Home Care Chronic Disease Prevention Program

1. Home Care Chronic DiseasePrevention Program Melanie S. Bunn RN,MS A collaboration of Duke University, Division of Community Health and University of South Carolina School of Medicine

2. Know your neighbor…Nosy neighbors? • Who’s been a CNA the longest? • The shortest? • Who’s had the most jobs? • The fewest? • Who’s lived in the same place the longest? • Who’s moved the most often? • Who’s…

3. Expectations come to class prepared participate with an open mind ask questions share your personal expertise be willing to learn and change Benefits improved patient care and outcomes increased job satisfaction network with others credit hours learn some things to help you be a healthier person Welcome!!!

4. Chronic Disease Prevention Program Module 1: Health/Illness, Vital Signs, Exercise, Nutrition Module 2: Motivational Interviewing Module 3: End of Life Module 4: Heart Attack Module 5: COPD Module 6: Stroke Module 7: Hypertension Module 8: Diabetes Module 9: Congestive Heart Failure

5. Module 1:Health and Illness

6. Objectives • Define health and illness and the continuum between them • Discuss common chronic illnesses and importance of accurate monitoring • Describe components of life style choices and their impact on health • Identify appropriate responses to change in condition and communication of these changes

7. What is health? • What is health? • Is it not being sick? • Or is it more???

8. What is health? • "health… • is a state of complete • physical, • mental and • social well-being • and not merely the absence of disease or infirmity" (World Health Organization, 1946).

9. Involves the body, mind, spirit and relationships Taking care of oneself How would you rate your own health? - + 0 10 Very Very Unhealthy Healthy What is health?

10. What is health? • Thinking about your physical health, which includes physical illnesses and injury, for how many days during the past 30 days was your physical health not good? __________________________________ days

11. What is health? • Thinking about your mental health, which includes being depressed or having anxiety, for how many days during the past 30 days was your mental health not good? __________________________________ days

12. What is illness? • What is illness? • Imbalance • Infection • Disease • How do we know if there is an illness? • Symptoms—what the client describes • Signs—what the aide observes

13. What are common geriatric illnesses? • Infection-pneumonia, urinary tract infection • Diabetes • Heart disease- hypertension, heart attack. Heart failure • Lung disease- asthma, COPD • Dementia, stroke • Depression, anxiety • Others?

14. Shortness of breath Elevated BP Rapid heart rate Dizziness Pain Blueness around lips 3 pound weight gain Weakness in right arm Fevers Chills Weakness Headaches Difficulty speaking Coughing Swelling Low blood glucose Noisy breathing Nausea Vomiting Fatigue Headache Change in mental status/confusion Diarrhea Loss of appetite Weight loss Sadness Tearfulness Is it a SYMPTOM or a SIGN?

15. Review of vital signs • Why is it important that we review vital signs with a group of experienced aides? • Sometimes things change • Sometimes we change • Vital signs are very important! • We need to know our clients’ normal ranges so we know when a change occurs • Reporting a change can be a life saving action

16. What are our tools? • Temperature • Blood pressure • Heart rate • Respiratory rate • Oxygen level • Weight • Blood glucose • Appearance

17. Review of vital signs • Observe and report changes to your supervisor

18. Other information • What are the client’s health problems? • What medications is the patient taking?

19. Temperature • “Normal” is 97.6-99.6 F or 36.5-37.2 C orally • Where do you take a temperature? oral (by mouth) rectal (in the rectum) axillary (under the arm) tympanic (in the ear/special thermometer) • How do you take a temperature?

20. Blood pressure • “Normal” blood pressure is less than 120/80 • How do you take a blood pressure?

21. Heart rate • “Normal” heart rate 60-100 • Where do you take a pulse? radial brachial femoral • How do you take a pulse? • Other characteristics of a pulse regular irregular

22. Respiratory rate and oxygen level • “Normal” respirations are 12- 20 • Oxygen level above 93% normal • How do you take a respiratory rate and measure oxygen level? • Other characteristics of respiration unlabored labored

23. Weight • “Normal” weight is… • How do you take a weight? • Yesterday Mrs. Harris weighed 145. Today she weighs 152. What might be different?

24. Blood glucose • “Normal levels” are 60-100 • How do you check blood glucoses?

25. Appearance • What does the person normally look like? • What’s different now?

26. Review of vital signs • Observe and report changes to your supervisor

27. How to maintain health • See doctor/health care provider regularly • Follow the team’s advice • Eat low fat, low cholesterol diet • Limit alcohol intake • Exercise • Do not smoke • Get enough sleep • Manage your stress

28. Eat diet with less than 2400 mg of salt Eat a variety of foods from all the food groups – grains, fruits, vegetables, meat and nuts, dairy products Moderation – control portion sizes Restrict foods high in fat and added sugar Keep diary of the foods eaten Nutrition guidelines

29. What is a serving? • What can fit in the palm of your hand • One “piece” of fruit or vegetable • Half cup of canned, cooked, fresh, or frozen vegetables • 6 ounces of fruit or vegetable juice • ¼ cup of dried fruit

30. Portion size should equal the recommended serving size Meat, fish, poultry 3 ounces (deck of cards (25% of plate) Pasta, rice 1 cup (baseball) (25% of plate) Veggies, fruit Half of plate

31. Why fruits and vegetables? • High in nutrients like vitamins and minerals • Most have no cholesterol • Most have fiber • Most are low in calories

32. Not vegetables/ fruit • Potato chips • French fries • Jam, jelly • Fruit bars • Sweetened drinks (like “Kool Aid” or fruit punch)

33. Fat • Should represent 30% of calories • Prefer Polyunsaturated sunflower, soybeans, and corn oils • Prefer Monounsaturated canola and olive oil • Limit Saturated (should be only 7-10%) animal products – milk, butter, meat • Avoid trans fats

34. Cholesterol • Fat-like substance in the body • Important uses in the body • Most that is needed comes from body —produced in the liver • Additional cholesterol comes from foods • Limit to less than 200- 300 mg per day

35. Sodium • Necessary mineral in the body • Consumed in the form of salt • Can cause fluid to be retained and blood pressure to rise – where salt goes so does water • Recommended 2,000- 2,300 mg/ day • Reference: one teaspoon= 2,000 mg sodium

36. Sodium • Processed foods are high in salt • Rinse canned foods before eating to decrease salt

37. Typical American diet 2,200 calories per day Carbohydrates 50% calories Protein 15% of calories Fat 35% of calories Healthy diet 1500-2000 calories per day for most men and women Carbohydrates 40-60% of calories Protein 20% of calories Fat Less than 30% of calories How are YOU doing?

38. Calories and percentages • A gram is a measurement of weight • 1 gram of carbohydrate = 4 calories • Should be 40 to 60% of daily calories • 1 gram of protein = 4 calories • Should be 20% of daily calories • 1 gram of fat = 9 calories • Should be no more than 30% of daily calories

39. DASH diet • 2,000 calorie diet • 7-8 servings of grains and grain products • 4-5 servings of vegetables • 4-5 servings of fruits • 2-3 servings of low fat dairy • 2 or less servings (3 ounces cooked) of meat, poultry, or fish • 1 serving of nuts/seeds • 2-3 servings of fats, oils

40. Alcohol intake • Limit • At most one drink per day for women and two drinks per day for men • Less than 20 grams per day for women and less than 30 grams per day for men • One drink is defined as: = 12 oz beer = 5 oz wine = 1.5 oz spirits

41. Exercise • Advised most days of the week • Start slow and build up • Aerobic, strength training, flexibility • Goal is 30 minutes most days • Exercise heart rate to 50 to 85% of the difference between 220 and age

42. Exercise • Walking • Running • Dancing • Biking • Swimming • Most important…do something you enjoy!

43. Exercise – Getting started • Discuss with doctor first • Start slow and build up • Make goals that are achievable • Example: walk up and down halls of apartment for __ minutes each day; then increase by __ minutes each week

44. Smoking • More than 400,000 deaths in the United States each year related to smoking • There are ~ 4000 chemicals in cigarettes • Many of the chemicals are toxic and many cause cancer • Nicotine is a stimulant in cigarettes that is more addictive than heroin http://dccps.nci.nih.gov/tcrb/Smoking_Facts/about.html www.cdc.gov

45. Smoking • Quitting smoking is probably one of the best • and hardest • single health decision a person can make.

46. Sleep • Sleep is important to health and well-being • When a person doesn’t get enough sleep, the body, mind and spirit suffer. • Enough sleep is 7-8 hours each night.

47. Stress management • Managing stress makes a difference in health. • Stress can change vital signs, make it more difficult to control blood glucose and increase risk for dementia

48. Managing Change Home care workers may be the first person to notice changes in their clients Your response may make the difference between: Hospitalization or home management Suffering or comfort Death or life

49. 4 Steps to Dealing with Changes • Step 1: Watch for changes • Step 2: Gather information • Step 3: Report what you’ve found • Step 4: Document your findings

50. Step 1: Watch for changes • Small changes may mean big problems. • Older people and people with several health problems have more trouble recovering from illness. • SO…they get sicker faster • AND…take longer to recover • The sooner we notice something wrong- • The sooner we can start to fix it- • The more likely we are to get a better recovery.