Med-Surg SG Exam One - Nursing Management

Med-Surg SG Exam One - Nursing Management - Med/Surg SG...

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Med/Surg SG Exam One COMMON CONCEPTS IN THE CARE OF ADULTS WITH CHRONIC ILLNESS Chronic Illness: medical condition or health problem associated with symptoms or disability requires long-term management (> 3 months); prolonged course, cure unlikely Examples: asthma, diabetes, alzheimer’s, dementia, CAD, cancer Chronic illness Permanent or lasts long time Physical or mental condition Causes symptoms and/or disability Caused by illness, genetic condition, injury, unhealthy behaviors Disability: limitation performing ADL Can be developmental, acquired, age-associated May be independent, productive, substantial limitations Protection Federal Law (ADA 1992) Cost of Chronic Illness 78% of health care costs 88% prescriptions 72% MD visits 76% hospitalizations Why is it increasing? 1. Longer Lifespan Elderly population increased; have complex health care needs (multiple conditions, live alone) 2. Lifestyle Options Smoking, physical activity, and obesity BMI (body mass index): body weight (kg)/ square of height (m 2 ) Pre-Obese: 25-30
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Med/Surg SG Exam One Obese: >30 3. Changing Patterns of Disease < risk of contagious disease Emerging risks include HIV, AIDS, MRSA, VRE, multi-drug resistant TB, C diff 4. Improved treatment and diagnosis living longer with more comorbidities 5. Healthcare Payment System Fee for service payment (encourages over testing) Focus on episodic care (funding goes to tests, not prevention) Primary Care Providers (PCPs) limited reimbursement 6. Over and Under Spending 15% uninsured; 35% underinsured More $$ spent on healthcare than any nation 2010 Healthcare Reform ??? Management Strategies – Care Models Managed Care: HMO (Health Management Organization) Case Management: PNCC (Primary Nurse Care Coordinator) Care Models: Chronic Care Model Chronic Care Model Assess self-management skills, confidence and clinical status Tailor clinical management to patient needs Set goals collaboratively Problem-solve to achieve a shared care plan Insure active, sustained follow-up Management Strategies – Financial Limits Diagnosis Related Group (DRGs): system to classify cases into one of approx. 500 groups expected to have similar hospital resource use. Developed for Medicare as prospective payment system. Based on diagnosis, comorbidities, age, gender, etc. Since 1983
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Med/Surg SG Exam One Management Strategies – Post Acute Care Long Term Acute Care (LTAC): Complex care up to 30 days; different DRGs Rehabilitation Hospital: HealthSouth; no vent patients Skilled Nursing Facility (SNF): long term, limited/no rehab services Management Strategies – Telehealth Monitoring & Decision Support Track movement (or lack) of frail elderly Transmit data Automatically generates feedback Cost-effective way to monitor and manage Early detection of problems, social support, and titrate care w/o travel Management Strategies – Health Promotion Promoting Physical Activity and Healthy Eating Management Strategies – End-of-life issues Palliative Care: relieve symptoms, stress at any stage of illness Expert management of pain and other symptoms, help navigating health care system, guidance
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