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Breakthrough technologies, newer drugs, and research have combined to increase
the average life expectancy. People who might have died of injuries or illnesses
50 years ago may now continue to lead satisfying and productive lives.
Many of these patients require physical support and care of chronic illnesses—
care that may take place in the home setting.
In rehabilitation care, the focus is on restoration of a person with disabilities to his
or her maximum potential along several fronts: physical, social, spiritual,
psychological, and vocational areas.
Chronically ill patients are cared for at home by a wide range of caregivers, who
may include family members, unlicensed caregivers, licensed nonprofessional
caregivers, licensed professionals, or a combination of these.
Consumers of home health care are vulnerable, are frequently too sick to advocate
for themselves, and may lack advocates. Paramedics have a unique opportunity to
assist in securing additional resources, reporting to protective agencies, and
offering guidance for in-home injury prevention.
Many family members who care for chronically ill patients are medically
sophisticated and are often the paramedic’s best source of information and care
guidelines.
In the home care setting, you may encounter patients who are chronically ill or
permanently injured, as well as those who have recently had a hospital stay,
surgery, or a high-risk pregnancy. You may also encounter newborns with
medical complications. Many of these patients experience similar physical
problems regardless of the initial cause.
Assessment of the chronic care patient follows the standard guidelines. Ask the
caregivers how the patient’s condition differs today.
It is important to assess for airway patency in all patients, but especially in
patients with artificial airways.
Patients with respiratory compromise have the inability to adequately ventilate
themselves. The home care treatment plan is designed to supplement the patient’s
loss of respiratory effort. Any stressor can tip the balance, increase the severity of
signs and symptoms, and render the current respiratory support inadequate.
Ventilators mechanically deliver air to the lungs. Home ventilators are smaller
than most microwave ovens, use regular household electricity, and may include a
battery backup.
Patients who have chronic cardiovascular disease are often cared for in the home
setting. Many patients have cardiac insufficiency or heart failure, an inability of
the heart to keep up with the demands placed on it and failure of the heart to
pump blood efficiently.
Central venous catheters are used for many types of home care patients, including
those receiving chemotherapy, long-term antibiotic therapy or pain management,
high-concentration glucose solutions, and hemodialysis.
A gastric tube may be placed when a patient cannot ingest fluids, food, or
medications by mouth.
Chronically ill patients and patients with neurologic damage may require a longterm indwelling urinary catheter or intermittent urinary catheterization.
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A wound with minor redness, slight warmth to the touch, and swelling may
indicate a superficial infection. A painful reddened area with cracks, serous
drainage, or red streaks extending from the area may indicate that the patient has
cellulitis. Cellulitis may be more severe and require hospitalization in patients
who have venous stasis, diabetes, or who are immunocompromised.
Complications in the postpartum period that you may see in the field include
postpartum bleeding, depression, sepsis, pulmonary embolus, and infant
septicemia. You may also be called to assist with pediatric apnea monitors.
Patients in hospice care can experience pain and discomfort from tumor growth,
treatment modalities (eg, radiation and chemotherapy), immobility, inflammation,
or infection. Treatment of hospice patients is based on the type and severity of
pain.
Patients receiving home care are encouraged to make end-of-life decisions early
in their care. A durable power of attorney allows a patient to appoint someone to
make health care decisions in the event that he or she becomes incapacitated.