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Preventive Medicine

Preventive Medicine. Members: Epetia-Erestain-Esguerra-Esmael-Eugenio-Evangelista E, Evangelista K, Facton, Fajardo, Fang, Florendo, Fontano, Francsico, Gabuat, Gaffud, Gagtan, Gallardo, Garan Section B. HOME CARE.

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Preventive Medicine

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  1. Preventive Medicine Members: Epetia-Erestain-Esguerra-Esmael-Eugenio-Evangelista E, Evangelista K, Facton, Fajardo, Fang, Florendo, Fontano, Francsico, Gabuat, Gaffud, Gagtan, Gallardo, Garan Section B

  2. HOME CARE

  3. It is the provision of health care in the patient’s home to promote, maintain, and restore health or minimize the effects of illness and disability

  4. formal care • skilled care • informal care • non-medical care or custodial care • home health care

  5. To get better • To become independent • To become self-sufficient • to maintain your highest level of ability or health, and help you learn to live with your illness or disability

  6. Older people unable to care for themselves • Disabled people • w/ Chronic illnesses • w/ Acute episodic illnesses • Discharged patients requiring medical supervision or rehabilitation • Terminally ill patients

  7. ASPECTS OF HOME CARE

  8. PREVENTIVE • Health promotion • Maintenance for each family member • Screening in the home for undetected diseases DIAGNOSTIC • Includes laboratory and ancillary procedures in the management of the patient and their family members

  9. THERAPEUTIC • Pharmacologic and non-pharmacologic management of the patient’s illness as well as that of their family REHABILITATIVE • various exercises and rehabilitation measures

  10. LONG TERM MAINTENANCE • Sustaining the care of the chronically or terminally-ill patients PSYCHOSOCIAL CARE • addressing the psychological, emotional and social needs of the patients and their families

  11. Preparation for Home Care

  12. Preparation for Home Care Planning includes : Assessment and preparation of the patient and the home environment  facilitate the safest and smoothest transition

  13. I. Preparing the Patient • Sharing information about the diagnosis considered. • Treatment plans and therapeutic options are also discussed.

  14. II. Patient Assessment Includes the evaluation of the patient’s : • physical condition • Functioning of extremities • Sensory components • Excretory functions

  15. Prior to Discharge : Physical Functioning must be enhanced by : • Eliminating unnecessary bed rest in the hospital. • Physical activity must be encouraged  appropriate limit of tolerance will be reached.

  16. III. Preparation of the Physical Environment at Home • Done with the help of the caregivers • Caregivers should be trained • Safety measures and mobility for the bathroom, bedroom, doors and stairs should be planned.

  17. Conclusion The patient’s QUALITY OF LIFE must be the concern of the physician. With proper coordination and planning, the patient could be relegated to an independent life.

  18. Organizing a Home Care Program

  19. Organizing a home care program • Get manpower • Train staff • Prepare a home care program • Do networking and linkages • Implement the program • Evaluate the program

  20. 1. Get manpower • Home care team consist of • Primary care physician • Nurse • Therapist • Social worker • volunteers

  21. 1. Get manpower • The home care team works together • Blend their skills and services • Meets the needs of the patients and family

  22. 2. Train staff • Staff must be trained in • Assessing hazards of home • Conducting functional assessment • Monitoring medications • Assessing caregivers

  23. 3. Prepare a home care program • Various services • Mechanics of implementation • Policies and fees including reimbursements

  24. 4. Do networking and linkages • Communications with various agencies • Community resources • Awareness of what they have to offer

  25. 5. Implement the program • Meet the patient and establish rapport • Know their expectations and do goal setting • Assess educational and clinical needs • Schedule visits • Checklist of gadgets and equipments • Financial agreements

  26. 6. Evaluate the program • Monthly health management meeting • Adjustments are done depending on the results of the evaluation

  27. Guidelines for Home Visit

  28. Guidelines for home visit • Enables the physician to identify problems hidden during clinic visits family interaction family role in illness role in healing Home visits can deepen the physicians understanding of the family

  29. Guidelines for home visit • Preparation • Planning • Coordination

  30. Guidelines for home visit • Select the patient and schedule the visit • Review medical records • Background regarding the disease is warranted • REVIEW LITERATURE • Prepare home care plan

  31. Guidelines for home visit • During the visit • Necessary instruments • Develop rapport • History and psychosocial issues • Living conditions • Cleanliness and safety It is important to select a PRIMARY CAREGIVER

  32. Guidelines for home visit • During the post visit • Write the report • Problem list • Intervention performed • Schedule follow up visits • Coordinate if referral is needed

  33. Home Care Technique: NGT insertion • Lubricate NGT with water soluble jelly for 3-4 inches at the dital end. • Introduce lubricated tube along the floor of the nose with the patient sitting and the head supported to prevent reflex withrawal. • Advance the tube towards nasopharynx then to esophagus. • The gastroesophageal junction is reached typically at 40 cm.

  34. Technique: 5. Once the tube has been passed, confirm if placement is correct by: a. open end of the tube placed in a glass of water. Air bubbles = tube in bronchi or trachea b. patient asked to hum or talk. Not possible = tube in larynx. Withraw tube. c. a 60ml syringe with air is connected to the suction lumen of the NGT. The examiner auscultates the stomach while an assistant empties the syringe slowly. whooshing sound of borborygmi produced only at 10-20ml of air = tube is in the stomach

  35. Technique: 6. Secure the tube by anchoring it into the nose with a hypoallergenic tape.

  36. Mechanical Ventilation • Indicated for respiratory failure. • Recommended Set-up • Tidal volume – 60-80 breaths/min • FiO2 0.40 • Ventilator mode – assisted control • Inspiratory flow – 50% • Peak P – 50cm H20 • I:E ratio – 1:2 • Humidifier T – 350C

  37. Tracheostomy Tube Suctioning and Cleaning Removal of accumulated secretions facilitates: • patient comfort • increases respiratory frequency • decreases risk of complete airway obstruction with secretions • decreases risk of infection.

  38. Tracheostomy Tube Suctioning and CleaningSuctioning Procedure • Wash hands. • Position patient in a semi-sitting position. • Prepare materials. • Attach catheter to suction tubing. • Suction the sterile saline to moisten the catheter. • Cover the suction port with thumb while inserting the catheter and rotating it between the thumb and forefinger. Periodically release the suction pressure for a brief second.

  39. Tracheostomy Tube Suctioning and CleaningSuctioning Procedure • Inner canula – soaked in hydrogen peroxide then rinse with normal saline. • Tracheostomy site – cleaned with sterile cotton buds and normal saline. 7. Allow the patient to breath or cough between suctioning. 8. Observe for sign of respiratory distress. Use manual amby bagging if needed. 9. Flush catheter with saline.

  40. Catheter Insertion • Females – half of the catheter must be inserted before inflating the balloon. Place it in the urethral meatus to the urethra then upwards towards the bladder. • Males – catheter inserted at least 24 cm before inflating the balloon.

  41. IV insertion • Peripheral Iv lines are used for maintenance of fluid balance, administration of drugs and nutrition. • Butterfly or catheter may be used. • Connected to the tubing of the IV system.

  42. Nursing Care • Positioning of the patient in the bed • Moving patient in bed • Perineal Care • Oral Care • Bed bath • Transfers

  43. Exercises • ROM exercises – to maintain muscle tone and joint mobility • Types of ROM: • Active in which patient performs movements on a non-functioning joint • Active-assisted – patient and care-giver participates • Passive – exercise performed by the caregiver.

  44. Common geriatric problems in the home Home care of a stroke patients

  45. Home care of Stroke Patients IMMOBILITY • PE • Sitting balance • Neck turning • Ability to rise from a sitting position • Evaluate ROM of all joints and contractures note

  46. Home care of Stroke Patients • consequences of immobility • ↓CV fitness • Joint stiffness and contractures • Muscle wasting • Accelerated osteoporosis • Pneumonia • Venous stasis • Pulmonary emboli • Decubitus ulcer

  47. Home care of Stroke Patients • Treatment goal: • Maintain ADL • Achieve functional independence • Non pharmacologic • First approach • Patient’s education • Avoid complete bed rest • Physiotherapy • Occupational therapy

  48. Home care of Stroke Patients • ROM exercises without excess stress • Flexibility • Avoid contractures • Progressive work programs • Promote CV fitness • Assistive devices- enhancement of ADL • Crutches • Canes • Contour pillow

  49. Home care of Stroke Patients • Analgesic- pain and anti-inflammatory effect • TENS- painful shoulder

  50. Home care of Stroke Patients • INCONTINENCE • 5 clinical classification • Urge • Stress • Overflow • Reflex • Functional

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