eating/sleeping for the most part  Decrease infection rates at home o 3. Care is short term and intermittent and is based on the needs of the client. Needs are determined by the nursing assessment and MD orders. o What is home care: Think of continuum for health care  Acute careExtended careAmbulatory careIndependent living  Home care is the link to keep clients moving through the system or the continuum of care.  Ex. allows the client with the broken hip to go to the hospital to rehab to home.  History of Homecare o 1. 1960s Medicare starts to say how HC nurses will do their job and introduced regulations. o 2. Later switched from PHN focus of prevention to illness focus  Focus changed somewhat from maternal-child health and prevention, to care of the elderly  Home health care agencies are now able to meet the demands of many populations with a wide variety of problems  IV therapy, TPN, PT

Katy Needle NUR443 Exam 2 Study Guide

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o 3. Directives on home care/nurses/agenciesMedicare stated what they will and won’t pay for in home care.  A lot of agencies were paid little and survived by donations, or received some from 3rd parties o Medicare is the #1 insurer of the elderly Medicare vs Medicaid in Homecare

o Medicaid payments to agencies and services vary state to state o Most medications are covered under Medicaid o Medicaid has programs where services, usually HHA services are not intermittent, the HHA is permanent o Under Medicare, the client must have a skilled need Home healthcare grew due to DRGs OASIS o Outcome and assessment information that gets completed on every single patient on admission  27-page document o Guides care plan and helps predict those at greatest risk o Helps capture outcomes functional and physical health o Determines payment o Required by Medicare and Medicaid—they just go ahead and use it for all insurances o 3 domains of assessment  1. Clinical (sensory, elimination, neuro, emotional, etc.)  2. Functional (ADLs—based on ability, not willingness)  3. Service utilization (what is the patient going to need?) o Domains scored 1-3, 3 being the highest risk; ex. C3, F3, S3 is the highest risk patient but also the highest you’ll get paid o Done on admission, done if they are transferred to a hospital, done when they are put back into homecare, done on discharge, done every 60 days if you realize they still need homecare Documentation in HHC o Specific each visit stands on its own o Goals must be measurable and follow the plan of care o Show progress towards goals o Must be evidence-based (ex. Braden scale) o Demonstrates compliance with Medicare for reimbursement

Katy Needle NUR443 Exam 2 Study Guide

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 Skilled need  Homebound status How to get into HHC o Must be referred can be by MD, NP, LTC, or hospital o In Rhode Island, patient must have had contact with a provider within the past 90 days o Must have skilled need and be homebound Skilled need o Nursing education: teaching and compliance o Assessments: home safety assessment, CP assessment o Dressing changes, IV therapy: services client would have done at the hospital Homebound status o May leave home for medical or non-medical reason for a short duration  Ex. Church, hair appointment, adult daycare o Must be confined to home Purpose of Home Visit o To make patients more independent o Help patients manage care on their own Differences in HHC and inpatient o Client owns the environment o More holistic assessment o Coordinates interdisciplinary care o Knowledge of coverage o Creative and adaptive o Knowledge of community resources o Ability to solve problems and be autonomous Visits provide skilled need o Assessment of physical, psychosocial, environmental, economic, and functional needs  Psychosocial depression is really common and patients will often neglect self-care and get sicker Phases of a home visit o Planning  Purpose and patient diagnosis  Read all orders and treatments  Review medications  Read advance directions  Know who is in the home  Are there other disciplines involved? o Implementation  Ordered treatments  Physical assessment  Patient education  Med rec  Ask open ended questions

Katy Needle NUR443 Exam 2 Study Guide

o Assessment  1. Physical Assessment:  a. Review of systems: VSS, eating, cp assess, elimination  b. Appearance: dressed, washed  c. Acute problem and chronic illness  2. Functional:  a. Information on ambulating  b. Ability to perform ADL’s: Pants soiled-incontinent or not able to ambulate to bathroom o Ask about meals-ask what they eat and look in their kitchen and make sure they are telling the full truth  c. Ability to use assistive devices or need for a walker or cane-is client walking grabbing onto furniture or walls for support?  d. Functional limitations: SOB or muscle weakness. Does client need equipment to make things easier-hospital on first floor near bathroom or bedside commode or w/c.  3. Psychosocial  4. Environmental  5. Economic o Termination  Discuss plan for next visit  Thank them for letting you into their house o Evaluation  Evaluate both the client’s progress and the future plan II. Palliative Care  Centers on providing comfort and decreasing pain  Symptom management  These patients may still be seeking treatment  “Cloaking” helps patients be comfortable during major illnesses III. Hospice  Provide support for the client and family from expectation of recovery until acceptance of death  Provided for prognoses of less than 6 months  Aims to improve quality of life for clients and family  Addresses primary concerns of the client o Does aftercare with the family for up to one year  Death and dying o Understand your patients and your own beliefs and experiences as well as religious and cultural practices regarding dying, death, grief and loss o Stages of grief o Do not use “hospice” right upfront because patients sometimes shut down o Know causes of illness and injury o Expressions about illness and injury  Progressive stages of death o Lapses of consciousness o Blood is shunted to vital organs

Katy Needle NUR443 Exam 2 Study Guide

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o Hearing is the last sense dying patient can hear you so don’t be stupid o Pulse is weak and thread o Diaphoretic, increased mucous (death rattle—give atropine to dry secretions) o Cheyne-Stokes respirations o A last “rally” Nursing interventions during death o Comforting and soothing conversations o Keep warm o Light comforting touch o Discuss with family members the option to say goodbye or give patient permission to die Major issues in homecare and hospice o Caregiver strain o Client neglect o Lack of resources  Obesity and diabetes are some of the biggest epidemics, but patients often cannot afford healthy food o Ethical dilemma

Epidemiology and Biostatistics  Epidemiology  study of distribution and determinants of health events in human populations o Basic science of public health o Used to control health problems o Employs statistical tools and methods to quantify the distribution and determinants in groups of people rather than individuals  Uses of Epidemiology o Studies the history of health—the rise and fall of diseases  Ex. Leukemia spiked in Japan in the 1900s due to radiation exposure o Diagnose community health—population or community assessment o Study health services  Ex. Legislation—helmets and seatbelts o Estimate individual behavioral decision-making risks and chances of avoiding them  Ex. smoking o Identify syndromes  Ex. Legionnaires, SARS, HIV/AIDS o Completing the clinical picture and natural history of disease o Determining causation—genetic, behavior, environment  Historical Development o Religious era: disease was caused by divine intervention/ was punishment o Environmental era: disease caused by environmental substances/ miasma o Bacteriological era: disease is caused by specific bacterial or nutritive agents o Era of multiple causation: (current) disease is caused by an interaction of multiple factors

Katy Needle NUR443 Exam 2 Study Guide

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Review of terms o Epidemic: disease occurrence that exceeds normal or expected frequency in a community or region (ex. Flu) o Pandemic: an epidemic that becomes worldwide (ex. HIV/AIDS) o Endemic: continuous presence of a disease or infectious agent in a given geographical area (ex. Pneumonia) John Snow o Related spread of cholera to the water o Systematic disease plotting he plotted the areas of outbreak on a map and tried to figure out what was central to all of the areas of the outbreak and found it was related to a bad water pump  Water  People  Source of exposure o Made hypotheses about disease and its spread, transmission, and control Sources of data o Routinely collected  Census, vital statistics, CDC surveillance o Data collected for other purposes  Medical and insurance records o Specific epidemiological studies Risk  probability that an event will occur within a specified time period o Populations at risk is the population of people where there is some finite probability of the event  Intrinsic  Extrinsic Natural life history of disease ex. Hypertension and levels of prevention o Prepathogensis period health person  Health promotion and specific promotion o Early pathogenesis artherosclerosis (plaque build-up) but maybe no symptoms  Early diagnosis and prompt treatment o Discernible early disease elevated blood pressure  Disability limitation o Advanced disease kidney disease, blurred vision, stroke, cardiomyopathy  Disability limitation o Convalescence After a significant event (like a stroke d/t HTN)  Rehabilitation o Death, disability, chronic state, recovery Epidemiological triad Agent

Host Environment

o Agent  Infectious agents bacteria, viruses, fungi, parasites

Katy Needle NUR443 Exam 2 Study Guide

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 Chemical agents heavy metals, toxic chemicals, pesticides  Physical agents radiation, heat, cold, machinery o Host (generally us)  Genetic susceptibility  Immutable characteristics age and gender  Acquired characteristics immunology status  Lifestyle factors diet and exercise o Environment  Climate temperature, rainfall, sun  Plant and animal life may be agents or reservoirs  Human population distribution crowding, social support  Socioeconomic status education, resources, access to care  Working conditions levels of stress, noise, satisfaction Multiple Causation o No single host, agent, or disease can cause disease on its own  Interrelationships and interactions come together o Concept of multiple causation is easily understood when looking at non-infectious diseases like chronic illness and accidents Person-place-time relationships o Who? When? Where?  Important to understand the factors that came together to figure out how a disease is spreading and how to control it  Think about Contagion Epidemiological Process o Determine nature and extent of the problem o Formulate a tentative hypothesis o Collect and analyze further testable data o Plan for control  Implement control plan  Evaluate control plan o Make appropriate report o Conduct research Use of numbers o Frequency—how often something occurs o Mean—average o Median—middle often used to eliminate outliers o Mode—most common Ratios o Numerator is not included in the denominator o Ex. 1:10 asthmatics to non-asthmatics Proportion o Numerator must be included in the denominator o Each person in the denominator must be at risk for ending up in the numerator Rates

Katy Needle NUR443 Exam 2 Study Guide

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o Method of measurement to asses the amount of disease in a population and describe groups of persons o Used to facilitate and interpret raw data and make comparisons o Fractions number of events in specified time divided by population in area in that time period o May make meaningful comparisons across districts o Incidence Rates  Number of new cases of a disease in a population over a specified time period  IR=number of new cases in a time period/population at risk during the same time o Prevalence Rate  Number of new and old cases of a specified disease or condition existing at a given point/total population estimated  Influences on prevalence rates  Incidence number of new cases  Duration of condition o If you die fast from it, the prevalence technically decreases Point Prevalence o Rate describing the number of persons with a disease at a specific point in time o Useful in examining disease rates at a specific time o Ex. Used when census counts the homeless one night Period Prevalence o Number of existing cases during a specified time period and includes old cases as well as new cases that develop during that time o Ex. Increase in trauma during the summer months Attack Rate o Incidence rate that identifies the number of people at risk who become ill o Ex. If our class all ate the same bad food and 50% got sick, that’s a 50% attack rate Relative Risk Rate o Traditional measure to study associations between group characteristic and disease o Ratio of the rate of incidence among those exposed as exposed to those not exposed to the disease  Ex. People with lung cancer: smokers/non-smokers Infant Mortality Rate o Sensitive indicator for health statues of population  Ex. Nutrition, housing, sanitation Types of Epidemiological Investigations o Descriptive studies  Asks who, when, and where  Identifies the types of people at risk  Looks at the distribution of health problems  Time of occurrence

Katy Needle NUR443 Exam 2 Study Guide

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o Analytic studies  Cross-sectional studies prevalence or correlational  Prospective studies  cohort (follows healthy group over time and see what happens)  Retrospective studies  case control (go back in data and review)  Experimental  therapeutic and clinical trials (random control trials) Surveillance used after identifying the problem/causation/cases o Mechanism used to monitor the health of their communities to provide a factual basis so agencies can set priorities, plan programs, a take health promotion actions o Ex. Monitoring children with lead poisoning in Flint, Michigan to make sure they are recovering and their lead levels are decreasing

Communicable Diseases  Communicable/infectious diseases are caused by microorganisms that can spread directly or indirectly from one person to another o Some are transmitted through insect bites, others are from ingesting contaminated food or water—many different modes of transmission  Modes of Transmission o Direct contact  exposure to infected body fluids like blood or saliva o Indirect contact  pathogen that remains on a surface that was in contact with an infected person o Vectors/reservoir germs that are spread by an animal or insect (usually a bite) o Airborne  germs spread through the air (coughing, sneezing) o Food/water spread through… you know… food and water  Chain of Infection o Infectious agent organism causing the infection any microorganism, such as a bacteria, virus, parasite, or fungus o Reservoir  anything in which the infectious agent lives and multiplies  Ex. Food, water, toilet seat, feces, respiratory secretions o Portal of exit site where the infectious agent leaves the reservoir and causes the disease  Ex. Respiratory tract (nose, mouth), GI tract (rectum), blood, urine, etc. o Mode of transmission route by which the infectious agent is transmitted  Ex. As above; direct, indirect, airborne, food, vectors o Portal of entry site where infectious agent enters the host  Ex. Mucus membranes, open wounds, tubes (like catheters or NG tubes) o Susceptible host person who is at risk for developing an infectious disease  Ex. Elderly, young people, those with immunosuppressive diseases  Risk factors Age, underlying chronic disease, immunosuppressive conditions, invasive devices, malnutrition  Immunity o Natural immunity Innate resistance to a specific antigen or toxin

Katy Needle NUR443 Exam 2 Study Guide

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o Acquired immunity derived from exposure to the specific infectious agent, toxin, or vaccine o Active immunity body produces its own antibodies o Passive immunity temporary resistance that results from introduction of antibodies from another person or animal (ex. From mother at birth) o Herd immunity immunity of a group or community based on the immunity of many in the community Stages of Infection o Incubation  time of invasion to time when symptoms first appear  Latency: period of replication before shedding patient is asymptomatic but still can spread the disease  Communicability: begins with shedding of agent and before symptoms are present o Prodromal  onset of non-specific symptoms o Illness  signs and symptoms of a specific type of infection o Recovery  when acute symptoms disappear Notifiable diseases  diseases that are required by law to be reported to government authorities so it can be tracked o Ex. Ebola, Zika Reportable disease  Disease mandated by law to be reported to healthcare providers o Ex. STDs, salmonella, chicken pox, TB Ebola—spread and chain of infection o Direct contact with broken skin or mucous membranes  Blood or bodily fluids of someone who is infected  Objects that have been contaminated with blood or bodily fluids from someone with Ebola  Not spread through water, air, or food  Evidence suggests that the virus can last up to 6 days—can be killed by bleach and chlorine o Incubation period of anywhere from 2 to 21 days (average is 8 to 10) o Not infectious until symptoms develop o Early signs Fever, muscle pain, fatigue, headache, sore throat o Later signs vomiting, diarrhea, rash, bleeding (internal and external) o Patients died from dehydration and organ failure o Early detection is critical  If symptoms are present—notify hospital infection control, report to health department, isolate and determine PPE needed Zika o Transmitted by sex, mosquito bites, pregnant women to fetus, blood transfusions, and breastfeeding o Intrauterine and perinatal transmission are two major concerns  Can cause microcephaly and abnormal brain development o Symptoms Fever, rash, joint pain, red eyes, muscle pain, headache  Can last several days to weeks o No ...