Week 3 - Disability and Home Care Nursing Flashcards

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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
Q

We find that as SES decreases…

A

incidence of CI increases (d/t being uninsured and underinsured)

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26
Q

Th leading cause of death in almost every country is

A

CI (7/10 of the leading causes of death in US are CIs)

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27
Q

What are the implications of increasing CI rate

A

rise in cost of healthcare - more than 4 out of 5 dollars spent on CIs

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28
Q

Most CIs are ___

A

preventable!

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29
Q

Why is CI prevalence rising?

A

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

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30
Q

Examples of CI

A

Crohn’s Disease

Ulcerative Colitis

Cancer

Addison’s Disease

Cirrhosis

and more…

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31
Q

Characteristics of CI

A

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

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32
Q

What domino effect occurs from CI?

A

One CI often leads to another one

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33
Q

What is our role in the care of CI as nurses?

A

1 EDUCATE ON PREVENTATIVE MEASURES

Address gaps in care

Prevention

Support

34
Q

Trajectory Model of Chronic Illness

A

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
Q

Stages of the Trajectory Model of CI

A
  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
Q

Nursing Process with Trajectory Model

A

Assessment

Nursing Dx - prioritizing 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
Q

Pre-trajectory Phase

A

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
Q

The pre-trajectory phase is all about what level of prevention?

A

Secondary Prevention

They have already been screened for risk factors

39
Q

Goals and Interventions revolve around what in the pre-trajectory phase?

A
  1. Testing
  2. Counseling
  3. Education

*include caregiver too

40
Q

Trajectory Phase

A

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
Q

Goals and Interventions revolves around what in the Trajectory Phase

A
  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
Q

Stable Phase

A

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
Q

Goals and Interventions revolve around what in the Stable Phase

A
  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
Q

Unstable Phase

A

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
Q

Goals and Interventions revolve around what in the Unstable Phase

A
  1. Guidance and Support
  2. Education

Reinforce previous teaching, get them to cont. compliance, reinforce care, provide education on details why exacerbation occurred

46
Q

Acute Phase

A

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
Q

Goals and Interventions revolves around what in the Acute Phase

A
  1. Direct Care
  2. Support

Get them stabilized, support family caregivers and pt

48
Q

Crisis Care

A

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
Q

Goals and Interventions revolves around what in the Crisis Phase

A
  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
Q

Comeback Phase

A

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
Q

Goals and Interventions revolve around what in the Comeback Phase

A
  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
Q

Downward Phase

A

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
Q

Goals and Interventions revolve around what in the Downward Phase

A
  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
Q

Dying Phase

A

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
Q

Goals and Interventions revolve around what in the Dying Phase

A
  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
Q

Home care gives clients and families a chance to get what?

A

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
Q

For homebound clients __ __may be a necessity

A

home care

58
Q

Home care wasnt covered by insurance until ___

A

1965

59
Q

Research shows what can speed recovery

A

home care / comfort in their own home

60
Q

Home Care

A

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
Q

Home care is usually only how long?

A

2 months with maybe some recertification before looking at other things

62
Q

Home care is part of a continuum where clients have the opportunity to do what

A

live and move through the experiences of subacute, chronic, and end-of-life care.

63
Q

Care given in the home care setting is often managed and directed by a __

A

RN (but other members do get involved interdisciplinarily)

64
Q

Care given in home care settings is __ in nature

A

interdisciplinary

65
Q

With caregiving it is essential to…

A

work with the family in the provision of care to an individual client

66
Q

Family is defined by …

A

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
Q

Family caregiving includes…

A

assisting clients to meet their basic needs and providing direct care such as personal hygiene, meal preparation, medication administration, and necessary treatments

68
Q

A caregiver is defined as __ and __

A

willing and able

69
Q

Nurses practice ___ in the home setting

A

autonomously (little structure so have to have competence and creativity)

70
Q

Troubles with Working Home Care

A
  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
Q

Role and Scope of the Home Practice Nurse According to the Nursing Process

A

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
Q

Scope of Practice - Direct Care

A

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
Q

Examples of Direct Care

A

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
Q

Do we give oral meds in home care

A

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
Q

Scope of Practice - Indirect Care

A

activities a nurse does on behalf of client to improve or coordinate care

76
Q

Examples of Indirect Care

A

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
Q

Nursing Roles in Home care

A

Clinician

Case manager

Client advocate

Educator

Mentor

Researcher

Administrator

Consultant

78
Q

What are the steps of a Home Visit

A
  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
Q

What are some Reimbursement mechanisms for Home Care

A
  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
Q

___ and ___ are the principal funding sources of home care

A

Medicare and Medicaid

81
Q

How does the Federal Govt maintain cost effectiveness of home care

A

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