Psychiatric Nursing Services

 Individuals that are diagnosed with a psychiatric condition may be frowned upon by some members of society.  Generally, they will be judged and others will act different if in their presence.  Some psychiatric conditions can be dangerous.  With the medical advances of the current time, psychiatric conditions tend to be less difficult to live with and can be better managed to maintain functioning as best as possible.  Some examples of psychiatric conditions include:  obsessive-compulsive disorder, post-traumatic stress disorder, autism, schizophrenia, bipolar disorder, eating disorders, personality disorders, etc.  Safety is usually the number one priority in the care of a client with a psychiatric condition and licensed professionals should ensure a safe environment for their care at all times. 

Following is a compiled list of several things for you to look for either in yourself or in your loved ones.  If you see any of these changes, you should reach out to a medical professional for evaluation, so they can help you to maintain or resolve your condition.  Pay attention to your loved ones as the following signs could lead to development or exacerbation of a psychiatric condition; the signs include but are not limited to:

·         A noticeable and serious change in personality

·         Noticeable change in eating and sleeping patterns

·         Inability to cope with problems or carry out daily activities

·         Expression of strange ideas that are obviously out of reach

·         A depressed state that lasts greater than two weeks

·         Excessive anxiety or panic when dealing with daily life

·         Thinking or talking about suicide

·         Engaging in substance abuse with drugs or alcohol

·         Display of violent behavior, hostility, or extreme mood swings

If you see any of those signs in your loved one, please seek medical attention.  If you wait, it may be too late.  Many people with any of the signs mentioned above usually will think they are a normal part of their life.  Going to your family physician, or making an appointment with a counselor or psychologist will offer an assessment to see if the behaviors or feelings are indeed a mental health condition, or something else.  Most always there are different treatments available depending upon your condition that can help to resolve your issues and allow you to function at your normal level on a daily basis again and be socially accepted.

The care plan will always be patient-centered and involve the patient, along with the family to a reasonable extent.  Needs may arise in the care of the client that result in deviation from the routes that were initially planned out to meet their goals.  As long as the client is making progress and moving forward to reach their goals, let them be the leader in helping themselves recover and cope with their condition.  If the client is motivated it will increase the chance of success in reaching their goals.

Total Home Health will support the treatment of each of our clients and help them, along with their families live with, and in many cases recover from a mental illness.  When the family is around the individual with the psychiatric condition, usually they will get burned out from being in their presence on a daily basis without being able to do anything to help them get better.  Total Home Health has licensed professionals as a part of our team to create a home care plan that will support the client’s treatment and management of daily life.  The family will also be educated on ways to cope with the condition their loved one has been diagnosed with, so they will be able to observe the progress their loved one is making toward their treatment goals.

If ever you feel you need to contact us regarding psychiatric nursing services, please do not hesitate.  At Total Home Health we are here to provide the best care possible to you 100% of the time.  We have professionals that will be at your beck and call to care for any problem that may arise.  Let us be by your side and assist you during your time of trouble.

Behavioral Health

Before we get to simple terms allow us to bestow upon you the medical definition of behavioral health.  Behavioral health is the scientific study of the emotions, behaviors and biological function related to the mental well-being of an individual, their ability to function in daily activities of life, and how they view themselves as a person.  “Behavioral health” is the preferred term to “mental health.”  However, the general population tends to use the term “mental health” a majority of the time.  A person struggling with his or her behavioral health may come face to face with several conditions that may interfere with their daily life causing their loved one to notice disruptions in their usual routines.  If that is the case, the condition has resulted in problems in which they should seek medical attention for before anything worse happens.

You or your loved one may be involved in a situation during life that has negative effects that may become chronic and eventually result in problems that require medical intervention to get back to “normal.”  Most everyone should have a good idea of what their “normal” level of functioning is and how they cope with daily situations.  Examples of situations that could result in disruption of an individual’s behavioral health include but are not limited to:  stress, depression, anxiety, problems with relationships, grief, addiction, ADHD or learning disabilities, mood disorders, or other psychological concerns.  Several professionals such as counselors, therapists, life coaches, psychologists, nurse practitioners or physicians can evaluate your situation to develop a plan to help manage your specific behavioral health concerns with treatments such as therapy, counseling, and/or medication. 

It is important to always determine if non-pharmacological interventions will prove to resolve the condition causing your behavioral health to be compromised.  If your condition is more serious and has caused problems in other body systems other than just your emotional well-being, medications may be prescribed to treat your signs and symptoms and prevent any worsening that could occur.  If you were to ever have any questions or concerns regarding your treatment plan or medications, please do not hesitate to contact us or your provider.  Any hesitation could result in a delay in your progress toward resolving or adapting to your current situation to restore your functioning in daily activities.

In order for individuals to be completely healthy, components of their behavior well-being must be maintained as best as possible to maintain their optimal level of functioning.  There is much more to the health of individuals than just their observable, physical needs.  A goal of medical care is to provide holistic care, catering to the needs of every part of the being, emotional, physical, and spiritual, etc.  With Total Home Health, we strive to generate trusting relationships with you and provide 1:1 care in order to understand your needs as best as possible.  The care you receive from us will be on a personal level and we will provide care directed by your care plan that was developed after your evaluation, while treating you as a whole to ensure holistic care for optimal functioning.

Our professional staff will bring care to you in your home environment.  With behavioral health issues, generally being able to remain in a familiar environment with less stimulation, such as your home, will most likely result in better outcomes for you related to your condition.  If you or your loved one is diagnosed by your provider with a condition that may compromise your behavioral health and are able to safely remain in your home, Total Home Health professionals are ready and will be there to care for you! 

If your provider decides that your condition can be managed safely by adhering to a regimen of home health care, look no further than our company.  Several different routes may have to be taken to reach the goals of your treatment, because everyone is different in the way they tick and go about activities.  To provide care to someone who has compromised behavioral health it takes a special person who is dedicated, motivated and passionate about their work.  We will also do our best to educate the family that may be having trouble grasping the condition of their loved ones, so that they can better understand what is going on.  Our licensed professionals at Total Home Health will be there for you every step of the way.

Wound VAC

A wound VAC system and its complexity with all of the different pieces can prove to be very intimidating to you and your loved ones.  It is important that you gain as much knowledge as possible related to this system before it is introduced into your home.  The more knowledge you gain about the system the less difficult the process will be for you despite any other inconveniences it may pose in your life.

First of all, VAC refers to vaccum-assisted closure.  You may also hear it referred to as vacuum therapy or negative pressure therapy.  The wound vac system has been used increasingly over the past ten years or more for both acute and chronic wounds.  Its use has even been extended to other types of wounds, such as wounds from abdominal and heart surgeries.  In the present medical technological advances of today, vacuum-assisted closure can be used on all types of wounds including acute, subacute or chronic.  The patients that assume the most benefits are those with deep, chronic wounds.  So you may be asking, “What are the parts of a wound vac system and how will it be applied?”

Overall, the application of a wound vac is a simple procedure if completed by a professional who is competent in this area.  You and your loved ones may be educated in the procedure in order to be prepared if the situation would warrant that you would have to change or reinforce the system yourself.  The wound vac system includes a piece of foam with an open-cell structure that is inserted into the wound bed area, then a wound drain with lateral perforations is laid atop it.  The foam has a few functions that are important to the system including:

·      Foam ensures that the entire surface area of the wound is exposed in its entirety to the negative pressure effect.

·      Foam prevents occlusion of the perforations in the drain by contact with the base or edges of the wound.

·      Foam eliminates the possibility of localized areas of high pressure that could result in tissue necrosis (death), which could hasten or prolong the treatment.

After the foam along with the wound drain atop it is placed into the wound bed, the entire area is then covered with a transparent adhesive film that is firmly secured to the healthy skin around the wound.  This film membrane will prevent air from entering so that a partial vacuum is formed within the wound to facilitate the removal of fluid.  Finally, the exposed end of the drain tube is connected to a vacuum source in which fluid will be drawn from the wound through the foam/drain and will travel through the drainage tube, into a reservoir for disposal.  “Well now that it is applied, what makes it work?”

The application of negative pressure in vacuum-assisted closure removes any fluid via suction from the wound that may have accumulated from edema.  Removal of the excess fluid, allows for an increased blood flow to the wound by causing the blood vessels to dilate.  Removal of fluid also results in a rapid increase in the number of cells in circulation which will enhance perfusion to the compromised tissue making it heal quicker.  Another important benefit of fluid removal is to decrease bacterial colonization within the wound, which ultimately decreases the risk of wound infections.  Through these effects of this treatment, the goal of the vacuum-assisted closure system is to enhance the formation of granulation (healthy) tissue, which is a vital factor in the resolving of a wound and its closure.

When you think of chronic wounds, it often brings to mind prolonged hospital stays for treatment.  The use of the wound vac system can greatly reduce the length of a hospital stay by enhancing wound closure at a faster rate.  Or, with your enrollment in Total Home Health, we will bring the wound vac professionals to you so that you may return home early to your familiar environment.  Faster wound healing will also result in less discomfort and pain for you or your loved one, leading to a greater sense of well-being and increased motivation.

Our professionals at Total Home Health will assist you with care according to your specific provider orders, as some wounds require more extensive treatment and special skills or technique to further minimize the risk of infection.  Most generally, the wound vac system is a closed system that requires a dressing change only every 48 hours.  Another goal of this system is to only expose the wound when absolutely needed to limit chance of infection and to reduce the use of materials, which can be costly.

Ultimately, the length of your treatment with the wound vac system will depend on your specific wound.  The process may seem like it takes forever, but our professional staff will discuss all progress made with you or your loved one at each visit.  Total Home Health will be with you every step of the way, providing you with information and education regarding any concerns that may arise with your wound vac system so that you may have the best experience possible.

Fall Risk

Patient safety is always a top priority; patients must be safe in order to complete other aspects of care.  To ensure safety medical professionals will work to minimize risk factors that could result in injury or harm, while promoting high-quality care and maintaining a secure environment for their patients, themselves and others.  Falls are very common occurrences, and experiencing a fall could possibly result in debilitating injuries for you or your loved ones. 

Anyone is at risk for a fall, of course some are at more of an increased risk than others; the young and old are at a greater risk.  As we age, we may become more prone to sustaining a fall due to decreased strength, impairments in mobility and balance, and limitations on our endurance combined with decreased sensory perception.  Medications regimens that individuals follow on a daily basis may also increase the fall risk, for example if any of the medications cause drowsiness.  Other factors that may affect how an individual protects himself would include mobility, their cognitive and sensory awareness, their emotional state, the ability to communicate, and their current lifestyle and awareness of safety.  Of course, the fall risk will become even greater when more than one of the risk factors is present.  Becoming hospitalized also makes an individual at an increased risk for falls due to the unfamiliar environment, being hooked up to machines, experiencing pain or weakness, etc.

Your healthcare professional, most likely a registered nurse, will determine your risk factors upon the initial evaluation performed in your home.  A plan of care with nursing actions will be implemented specific for you to begin to decrease risks in your home to ensure your optimal safety.  It is important that upon choosing to be cared for in your home that you become familiar with safety hazards that could pose a potential to increase the risk of falls in your home, and actively participate with your nurse to avoid hazards that can easily be prevented.

There are general measures that can be followed to prevent falls which include but are not limited to the following:

·      Keep floors in the home free from clutter, providing clear pathways to all rooms.

·      Avoid or remove scatter rugs; if rugs are a must, make sure they are secured to the floor.

·      Avoid placing furniture in pathways.

·      Ensure adequate lighting; have nightlights throughout the home if client has to ambulate to the bathroom in the middle of the night.

·      Use nonskid bath mats in tubs and showers.

·      Use a raised toilet seat.

·      Install grab bars and handrails on stairways, in doorways, in bathroom, etc.

·      Install ramps over small flights of stairs if applicable to your home situation.

·      Electrical cords that are lying in the pathway should be removed if at all possible, if not they should be secured to the floor with the appropriate method.

·      Always make sure frequently used items are within easy reach, this includes the telephone, tissues, remote control, drinking water, eyeglasses.

·      Remind client to always wear eyeglasses and/or hearing aids.

·      Provide education on correct use of assistive devices, such as a cane or walker to the client/family and always keep the device within reach.

·      Provide thorough education regarding the identified risks that were found in the home and discuss the plan of care with the patient/family; if they are aware of the risks, they will be more likely to call for assistance.

With the professional staff at Total Home Health a thorough assessment of your condition along with any risks in your home will be performed initially to address safety hazards.  This assessment will be carried out throughout your service with us, so that we may promptly intervene if you are ever at risk.  If at any point during your service with us you feel that something in your home is posing a risk that may increase your chance of falling, please do not hesitate to contact us and we will send a professional out to you as soon as possible.  Ultimately, the safety of you and your loved ones is the main goal of Total Home Health because you are always number one. 

Administering Injections

Healthcare professionals that provide patient care are expected to be clinically competent to perform administration of injections if the need arises for you or your loved one.  Medications given by injection generally work more quickly than if given by mouth, but they are more uncomfortable for those receiving them.  Most patients will frown upon having to get a shot, but the benefits most always outweigh the few seconds of discomfort that will be experienced.

Injections can be administered in different ways into the body, depending upon where in the body the most desirable effects of the specific medication will occur.  Injections can be given intramuscularly (IM), subcutaneously (SQ), or intradermally (ID).  The type of medication that is being administered and the body type of the patient are key factors that will determine the way the injection is given for each route.

The following are general nursing implications that the Total Home Health professional should always take into consideration when administering medications via injection:

·      Vastus lateralis site is the recommended site for infants and children younger than 2 years of age.

·      Injection sites should always be rotated to enhance absorption of the medication; staff should always note which site was used so that the next injection can be given into a different site.

·      Do not use injection sites that are swollen, inflamed, or have moles, birthmarks, or scars.

·      Always discard all sharps (needles) in the designated containers to prevent accidental needle sticks.

The intramuscular (IM) route is the most appropriate for medications that could be irritating otherwise.  Common sites for IM administration include ventrogluteal, deltoid, and the vastus lateralis if caring for the pediatric population.  The dorsogluteal site is no longer recommended due to its proximity to the sciatic nerve and the damage it could cause.  Needle size should range between 18 to 27 gauge, generally a 25 to 27 gauge needle is used.  Needle should be 1 to 1.5 inches long.  The volume of medication that is injected is usually 1 to 3 milliliters, and needle is to be inserted at a 90 degree angle.  If the physician order requires that more than 3 milliliters is to be administered, medication must be divided into two syringes, and given in two different sites.  IM injections may be more inconvenient for patients due to the need to remove clothing to expose the appropriate sites.  Also, they may be more difficult for a family member to administer, this is where the professionals at Total Home Health will be there to assist you. 

The Z-track method may also be used when giving medication via the IM route.  This type of injection will prevent the medication from leaking back into the surrounding subcutaneous tissue.  For example, the Z-track method is used for iron preparation because the medication will possibly cause visible, and possibly permanent, skin stains.  To perform Z-track, the skin and tissue at the site is displaced by pulling and holding it firmly to the side while the needle is inserted.  After the medication is injected, the skin and tissue are released.  The displacement and replacement of the skin causes the needle track to take the shape of the letter “Z,” which causes the medication to track in a way as to prevent leakage into the surrounding tissues.  Z-track injection is usually less painful than the traditional IM injection.

The subcutaneous (SQ) route is the most appropriate for small doses of nonirritating, water-soluble medication.  The common medications administered SQ include insulin and heparin.  Sites are determined related to body type of patient.  They usually say if you can “pinch an inch,” you can give an SQ injection there.  Most common sites include the abdomen, upper hips, lateral upper arms, and thighs.  A 3/8 to 5/8 inch, 25 to 27 gauge needle, or an insulin syringe of 28 to 31 gauge is generally used.  No more than 1.5 milliliters of solution should be given per this route.  For an average-sized client nurse should pinch up the skin, and inject at a 45 to 90 degree angle.  If client is obese, nurse should always inject at a 90 degree angle for adequate absorption.

The intradermal (ID) route may also be utilized if the situation warrants.  This is usually used for tuberculin testing or checking a patient for allergies.  Only small amounts of solution should be used, 0.01 to 0.1 milliliters, for an ID injection.  A tuberculin syringe with a fine 26 to 27 gauge needle is used.  The injection should be given in a thin-skinned, hairless site at a 5 to 15 degree angle, making sure that the bevel of the needle is facing upwards.  The sites most generally used are the inner surface of the mid-forearm or the scapular area of the back.

Injections should always be administered per physician orders.  An increased risk of infection exists with any of the injection routes, due to it being an invasive procedure.  Hand washing prior to injections and preparing the injection site by cleansing it with an anti-microbial agent, or alcohol swab, will greatly decrease chance of infection.   Total Home Health professionals will be there to assist you with all your needs when it comes to administering your medications by injection.  Knowing that it is a rather unpleasant experience, their compassionate care will help to make you feel more at ease during these times.