Republic Polytechnic Singapore A252 Compiled 6ps PDF

OFFICIAL (CLOSED) \ NON-SENSITIVE Problem 1: Meeting the Demand Republic Polytechnic Singapore ACTIVITY OWNER: NIKHIL NICHOLAS INPUTS BY: DAWN ER (DR) APPROVED BY: DAWN ER (DR) MODULE CHAIR: NIKHIL NICHOLAS Copyright 2023 @ Republic Polytechnic, Singapore ...

OFFICIAL (CLOSED) \ NON-SENSITIVE Problem 1: Meeting the Demand Republic Polytechnic Singapore ACTIVITY OWNER: NIKHIL NICHOLAS INPUTS BY: DAWN ER (DR) APPROVED BY: DAWN ER (DR) MODULE CHAIR: NIKHIL NICHOLAS Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE In today’s problem Tim and Tammy discussed about Bukit Batok Community hospital being built to handle the increasing need for demented individuals in Singapore. Tammy mentioned that there are many technological advances that may assist in their care. Tim also mentioned risks and questioned how these technologies could still be useful. How would you reconcile their positions? Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE What do you recognize? Hospitals are institutions where people receive healthcare. The healthcare system must be ready to handle the increase in demand of healthcare services according to the country’s population. Building more hospitals is one of the ways of meeting the demand. What can you infer? Hospitals need specific management system to improve workflow and efficiency. Due to the nature of the industry, management of healthcare is complex and unique. Other than building more hospitals, improving medical workflow and other admin processes can also increase the quality of healthcare delivery. Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE The Approach Why do we need more healthcare institutions? What are the existing types of medical services? What are the types of healthcare institutions? How are hospitals structured in order to provide healthcare services? What is the typical process for patients seeking treatment? What are the clinical & managerial infrastructures involved in patient care? How may we improve healthcare service delivery? How can technology integrate all the processes in healthcare services? What are the risks in implementing these technologies? How would more efficient processes improve patient care? Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE Why do we need more healthcare institutions? Increase in population (Foreign input/country progression) Increase in hospital admission (more industrial accidents/more complex cases) Long waiting time(lack of staff/more complicated cases/foreign diseases) Waiting time for admission to ward (Singapore Department of Statistics, 2023). (Ministry of Health, 2016). Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE What are the existing types of medical services? Singapore today has a mixed delivery model: The public hospitals provides around 80% of the primary care and secondary/acute care sector. The private sector provides 20% of the care in the primary care and secondary/acute care sector. In the step-down care sector (e.g. nursing homes, community hospitals and hospices), service provision is mainly provided by voluntary welfare organisations, most of which are funded by the Government for their services rendered to patients. Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE What are the types of healthcare institutions? Hospitals Polyclinics Nursing Clinics homes Private Medical Ambulance Laboratories Operators https://www.hcidirectory.gov.sg/hcidirectory/ Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How are hospitals structured in order to provide healthcare services? (1) 1. By organising the public healthcare system into three integrated clusters Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How are hospitals structured in order to provide healthcare services? (2) Copyright 2023 @ Republic Polytechnic, Singapore Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How are hospitals structured in order to provide healthcare services? (3) 2. By forming functional teams/departments Managerial Human resource management Finance Legal department Total Quality Management Clinical Surgical(eg: Example of organisation chart Cardiothoracic) Medical(eg: Cardiology) Research and statistics Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How are hospitals structured in order to provide healthcare services? (4) 14% 18% 3% 4% 14% 47% Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE What is the typical process flow for patients seeking treatment? Diagnostics Services -imaging Registration Consultation -laboratory Discharge Treatment Admission Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE What are the clinical & managerial infrastructures involved in patient care? Patient Access Department Clinical Department Allied-Health Departments Finance/ Billing Department Patient Access Department Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How may we improve healthcare service delivery? (1) 1. Technology aids  Harness the latest technology to improve processes e.g. bed management system, pharmacy systems, tracking of patients  With increasing use of technology in healthcare, it is important to have good patient care information systems.  User friendly  Easy to retrieve information needed  Accurate  Secure and safe system  Integrated across health disciplines Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How may we improve healthcare service delivery? (2) E-tracking of patient E-Registration (eg. RFID) Registration Consultation Treatment Admission Discharge E-Bed-Tracking Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How may we improve healthcare service delivery? (3) https://youtu.be/HdQvUwIMfs8 https://youtu.be/d-d599YEhlk - Process and manpower skillsets to change - Innovate in information and data transactions e.g. online/electronically Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How may we improve healthcare service delivery? (4) VIDEO Consultation implemented in Apr 2023 Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How may we improve healthcare service delivery? (4) Examples of tools required to facilitate technology use 1. LCD TV - Display 2. CCTV - Camera 3. Microphone - Speech 4. Video-Con panel – For multi users 5. Fibre BroadBand (high-speed) – Minimum connectivity requirements 6. Facial recognition - Authentication 7. Thumbprint – Authentication Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How may we improve healthcare service delivery? (5) 2. Workflow improvement Workflow processes can be streamlined and improved to make operations more efficient IT and automation can be employed to perform the routine tasks and remove the human component (eg. Self-registration) Departments can operate more efficiently by removing tasks that are otherwise laborious and redundant (eg. payment and billing sent to home) Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How may we improve healthcare service delivery? (4) Identifying interventions suitable as day surgeries to free up resources for inpatients Whereby patients are pre-assessed as outpatients. For non-emergency conditions. Patients are directly wheeled into the operation and can go home after a few hours of rest, as there is no need to admit as inpatient Therefore, beds are freed up for more urgent cases (inpatients) Examples of Day Surgery procedures: LASIK=Laser-Assisted In Situ Keratomileusis; TURP= Trans Urethral Removal of Prostate, surgery for enlarged prostate; cataract removal, simple fractures, cholecystectomy, dental procedures Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How may we improve healthcare service delivery? (5) 3. Medical care plans There is a medical care coverage in place with multiple layers of medical protection A mixed financing system, with multiple tiers/levels of financial protection to ensure “that no Singaporean is denied access to basic healthcare because of affordability issues”. 1st level: Government subsidies 2nd level: Medisave 3rd level: MediShield; ElderShield; (“Integrated Shield plans”); “ElderShield Supplements”; Medifund; Medishield LIFE; Private insurance  OFFICIAL (CLOSED) \ NON-SENSITIVE How may we improve healthcare service delivery? (6) 4. Quality Assurance Hospitals can undergo accreditation under 5 areas: Leadership Process and Accountability Competent and Capable Workforce Safe environment for Staff and Patients Clinical care for patients Improving Quality and safety Obtaining the accreditation ensures hospital work processes are safe and efficient and meets international standards. Joint Commision International (JCI) Standards for accreditation of health care institutions Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How may we improve healthcare service delivery? (7) 5. Community/Home Care Pooling resources - Instead of duplicating services, have pooled services in different clusters. Improves efficiency as well as expertise Step down care to improve the overall patient experience and leaving hospitals only for the critical cases. Leveraging on proper and efficient patient management to care for the patient remotely and leaving the critical cases for hospitals to care for Setup proper community groups for greater social care support Training of laymen to care for non-critical care cases Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How can technology integrate all the processes in healthcare services? (1) Digital Healthcare Involves the use of information and communication technologies to help address the health problems and challenges faced by patients. These technologies include both hardware and software solutions and services. Makes connection with the patients easier through remote means Technology enablers improve accessibility of healthcare to the masses or those unable to access healthcare Patient-centric activities Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How can technology integrate all the processes in healthcare services? (2) Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How can technology integrate all the processes in healthcare services? (3) Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How can technology integrate all the processes in healthcare services? (4) AI and Data Analytics Artificial Intelligence can be used to predict diseases, trends as well as assist the clinician to model outcomes Many AI processes and Data analytic tools were used to predict mortality rates as well as determine trends of COVID-19 over time Allows policymakers, clinicians and care providersto work on the best possible outcome to care for patients Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE What are some risks in implementing these technologies? Data security Network connectivity issues Human entry errors Fear and resistance Reduced in-person contact with patients Technical problems Benefits far outweigh the risks and should be mitigated through continuous checking as well as maintenance including a quality control programme to ensure that they are always secure and safe Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE How would more efficient processes improve patient care? Reduce waiting time Improve treatment outcomes Reduce duration of inpatient stay Reduce medical cost and have viable medical insurance system in place Reduce medical errors and legal risks Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE What have you learnt? List the different types of healthcare institutions and medical services in the healthcare industry. Identify the numerous departments and specialties in a typical modern hospital. Describe the processes involving inpatient care, at macro- (corporation) and micro- (patient) level. Identify types of medical protection schemes. Explain possible factors that influence the quality of medical care process, such as the use of technology in healthcare. Explain how the centralized patient information system contributes to health care. Justify the need for improved medical and administrative workflows in a healthcare institution Describe the importance of Quality Control and Quality Assurance in the health care industry with reference to JCI accreditation. Devise strategies to improve healthcare delivery in a modern hospital Compare the various medical insurance schemes available in Singapore. Propose improvements to delivery of healthcare workflows and utilizing Digital Healthcare concepts and other improvement tools. Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE SG Revamped Healthcare Cluster system Copyright 2023 @ Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE AY2023 SEMESTER 2 A252 PATIENT CARE P2 P3 P4: WRITING THE STORY! 6TH PRESENTATION ACTIVITY OWNERS: NIKHIL NICHOLAS APPROVED BY: DAWN ER (DR) MODULE CHAIR: NIKHIL NICHOLAS Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE In this problem David was admitted to the Accident and Emergency, with the suspicion of a stroke David seemed to be in denial of his condition and was unwilling to face reality His history needed to be taken and the communication needed to be sensitive to react to his feelings of animosity A proper history was needed to document all aspects leading up to the stroke Copyright © 2023 by Republic Polytechnic, SAS Copyright © 2023 Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE The Approach Chronic illness and the KR model of sickness How to define illness? KR What are the differences between Acute and Chronic illnesses? Model What are the stages of illness? Communication is important throughout the process Healthcare What are the types of communication? Communication Why is communication crucial in the healthcare setting? How to document the patients’ history Why is the case notes an important document? What are the sections in a patient’s case notes? Case How to systematically record the information in the case notes? Notes How do we document patient’s case notes? Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE HOW TO DEFINE ILLNESS? Alternative terms: Disease/illness/medical disorder/ medical condition Impairment of the normal state of the living human body or one of its parts that stops or modifies the performance of the vital functions (circulation and respiration). Manifests by distinguishing signs and symptoms Occurs as acute or chronic types in response to: o environmental factors (malnutrition, industrial hazards, climate), o specific infective agents (as worms, bacteria, or viruses), o inherent defects of the organism (as genetic anomalies), o combinations of these factors Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE DIFFERENCES BETWEEN ACUTE AND CHRONIC ILLNESSES? Acute illness Chronic illness Are of sudden onset and short duration. Its effects are long lasting or recurrent over a long period of time. Requires short term treatment. Requires long term treatment and holistic management due to the pervasive nature of the disease Usually do not require more medical care Usually requires more medical/ specialised and resources to maintain normalization in care and resources to maintain lifestyle. normalization in lifestyle. Examples: Examples: Acute Renal (Kidney) Failure, Acute Chronic Renal (Kidney) Failure, Coronary Myocardial Infarct,Acute Hepatitis, Acute Artery Disease, Chronic Cardiac Upper Respiratory Disease, Acute Insufficiency, Diabetes, Chronic Hepatitis, Bronchitis, Acute Respiratory Distress Asthma, all types of cancer (malignant Syndrome, Acute Lymphocytic Leukaemia. tumors). Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE STAGES OF ILLNESS? Kubler-Ross 5 Stages of Grief applied Similar Behavior Traits to chronic illness Stage Reaction Stage Reaction Denial Avoidance; withdrawal; unrealistic; Denial “No way, you must be emotional overload; mistaken.” Anger Tantrums; unstable; mood swings; Anger “Why me? Whose fault is it?” rebellion; random directed anger Bargaining negotiation; charity; prayerful; lesser Bargaining “Ok fine, but in exchange for sentence this can I live a few more Depression mood swings; withdrawal; crying; years?” anxiety attacks; regret; fear; Depression “What’s the point, just let me distanced; uncertainty die.” Acceptance calm; counselling stance; education; Acceptance “Life goes on, I should make peer support; reflective; the best of it.” preparedness; closeness; planned and rehearsed; stable; bucket list By identifying these stages, we can help patients cope from one stage to another. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE BIOPSYCHOSOCIAL STAGES THEY ENCOUNTER? (1) Biological Require support groups and (Chronic illness) programmes Psychological Social (Changes in emotions (Adaptations to live and thoughts in with the condition and people’s lives) receive medical care) Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE BIOPSYCHO STAGES THEY ENCOUNTER? (2) Physical effects Possible effects Possible source of (Biological) (psychological) psychological effects Kidney failure Fatigue, wheelchair Depression, feeling of Loss of ability to work, bound, dialysis, uselessness and dependence on medications hopelessness, guilt caregivers, costs Stroke Loss of normal Depression, hopelessness, Loss of ability to function functions, cognition anger at self. normally, dependence on may be affected others Cancer Fatigue, loss of weight, Depression, sense of Fear of impending death, pain doom, denial, guilt pain, costs. Heart disease Fatigue, decrease in Denial, depression, fear, Fear of sudden death, function, pain, guilt. change in lifestyle, diet. medication and Fear of inheritance. lifestyle. Diabetes Fatigue, loss of weight, May be insignificant until Depends on severity of complications. too late, depression, diabetes, stereotyping, denial, guilt needles, costs, lifestyle change Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT KIND OF HELP IS AVAILABLE AND THEIR ROLES IN THE HOLISTIC CARE OF THE PATIENT? Case Managers (BioPsycho) Occupational Physiotherapists (BioPsycho) Therapists (BioPsycho) Patient Counsellors Psychologists (Social) (Psychosocial) Medical Social Workers (Social) Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS THE PARSON’S SICK ROLE MENTALITY OF PATIENTS? Acceptance of the “sick role” The individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. Rights of the sick person: The sick person is exempt from normal social roles The sick person is not responsible for their condition Obligations of the sick person: The sick person should try to get well The sick person should seek technically competent help and cooperate with the medical professional Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE TYPES OF COMMUNICATION? There are 3 main types of communication:  Verbal communication  Speaking in a language; tone of voice; specific sounds  Non verbal communication  Refers largely to “body language” including posture; eye contact; touch; certain actions  Often referred to as “subconscious”. Yawning?  Written communication  Writing in a language; art, drawings; SMS, Whatsapp, Email Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHY IS COMMUNICATION CRUCIAL IN THE HEALTHCARE SETTING? (I) Communication is dynamic and complex between: A. Healthcare professionals and their patients ◼ History taking and physical examination involves verbal and non verbal communication ◼ Explaining the condition to the patient requires tact and understanding ◼ Illness can impair the ability to communicate effectively ◼ Above all confidentiality and patient integrity must be maintained. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHY IS COMMUNICATION CRUCIAL IN THE HEALTHCARE SETTING? (2) B. Amongst healthcare professionals ◼ Handover of patients during change in work shifts ◼ Discussion between healthcare colleagues on the patients’ conditions including medical reports ◼ Written case notes that chart the health progress of the patient Copyright © 2023 by Republic Polytechnic, SAS Copyright © 2020 by Republic Polytechnic, Singapore  OFFICIAL (CLOSED) \ NON-SENSITIVE WHY IS GOOD COMMUNICATION IMPORTANT IN A HEALTHCARE SETTING? Puts patient at ease Allows more openness from the patient Able to determine patient anxiety level Minimise misunderstanding Ensures no miscommunication of treatment plan, diagnoses, drug prescriptions Prevents malpractice suits Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHY IS THE CASE NOTE AN IMPORTANT DOCUMENT? Case notes Legal documents that contain confidential information about a person’s health. It must thus be handled very carefully and seriously, and information in the case notes should not be let out to the public. Keep track of the patient’s past (medical history) and current medical records. Document the patient’s health conditions such as drug allergies and previous treatments such as surgeries. Serves as a health progress card for the patient and an important reference for healthcare professionals. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE SECTIONS IN A PATIENT’S MEDICAL CASE NOTES? (1) a) Systematic Enquiry: a checklist of questions in the history-taking notes 1. History of presenting complaint – all questions about the patient’s present complaint (the most important section of questions). 2. Social history – e.g. occupation, marital status, habits like smoking, alcohol drinking, physical exercise, sexual practice etc.. 3. Past medical history – includes the patient’s medical conditions like acute or chronic diseases, surgery, hospital admissions, etc. 4. Family history of diseases 5. Drug history – a list of medications that a patient is on and any drug allergies. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE SECTIONS IN A PATIENT’S MEDICAL CASE NOTES? (2) b) Systemic enquiry: a checklist of questions to ask that is broken down based on the various body systems: Integumentary system Locomotor system Cardiovascular system Respiratory system Gastrointestinal system Nervous system Endocrine system Genitourinary system Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE HOW TO SYSTEMATICALLY RECORD THE INFORMATION IN THE CASE NOTES? (I) Be aware of the common medical terminology. Be aware of the correct techniques when taking the medical history. Recall the importance of specific communication skills that are required in the healthcare setting. One or more medical professionals could be present Verbal/ non-verbal communication when taking medical history provided the patient is informed and the consent is obtained. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE HOW TO SYSTEMATICALLY RECORD THE INFORMATION IN THE CASE NOTES? (II) Questioning technique is important Always ask open-ended/non-leading questions and let patient tell his/her story so as to make the correct diagnosis. E.g. What kind of chest pain did you have? And not: Did your chest experience acute pain; radiate to your jaw; worsen with exercise? Do not be judgmental and keep information confidential Be sensitive when asking questions, especially to the opposite gender. Why do you ask these questions? Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE HOW DO WE DOCUMENT PATIENTS’ CASE NOTES? Current approach – e-documentation (EPIC System) Electronically entered and can store total inputs of patients from all sources Central source of information, giving a dashboard view of the patients care from admission to discharge, over many visits Analytics that can help in patient management and disease management  Security controlled measures so that only users who have access to patients can enter  System prompts that can alert if there are conflicts to note eg. drug allergies, etc  Generate accurate billing invoices to central billing system Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE HOW DO WE HELP DAVID? Approach David with care and sensitivity Communicate with David effectively in a manner so as to obtain information from him respecting the verbal and non-verbal cues Be sympathetic and empathetic to David’s condition and to listen to his plight always Document all aspects of his condition in the correct sections of the case notes Put in proper terminology so as to ensure that ALL healthcare professionals will understand and follow up accordingly. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT HAVE YOU LEARNT? (DISEASES) Define disease and the types of disease. Define specific patient care related terminology such as signs, symptoms and syndrome with adequate examples. State the psychological implications and social adjustments particularly during chronic illness. List some acute and chronic illnesses and the accompanying common psycho-social impacts. Explain the Kubler-Ross model for grief and how it can apply to helping the patient with chronic illness. Explain the BioPsychoSocial Model in chronic illnesses Apply the principles of Parson’s “sick role”. Evaluate condition-specific psycho-social implications for comparison, and discuss varied approaches to their care. (eg. pediatric conditions, chronic vs. acute conditions, psychiatric conditions). Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT HAVE YOU LEARNT? (HEALTHCARE COMMUNICATION 1) State that communication occurs through verbal, nonverbal means and written communication List the characteristics of verbal, nonverbal communication and written communication. Explain why good communication is important. Explain the function of medical/case history taking List the basic categories of information(systemic inquiry) taken during medical/case history taking List the components of systematic inquiry in patients’ medical case notes Identify the differences between closed and open-ended questions Apply the steps to take patients’ medical/case history Identify communication skills required in the healthcare industry (verbal, non-verbal, written). Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT HAVE YOU LEARNT? (HEALTHCARE COMMUNICATION 1I) Explain how/when to use empathetic language and sympathetic language when communicating to patients eg. empathy, sympathy and silence Identify the challenges in communicating bad news. Explain the need for patient confidentiality in the healthcare setting. Apply the relevant communication etiquette when using digital devices. Propose correct approach in verbal and non-verbal communication for all patients, such as during consultation and drug dispensing. Critique specific communication barriers which might occur in healthcare profession and suggest how to overcome these barriers. Evaluate and link nonverbal cues to possible patients’ health signs and symptoms Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT HAVE YOU LEARNT? (CASE NOTES) Explain the function of medical/case history taking List the basic categories of information(systemic inquiry) taken during medical/case history taking List the components of systematic inquiry in patients’ medical case notes Identify the differences between closed and open-ended questions Apply the steps to take patients’ medical/case history Explain additional categories of a medical history to include subcategories for special patient groups, such as women and children Explain why and know when to ask closed and open ended questions to achieve the desired clinical outcomes Explain legal and ethical issues regarding the medical record Compare the advantages and disadvantages between e-documentation versus traditional medical history taking. Critique the rationale of the flow of history taking and justify its importance. Demonstrate the ability to ask open and close ended questions specific to medical history taking Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE GENTLE REMINDER! End of today: 1. Complete Quiz, RJ, Peer, self evaluation 2. Upload all WS, videos 3. Complete SCQ Week 5: 1. HBL. 2. Complete SCORM. Post queries on the class padlet (if any) 3. Complete RJ (For attendance purposes) Week 6: 1. Report to E53F lab in the morning. DO NOT COME TO CLASS! 2. LAB ATTIRE! NO need LAB COAT! Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE AY2023 SEMESTER 2 A252 PATIENT CARE P5 P6 P7: OUCH! 6TH PRESENTATION ACTIVITY OWNERS: NIKHIL NICHOLAS APPROVED BY: DAWN ER (DR) MODULE CHAIR: NIKHIL NICHOLAS Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE It was during the Covid-19 Pandemic and George was a new Medical Office on Duty at the A/E department A Patient is in the triage and he is screaming in great pain and rolling all over the bed clutching his chest/abdomen Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE It was during the COVID-19 Pandemic A patient is being attended to at the A/E and is in great pain George, the new officer was reviewing the case notes and noted the findings charted in the notes George needed to take the necessary precautions before assessing the patient’s pain and condition He had a suspicion of the diagnosis before examining the patient Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE The Approach Pain and pain assessment How to define pain? What are the different types of pain? What are the different types of pain scales? Infection control and the proper PPE What is an infectious disease? How do infectious diseases spread? What are the methods to help prevent spread of infection in the healthcare setting? What are the general safety practices for healthcare professionals? What is the sequence of putting on and removing PPE? What is the correct approach for a COVID-19 patient? What are the physical examination methods of the patient? What are the physical examination techniques to examine a patient? What is inspection? What is palpation? What is percussion? What is auscultation? How do you use all these techniques to assess a patients’ vital signs? Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE DEFINITION OF PAIN “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” –International Association for the Study of Pain It is important to understand that pain is complex and not just a physical phenomenon, but also a psychological experience. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE DIFFERENT TYPES OF PAIN (1) Pain is classified into: Nociceptive pain: arises from stimulation of specific pain receptors e.g heat, cold, stretch, touch. Non Nociceptive pain: a result from actual nerve damage. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE DIFFERENT TYPES OF PAIN (2) Somatic pain: Source - tissues such as skin, muscle, joints, bones, and ligaments - often known as musculo-skeletal pain. Receptors activated - specific receptors (nociceptors) for heat, cold, vibration, stretch (muscles), inflammation (e.g. cuts and sprains which cause tissue disruption), and oxygen starvation (ischemic muscle cramps). Characteristics - often sharp and well localised, and can often be reproduced by touching or moving the area or tissue involved. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE DIFFERENT TYPES OF PAIN (3) Visceral pain: Source - internal organs of the main body cavities. There are three main cavities - thorax (heart and lungs), abdomen (liver, kidneys, spleen and bowels), pelvis (bladder, womb, and ovaries). Receptors activated - specific receptors (nociceptors) for stretch, inflammation, and oxygen starvation (ischaemia). Characteristics - often poorly localised, and may feel like a vague deep ache, sometimes being cramping or colicky in nature. It frequently produces referred/radiated pain to the back, with pelvic pain (i.e. pain to the lower back,) abdominal pain (i.e. pain to the mid-back), and thoracic pain (i.e. pain to the upper back). Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE DIFFERENT TYPES OF PAIN (4) Neuropathic and Sympathetic pain: Source - from within the nervous system itself - also known as pinched nerve, trapped nerve. The pain may originate from the peripheral nervous system or from the central nervous system Causes – Many causes such as physical injury to nerve, nerve diseases, infection or chemical irritation from surrounding inflammation. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE TYPES OF PAIN SCALES (1) Pain scales are useful for: patients to describe their perception of the pain monitoring the effectiveness of the prescribed pain management Assessment scales can be grouped into: 1. Pain assessment scales can come in the form of: Verbal intensity, Visual analog, Numerical rating or Faces 2. Behavioral pain assessment scale uses open ended questions which gives a more accurate assessment of the effect pain has on the patient Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE TYPES OF PAIN SCALES (2) Wong-Baker Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE TYPES OF PAIN SCALES (3) Verbal intensity pain scale Description: Advantages: Disadvantages: - Self reported scale - Quick and simple to use - Only assess pain severity - Preferred due to - Misrepresentation as the - Descriptive numbers between intervals - Numbers assigned to simplicity unequal pain - Insensitive to small changes in pain Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE TYPES OF PAIN SCALES (4) Visual analog scale Description: Advantages: Disadvantages: - Self reported scale - Quick and simple to use - Only assess pain severity - Must be administered on paper - Patents mark their pain on a - Can be parametrically analysed or electronically so challenging in 100mm line rating from ‘no pain’ - Shown to be the most reliable clinical practice to ‘worst imagined pain’ and valid when comparing the - Patients with cognitive - Can be represented graphically NRS and the VRS impairment less able to produce or verbally - Detects small changes in pain consistent outcomes Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE TYPES OF PAIN SCALES (5) Numerical rating scale Description: Advantages: Disadvantages: - Self reported scale using a - Quick and simple to use - Only assess pain severity 11(0-10), 21(0-20) and - Can be parametrically - Poor reproducibility has 101(0-100) mm analysed been demonstrated in one - Pain ranges from ‘no pain’ - Detects small changes in study but lack of other to ‘worst possible pain’ pain studies to confirm - Can be represented graphically or verbally Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE TYPES OF PAIN SCALES (6) Wong-Baker ‘Faces’ Scale Description: Advantages: Disadvantages: - The scale shows a series - avoids gender, age, and racial - Ambiguity between the scales and of faces ranging from a biases that some of the scale levels are happy face at 0 which represents - Effective for those with language shown smiling "no hurt" to a crying face at 10 barriers and speech impediments which represents "hurts worst. - Easy to score with the 6 faces - The scale includes numbers, faces shown (visual representation), and written descriptions - Can be translated into several languages Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE TYPES OF PAIN SCALES (7) Behavioural Pain Assessment Scale Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS AN INFECTIOUS DISEASE? Infectious diseases are disorders caused by organisms : bacteria, viruses, fungi or parasites. The human body has its own normal flora which is normally harmless, even helpful without causing disease. External pathogens may cause infections: Avian influenza, Cholera, Dengue fever, Hand-foot and mouth disease, Hepatitis, SARS, Ebola Infectious diseases can be transmitted : From person to person Via bites from insects or animals By ingesting contaminated food or water Through exposures in the environment. Signs and symptoms vary from one infectious disease to another even though they have fever and chills in common. Prevention Vaccines ( MMR, Polio etc.) Frequent and thorough hand-washing Treatment: Some light/mild infectious diseases can be treated at home more severe/life-threatening require hospitalization Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE HOW DO INFECTIOUS DISEASES SPREAD? Chain of infectious disease Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE METHODS TO PREVENT THE SPREAD OF INFECTION IN THE HEALTHCARE SETTING? (1) Breaking the chain of infection Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE METHODS TO PREVENT THE SPREAD OF INFECTION IN THE HEALTHCARE SETTING? (2) Personal Protective Equipment (PPE) Hand/ personal hygiene The use of PPE is an important component in breaking the cycle of infection. PPE= Personal Protective Equipment PPE refers to a variety of barriers used alone or in combination to protect mucous membranes, airways, skin, and clothing from contact with infectious agents. The selection of PPE is based on the nature of the person to person interaction and/or the likely mode(s) of transmission. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE METHODS TO PREVENT THE SPREAD OF INFECTION IN THE HEALTHCARE SETTING? (3) Personal Protective Equipment (PPE) 1. GLOVES Gloves are used to prevent contamination of healthcare personnel hands when: 1) Anticipating direct contact with blood or body fluids, mucous membranes, open wound and other potentially infectious materials; 2) Having direct contact with patients who are colonized or infected with pathogens transmitted by the contact route 3) Handling or touching potentially contaminated patient care equipment and environmental surfaces 4) Operating on patients (Surgical gloves which are sterile) Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE METHODS TO PREVENT THE SPREAD OF INFECTION IN THE HEALTHCARE SETTING? (4) Personal Protective Equipment (PPE) 2. ISOLATION GOWNS Protects the healthcare workers’ arms and exposed body areas and prevent contamination of clothing with blood, body fluids, and other potentially infectious material. Usually the first to be donned in the use with other PPE Method of removal equally important to prevent contamination of underlying clothes and skin. Note: Complete set of Full PPE is provided in the isolation units or operating theatres: cap, clothing (gown, medical suit), footwear, gloves, face mask, goggles/face shield. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE METHODS TO PREVENT THE SPREAD OF INFECTION IN THE HEALTHCARE SETTING? (5) Personal Protective Equipment (PPE) 3. FACE PROTECTION: MASKS, GOGGLES, FACE SHIELDS Protects both healthcare workers and patient from infectious agents that transmit via air, droplet, secretions. The mucous membranes of the mouth, nose, and eyes are Face Shield Goggles susceptible portals of entry for infectious agents. Type of protection used depends on type and severity of possible infection (e.g N95 respirator versus surgical mask) or the medical procedure itself (surgery vs. non- surgery) Surgical Mask N95 Mask Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS THE SEQUENCE OF PUTTING ON AND REMOVING PPE? Correct sequencing is very important to minimize contamination. Putting on PPE: Good hand wash technique →Good fitting mask→ Eye wear (if applicable) → Gown → Gloves Removing PPE: Gloves → Wash Hands →Eye wear (if applicable)→ Gown→ Wash hands → Mask→ Wash hands For surgical procedures and dentistry, masks and protective eyewear are applied first prior to hand preparation. Gown and gloves are then put on. Reference: AUSTRALIAN GUIDELINES FOR THE PREVENTION AND CONTROL OF INFECTION IN HEALTHCARE , 2010, Section B1.2.7.(Table B1.8) and Section B4.3.2. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS THE SEQUENCE OF PUTTING ON AND REMOVING PPE? Copyright © 2020 by Republic Polytechnic, Singapore Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE PHYSICAL EXAMINATION TECHNIQUES TO EXAMINE A PATIENT? Inspection - Looking at the surface of the patient’s body Palpation - Feeling the regions of the patient’s body Percussion - Tapping a certain region of the body Auscultation - Listening to various body parts Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS INSPECTION? (1) Inspection means to look at or observe the: 1) Physical state of the patient - whether breathless, wheezing, distressed, facial grimacing because of pain 2) Color of the patient – Pale (anemia), yellow (jaundiced), ash brown (uremic), blue (anoxic) 3) Abnormality or deformity of any part of the body, swelling of body part, facial asymmetry, deformed hands in rheumatoid arthritis 4) Breathing movements (count respiration rate), the eye pupilary reflexes to light Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS INSPECTION? (2) 1. Physical State 2. Color Eg. facial expressions/state/emotion Eg. Nails color, jaundiced eyes Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS INSPECTION? (3) 3. Abnormality 4. Breathing Movements Eg. physical abnormality Eg. breathlessness Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS PALPATION? (1) Palpation means to feel and you can palpate an organ or body part for - Size – to determine the size of any masses or growths Consistency – to feel for the consistent nature of any abnormal finding Texture – to feel for roughness or irregularity Location – to determine the exact location relative to organs Tenderness – to ascertain pain response and whether there is guarding or rigidity response Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS PALPATION? (2) Palpation means to feel and you can palpate the - Abdomen ( lumps, swelling) Neck (swelling) Limbs (swelling) Breasts (lumps) Testes (lumps) Wrist (lumps) Wrist radial artery (pulse) Chest wall movements ( respiration rate) Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS PALPATION? (3) Neck palpation Wrist palpation Lymphedema Ankle palpation Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS PERCUSSION? (1) Percussion means to tap using the middle finger of one hand onto the middle finger of the other hand and listening to the sounds: Dull – Filled sound indicating presence of fluid More dull indicates more fluid filling inside Hollow/Resonant – Empty low pitched sound indicating air filled More high pitch indicates more air filled Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS PERCUSSION? (2) Percussion can be used to examine the: Chest - the pitch will sound different if there is fluid or extra air in the lungs (dull versus hollow sound) Abdomen - the sound will be different if there is extra fluid or air (dull versus hollow sound) Boundaries of the heart or liver - the tone of the sound will be duller over the solid liver and heart Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS AUSCULTATION? Auscultate means to listen (using the stethoscope to amplify sounds) to: Lung – there are added noises called crepitations (crackles) in pneumonia and pulmonary edema Chest and heart – normally there is a two-heart sound (lub-dub) and no added sound like murmur Brachial artery (over the biceps) – for blood flow in BP measurement Neck and abdomen – sometimes there is a sound called bruit (swoosh-like sound) Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE HOW DO YOU USE ALL THESE TECHNIQUES TO ASSESS A PATIENTS’ VITAL SIGNS? (1) The most common method of assessing the patient is called measuring or recording of a patient’s vital signs. The recordings and measurements made externally of the patient are used to assess and measure the patient’s health status very quickly to ensure that the patient is not sick or in distress. Nurses in hospitals will record these vital signs hourly and paramedics in emergencies will take the injured patient’s vital signs to make an instant assessment. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE HOW DO YOU USE ALL THESE TECHNIQUES TO ASSESS A PATIENTS’ VITAL SIGNS? (2) The basic vital signs include - Temperature Pulse rate Respiration rate Blood pressure of the patient What are their normal values? Taking and recording of a patient’s vital signs make use of the four basic examination skills of Inspection, Palpation, Auscultation and Percussion. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE HOW DO YOU USE ALL THESE TECHNIQUES TO ASSESS A PATIENTS’ VITAL SIGNS? (3) The FULL Body Medical examination https://youtu.be/BsuQdEpHH_s Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE HOW DID GEORGE APPROACH THE ISSUE? Before approaching the patient, don on the appropriate PPE and take all necessary precautions to avoid spreading any infection Determine the level of pain of the patient with appropriate tools in pain assessment and ask relevant questions to solicit history Perform the physical examination thoroughly to get a better idea of the signs and symptoms and using appropriate correlation methods to provide a provisional diagnosis Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT HAVE YOU LEARNT (1)? Pain & Anesthesia Define what is pain. State the common causes of pain. Explain the types and function of pain assessment tools - pain history and visual scales State the common methods of anaesthesia - local, regional and general. Differentiate between anaesthesia and analgesia. Explain the modes of administration of anaesthesia and the various indications. Identify common pre- and post-operative risks involved in anaesthesia. Explain the different types of pain, namely somatic, visceral, and neuropathic. Describe clinical patterns of pain in angina and sciatica. Explain the neurology of pain with reference to the Gate Theory and the types of pain receptors. Explain the choice of pain scales in different settings Explain the basic physiology behind anaesthesia Compare the methods of anaesthesia using clinical examples Apply the principles of patient care to ensure patient safety and effective communication when administering anaesthesia. Analyse the accuracy of pain assessment, and its pros and cons. Evaluate the different pain assessment tools, citing examples when they are most applicable. Evaluate the considerations (the pros and cons) regarding choice of anaesthesia for Caesarian Section. Evaluate the use of anaesthesia for special patient groups - pediatric and elderly, and kidney failure patients. (Discussing pre-operative evaluation in more details) Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT HAVE YOU LEARNT (2)? Cycle of Infection and Infection Control Identify common sources and types of infection, such as airborne, blood-borne, contact etc. Describe the precautions taken to prevent infections. Identify the components of PPE and demonstrate competency in donning and removing PPE. Identify challenges faced by emergency departments during a pandemic. Explain the methods of preventing infection based on the cycle of infection Propose examples of different isolation/infection control methods, based on the patient’s condition (infectious vs. immunocompromised). Explain how each technique (inspection, auscultation, percussion and palpation) contributes to the diagnosis of the patient. Justify the choice of examination technique for specific anatomy, such as percussion for the abdomen Explain pre-procedural considerations such as patient modesty, chaperon requirements. Analyse the pros and cons of PPE, isolation methods and practices. Justify the need to adopt different practices and different precautions based on the types of infectious disease Analyse how the PPE can have an effect on patient assessment (history taking and physical examination, doctor-patient communication) and its disadvantages. Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT HAVE YOU LEARNT (3)? Medical Physical Examination State the definition of physical examination List the 4 techniques of physical examination: Inspection, Palpation, Percussion, Auscultation Explain how each technique (inspection, auscultation, percussion and palpation) contributes to the diagnosis of the patient. Justify the choice of examination technique for specific anatomy, such as percussion for the abdomen Explain pre-procedural considerations such as patient modesty, chaperon requirements. Justify how certain techniques complement each other to come to an interim diagnosis Demonstrate critical analysis of various findings from physical examination in drawing conclusions, such as linking inspection, percussion and auscultation findings to make a conclusion about the condition Copyright © 2023 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE A252 PATIENT CARE P8 P9 P10: LIFE AND DEATH! 6TH PRESENTATION ACTIVITY OWNERS: NIKHIL NICHOLAS APPROVED BY: DAWN ER (DR) MODULE CHAIR: NIKHIL NICHOLAS Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE Fred was suffering from Stage 2 Colon Cancer and was to undergo a partial hemicolectomy. He was to have it done under General Anesthesia(GA). Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE Fred was to have the following inserted in him for his surgery: NG tube Urinary Catheter Stoma Bag He however developed complications and needed further intervention for his: Pneumothorax Low O2 levels Monitoring of O2 levels Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE Unfortunately, during the surgery, Fred developed complications with respiration due to the GA. A tension pneumothorax developed and caused his O2 saturation to fall, and was noted by the Anesthetist. The immediate intervention plan was to: Rescue and reduce the pneumothorax Monitor the O2 saturation Provide immediate increased levels of oxygen Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE However, during the transfer to the HDU, Fred fell but he was not too badly injured. Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE The Approach Use of Devices What are the devices used? Where are the devices inserted? How do the devices help the patient? Care for the devices What is the proper way to care for the devices? What are the precautions in using the devices? Risks in the hospitals and how to transfer patients safely What are the risks in the hospitals? How are the risks classified? How to transfer patients effectively? Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE DEVICES USED AND HOW TO CARE FOR THEM? Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS A NASOGASTRIC TUBE? (1) A nasogastric tube (NG) is a tube that: is inserted through the nose and threaded until it reaches the stomach connects the nose on the proximal end to the stomach on its distal end is used for feeding and aspiration of gastric juice contents Fred is implanted with a nasogastric tube so that: after her long surgery, the gastric secretions are aspirated the liquid food can introduced into his stomach post-operatively because intestinal functions post-operatively are poor. Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS A NASOGASTRIC TUBE? (2) Nasogastric Tube Nasogastric Tube inserted into the stomach Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE POST CARE INSTRUCTIONS AFTER A NASOGASTRIC TUBE INSERTION?(1) Rinse the mouth regularly – NG tube would make a person breathe from the mouth and dryness would set in causing bacteria to grow which might lead to infections Ensure the patient is positioned such that the NG tube is always above the level of stomach to prevent backflow, i.e. semi-erect Ensure that tapes are changed regularly to prevent adhesion scars and kept clean Regularly check the patency of the NG tube by using a syringe to aspirate contents Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE POST CARE INSTRUCTIONS AFTER A NASOGASTRIC TUBE INSERTION?(2) Nasogastric tube Put tape Ensure the tube is not displaced by here to checking the indictor tape. indicate correct Inspect lips and nose for mucosal or level skin damage Follow diet orders strictly Lubricate lips and nose for comfort Consider psychological impact of having a NG tube inserted on the patient. Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS AN URINARY CATHETER? (1) A urinary catheter: is a tube that is inserted through the patient’s urethra and into urinary bladder to collect the urine. It is used to drain urine for patients who have urinary obstruction, urinary retention, patients who are in post surgery, or critically ill To monitor urine output Urinary catheterization could be used for: Intermittent catheterization Short-term indwelling catheterization Long-term indwelling catheterization In Fred’s case, it was most likely used to monitor his urine input and output as standardized procedure after an operation. Copyright © 2024 by Republic Polytechnic, Singapore Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS AN URINARY CATHETER? (2) Different types of Urinary catheters Urinary Catheter is inserted into the male urethra. UrinaryCopyright Catheter is inserted into the female © 2024 by Republic Polytechnic, Singapore U Copyright © 2024 by Republic Polytechnic, SAS urethra. r i n  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE POST CARE INSTRUCTIONS AFTER A URINARY CATHETER INSERTION? Make sure that urine is flowing out of the catheter into the drainage bag Check the area around the urethra for inflammation or signs of infection, such as irritated, swollen, red or tender skin at the insertion site or drainage around the catheter. Keep the urinary drainage bag below the level of the bladder. Make sure that the urinary drainage bag does not drag and pull on the catheter. Provide ABX cover for prevention of infections Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS A COLOSTOMY BAG AND WHY WAS IT FITTED ON FRED? (1) Colostomy creates a: stoma that connects the remaining end of the colon to the anterior abdominal wall passage for “feces” to evacuate into a colostomy bag Fred: had colon cancer which destroys the normal structures and functions of the colon; and is potentially invasive to other internal organs. has to undergo surgery to remove the tumor and portions of her colon (hemicolectomy) which will affect important colon functions. To allow Fred to eat, eliminate the waste products of her digestion ( “feces”) and have a better life quality, surgeons create a colostomy to complete the hemicolectomy operation. Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS A COLOSTOMY BAG AND WHY WAS IT FITTED ON FRED? (2) 2 1 (hemi-colectomy) 3 4 Colostomy Pouch/Bag is fitted to the Stoma. Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE POST CARE INSTRUCTIONS AFTER A COLOSTOMY BAG INSERTION? (1) ALWAYS wash hands before tending to the stoma bag and site Keep the site around the stoma bag clean and dry. Disinfect the area regularly Use warm water and pat gently to clean and never rub Eat a proper diet with high fiber Discard used stoma bags in the proper manner i.e. empty contents into the toilet bowl and discard the bag in a domestic refuse bin Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE POST CARE INSTRUCTIONS AFTER A COLOSTOMY BAG INSERTION? (2) Care of the stoma Ensure proper training of patient and/or caretaker on how to care for the stoma and the methods of cleaning and changing of bags. Encourage to follow diet rules to reduce discomfort, too much gas production, and odor. Consider the psychological impact on the patient who requires a stoma. Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE POST CARE INSTRUCTIONS AFTER A COLOSTOMY BAG INSERTION? (3) Care of the stoma Clean hands before changing Gently remove the pouch Clean the skin gently with warm water Dry the skin Sprinkle ostomy powder on the skin and wipe the extra powder off Reattach and replace the pouch Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS A PACEMAKER AND HOW DOES IT WORK? Function An electronic metal/plastic device that mimics the natural electrical impulses of the heart. It is surgically implanted into patients suffering from Arrhythmias like Atrial Fibrillation. Used to correct abnormal heart rhythms. The pacemaker’s electrodes are placed at the SA node. Dual chamber pacemaker The electrical impulse from the electrode stimulate the atria to contract and travel to the AV node. After a delay, the stimulus is conducted through the Bundle of His to the Purkinje fibers and the endocardium of the heart, then finally to the ventricular epicardium. Copyright © 2024 by Republic Copyright Polytechnic, SAS Republic Polytechnic, Singapore © 2024  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE POST CARE INSTRUCTIONS AFTER INSERTING A PACEMAKER? Post Patient Care Avoid pressure on the site of the pacemaker Keep the incision site clean and dry, especially after insertion. Monitor for signs of infection after insertion of the pacemaker Avoid electrical appliances that may affect the device like: MRI machines Car engine Security gantries at airports Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS A TRACHEOSTOMY TUBE AND HOW DOES IT WORK? Function When a patient has a blockage in his trachea and cannot breathe, an incision is made into the trachea below or distal to the site of obstruction. The tube is inserted into a patient’s trachea. Patient can now breathe. Copyright © 2024 Republic Polytechnic, Singapore Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE POST CARE INSTRUCTIONS AFTER INSERTING A TRACHEOSTOMY TUBE? Post Patient care Keep the site of the tracheostomy tube dry Monitor tube for blockages, excessive mucus, and infection around the skin Check positioning of the tube regularly and prevent dislodgment. Observe for any patient distress or breathing difficulties Ensure the balloon cuff is always inflated to ensure full oxygen access through the tube Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT IS AN OXYGEN MASK AND HOW DOES IT WORK? Function The oxygen mask allows delivery of oxygen to the patient. Types include: Non-rebreathing mask: prevents rebreathing of exhaled air, provides very high oxygen concentration over the short term. Partial rebreathing mask: The patient breathes in some exhaled air and some room air. Thus the oxygen concentration is lesser. Other methods of oxygen delivery include using nasal prongs and intubation. Copyright © 2024 by Republic Polytechnic, SAS  OFFICIAL (CLOSED) \ NON-SENSITIVE WHAT ARE THE POST CARE INSTRUCTIONS WHEN