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NURS363 - Practice of Nursing IV > Week 3 - Disability and Home Care Nursing > Flashcards

Week 3 - Disability and Home Care Nursing Flashcards

1
Q

Disability

A

Having a limitation in the performance or function of everyday activity - general and broad

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2
Q

WHO Definition of Disability

A

Disability is a dynamic between a person’s health condition and their environment

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3
Q

Americans With Disability Act Definition of Disability

A

Disability is one who has physical or mental impairment that substantially inhibits one or more major life activities

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4
Q

Severe Disability

A

Varies in definition from Inability to do ADL/IADLs, needing assistive devices, requiring someone else for assistance to do basic activities

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5
Q

Disabilities __ among people

A

vary

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6
Q

What are some difficulties a person with a disability may have

A 
talking
walking
hearing
seeing
climbing stairs
lifting
performing ADL/IADLs
doing school work
working a job
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7
Q

As __ increases so does disability prevalence

A

age

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8
Q

Many people with disabilities are still___

A

employed

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9
Q

Categories of Disability

A
  1. Developmental (Birth to 22 yo)
  2. Acquired (any age)
  3. Age Associated
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10
Q

Developmental Disabilities

A

Disabilities influencing individuals from BIRTH TO AGE 22

Impairment from something like birth trauma, serious illness, injury, etc

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11
Q

Models of Disability

A 
Medical
Rehabilitation
Social
Biopsychosocial
Functional
Interface
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12
Q

Medical Model of Disability

A

Equates people who are disabled with their disabilities and views disabilities as a problem of the person, a disease, trauma, or other health conditions that requires medical care in the form of individual treatment by professionals

Experts/Authorities: Health Care Providers

Management is aimed at curing or adjusting and behavior change

Promotes passivity and dependency

Views people with disability as tragic

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13
Q

Rehabilitation Model of Disability

A

Sees disability as a deficiency that needs rehabilitation specialists or other professionals to fix

Disabled people seen as having failed if unable to overcome disability

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14
Q

Social Model of Disability

A

“Barriers or Disability Model”

Views disability as socially constructed and a political issue that is a result of social and physical barriers in the environment

The perspective is disability can be overcome by removal of the barriers

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15
Q

Biopsychosocial Model of Disability

A

Integrates medical and social models to address perspectives of health from a biologic, individual, and social perspective

Suggests the disabling condition, rather than the person and the experience of the person, remains the construct

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16
Q

Functional Model of Disability

A

WHO: ICF

Considers disability as an umbrella term for impairment, activity limitations, participation restrictions, and interaction with environmental factors

Addresses components of health rather than disease consequences

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17
Q

Interface Model of Disability

A

Based on life exp. of the person with disability and sees disability at the intersection (interface) of medical diagnosis and environmental barriers

Person with a disability defines the problems and seeks or directs solutions

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18
Q

Regarding disability, it is important to do what for the individual

A

individualize the care plan to them

ask how they like their care, what assistive devices do they need, what are their needs, what are their preferences

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19
Q

General Nursing Role and Ways to Individualize Care for those who are Disabled

A

Majority live at home - start there

Learn preferences, assistive devices

Teach and promote patient safety

Teach and use communication strategies

Teach and promote independence

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20
Q

Types of Illnesses

A

Acute

Chronic

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21
Q

Acute Illness

A

curable, relatively short disease course allowing for recovery in a short period of time

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22
Q

Chronic Illness (CI)

A

refers to human experience of living with a chronic condition or disease - also includes individual’s perceptions of having a chronic disease and how they respond to it

Has irreversible alterations and there is not a complete cure for chronic illness

Individual needs long term support or care

Care and Support / Issues persist 3 mo +

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23
Q

Causes for Chronic Illness

A

Genetics

Injury

Behavior

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24
Q

CI can affect…

A

ALL ages, races, SES, and cultures

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25
We find that as SES decreases...
incidence of CI increases (d/t being uninsured and underinsured)
26
Th leading cause of death in almost every country is
CI (7/10 of the leading causes of death in US are CIs)
27
What are the implications of increasing CI rate
rise in cost of healthcare - more than 4 out of 5 dollars spent on CIs
28
Most CIs are ___
preventable!
29
Why is CI prevalence rising?
People live longer d/t technology Mortality decreased for acute conditions Acute conditions increase rate of getting CI Repeated scenario - unhealthy lifestyle behaviors, smoking, vaping, chronic stress Diagnosis - done earlier and more effectively now
30
Examples of CI
Crohn's Disease Ulcerative Colitis Cancer Addison's Disease Cirrhosis and more...
31
Characteristics of CI
Phases of the disease: Remissions, Relapses, Exacerbations - unpredictable Psychological and Social Impact - anger, depression, isolation, role changes Financial Impact Therapeutic Regimen - may not adhere to it Individual Responsibility - may not adhere or want to Domino Effect Collaboration - of healthcare team, family, pts, etc needed to treat Uncertainty - do not know outcomes of the illness
32
What domino effect occurs from CI?
One CI often leads to another one
33
What is our role in the care of CI as nurses?
#1 EDUCATE ON PREVENTATIVE MEASURES Address gaps in care Prevention Support
34
Trajectory Model of Chronic Illness
A model used to describe the role of nurses during the trajectory of chronic illness Medical Model + Nursing Wellness and Self Care Models = Trajectory Model of Chronic Illness
35
Stages of the Trajectory Model of CI
1. Pretrajectory 2. Trajectory 3. Stable 4. Unstable 5. Acute 6. Crisis 7. Comeback 8. Downward 9. Dying *phases do not need to be in order
36
Nursing Process with Trajectory Model
Assessment --> Nursing Dx priotizing potential problems and tackling them --> Goals (plan) that are realistic and collaborate with everyone --> Interventions --> Evaluation - determine if the nursing dx is better worse or the same
37
Pre-trajectory Phase
Patient does not have CI yet, but they could be headed that way d/t risk factors that contribute to CI ex: Pre-diabetic
38
The pre-trajectory phase is all about what level of prevention?
Secondary Prevention They have already been screened for risk factors
39
Goals and Interventions revolve around what in the pre-trajectory phase?
1. Testing 2. Counseling 3. Education *include caregiver too
40
Trajectory Phase
Pt starts seeing s/s chronic illness - they get a work up and are formally diagnosed with the CI/CC Family members may have feelings too - anger, apathy, blaming loved one, concern
41
Goals and Interventions revolves around what in the Trajectory Phase
1. Explanation/Educate 2. Emotional Support Reinforce provider given education, diagnosis and treatment regimen Refer to community resources Advocate and support pt and family
42
Stable Phase
When s/s of CI are under control via meds, lifestyle mods, or a little of both ; has adapted to the disability and any disability they can start adapting to their daily routines CI is managed at home in this phase and the Family may feel relief from stability, being at home, and no crisis is occurring - may be uncertain of disease but still know and find comfort in stability Caregiver may be involved or person may have full autonomy
43
Goals and Interventions revolve around what in the Stable Phase
1. Positive Behaviors 2. Health Promotion 3. Health Promoting Behaviors Reinforce and encourage behaviors and provide education and encouragement in participation in health activities
44
Unstable Phase
Pt experiences setback - a relapse or exacerbation where illness may re-activate Has difficulty carrying out ADLs, but diagnostic testing and changes to treatment may need to occur This can be managed outpatient, but may need healthcare team intervention May cause uncertainty
45
Goals and Interventions revolve around what in the Unstable Phase
1. Guidance and Support 2. Education Reinforce previous teaching, get them to cont. compliance, reinforce care, provide education on details why exacerbation occurred
46
Acute Phase
Like unstable phase, but is a sudden sever onset of symptoms Here the individual will need to be hospitalized and ADLs are interrupted Family may be fearful of what could occur and about long-term concerns N Dx: risk for caregiver strain or role strain
47
Goals and Interventions revolves around what in the Acute Phase
1. Direct Care 2. Support Get them stabilized, support family caregivers and pt
48
Crisis Care
Sudden crisis occurs where critical life threatening event occurs Event is immediate and emergent treatment ADLs completely suspended Family dynamic in state of crisis and suspension due to uncertainty on what will occur
49
Goals and Interventions revolves around what in the Crisis Phase
1. Direct Care 2. Collaboration w/ Healthcare Team 3. Stabilize Straightforward - physio stabilization of pt and collaboration with healthcare team Direct care and stabilizing the most
50
Comeback Phase
Gradual recovery of the ACUTE phase May see new or worsened disabilities May also see some need for rehabilitation following CRISIS phase - may not be able to immediately go home May see some family relief, but caregiver role strain persists
51
Goals and Interventions revolve around what in the Comeback Phase
1. Coordination of Care 2. Adaptation Arrange needed surfaces to return pt to prior level of independence or function Also coord care and adaptation due to potentially new acquired disability from acute or crisis phase give positive reinforcement for reaching goals too
52
Downward Phase
Rapid or Overall General Worsening of Illness - Physical Decline occurs over time and may increase disability ADLs alter on each downward step the pt takes Pts can linger a very long time and need palliative care Have longer than 6 mo or uncertainty of amount left to live Important to know where patient is in this phase and how family may be grieving and how they are doing lots of uncertainty in this phase
53
Goals and Interventions revolve around what in the Downward Phase
1. Home Care 2. New Treatment Plan 3. . End of Life Planning Support by nurses, PT, Social workers all coming into the home to maintain QOL Should start discussing end of life planning Home care will last until when there is determined to only be 6 mo left to live (then hospice comes in)
54
Dying Phase
Last Phase where death is imminent in 6 mo or less Hospice steps in Gradual loss of fxn, complete ADL withdrawal, hospice nurse visits more frequently, discuss end of life care Family a& Caregiver Distress and Grieving Some pts will accept this phase but their families may not
55
Goals and Interventions revolve around what in the Dying Phase
1. Direct Care 2. Comfort 3. Support Prime focus: Let pt die with comfort and dignity - the hallmark of the phase Support family and caregivers because they may not be ready for this phase
56
Home care gives clients and families a chance to get what?
health care in their usual environment, where they may feel more comfortable and where it may be easier to learn and practice how to make health related lifestyle changes
57
For homebound clients __ __may be a necessity
home care
58
Home care wasnt covered by insurance until ___
1965
59
Research shows what can speed recovery
home care / comfort in their own home
60
Home Care
includes disease prevention, health promotion and episode illness related services provided to people in their places of resident Is an approach to care provided in people’s homes because theory or research suggests this is the optimum location for certain health and nursing services includes PREVENTION and is EPISODIC (not permanent)
61
Home care is usually only how long?
2 months with maybe some recertification before looking at other things
62
Home care is part of a continuum where clients have the opportunity to do what
live and move through the experiences of subacute, chronic, and end-of-life care.
63
Care given in the home care setting is often managed and directed by a __
RN (but other members do get involved interdisciplinarily)
64
Care given in home care settings is __ in nature
interdisciplinary
65
With caregiving it is essential to...
work with the family in the provision of care to an individual client
66
Family is defined by ...
the individual and includes any caregiver or significant person who assists the client in need of care at home does not have to be blood related - could even teach caregiver IV therapy and wound care
67
Family caregiving includes...
assisting clients to meet their basic needs and providing direct care such as personal hygiene, meal preparation, medication administration, and necessary treatments
68
A caregiver is defined as __ and __
willing and able
69
Nurses practice ___ in the home setting
autonomously (little structure so have to have competence and creativity)
70
Troubles with Working Home Care
1. Home lacks many institutional resources - nurse should be organized, adaptable, and be interpersonally savvy to meet needs 2. Nurse is a guest and needs the trust and partnership with the client and family 3. Client safety is of utmost concern just like any other setting
71
Role and Scope of the Home Practice Nurse According to the Nursing Process
Assessment - collect data about home care client Diagnosis - through analysis of data Outcome ID - helps home care nurses ID nurse sensitive measures Planning - in the form of nurse sensitive interventions directed to the Identified outcomes Implementation - identified nurse centered actions in collab with client and families Evaluation - was outcome accomplished through nurse sensitive interventions
72
Scope of Practice - Direct Care
refers to the actual physical aspects of nursing care - anything requiring physical contact and face to face interaction skilled needs - anything a nurse would have to do in person
73
Examples of Direct Care
Performing a physical assessment on the client Changing a dressing on a wound Giving medication by injection inserting an indwelling catheter Providing IV therapy teaching clients/family how to perform a task
74
Do we give oral meds in home care
no its not direct c are - the pt is independent and should and can take care of that themselves - but we may do IM SQ IV injections and therapy
75
Scope of Practice - Indirect Care
activities a nurse does on behalf of client to improve or coordinate care
76
Examples of Indirect Care
Consulting with other nurses and health providers in a multidisciplinary approach to care Organizing and participating in client care team conferences Advocating for clients with the health care system and insurers Supervising home health aides Obtaining results of diagnostic tests Documenting care
77
Nursing Roles in Home care
Clinician Case manager Client advocate Educator Mentor Researcher Administrator Consultant
78
What are the steps of a Home Visit
1. Initiating the visit 2. Preparation (equipment, directions, personal safety) 3. Actual visit and Assessment (medication error risk, fall risk abuse and neglect risk) 4. Post visit planning
79
What are some Reimbursement mechanisms for Home Care
1. Medicare and Medicaid are principal funding sources with 3rd party health insurances providing another major source 2. Budgeted funds for public health from taxes covers preventive home care visits to the clients of public health agencies 3. Other home care services (health education, risk reduction, case management, primary case) may be reimbursed from a variety of sources like program funds, grants, contracts or third party billing
80
___ and ___ are the principal funding sources of home care
Medicare and Medicaid
81
How does the Federal Govt maintain cost effectiveness of home care
They instituted a prospective payment system in response to rising costs and increased number of agencies This prevents fraudulent use of Medicare funding Evaluation shows this system has increased efficiencies and reduced certain costs and that it has generally not been associated with declines in care quality

NURS363 - Practice of Nursing IV (17 decks)

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