Unit 15 Study guide:



Unit 15: Nursing in a Variety of Settings:Chapter 96: Extended CareChapter 97: Rehabilitation NursingChapter 98: Home Care NursingChapter 99: Ambulatory NursingChapter 100: Hospice Nursing(References: Rosdahl, C. B, Kowalksi, M. T. ( 2017). Textbook of Basic Nursing ( 11th ed.). Wolters Kluwer / Summer Putt)(THIS IS NOT ALL INCLUSIVE!)Chapter 96: Extended CareExtended-Care Facilities:Extended-care facilities (ECFs)“Extend” or continue care started in the hospital Subacute-care or transitional facilitiesMedically complex care facilitiesShort-term rehabilitation unitsLong-term care (LTC) facilities or skilled nursing facilities (SNF) (“nursing homes”)Long-Term Care Facilities:The skilled nursing facility (SNF) 24-hour care and must have a licensed nurse (LPN, LVN, or RN) on duty 24 hours a dayRehabilitation services, special diets, and access to pharmacy, x-ray, and laboratory servicesThe primary care or “medical oversight” is often provided by an advance practice nursePhysicians are on callThe intermediate care facility (ICF) Provide fewer services and less extensive care than the SNF Provide room, board, and some nursing careA licensed nurse is not required to be on duty 24 hours a dayA nurse is usually required to be on callComponents of LTC Facilities:Meal programs, activities, and servicesSkin and wound careThe ombudsperson, payment for long-term careThe quality improvement organizationThe case manager or care managerSpecialized communitiesRespite care and daycare programsServices provided to the community by long-term care facilities and volunteersServices Provided in Transitional Facilities:Intravenous (IV) therapyCardiac monitoringVentilator and/or tracheostomy careTube feedingsDialysisColostomy/ileostomy careManagement of severe woundsOther Extended Care Options:Independent living optionsThe continuing care retirement communitySenior and other special housing programsCongregate housingBoard-and-care home Supervised group home Hospice care or end-of-life care Assisted livingGoal of Quality Improvement Networks:Improve care, particularly for Medicare recipientsProvide educational materials and resources to facilities for staff developmentProvide guidance for quality improvement for facility managers and staff (to improve care)Monitor techniques and intervention strategies, to improve careProvide recommendations for training and/or certification of nonlicensed personnel Transitional Care:Transition of care (TOC) Safe and appropriate transition between agencies and facilities and between departments in a single facilityHandover or handoff Transfer of information, as well as the professional responsibility to make sure information is understood by the receiverThe SBAR processA method of organizing information in preparation for a handover Universal transfer form (UTF)Personal health record (PHR) SBAR Process:Situation: Who are you and why is contact being made?Background: Pertinent information, as listed aboveAssessment: What is the situation, as reported by nursing staff?Recommendations: What should be done for the client? Why is the transfer being made or what instructions are you seeking from the healthcare provider? These recommendations must be clearly communicated to all staff involved.Ways to Prevent Rehospitalization:Ongoing education of clients and families about the disease process and care neededIncreasing the ability of clients/families to self-manage chronic conditionsBetter discharge planning during the stayMedication reconciliationBetter communication between settings and persons providing careIncreased use of telehealthUtilization of electronic medical records between facilities, agencies, and providers’ officesBetter utilization of palliative care and hospice servicesEncouraging primary providers to be truthful with clients/families who have progressive diseases and to offer options other than hospital careChapter 97: Rehabilitation NursingRehabilitation:RehabilitationRestoring a person who becomes physically or mentally challenged to his or her former abilities, as much as possibleLong-term rehabilitation Short period of rehabilitation Rehabilitation can occur in the healthcare facility, in the community health center, or in the client’s home.Stages of Adjustment to a Disability:Early reactionsExperiences defense, shock, and denial; fear and anxietyExperiences angerTries to bargain with God or make dealsEventually, the client with permanent disabilityFaces reality and may experience severe depressionAccepts realityThe Rehabilitation Team:PhysicianPhysiatrists or physical medicine and rehabilitation (PM&R) specialistsNurse, advanced practice nurse, or certified rehabilitation nurseTherapists (physical, occupational, speech, music, recreation, sexual) Vocational counselor, social worker, and psychologistCase manager (care manager)Rehabilitation and Maslow Hierarchy of Needs:Principles of rehabilitationBased on early recognition and individualized planning for each clientMaslow hierarchy of needsAssistance with basic survival needs Assistance with activities of daily living (ADLs) Work toward self-actualization Activities of Daily Living (ADLs):Paramount goal of rehabilitationTo assist the client to regain the ability to perform as many ADLs as possibleThis goal reduces the workload of the client’s caregivers and enhances the client’s self-esteem, which is of primary importanceFunctional ADLs (FADLs)Instrumental ADLs (IADLs)Nursing Considerations in Rehabilitation:Treatments to halt destructive processes and to repair body damagePrevents further injury and restores normal functions whenever possibleProvides clients with emotional supportScope of rehabilitation nursing practiceExtends from primary prevention, through acute and subacute levels, and beyond tertiary intervention into community and lifelong careSkin Care:Risk for skin breakdownClients with impaired sensation or mobility Primary goal of all nursing careTo prevent skin breakdown A number of nursing measures related to skin care do not require a provider’s orderFall Assessment:A formal fall assessment should be done on each client on a regular basis, whether they are in a rehabilitation program or not The Hendrich Fall Risk Tool Elimination:Management of incontinence is a major factor in a person’s quality of lifeA person’s independence and ability to live at home, rather than being required to live in a healthcare facility, is directly related to the person’s ability to maintain continenceBowel eliminationBladder eliminationSome nurses specialize in continence care and set up programs for continence rehabilitationChapter 98: Home Nursing CareHome Care:Part-time, medically necessary skilled care ordered by a healthcare providerAssistance with activities of daily livingThe instrument/data collection tool (OASIS)Collect and report performance data by home health agenciesThe National Association for Home Care (NAHC)Assist agencies in the delivery of home care Types of Agencies and Services:Long-term home careTelehealthChildren with special healthcare needsSelf-management of chronic conditionsIntermittent or short-term home careCenters of excellenceReasons for Home Care:To reduce unnecessary and avoidable rehospitalizations Quality indicators of home careAcute care hospitalization (ACH) Avoidance of unnecessary rehospitalizations is vital for the home care agency to maintain its fundingFewer people are being admitted to hospitals, and those who are admitted are going home sooner, with more need for assistance at homeCharacteristics of Home Care:Third-party payors require early discharge.New mothers may require assistance during the first few days at home.Some people receive their entire care at home.The aging population is increasing.Clients may not have family caregivers.Sophisticated electronic equipment allows clients to receive complex care at home.Telehealth; nurses use digital cameras to record information.Advantages of Home Care:Home care is less expensive than hospital or nursing-home care.Nurses, support personnel, and primary caregivers can provide continuous care from hospital to home. Clients are more comfortable receiving care in their own home.Home care agencies often provide hospice care.Clients and families experience less emotional strain at home because they avoid separation.The Role of the LV/LPN:Furnish services in accordance with agency policies.Prepare clinical and progress notes.Assist healthcare providers and RNs to perform specialized procedures.Prepare equipment and materials for treatments, observing aseptic technique as required.Assist clients in learning appropriate self-care techniques.Chapter 99: Ambulatory NursingAmbulatory Healthcare:Ambulatory healthcareCare of clients who do not need to be in an acute-care hospital or long-term care settingPrimary care provider (PCP)Physician Clinical nurse specialistAdvance practice nurseTrained physician’s assistantThe Role of the Nurse:Routine client care Some of the other duties include Setting up schedules for physiciansTeletriage; fall risk assessmentPerform medication reconciliation, routine hearing, and vision screeningTrack preventive and health-promotion procedures Assist with teaching clients and families Enter all data on the client’s computer recordPrivate Clinics:Private physicians or groups of physicians often practice in a clinic, which may be associated with hospitals or may be free-standing. Other professionals who work in these clinics include advance practice nurses, physicians’ assistants, general staff nurses (RNs, LPNs), and various specialists and office personnel. The Community/Family Health Center:The community/family health center (CHC or FHC)Provider of primary care for a large segment of the population, particularly underserved populationsSpecialized populationsThe role of the advance practice nurse The Emergency Department and Emergi-Center:Emergency department (ED) or emergency room (ER) in hospitalsCare for clients with traumatic or life-threatening conditions Urgent-care departments (urgi-centers)Care for less critically ill clients Free-standing emergi-centersTreat only vertical clientsWalk-in clinics not attached to hospitalsThe Same-Day Surgery or Ambulatory Surgery Center:Endoscopy, laser, fiberoptics, ultrasound, MRI, CT, and positron-emission tomography (PET/PETT) scansProcedures, such as extracorporeal lithotripsy, stent placement, robotic proceduresIncreased sophistication of local, spinal, and block anesthesia; client-managed pain-control pump systems Operating microscope, computerizationSpecialized implant materials, joints or bone stabilization; external fixators, halo devices, and so onThe determination of candidates for ambulatory surgery is based on factors such as:Client conditionClient ageComplexity of the procedure Availability of after careExistence or absence of underlying physical or mental disordersBenefits of same-day surgeryClient Criteria for Outpatient (Same-Day) Surgery:Class IWound debridement, tonsillectomy, tubal ligation, vasectomy, biopsyClass IIRemoval of tubal pregnancy, hysterectomy, stent placement (in blood vessel)Class IIITotal colon resection, radical mastectomy, coronary artery bypassElectronic Health Record (EHR):The EHR greatly enhances communication between agencies and facilities. It improves client care and increases safety.Clients can access their own information and ask informed questions.Providers can access client information from remote areas.The EHR also allows clients to receive medications ordered by their provider when they are in a different part of the country, using a nationwide system, such as Walgreen’s.Chapter 100: Hospice NursingHospice:A philosophy of careBased on the concept that most people want to die at home, free of pain, and among their loved onesPhysical and emotional comfort and quality of life Care is available to clients with chronic illnesses that have progressed to terminal stages or chronic situations such as end-stage renal disease (ESRD), end-stage cardiac disease, chronic obstructive pulmonary disease (COPD), and Alzheimer disease.Goals of Hospice:Hospice care focuses on the human needs.Physical, psychological/emotional, social/cultural, and spiritualThe goals of hospice are:Relief of distressing symptomsProvision of expert care and a protective environmentAssurance that the client and family will not be abandonedCharacteristics of a Hospice:The hospice must be a centrally administered, autonomous program. The goal is symptom control, not curative measures. Team members should practice interdisciplinary care under a qualified healthcare provider’s direction, and consultation must be available at all times, day or night. Support should be available for hospice staff and for the client’s caregivers.Hospice services must be extended to the family during the time of bereavement for at least 1 year; it must be based on a client’s needs.Respite Care:Caregivers “take a break,” usually for two to four weeks, but it may be just for one day. Respite care is accomplished by admitting clients to inpatient hospice settings or by arranging for supplemental home care.Family caregivers should be encouraged to utilize respite services. In this way, they will be physically and emotionally better able to continue with the difficult task of caring for their loved one.Palliative Care: Symptom Management:Symptoms related to hospice care often span a longer period of time or require management different from that in other settings.Do not resuscitate (DNR)Do not intubate (DNI)Do not hospitalize (DNH)One philosophy of hospice is that suffering is not prolonged. Symptoms are managed as noninvasively as possible.Emotional Support:Fear of most clientsThey will be left alone to dieUncontrolled painHospice careEmpathic communication with clientEmotional support to caregiversHelp client to reconcile with estranged loved ones, heal relationships, and complete other important personal tasksSpiritual Support:Most hospice teams have chaplains available for consultation if clients are interested.Respect each client’s cultural and religious customs.Ask the client or family about desired procedures. Bereavement Care:Bereavement is part of the process of dealing with a loved one’s death.Attend memorial services.Urge family members to reminisce.Make home visits.Support for Hospice Staff:Hospice staff members need emotional support when they regularly work with dying people. Support groups or other outlets must be available for team members to help deal with the loss of people for whom they have cared.Assisting the Hospice Client:Basic needsOxygen and airway, respiratory distressSeizuresNutrition and hydrationAnorexiaNausea and vomitingDehydrationSleep and restInsomnia and hypersomniaEliminationDiarrhea, constipationPersonal care and comfortSkin breakdownManagement of odorEmotional concernsDepressionAnxietySelf-actualization and acceptancePain Management:Evaluation of painPharmacologic therapyAdministration routesManagement of side effects Psychosocial and other nonpharmacologic modalities for pain managementPalliative radiation, medications, and surgeryChildren in Hospice Programs:Staff members must consider dying children in terms of their developmental levels and levels of understanding. Children usually understand what is happening, but need their questions answered truthfully. They need to discuss their feelings, perhaps more so than do adults. Allow children to see your feelings about them and the situation. Let them know you care. Medication doses are adjusted according to a child’s size and reactions.When the Client Dies:Some nursing functions performed for a client who dies at home:Remove all equipment.Allow the family time alone with their deceased family member.Prepare the body for transportation to the funeral home. Assist in notifying the funeral home, if needed.Count narcotics, IVs, and other medications and dispose of them, per agency policy. Document all information.Summer Putt Study Guide (Need to Knows):UNIT 15: (Chapters 96, 97, 98, 99 & 100)What is a long-term care facility? What are some characteristics of LTC? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What services are provided in transitional facilities? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is SBAR? What does it stand for? What does it mean and how will you use it as a nurse?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How can we as nurses prevent rehospitalization? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is rehabilitation? Are there more than one time? Where can this take place?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How does Maslows hierarchy of needs play into rehab? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What does ADL stand for and what are ADL’s?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What are some nursing considerations with rehab? Skin Care? Fall assessment? Elimination?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is the role of the LPN in home care?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is the role of the LPN in ambulatory care?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What does EHR stand for and what is the EHR?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is hospice care? What is it based off of? When is care available? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is respite care? What is the purpose? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What does DNR, DNI and DNH mean? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________How can you as a nurse offer emotional support? Spiritual support? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is bereavement care? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________In what ways can the nurse assist the hospice client? The basic needs…what are they? There are several…..________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What about children in hospice care? What is unique about children and hospice? How do you explain this to them? Does it matter to them? Developmental level is important….______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What are the nurses role/function when the client dies at home?___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ................
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