The next section is for Direct Care Providers Only!.ppt

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1、The next section is for Direct Care Providers Only!,Age-Appopriate/ Population Specific Care,Age-Specific Care,Each age group has specific needs that health care providers should recognize and address when interacting with patients and family Being sensitive and knowledgeable of the various stages o

2、f the patients life cycle helps the caregiver to respond more appropriately to the specific needs of their patient,Age Groups,Neonate (First 4 weeks of life) Infant (1 month to 1 year) Toddler (1 3 years) Pre-school Child (3 -5 years) School age Child (6 12 years) Adolescent (13 18 years) Young Adul

3、t (19 40 years) Middle age Adult (41 65 years) Older Adult (over 65 years),Age-Specific Needs,Age-specific needs for all age groups must focus on the: physical motor/sensory responses cognitive/knowledge level psychosocial needs of the patient and parents and/or significant other(s),Age-Specific Nee

4、ds,As a child reaches school age and moves into adolescence, young adulthood, and older adulthood, other factors will influence the needs of the patient. These include: Growth and Development Psychosocial tasks Developmental tasks Significant persons in their life Major fears/stressors Communication

5、 level Safety,Neonate (1st 4 weeks) Infant (1 month to 1 year),Physical Development Grows at a rapid rate, especially the brain Motor/sensory Responses Responds to light and sound Towards middle of year able to; raise head, roll over, bring hand to mouth Towards end of year able to; crawl, stand alo

6、ne, may be walking with assistance or by themselves Cognitive/Knowledge Toward middle of year, able to recognize familiar objects and people. Psychosocial Significant persons are the primary caregivers or parents Develops a sense of trust and security if needs are met Fears unfamiliar situations 7 8

7、 months; fear of strangers, 9 10 months; separation anxiety,Neonate and Infant -Interventions for Caregivers,Involve parents in procedures/encourage parents to assist in the daily care of their infant, as appropriate Limit the number of strangers caring for infant Keep environment safe, keep side-ra

8、ils up at all times Provide opportunity for parents to return demonstrate procedures. Allow time for parents to ask questions Speak softly and smile at infant,Toddler (1 to 3 years),Physical Growth rate decreases, has intermittent growth spurts By about 18 months; bowel control, by 2 3 years; bladde

9、r control Motor/Sensory Response Walks independently, progressing to running, jumping and climbing Able to feed self Cognitive Able to use language Short attention span Can understand simple directions and requests Psychosocial Parents are the significant persons Becomes independent, develops a sens

10、e of will, temper Attached to security objects, toys Skills may regress due to illness or hospitalization,Toddler -Interventions for Caregivers,Encourage child to communicate Use distraction as a way to minimize fear and or pain Give one direction at a time Prepare child shortly before a procedure,

11、let them touch equipment, use a doll Allow for rest periods based on home routine if possible Maintain a safe environment at all times Involve parent in care if possible,Pre School (3-5 years) and School-Age Child (6-12 years) - Interventions for Caregivers,Explain procedures, demonstrate use of equ

12、ipment Focus on one thing at a time Encourage child to verbalize Involve the child whenever possible Maintain safety at all times Give permission to express feelings Provide for control over privacy Praise for good behavior,Adolescent (13 18 years),Growth and Development: Physical grows in spurt, ma

13、tures physically Mental abstract thinker, chooses own values Social/Emotional Develops own identity, builds close relationships, challenges authority Psychosocial Tasks: Concerned with body image and flaws Learning to relate to opposite sex Behavior may be inconsistent, unpredictable Makes own decis

14、ions independent of parents,Adolescent (13 18 years),Significant persons Peer group acceptance, relationships start with members of opposite sex Major Fears/Stressors Appearance, school performance, rejection Need time to adjust and cope with change,Adolescent -Interventions for Caregivers,Assist pa

15、tient in dealing with concerns with body image Involve in decision-making Encourage questions Provide acceptance, privacy and respect Discourage risk taking behavior,Young Adult (19 to 40 Years) - Intervention for Caregivers,This age group forms relationships with members of same and opposite sex, s

16、ets career goals, starts own family Assist with struggles of balancing family, work and health issues Allow for as much decision making as possible,Middle Age Adult (41 - 65 years),Growth and Development: Begins to age, develop chronic health problems, women experience menopause Use life experiences

17、 to solve problems Psychosocial Tasks: May have concurrent responsibilities for their children and aging parents Significant Persons: Spouse, friends, aging parents Major Fears/Stressors: Major life decisions to make, mid-life crisis Losing youthfulness, vitality, death of spouse,Middle Age Adult (4

18、1 65 years) -Interventions for Caregivers,Provide information and education Provide decision making opportunities Allow choices Address age related changes Encourage self care and health screening,Older Adult (65 till),Growth and Development: Ages gradually, decline in abilities Memory skills may st

19、art to decline Balances independence and dependence Psychosocial Tasks: Adjusting to advanced age, illness, disability Significant Persons: Spouse, adult children, friends Major Fears/Stressors: Declining health, loss of spouse, change in social and economical status,Older Adult (65 years till) -Int

20、erventions for Caregivers,Give respect Provide information on aging Recognize hearing, visual, mobility and mental disabilities/limitations that may impact on health care Implement measures to provide hospital safety Promote home safety,Medication Management,Component of the palliative, symptomatic,

21、 and curative treatment of diseases and conditions Selection and procurement Storage Ordering and transcribing Preparing and dispensing Administration Monitoring,Medication Management System,Reducing practice variation, errors and misuse Monitoring medication management processes in regard to effici

22、ency, quality and safety Standardizing equipment and processes across the hospital Using evidence-based practice Managing critical processes Handling all medications in the same manner,Medication Management Indicators,Pyxis Medstations Audits Just in time follow-up Implementation of IV admixture pro

23、gram,Pain Management,Pain relief is everyones priority Patients have the RIGHT to have their pain Assessed Reassessed, and Managed Nursing and medical staff must recognize that pain is a priority and act accordingly All staff in the hospital must be sensitive to patient pain and report it to the app

24、ropriate staff member Any staff member who comes into contact with a patient complaining of pain MUST report it,Pain Management Patients Rights,As a patient at SUNY Downstate Medical Center you have the right to Describe your pain in a manner that is accepted and respected by the staff as the best i

25、ndicator of your pain Be seen by competent staff who will help you deal with your pain Have your pain addressed promptly Get information about pain and how to relieve it Be informed and participate in your pain management plan of care Receive pain care that is continuously monitored and evaluated by

26、 staff dedicated to relieve pain Request changes in your pain management plan of care Help your doctor or nurse measure your pain Talk to your doctor or nurse about your pain relief choices Ask for pain relief when your pain starts Tell your doctor or nurse if your pain is not relieved Tell your doc

27、tor or nurse any worries you have about taking pain medication,Pain Scales,What pain rating scales are used at University Hospital of Brooklyn?AdultPediatricNeonateBehavioral assessment scale,Pain Management,Patient Education Patients and their families must be informed and educated about pain manag

28、ement strategies and alternatives Print Audio/visual Discussion Patient and their families must understand that the management of pain is critical to the healing process Patient and their families must understand that we care about their painDischarge Planning Pain and symptom management must be inc

29、luded in ALL discharge planning Documentation of this process is critical in the continuity of care of our patients Patients should have a list of resource and contact numbers to call when they are home,Moderate Sedation,Definition: a drug-induced depression of consciousness during which patients re

30、spond purposefully to verbal commands.,Sedation and Analgesia by Non-Anesthesiologist Policy,All persons who administer sedation and analgesia must be privileged and credentialed Requirements: Knowledge of pharmacology of the sedative and analgesic agents Training in the recognition of respiratory a

31、nd cardiovascular side effects Recognition of air way obstruction Skills to manage compromised airway Completion of educational program by the chairman of the Department of Anesthesiology Good judgment and discretion of individual patient needs Evaluation prior to performing sedation and Analgesia A

32、ssessment and Reassessment of patient,Consent,Policy: The written informed consent of the patient or in the case of a minor his/her parent or legal guardian, is required prior to the performance of any medical or surgical procedure except in emergency, life threatening situations New York State law

33、defines the parameter of professional practice and SUNY Downstate sets forth the policies and procedures which implement these parameters.,Consent,The New York State Mental Hygiene Regulations prescribe a separate procedure for obtaining consent from a patient with a psychiatric admission status who

34、 lacks capacity to make treatment decisions for him or herself. Therefore, when questions arise, the Risk Manager or Administrator on Duty (AOD) should be contacted in relation to the performance of medical procedures requiring consent for psychiatric patients.,Consent,General Consent Governs the pe

35、rformance of any routine procedure or treatment Signature must be witnessed by an adult employee of the facility Provisions for patient with LEP Need to include Interpreter,Valid Informed Consent Legally and mentally capable of making health care decisions Patient has sufficient information to make

36、health care decisions Who is legally responsible for explaining and obtaining the Informed Consent? Licensed Independent Practitioner,Advance Directives (Health Care Proxy),Purpose: The Patient Self-Determination Act of 1990 (U.S. PL 1102-508, sec. 4206) requires hospitals and other health care prov

37、iders to provide written information to adult patients, at the time of admission to the hospital, regarding their right to participate in and make treatment decisions for themselves, and their right to prepare an advance directive as recognized under State Law and to provide education for staff and

38、community on the issues concerning advance directives.,Advance Directives (Health Care Proxy),Definitions: Adult: defined as a person eighteen years of age or older, or who is married, or who is the parent of a child Health Care Proxy: a form that designates that an agent may make decisions on the p

39、rinciples behalf in the event that the individuals is unable to do so him/herself Advance Directive: is an instruction or set of instructions regarding health care treatment decisions to be made on behalf of an individual if he/she should become incapable of making such decisions,Advance Directives

40、(Health Care Proxy),Policy: Patients have the right to refuse or consent to present or future health care including, but not limited to, forgoing or withdrawing life-sustaining treatment appoint a Health Care Proxy to act on their behalf in the event they are unable to make health care decisions and

41、 assistance in executing wishes by naming an agent, if they so desire consent to a hospital or non-hospital DO NOT RESUSCITATE (DNR) order effective in the hospital and community,Palliative Care,Patients at the end of life may require palliative care Palliative care includes Providing care to patien

42、ts and families with advanced illness by an interdisciplinary team to achieve quality of life Respecting the goals, likes, and choices of the dying Assessment of and intervention for pain management Support services to families and caregivers,Restraints Policy,The restraint/seclusion of a patient is

43、 determined by the individuals needs Restraints will be removed as soon as possible after criteria for discontinuing are met Less restrictive measures must be considered and/or used prior to applying restraints Restraints/Seclusion are ordered by a licensed independent practitioner Nurse Practitione

44、r and MD (PGY-2 and above) A Resident Physician practices under the supervision of an Attending Physician therefore a co-signature within 24 hours is required for written orders,Restraints Policy,In an emergency situation an RN may initiate the application of restraints the RN must notify the physic

45、ian immediately a face to face assessment must be done and a medical order for the restraints must be written by a PGY2 orabove within 1 hour of restraint application An RN or PA may evaluate the patient within 1 hour of institution of restraint or seclusion and the attending physician or other LIP

46、responsible for the care of the patient must be notified and consulted as soon as possible. Family notification is required by the physician or nurse within 2 hours of the application (at whatever hour it occurs).,Restraints,Medical/Surgical Management Interference with medical procedures or dislodg

47、ing necessary medical devices/invasive linesRestraint Orders Must be renewed every 24 hours,Behavioral Management Demonstrated behavior that presents a physical danger to the patient and/or others: Demonstrates Violence Dangerous to Self/Other Suicidal IdeationRestraint Orders Must be renewed Every

48、4 hours for persons 18 years or older Every 2 hours for adolescents 9 17 years Every 1 hour for children under 9 years old,Basic Life Support Update,PUSH HARD AND PUSH FAST number of compressions increased from 15 to 30 for all ages during 1-Rescuer and Adult 2-Rescuer CPR rate remains the same (100

49、 per minute) allow chest to recoil fullyHANDS OFF THE PATIENT no more than 10 seconds, i.e., assessing for breathing, checking for a pulse between chest compressions and ventilations EXCEPT in the event you are the LONE rescuer and are using an Automated External Defibrillator (AED) maximum hands-off time between setting up the AED and resuming CPR should not be more than 90 secondsTO REDUCE THE POSSIBILITY OF HYPERVENTILATION Give 1 breath every 6 8 seconds when the victim has an advanced airway,