Nursing Home Care Flashcards Preview

Geriatrics > Nursing Home Care > Flashcards

Flashcards in Nursing Home Care Deck (32):
1

Purpose for a Skilled Nursing Facility

House persons requiring the care & supervision of a skilled nurse

2

Skilled Nursing Facilities

Licensed & regulated by state agencies
Mostly staffed with nursing aides
Few licensed nurses are present to conduct assessments, distribute medications, supervise aides, communicate with providers, & administer treatment

3

Assisted Living Facilities

Diverse facilities
Residents tend to be somewhat less impaired than nursing home residents

4

Services Assisted Living Facilities Provide

Room & board
Assistance with ADLs & IADLs

5

Long Term Care Residents Demographic

Mean ages: 78-85
Alzeimer's
Multi-infarct dementia
Severe chronic heart disease
Amputation
COPD Widows
No children
Low income

6

Short Stay Care

Terminal care
Rehabilitation

7

Long Stay Care

Medical problems
Dementia

8

Payment for Nursing Homes

Medicare (60 days)
Medicaid
Private pay

9

Who pays for assisted living centers?

Private pay

10

Reasons for a Medical Director or Skilled Nursing Facilities

Ensures provider care addresses legal & medical needs
Quality improvement
Committees such as infection, control, pharmacy & utilization review
Reviews incident reports
Assists with development of policies & procedures for residents & staff
Oversees the health program for employees
Conducts educational programs for employees, residents & families
Acts as spokesperson for the facility in the community & with regulatory & other heath care agencies

11

Function-Oriented Care

Maximize what each patient can do independently
Rehabilitative mind set
Assessment & care plan for functional status, establish prognosis, identify specific functional objectives & time frame to accomplish these
Monitor functional status improvement, preventing iatrogenic consequences
Plan a discharge date

12

Types of Restraints

Vest
Wrist
Ankle
Chairs with locking lap trays
Waist restraints
Safety belts
Bed rails

13

Alternatives to Restraints

Increased involvement for residents in structured activities
Assisted daily ambulation, regular toiling
Active listening
Therapeutic touch
Behavior modification
Search for physiologic causes of agitation
Recliner chairs
Carpeted floors
Lower beds
Motion detectors & position monitors

14

Two Parties Involved in Long Term Care Admissions

Family
Patient

15

Function as Providers

Take time to meet with family
Anticipate future events & discuss in advance with family
Learn about family dynamics
Advanced directives
DNRs
End of life measures
Withholding treatments

16

Common Problems in Long-Term Care Settings

Pneumonia
Urosepsis
Immobility
Falls & pressure sores
Nutrition, hydration, & maintenance of weight

17

Cognitive Status of Falls & Pressure Sores

Risk assessment
Skin care
Frequent turning & positioning
Special beds & mattresses
Early treatment of pressure sores

18

Causes of Constipation

Polypharmacy
Decreased physical activity
Immobility
Decreased oral intake
Decreased dietary fiber intake
Dehydration
Loss of functional status
Normal aging changes involving decreased gastric motility & peristalsis

19

Meds that Cause Constipation

Antacids
Anticholinergics
TCAs
CCBs
NSAIDs
Benzodiazepines
Neuroleptics

20

Treatment of Constipation

Exercise
Hydration
Stool softeners
Bulk laxatives
Drug changes

21

Define Significant Weight Loss

Reduction of 5 pounds or more

22

Reasons for Significant Weight Loss

Depression
Medications
Cancer
Swallowing disorders
Poor fitting or absent dentures
Advanced dementia

23

Treatment of Nutrition, Hydration, & Maintenance of Weight

Monitor food & fluid intake
Weigh patients at least once a month
Look for reversible causes
Simple form diet: soft, puree

24

Health Maintenance for Nursing Home Patients

TB screening
Flu vaccination
H&P
Labs based on H&P

25

Overal Goal of Geriatric Medical Practice

Maintain older persons in the familiarity, comfort, & dignity of their own homes for as long as possible

26

Reasons for Home Care

Aging of society
Family caregivers provide 80% of care
Pressure contain overall health care costs
Alternative for hospitalization

27

Technologies Available for Better Home Care

Infusion pumps
Dialysis units
Ventilators
O2 concentrators
Monitoring systems

28

Criteria for Selecting Patients for Home Care

Clinical stability
Caregiver support
Appropriate environment
Availability of professional services
Financial support

29

Provider Performs These Things at a House Call

H&P
Counsel to patient & family
Medication review
Nutritional screening
Assessment of environment
Assessment of caregivers
Home support devices (safety)
Obtain specimens

30

Benefits of Home Care

Improve desired outcomes of care
Medical-legal actions involved in home care visits are almost non-existent

31

Basic Entry Criteria for Medicare Home Health Care

Must be homebound
Leaving home must require assistance & considerable effort
Must require intermittent skilled care: nurse visits, PT, ST, home health aide

32

Home Medical Equipment

Wheelchairs
Hospital beds
Beside commodes
Home nebulizer units