Thursday, January 29, 2015

Congestive Heart Failure (CHF)

If a layperson with no medical background at all were to hear a doctor say, “Your father has congestive heart failure,” they may become alarmed immediately and think that the heart has stopped working.  However, this is not the case.  Heart failure simply means that the pumping power of the heart is weaker than normal.  Due to this, the flow of the blood throughout the heart and the body occurs at a slower rate, and pressure in the heart increases to compensate.  As a result of the weakening of the heart, the oxygen supply and nutrients pumped throughout the body becomes inadequate to meet its demands. 

The normal heart consists of four chambers, two atria which lie superiorly to two ventricles.  In response to congestive heart failure as mentioned above, pressure in the heart increases, this means that the chambers of the heart may respond by stretching to hold more blood to pump throughout the body.  The chambers may also begin to become stiff and thicken over time.  The blood keeps moving; however the heart muscle walls eventually will weaken and begin to pump insufficiently. 

Once the heart begins to pump insufficiently and meeting the demands of the body becomes inadequate, other organs also begin showing insufficiencies.  The kidneys, for example, may respond by causing the body to retain fluid and sodium.  If unnoticed and fluid begins to build up in the arms, legs, ankles, feet, lungs or other organs, the body becomes congested as a result.  This ultimately is where the term “congestive heart failure” stems from.

Heart failure can be caused by many conditions that cause damage to the heart muscle, including:  coronary artery disease, having a heart attack, cardiomyopathy, or other conditions that cause the heart to be overworked.  In coronary artery disease there is a decrease in blood flow to the heart muscle and if the arteries become blocked or extremely narrowed, the heart will become starved for its oxygen and nutrients.  A heart attack occurs when a coronary artery suddenly becomes blocked causing ischemia to a certain area of the heart muscle, which damages the area and causes scarring and a scarred area never will function as normal.  Conditions that a patient may have that will result in the heart being overworked may include:  HTN, thyroid disease, kidney disease, diabetes, heart defects, etc. 

Just as with most other abnormal conditions that go on in the body, the signs and symptoms of CHF may range from mild to severe and they may come and go or be constant.  These may include congestion in the lungs, fluid and water retention, unexplained weight gain of five or more pounds in a week, dizziness, fatigue, weakness, tachycardia, or arrhythmias.  If you experience any of the mentioned signs and symptoms it would be in your best interest to consult with your medical provider for further tests to determine the etiology of your problems and begin treatment if necessary.  To help in diagnosis of CHF an individualized and specific physical examination will most likely be carried out.

If diagnosis is indeed confirmed, strict control over medication regimen and lifestyle, along with carefully monitoring for signs and symptoms of CHF to report are the first steps for treatment.  If further progression of CHF would occur, more advanced treatment will then be initiated by the appropriate provider.   You as the patient, along with your provider can come up with the best treatment for your own personal situation.

Our company has a program available for congestive heart failure (CHF).  If admitted here with us, you or your loved one will receive a specialized CHF Kit that contains tools to help monitor your disease process.  Also enclosed in the CHF Kit is teaching material to help ensure our patients and caregivers are aware of all aspects CHF treatment.  You will not be alone in your journey, because with us you will always be informed of the best treatment options.

Wednesday, January 28, 2015

TPN Management

Total parenteral nutrition (TPN) is utilized for patients who cannot or should not get their nutrition orally or enterally when the gastrointestinal tract is not functioning, hence the term “parenteral.”  Parenteral refers to administration not delivered via the gastrointestinal tract.  Therefore, TPN will be administered intravenously to patients through a vascular access device into a central vein only.  It can be used when caloric needs are very high, when the anticipated duration of therapy is greater than 7 days, or when the solution to be administered is hypertonic (composition of greater than 10% dextrose).  

TPN may include a combination of all the substances that maintain our health, including:  sugar and carbohydrates for energy, proteins for muscle strength, lipids as a source of fat, electrolytes, and trace elements. Electrolytes include sodium, potassium, chloride, phosphate, calcium, and magnesium. Trace elements include zinc, copper, manganese, and chromium. Electrolytes are important for maintaining almost every organ in your body.  They help your heart, muscles, and nerves to work properly and also keep you from becoming dehydratedTPN is commonly used in patients undergoing treatment for cancer, bowel disorders, and those suffering from trauma or extensive burns, as these conditions being associated with high caloric requirements.  Total Home Health works with most infusion therapy companies in the coordination and delivery of the medication and supplies.

Prior to beginning TPN your provider will perform laboratory tests to have as a baseline to refer to in case of emergency or if any changes occur during therapy.  Be sure to share with your provider if you have any allergies, and the list of the medications you are currently taking.  The depth of the initial assessment before TPN initiation will be unique to your personal diagnoses and situation.  During TPN therapy ongoing nursing assessment parameters include intake and output, daily weights, vital signs, pertinent laboratory values, and an ongoing evaluation of the patient’s underlying condition.  Per provider guidelines serum and urine glucose will be monitored.  Caregiver should monitor the flow rate carefully.

Before TPN is administered, remember to look at the solution closely. Do not use the solution if it is discolored, and make sure it is free of any floating material. Gently squeeze the bag or observe the solution container to make sure there are no leaks.  Definitely do not use the solution if it is discolored, has visible floating material, or if the bag is leaking.  Use a new solution, but make sure to show the damaged one to your health care provider.  It cannot be reinforced enough to make sure you use your medication exactly as directed.  Do not change your dosing schedule without consulting with your health care provider. 

Your provider may tell you to stop your infusion if you have a mechanical problem (such as a blockage in the tubing, needle, or catheter); if you have to stop an infusion, call your health care provider immediately so your therapy can continue as soon as possible.

Your provider will most likely give you a several-day supply of TPN at a time.  You will be instructed to store it in the refrigerator or freezer.  Before each use a bag of TPN solution should be taken from the refrigerator 4-6 hours before its use, remember to place it in a clean and dry area to allow it to warm up to room temperature.  If you must store additional TPN in the freezer, always move a 24-hour supply to the refrigerator so that it may be warmed within 4-6 hours.  Never refreeze TPN solutions.  Store TPN only as directed and make sure you understand what you need to store it properly.  Your provider will tell you how to dispose of any used needles, syringes, tubing, and containers to avoid any accidental injuries.

Total Home Health has a program available for patients requiring TPN.  You will not be alone in your journey, because with us you will always be informed of the best treatment options for your situation.

Diabetic Insulin Injection

Insulin is a hormone produced by the body that helps to covert the food you eat into energy.  People with diabetes may need or require insulin injections either because they do not produce enough insulin in their bodies, or they cannot properly use the insulin that they do produce, or for both reasons.  Insulin is like a key that opens up the locks on the cells within your body so that blood sugar can get inside and be used for energy.  If the sugar cannot get inside your cells, it will build up in your bloodstream and if left untreated a high blood sugar level can cause long-term complications to your health.  Insulin cannot be taken orally as a pill or capsule because the digestive juices in the stomach ruin its effectiveness, so the only way to take it currently is by injection.

With the use of insulin you may hear your provider talking about the onset of action, peak and duration of the medication.  The onset of action is how fast the insulin starts to work after it is injected.  The peak is when the insulin is working the hardest, resulting in the greatest effect.  The duration is how long the insulin continues to work after it reaches its peak.  As a diabetic requiring insulin use, it is very important for you or your loved one to be familiar with these concepts to prevent hyper- or hypoglycemia.  Your provider will supply you with material for the specific insulin you are prescribed because they do vary.

Remember to always read the instructions carefully that come with your insulin.  Vials of insulin open or unopened when stored at room temperature are considered “good” for approximately 28 days, after this your insulin may lose its potency.  If stored in a refrigerator, unopened vials are “good” until the expiration date printed on the label.  Opened vials stored in a refrigerator should be used within 28 days of being opened.  Many people store only unopened vials in the refrigerator and keep their open vials at room temperature because they find it more uncomfortable to inject insulin that is cold.  Do not freeze insulin or store it in direct sunlight.  Do not use insulin vials past the expiration dates that are printed on the label, and no matter what the expiration date is, dispose of opened vials at least one month after they are opened.  A good tip to keep in mind is that whenever you open a new vial, write the date on it so that you know when the 28 days have been reached.  On the other hand with insulin pens and their cartridges, the storage life will range from seven days to one month, make sure to read instructions or consult with your provider regarding this issue.

There are many different types of diabetes, generally though the majority of people are only familiar with Type 1 and Type 2.  Type 1 is referred to as IDDM, or insulin-dependent diabetes mellitus.  Type 2 is referred to as NIDDM, or non-insulin dependent diabetes mellitus.  So, the key to controlling blood glucose levels for type 1 diabetics is the administration of insulin.  For Type 2 diabetics, at times insulin may be administered, otherwise the blood glucose levels are controlled by dietary habits, exercise and oral medications. 

Insulin should be injected into the same general area of the body to maintain some sort of consistency; however injections should never be consecutively administered in the exact same location.  The most common site for an insulin injection is the abdomen; other appropriate locations are as follows:  back of the upper arms, the upper buttocks or hips, and the outer sides of the thighs may be used.  The areas mentioned are used because they have a layer of fat just below the skin and not many nerves, so that the medication will be best absorbed with the least amount of discomfort.  Some people prefer the abdomen as their first choice for injection because it will absorb the best there.  However, others such as young children or people who are so thin or heavily muscled that they are unable to pinch at least a half an inch of subcutaneous tissue, find it more difficult to inject into the abdomen.  Patients should consult with their provider as to what the best location is for their insulin injections.  The provider will most likely take into play both insulin absorption and site rotation.

If you are a diabetic and require daily injections of insulin, Total Home Health has a program available for you!  If admitted with us, you or your loved one will receive a Daily Diabetic Insulin Injection kit that contains tools to help monitor your treatment.  Also enclosed in the kit is teaching material and tips to help ensure our patients and caregivers are aware of all aspects of the importance regarding daily insulin injections.  You definitely will not be alone in your journey, because with us you will always be informed of the best treatment options to maintain your optimal health.

Monitoring your blood pressure

Monitoring the blood pressure allows individuals to get an insight on their overall health.  It is a dangerous condition because nearly 33 percent of people are not even aware that they have HTN, how scary!  The only way to know for sure it is elevated is through frequent checkups, with consistent and consecutive BP monitoring.  Plus, if you are aware that an immediate relative has HTN you should be proactive and begin to monitor yours to prevent it from happening to you.  Most generally the layperson will refer to the normal blood pressure reading to be 120/80 mmHg, and if it is anywhere close when they measure it, all is well.  Some households have the equipment to measure their blood pressure, generally with the use of an electronic meter.  Gaining the knowledge to perform the task manually with a stethescope and a sphygmomanometer, or blood pressure cuff, would be beneficial because the results are more reliable if taken manually in most situations.  Also, if the person were to disagree with the reading provided by the electronic machine, the blood pressure could be taken manually if possible.  Below are parameters regarding different blood pressure results and how they are categorized, hopefully yours are normal.  The categories are as follows:

Normal blood pressure:  less than 120/80 mmHg
Pre-hypertension:  120/80 – 139/89 mmHg
Stage 1 HTN:  140/90 – 159/99 mmHg
Stage 2 HTN:  greater than 160/100 mmHg
            Hypertensive Crisis:  greater than 180/110 mmHg

So what are the differences between the top and bottom numbers you may ask?  Well the top number is referred to as the systolic blood pressure.  This means that when your heart beats, it contracts and pushes blood through the arteries to the rest of your body.  The bottom number is referred to as the diastolic blood pressure.  This number indicates the pressure in the arteries when the heart rests between beats.

To remain within the normal range and to avoid having to seek medical attention, results should be near 120/80 mmHg and vary only slightly at consecutive blood pressure checks.  If results were recorded and are in the category of a hypertensive crisis, the individual should seek immediate emergency care.  When it comes to blood pressure cuffs, size does indeed matter.  It is important to remember this when monitoring BP and obtaining reliable results.  If a cuff that is either too big or too small is used, the reading obtained may either be a false high or false low.  Try to remember for home testing that the inflatable part of the BP cuff should cover about 80 percent of the circumference of your upper arm.  Also, the cuff should cover two-thirds of the distance from your elbow to your shoulder.  If there still is a question about the correct size of cuff to be used, approach personnel at your provider’s office for clarification. 

Not only can having high blood pressure (hypertension) pose health problems, but the other end of the spectrum, low blood pressure (hypotension) may also cause adverse health issues.  An example of hypotension would most likely be if the blood pressure reading was approximately 85/55 mmHg for an extended time period.  Most providers though will consider a blood pressure that is chronically low dangerous, only if it also caused noticeable signs and symptoms.  Some of the signs and symptoms to be aware of include, but are not limited to:  dizziness, syncope, unusual thirst, dehydration, blurred vision, nausea, fatigue, depression, etc.  If no signs and symptoms are present, having a low blood pressure should not be problematic.  Of course if your BP was to suddenly decrease, you should consult medical attention as you may have a serious underlying problem.  Also, if you are used to having a higher blood pressure and it has recently lowered consecutively, or you begin to experience one of the items listed above there may be an underlying cause for you low BP.

Hypertension (HTN) is a diagnosis that frequents the medical history of a majority of the U.S. population today.  Due to the fast-paced world we live in, and the convenience of fast-food our dietary habits are negatively affected, and if prolonged will most likely lead to developing or worsening HTN.  If possible, dietary and exercise routine changes should be implemented to prevent further development or worsening of HTN as a first resort.  If this fails, medical attention will most likely occur resulting in the individual being placed on an anti-hypertensive medication.  If placed on a medication, the individual should follow all instructions strictly to ensure positive effects occur from the regime.  Listed above in the article were the BP parameters.  The following are signs and symptoms of hypertension which include, but are not limited to:  severe headache, fatigue, confusion, vision problems, chest pain, difficulty breathing, irregular heartbeat, etc.  If you experience any of these signs and symptoms, seek medical care.  HTN just like any other medical condition can have negative effects if left untreated, so please do not hesitate to seek medical care.

Total Home Health has a program available for BP monitoring following physician orders and treatment plan.  Skilled nursing visits may be performed daily, or twice daily depending upon the monitoring of the medication.  You will not be alone in your journey, because with us you will always be informed of the best treatment options.

Wednesday, January 21, 2015

Blood Sugar Monitoring

Blood Sugar Monitoring

Blood sugar testing and monitoring is an extremely important part of the care in patients with diabetes.  If you or a loved one has diabetes, self-testing blood sugar levels should be taken seriously, and the regimen should be strictly followed to prevent adverse health problems.  If a person strictly adheres to their prescribed regimen of testing their blood sugar, this will help to prevent many long-term complications of diabetes that could occur.  If patient’s test their blood sugar at home, they are provided with instructions from their primary care provider of how to use the equipment appropriately to get the most reliable results.  Even though basic instructions are given in the MD office the patient needs monitoring in the home by a home health skilled nurse to ensure that the patient is performing the test correctly, and that blood sugar results are staying within the parameters as set by the MD.  Also, skilled nursing professionals will perform education regarding the Diabetes regime.

The electronic machines that measure blood sugar, and the ways in which they are used may vary.  Generally the steps are as follows.  Patient should wash their hands and dry them well, place a test strip into the glucose monitor, decide on a finger to obtain a blood sample from, wipe area with an alcohol prep pad, use lancet to pierce skin, squeeze area to reveal a drop of blood, due to using alcohol to prep the area the first drop of blood should be wiped away with a clean cloth or gauze and the second drop should be placed onto the test strip.  After placing a drop of blood onto the test strip most machines will provide the patient with a blood glucose result within five seconds.  From the result, the patient proceeds to administer their insulin if necessary.  All results should also be recorded in order to monitor long-term, and to differentiate between what is normal for you and what could possibly have changed.  If a patient gets a reading from the machine that is abnormal compared to their usual results, they should pick an alternative location to obtain a drop of blood from and perform the test again.  If the result remains abnormal, the patient may want to report it to their provider, along with any other symptoms they may be experiencing at that time.

The primary care provider that a patient sees will generally set target blood sugar test results ranges that are based on several underlying factors, including but not limited to:  type and severity of diabetes, patient age, length of time patient has had diabetes, whether or not patient is pregnant, any current complications related to diabetes, the overall health of the patient, and the presence of any other medical conditions that may alter blood sugar levels.  The therapeutic range of normal blood sugar levels varies according to each unique patient situation and their diagnostic background. 

Just to be prepared, following are some warning signs of hypoglycemia and hyperglycemia that as a diabetic patient you should be aware of to prevent complications.  Some signs and symptoms of hypoglycemia include, but are not limited to:  blood sugar test result less than 60 mg/dL, blurry vision, tachycardia, shakiness, unexplained fatigue, cool and clammy skin, headache, hunger, dizziness.  A way one can remember signs of hypoglycemia is, “Cool and clammy, give me candy.”  Some signs and symptoms of hyperglycemia include, but are not limited to:  blood sugar test result greater than 200 mg/dL, frequent urination, increased thirst, blurred vision, fatigue and headache.  All signs and symptoms listed for both situations are early warning signs, if left untreated both conditions could lead to unconsciousness resulting in emergency medical care, or death.

Diabetes is a disease that should not be taken lightly, if you or a loved one is affected please take special care to adhere strictly to your prescribed regimen so that you are not faced with any life-threatening emergencies or long-term complications.  Always consult your provider with any questions or concerns and if possible follow up with a diabetic educator if need be, as this disease is their specialty. 

Anticoagulant Therapy

Anticoagulant Therapy

The therapeutic use of anticoagulants is to discourage the blood from clotting.  Anticoagulant use is mainly preventative, the general public usually refers to this type of medication as their “blood thinner.”  Anticoagulants take a thrombolytic action, which means they can destroy a clot and work to improve the condition of ischemia at the location of the specific vessel that is affected,  if a patient is experiencing an event, such as a stroke.  If a patient enters the emergency department with signs and symptoms of a stroke, there are certain criteria that have to be met in order to continue with anticoagulant therapy.  Other conditions in which anticoagulant therapy is used may include coronary occlusion, phlebothrombosis and pulmonary embolism.  Also, anticoagulants are administered prophylactically when major surgery is scheduled for a patient with a history of arterial insufficiencies or other related diagnosis that would warrant anticoagulant use.  In addition, anticoagulants are also used at times for patients who must be immobilized for an extended period of time; these types of anticoagulants are generally given as injections if patient is immobilized.

Atrial fibrillation is a diagnosis that warrants use of anticoagulant therapy that is seen most often. With the diagnosis of atrial fibrillation, warfarin sodium (Coumadin) therapy will be prescribed for the patient to take by mouth once daily.  Blood will be drawn frequently from the patient to have the PT/INR levels reviewed to keep the dosage of Coumadin adjusted accordingly so the blood level remains in the therapeutic range to minimize the risk of problems if it were to become elevated or fall below normal.  Patients should also be advised to take this medication strictly the way it is prescribed; deviations could result in harm to their health.  Patients on oral anticoagulant therapy should be educated enough about the medication so that they can report to their physician if they experience unusual bleeding or if they begin to bruise easier than normal, as these may be signs of adverse effects.

Anticoagulants are not limited to the ones mentioned above.  A lot of the general population at least over the age of 40 years takes an aspirin every day mainly to prevent their risk of heart attack and stroke.  Aspirin is an “anti-platelet” medication, meaning that it interferes with the platelets in the blood and blocks the formation of clotting substances within the body.  Aspirin tends to also cause fewer bleeding complications; however it may not block the clotting process as well as other anticoagulants.  For more information, consult with your family physician to determine the anticoagulant that is right for you.

Along with anticoagulant therapy, patients should avoid activities that may result in increased contact, especially head injury, such as any contact sports.  Dietary changes may also have to occur if taking warfarin sodium.  Over the counter medications may also cause an interaction with warfarin sodium causing an alteration in the PT/INR levels.  Any alteration in the PT/INR levels can be hazardous.

Every patient situation is unique and equally important; therefore the type and dosage of the anticoagulant that will be prescribed and implemented will be dependent upon the patient situation and the decisions made by the physician.

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Sunday, January 11, 2015

What is Home Health Care

Home health care: what it is and what to expect?

What is home health care?

Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).

Examples of skilled home health services include:

Wound care for pressure sores or a surgical wound
Patient and caregiver education
Intravenous or nutrition therapy
Monitoring serious illness and unstable health status
The goal of home health care is to treat an illness or injury. Home health care helps you get better, regain your independence, and become as self-sufficient as possible.

If you get your Medicare benefits through a Medicare health plan, check with your plan to find out how it gives your Medicare-covered home health benefits.

If you have a Medicare Supplement Insurance (Medigap) policy or other health insurance coverage, tell your doctor or other health care provider so your bills get paid correctly.

If your doctor or referring health care provider decides you need home health care, they should give you a list of agencies that serve your area, but must tell you whether their organization has a financial interest in any agency listed.

What should you expect from home health care?

Doctor’s orders are needed to start care. Once your doctor refers you for home health services, the home health agency will schedule an appointment and come to your home to talk to you about your needs and ask you some questions about your health.
The home health agency staff will also talk to your doctor about your care and keep your doctor updated about your progress.
It’s important that home health staff see you as often as the doctor ordered.
Examples of what the home health staff should do include:

Check what you’re eating and drinking.
Check your blood pressure, temperature, heart rate, and breathing.
Check that you’re taking your prescription and other drugs and any treatments correctly.
Ask if you’re having pain.
Check your safety in the home.
Teach you about your care so you can take care of yourself.
Coordinate your care. This means they must communicate regularly with you, your doctor, and anyone else who gives you care.

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