Title NCM 114 PRELIMS ✅

NCM 112 BY TONS and MADS Settings for Care 1. Acute Care Hospital a. often the point of entry into the health care system for older adults. b. About half of all patients in this setting are 65 years of age or older. c. Gerontological nurses focus on nursing care of acute problems: exacerbations of cardiopulmonary conditions, cancer treatment, and orthopedic problems. d. Goal of inpatient care: promote recovery and prevent complications. 2. Acute Rehabilitation a. Found in various degrees in several settings: acute care hospital subacute care transitional care, and long-term care facilities (LTCFs). b. Accomplished through the work of an interdisciplinary team: nurses, therapists, physicians and other professional staff. c. Goals: maximize independence, promote maximal function, prevent complications, and promote quality of life d. Level of intensity of acute rehabilitation is greater than for subacute or long-term care. e. For older adults to qualify: able to tolerate at least 3 hours of therapy per day. f. Inpatient: beneficial to stroke, head trauma, neurological diseases, amputation, orthopedic surgery, and spinal cord injury. 3. Home Health Care a. Independent-living older adults requiring a longer period of observation or care b. Designed for homebound due to severity of illness or immobility. c. Visiting nurse associations (VNAs) provide home health care. d. For reimbursement, home health care services must be ordered by a physician e. People’s desire to be cared for in familiar surroundings by their families than institution f. Physical, occupational, and speech therapies, home health aide services g. The majority of home health care patients are elderly with a variety of nursing needs, such as wound care, intravenous therapy, management of newly diagnosed diabetes, and tube feedings. 4. Long-Term Care Facility (LTFCs) or Nursing home's s a. Provide support to persons of any age who have lost some or all of their capacity for self-care due to illness, disability, or dementia. b. Though not acutely ill, they require 24-hour nursing care. c. Provide care planning & oversight of numerous residents, directing coordinating care via licensed practical & certified nursing assistants or unlicensed assistive personnel (UAP). d. Challenged to maintain functional and nutritional status of residents, while preventing complications of impaired mobility such as pressure ulcers and falls. e. Dementia care f. Skilled Nursing Facilities (SNFs) or subacute or transitional care i. For those patients requiring more intensive nursing care than provided in long-term care ii. Usually found as specially designated units within long-term care facilities or occasionally within hospitals iii. Patients are often transferred from hospital to continue their recovery from an acute episode and often require continued therapy (physical, occupational, and/or speech). iv. Frequent patient assessments for a limited time period for stabilization or completion of a treatment regimen. v. Typically those needing assistance as a result of non-healing wounds, chronic ventilator dependence, renal problems, intravenous therapy, and coma management and those with complex medical and/or rehabilitative needs, including pediatrics, orthopedics, and neurological. These units are designed to promote optimum outcomes in the least expensive cost setting vi. Should have knowledge of transfer techniques, prevention and assessment of swallowing problems, bowel and bladder management, and nutrition, preventing the hazards of immobility such as pressure ulcers and contractures. g. Alzheimer’s Care i. care of persons with Alzheimer’s disease and other dementing illnesses. ii. High rate of Alzheimer’s with advanced age iii. Due to impaired judgment that may pose safety issues, during middle and late stage dementia the older adult cannot be left alone. As memory loss progresses, home caregivers often feel overwhelmed and unable to provide the required care. iv. Goal: preserve the functional status of the demented person via supportive care that fosters self-worth and socialization even within the context of diminishing cognitive capacity. 5. Hospice a. caring for dying persons and their families. b. Many patients are not elderly but the majority of the dying are older. c. Concept is centered on holistic, interdisciplinary care that helps the dying person “live until they die.” d. Specialize in thanatology and palliative care work together to provide quality care e. Pain management and comfort care are the standards upon which treatment is based. f. Nurses and physicians work closely with social workers, chaplains, psychologists, and other hospice 2