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Hospice – Eligibility (Reading & Sharing)

Hospice is an all-encompassing service available for patients with a prognosis under 6 months. Under the Medicare hospice benefit, patients eligible for hospice are greater than 65 years or receiving Medicare disability payments. At the start of care, two physicians must sign a statement certifying that the patient’s life expectancy is six months or less based on their best estimate of the patient’s medical prognosis. While hospice benefit was originally designed for Medicare recipients, most insurance providers cover hospice care for patients not eligible for Medicare. But, hospice eligibility depends on more than only a physician determining a prognosis of six months o less until death.

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A Review on Pain Scales

  1. PAINAD
    • Is used when the patient’s verbal responses might be unreliable because of a dementia diagnosis.
    • Assesses the patients breathing, vocalization, facial expression, body language, and consolability (0-2 each)
    • The scale describes 0 as no pain and 10 as severe pain.
  2. PQRST – a pain scale but not for dementia patients
    • P stands for provokes
    • Q stands for quality
    • R stands for radiates
    • S stands for severity
    • T stands for time.
  3. OLD CART stands for Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, and Treatment.
  4. CHIPPS – pain scale for infants and children
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Making the Right Decision – Ethical and Legal Considerations (Reading & Sharing re: End-of-life)

Scope and Standards of Practice – End of life Care

  1. Structure and processes of care: the composition and qualifications of the interdisciplinary team and define how the team should collaborate with patients and families.
  2. Physical aspects of care: management of physical symptoms such as pain, fatigue, anxiety, and others.
  3. Psychological and psychiatric aspects of care: assessment of the psychosocial needs of patients and families. the requirement for bereavement support is included in this domain.
  4. Social aspects of care: focus on leveraging family strengths and social support mechanisms to alleviate family stress.
  5. Spiritual, religious, and existential aspects of care: emphasizes the roles of the members of the interdisciplinary team, especially the chaplain, in recognizing and addressing spiritual and existential distress. Specifically, the competency of all team members in understanding and supporting the religious practice preferences of patients and families is stressed.
  6. Cultural aspects of care: describes cultural competence and defines processes for the provision of culturally sensitive care.
  7. Care of the patient at the end of life: Highlights the importance of providing multidimensional interdisciplinary end-of-life care for patients and their families, which includes educating them and building them through the dying process.
  8. Ethical and legal aspects of care: addresses advance care planning, ethics, and legal aspects of care. The role of the interdisciplinary team in broaching end-of-life conversations and documenting patients’ preferences is stressed. Consultation with ethics committees and legal counsel is also emphasized.
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Mechanical Ventilation (Reading & Sharing)

The clinical applications of ventilation and the use of specific modes during the acute stage of illness focus on protecting the lung and improving the patient outcomes.

Acute respiratory distress syndrome (ARDS), the most severe presentation of acute lung injury, results from an acute insult to the body that may be direct or indirect (pneumonia vs sepsis). The release of mediators and a host of other toxic substances affect the alveolar- capillary permeability adversely and result in a noncardiac pulmonary edema. Pathology includes decreased compliance, shunting, and refractory hypoxemia. No definitive treatment, but the therapy focus on managing the underlying condition and on supportive mechanical ventilation.

The two most common types of ventilations:

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