Assessment of infections in home care patients.

Infections can occur in any individual fairly rapidly. If the patient is hospitalized, frequent assessment by the nurse usually leads to early detection and treatment. In the home, patients are assessed less frequently, and therefore infections may go undetected for longer periods. Thus it is important for home care providers to assess patients who may be at risk for infection during each visit. Knowing who is at risk for developing a specific infection is an essential element in the assessment process. Such knowledge helps determine both the frequency and depth of patient assessment and the time necessary for the home health care provider to perform this activity. Additionally, family caregivers need to be taught information about infections (i.e., what to assess, how to prevent) whenever possible.

Limb loss: alterations in body image.

An estimated 10% of persons older than 70 years have peripheral vascular disease. Peripheral vascular disease includes venous and arterial medical conditions. Peripheral arterial disease (PAD) is a major concern in assessment of patients for loss of limb. With the ever increasing numbers of senior citizens in the United States today, a major public health concern is the management of chronic health problems. Many persons who have progressive PAD as a result of circulatory changes eventually are forced to have a limb amputated. This amputation triggers the realization of the loss of the limb, which directly influences body image. Therefore, management of the effect of limb loss on body image becomes a major nursing consideration in health promotion/health maintenance endeavors by health care professionals. This article explores the concepts of limb loss and body image. The relationship between PAD and limb loss is established. The conceptual link between limb loss and body image alteration is described, with emphasis on the importance of nursing interventions to manage body image alterations. Pathophysiologic conditions leading to PAD and limb loss are reviewed. Nursing implications for management of body image alterations with limb loss are summarized.

Caregivers of chronically ill elderly: perceived burden.

Family members play a major role in providing caregiving assistance to elderly persons and their families. The effect of stressors on family members caring for a physically or mentally ill person has been referred to as caregiver burden. It is an important concern and will become more so with the inevitable aging of the population. Community health and home health nurses must be able to recognize those factors associated with caregiver burden to effectively render care to their clients and families. This study examined caregiver characteristics and the degree to which these variables affect caregiver burden. Although much research focuses on caregivers of Alzheimers clients, this research utilized a wider variety of client diagnoses to examine caregiver burden of those clients. A sample representing 88 caregivers of elderly chronically ill persons was obtained from various sources in the community. Demographic data about the caregiver was collected. The amount of burden they experienced was recorded using the Burden Interview (Zarit et al., 1986). This study found that there was a positive correlation between increased activities of care performed by the caregiver and caregiver burden. This included both the provision of direct care such as bathing and indirect care such as running errands, preparing meals, and performing housework. It was found that sons, as caregivers, reported significantly less burden than did daughters or other relatives. Community health and home health nurses working with families in a caregiving situation have an opportunity to reduce caregiver burden. This is done by assessment of the caregiving environment and implementation of plans for early intervention.

Assessment of peripheral arterial pulses.

For the home care provider, determination of adequate cardiac function is vital to the well-being of the patient at home. If the heart fails as a pump, the patient's physical condition will deteriorate rapidly. This article will briefly review the normal blood vessel and blood flow principles and the principles guiding assessment of peripheral arterial pulses.

Assessment of immobility hazards.

As home health care nurses, we see many patients who are bedridden or immobilized. Impaired physical mobility (immobility) is defined by the North American Nursing Diagnosis Association as a state in which the individual experiences or is at risk for experiencing limitation of physical movement. Altered physical mobility can be a result of prescribed bedrest, movement physically restricted by an external device (e.g., a cast), voluntarily restricted movement, or impaired or lost motor function.

Reflex sympathetic dystrophy syndrome: an update.

RSDS is a complicated condition that requires early diagnosis and treatment for a favorable prognosis. The nurse should be alert to clinical signs in a patient with a traumatized area and report them to the physician as soon as possible. Management of the pain and establishment of trust will help promote successful physical therapy for the patient. The nurse should coordinate and manage the total care of the patient so that emotional and physical care can be at an optimum level for the patient and the patient's family.

Assessing laboratory values: serum Na+, K+, and Ca+.

Three common electrolytes--sodium, potassium, and calcium--often are measured in home health patients. The nurse must monitor these laboratory values so that any abnormalities are detected early. Early detection and early treatment can prevent further complications for the homebound patient.

Through the eyes of a family caregiver. Part 2: Strategies to manage caregiver problems.

With the ever-increasing number of U.S. senior citizens, maintaining the health of care-givers for the chronically ill has become a major public concern. About 20% of older Americans need help getting out of bed and bathing. Millions more need help with finances, meals, and transportation. Overwhelmingly, their families provide that help; only about 5% of elderly Americans live in nursing homes.

Caring for the patient with a gastrostomy/jejunostomy tube.

A gastrostomy or jejunostomy (G or J) tube is useful for feeding malnourished patients and is preferred to prolonged use of total parenteral nutrition. Because enteral feeding has become commonplace in both the hospital and home setting, it is vital that health care workers instruct caregivers on the treatment of individuals with G tubes and/or J tubes. Many problems can be prevented when caregivers know how to care for the patient and troubleshoot potential concerns.

Assessment of the child: what's different?

As home health nurses, we see a lot of adult patients. Our skills may be pretty sharp when assessing these adults, but when a child is sick in the home, it is important to consider the differences in assessing this child and an adult.

Interpretation of arterial blood gases by nurses.

Many clinical nurses find the concept of acid/base balance confusing. This article presents a step-by-step approach to arterial blood gas (ABG) analysis. In addition, the components of ABGs (pH, PCO2 and HCO3) are presented; metabolic and respiratory abnormalities (acidosis and alkalosis) are discussed in relation to cause and signs and symptoms; the concept of compensation is reviewed; the degrees of compensation are explained; the five steps of ABG analysis are outlined; and practice problems are provided and explained. By using this approach, the nurse can analyze the ABG values confidently and make a wise choice about appropriate nursing actions.