Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 6 Acute Interventions for the Chronic Care Patient

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Home Health Care Home Care Providers ALS Support for Home Care Patients Hospice

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Introduction A major trend in health care involves the shifting of patients out of the hospital and back into their homes as soon as possible. The result has been a huge increase in home health care services.

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ History of Home Care A number of factors have promoted the growth of home care in recent years. They include: –Enactment of Medicare in 1965 –The advent of HMOs –Improved medical technology –Changes in the attitudes of doctors –and patients toward hospital care

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ In 1992… Almost 75% of home care patients were age 65 or older. Of the elderly home care patients, almost two-thirds were female.

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The home care provider is an important source of information.

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A number of situations may involve you in the treatment of a home care patient: Equipment failure Unexpected complications Absence of a caregiver Need for transport Inability to operate a device

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Many of the pathologies that you will encounter in a home care setting are the same as others. You must always keep in mind that the home care patient is in a more fragile state. Typical Responses –Airway complications –Respiratory failure –Cardiac decompensation –Alterations in peripheral circulation –Altered mental status –GI/GU crises –Infections/septic complications

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pressure sores are classified by the depth of tissue destruction.

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Common medical devices for the chronic care patient

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

General System Pathophysiology, Assessment, and Management

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Assessment Assessment of the home care patient follows the same basic steps as any other patient. The one thing home care calls have in common is their diversity. Try to ascertain from the primary care provider the patient’s baseline health status.

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Tailor your questions to the home care setting.

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Common Acute Home Health Situations (1 of 2) Respiratory disorders –COPD –Bronchitis –Asthma –CHF –Cystic fibrosis –Bronchopulmonary dysplasia

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Common Acute Home Health Situations (2 of 2) Neuromuscular degenerative diseases –Muscular dystrophy –Poliomyelitis –Guillain-Barré Syndrome –Myasthenia gravis Sleep apnea Patients awaiting lung transplants

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Medical Therapy Found in the Home Setting Home oxygen therapy Artificial airways/tracheostomies Vascular access devices

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Common Technical Problems with Oxygen Systems

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Artificial ventilation in a patient with a tracheostomy tube

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Use of continuous positive pressure airway pressure—CPAP—for sleep apnea patients

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Vascular Access Devices Hickman, Broviac, Groshong Peripherally inserted central catheters Surgically implanted medication delivery systems Dialysis shunts

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ An A-V shunt is used in home care patients requiring dialysis.

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Vascular Access Never access a surgically implanted port unless protocols allow you to do so—and you have the training/ equipment. Avoid vascular access and blood pressure in the extremity of a shunt.

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ GI/GU Crisis Devices to support GI/GU function are common. Be familiar with the various devices and their complications.

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ An external urinary tract device

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ An internal urinary catheter with balloon

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A nasogastric feeding tube

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A gastrostomy feeding tube

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Examples of colostomy stoma locations

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Maternal and Newborn Care Many women who deliver their babies in the hospital will be discharged in 24 hours or less. ALS providers may be called upon to assist new parents in caring for newborns or post-partum complications.

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Postpartum bleeding and embolus are common complications. Management includes: –Massage of uterus –Administration of fluids –Administration of Pitocin –Rapid transport, if necessary

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Common Infant/Child Complications Signs/symptoms of cardiorespiratory insufficiency include: Cyanosis Bradycardia Crackles (rales) Respiratory distress

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Commonly found medical therapies for children who are home care patients include: Mechanical ventilators IV medications Oxygen therapy Tracheostomies Feeding tubes Pulse oximeters Apnea monitors

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hospice More than 2,250 hospices provide support for the terminally ill and their families. The goal of hospice care is to provide palliative or comfort care rather than curative care.

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Percentage of Hospice Patients by Age

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Children with AIDS or HIV infection in a hospice setting

Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Home Health Care Home Care Providers ALS Support for Home Care Patients Hospice