bledsoe et al., essentials of paramedic care: division v © 2006 by pearson education, inc. upper...
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Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Division 5Special Considerations/
Operations
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 46Acute Interventions for the
Chronic-Care Patient
Bledsoe et al., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
The home care provider is an important source of information.
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
A number of situations may involve youin 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., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pressure sores are classified by the depth of tissue destruction.
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Common medical devices for the chronic-care patient
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General System Pathophysiology, Assessment,
and Management
Bledsoe et al., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Tailor your questions tothe home care setting.
Bledsoe et al., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Medical Therapy Found inthe Home Setting
Home oxygen therapy
Artificial airways/tracheostomies
Vascular access devices
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Common Technical Problems with Oxygen
Systems
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Artificial ventilation in a patientwith a tracheostomy tube
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Use of continuous positive airway pressure—CPAP—
for sleep apnea patients
Bledsoe et al., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
An A-V shunt is used in home carepatients requiring dialysis.
Bledsoe et al., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
An external urinary tract device
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
An internal urinary catheter with balloon
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
A nasogastric feeding tube
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
A gastrostomy feeding tube
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Examples of colostomy stoma locations
Bledsoe et al., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Postpartum bleeding and embolusare common complications.
Management includes:– Massage of uterus– Administration of fluids– Administration of Pitocin– Rapid transport, if necessary
Bledsoe et al., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Commonly found medical therapiesfor children who are home care
patients include:
Mechanical ventilators
IV medications
Oxygen therapy
Tracheostomies
Feeding tubes
Pulse oximeters
Apnea monitors
Bledsoe et al., Essentials of Paramedic Care: Division V© 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., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Percentage of Hospice Patients by Age
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Children with AIDS or HIV infectionin a hospice setting
Bledsoe et al., Essentials of Paramedic Care: Division V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Home Health Care
Home Care Providers
ALS Support for Home Care Patients
Hospice