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  • Here are some good resources: The National Health Care for the Homeless
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    • 1. Common Medical Issues For People Who are HomelessEllen M. Brown, RN, LCSWDHHS Program ManagerHealth Care for HomelessDanielle Jacques, RN, MSNCommunity Health Nurse IIHealth Care for the Homeless 1
    • 2. IntroductionToday we’ll discuss some common medical problems and the issues that arise in providing care to people who are homeless.We will also review where to refer the homeless for primary medical care 2 2
    • 3. Why is this important? Studies show that 40% of homeless suffer from one or more chronic health problems Chronic diseases among the homeless are typically more severe than in people who are housed The management of health problems is more difficult in the homeless. 3 3
    • 4. Homeless Homelessness can bethe cause of poor healthPoor health can lead to homelessness Homelessness makes management of any health problem more difficult Health 4
    • 5. Objectives of this training:  Be aware of the major health problems encountered among people who are homeless  Gain knowledge into which clients should go immediately to the emergency room and which to refer for an appointment with primary care  Be knowledgeable of the primary care providers for homeless clients 5 5
    • 6. The Top Ten Medical Conditions 1. Upper respiratory infection 2. Skin problems 3. Dental problems 4. Hypertension 5. Diabetes 6. Asthma 7. Peripheral vascular disease 8. Allergies 9. Seizures 10. Joint Pain 6 6
    • 7. Upper Respiratory Infection  Prevention is important  Treatment is encourage fluids, take OTC meds, and rest  Need to make sure it’s not bronchitis, pneumonia, or allergies 7 7
    • 8. Common Cold vs.Serious Respiratory Infection Routine visit Send to clinic Send to ER ASAPend Runny nose, Coughing up Breathing Dry cough or sputum rapidly small amt Normal Has high fever sputum breathingCoughi Sudden onset Gradual onset ng up Skin color not normal 8 8
    • 9. Skin Problems  Many kinds of skin problems; most are not contagious  Treat with creams or occasionally need oral meds  Watch out for lice or scabies 9 9
    • 10. Scabies  Caused by a mite, Sarcoptes scabei burrowing under the skin  Causes severe itching, especially at night  Transmitted by skin to skin contact, very contagious  Treatment: prescription cream wash clothes in hot water 10 10
    • 11. Frostbite Caused when tissues freeze and ice crystals form and rupture causing tissue death 3 stages  1st redness and pain  2nd blistering  3rd deep red/purple, hard Treatment is re-warming tissues and preventing infection DO NOT Burn the skin by trying to reheat over an open fire DO NOT rub skin, this causes further breakdown of tissues 11 11
    • 12. Fungal InfectionsAthletes foot  Can affect any part of the body  Can be contagious  Often treated with creams or other “topical” medications  Can take a long time to resolve  Can be recurrent 12 12
    • 13. Bacterial infections  Pus-filled blisters (“pustules”) or open wound draining purulent drainage  May have swelling, redness, warmth 13 13
    • 14. Is it MRSA?Methicillin Resistant Staphylococcus Aureus  Skin Infections  Transmitted by skin to skin contact  Characterized by a reddish rash with a boil  Requires aggressive antibiotic therapy 14 14
    • 15. Practice‘Universal’ Precautions Wash your hands often, carry disposable hand wipes Protect you hands from cracking Wear gloves when handing contaminated items Cover open wounds and change dressings when they are wet Properly discard all contaminated materials by double bagging Clean soiled surfaces with a 1:10 bleach solution 15 15
    • 16. Skin Problems Routine visit Send to clinic Send to ER ASAPBleeding stopped Cut or sore: red Deep cut andwith pressure puffy bleeding not stopped Human bite that with pressure breaks skin Burn over large area Small burn on top Itchy lesion with layer of skin swelling, can’t breathItchy lesions that Itchy lesion, wet withdon’t disturb sleep blisters, trouble sleeping Open wound that is draining 16 16
    • 17. Dental Problems  Refer to primary care for infections then dental clinic  May need antibiotics  May need pain meds  Need immediate care if extra-oral swelling occurs 17 17
    • 18. Teeth/Mouth Problems Routine visit Send to Clinic Send to ER ASAPToothache Bleeding gums Bleeding gums andNeeds dental Tooth knocked out takes blood thinnercleaning and doesn’t have it Tooth knocked out Toothache with and has tooth swelling, bleeding, Mouth sores-can’t fever eat or drink Swollen face, can’t talk or can’t swallow 18 18
    • 19. Hypertension (HTN)  HTN is elevated blood pressure  More common in the homeless population than in the general population  HTN is twice as prevalent in alcoholics than in non-alcoholics  HTN may have no symptoms Found on routine examination  HTN can be an emergency 19 19
    • 20. Hypertension: The keys to treatment  Try to avoid salt  Avoid alcohol and drugs  Take prescribed Medications  Monitor BP HCTZ Verapamil Lisinopril Atenolol Clonidine10/01/09 20 20
    • 21. Heart and Circulation Problems Routine Visit Send to Clinic Send to ER ASAPRunning out of Shortness of Chest pain &blood pressure breath with weakness,pills in a few days movement or numbnessRunning out of lifting Shortness ofblood thinner pills Is out of meds breath in a few days Pale skin Sweating 21 21
    • 22. Diabetes Symptoms may include excessive urination, excessive thirst, fatigue It is diagnosed through blood tests Complications can include peripheral neuropathy (loss of feeling in extremities), kidney problems, eye problems 22 22
    • 23. Management of Diabetes Clients need to monitor blood glucose with a glucometer, primary medical provides them May be controlled with diet (avoid sugar) May need oral medication or insulin injections Clients need to have regular, balanced meals. Timing is important. Dental and foot care is important 23 23
    • 24. Diabetes Routine visit Send to Clinic Send to ER ASAPBlood sugar less Blood sugar is Change inthan 120 and getting higher. mental status,feels well. Is Increased with either hightaking meds urination. or low sugarregularly. Out of meds.Running out ofmeds. 24 24
    • 25. Asthma A chronic inflammatory disease of the airways Prevalent in people experiencing homelessness Symptoms may include wheezing, dry cough at night, tightness in chest, especially when exercising 25 25
    • 26. Management of Asthma  Inhalers  Oral meds  Control environment as possible  Flu vaccine, pneumonia vaccine 26 26
    • 27. Asthma Triggers Tobacco Cold air Perfume, paint, cleaning fluids Allergens such as mites, pollen, cockroaches Common cold, flu, other respiratory illness 27 27
    • 28. Asthma Routine visit Send to Clinic Send to ER ASAPCan breath OK if Trouble breathing Trouble breathinguses inhaler Increased use of and unable toHas enough “rescue” inhaler conversemeds/inhaler and More frequent Change in skinis taking them coughing color 28 28
    • 29. Peripheral Vascular Disease (PVD)  Includes a broad group of problems: chronic edema, cellulitis of the legs, phlebitis (blood clots)  Prevalence is 10-15 times greater than in general population  High rates are related to lifestyle: constant walking, inability to elevate feet during sleep 29 29
    • 30. Cellulitis as a result of PVDContributing factors: Malnutrition Lack of adequate rest Exposure to the elements Limited access to showers/hygiene Psych issues/substance abuse 30 30
    • 31. Treatment of Peripheral Vascular Disease Elevate feet as much as possible May use compression stockings or ace bandages Proper footwear Patients with ulcers may need dressing changes Infected wounds may need antibiotics 31 31
    • 32. Peripheral Vascular Disease Routine visit Send to Clinic Send to ER ASAPSwelling in feet Persistent Swelling ofor ankles by swelling of feet, feet, ankles,the end of the ankles, legs legs withday, goes shortness ofdown in the AM breath or other symptoms 32 32
    • 33. Allergies There are many types of allergies Possible symptoms include sneezing, watery eyes, itching, skin rash or hives, wheezing, coughing, vomiting, diarrhea, swelling around the mouth… 33 33
    • 34. Allergies Rarely, an allergic reaction can become life- threatening. “Anaphylaxis” may begin with severe itching of the eyes, and rapidly progress to difficulty in breathing and swallowing, cramps, and shock. 34 34
    • 35. Management of Allergies Oral antihistamine medications (Benadryl, Loratadine) Skin creams Nasal sprays Control of environment 35 35
    • 36. Allergies Routine visit Send to Clinic Send to ER ASAPSneezing. Swelling of an Swelling of theRash but skin arm or leg face or throatunbroken. Skin rash with Difficulty excoriation. breathing or Sneezing, swallowing coughing Weakness 36 36
    • 37. Seizures This is most common neurological illness in the homeless population. The most common cause is alcohol abuse, followed by head trauma. There are many other causes. 37 37
    • 38. What does a seizure look like? Any of these:  Sudden falling  Passing out  Drooling, frothing at mouth  Grunting, snorting  Breathing stops temporarily  Uncontrollable muscle spasms  Teeth clenching  Eye movements  Unusual behavior  Staring 38 38
    • 39. Management of Seizures Requires good relationship with a primary medical care provider Compliance with Medications Controlling environmental factors 39 39
    • 40. What to do if someone has a seizure Don’t panic Keep him from hurting himself by easing to the ground or positioning him safely If possible, try to gently turn him on his side Tell someone to call 911 Note how long the seizure lasts Don’t try to put anything in his mouth When it’s over, have him rest comfortably. Don’t try to move him right away. 40 40
    • 41. Seizures Routine visit Send to Clinic Send to ER ASAPTakes seizure Is out of meds. Witnessedmeds but has Reports having seizure, esp. ifhad no seizures. seizure for first time. Prolonged seizure. 41 41
    • 42. Joint Pain Back pain, hip pain, leg pain very common Made worse by walking, sleeping on an uncomfortable bed May be a sign of more serious disease 42 42
    • 43. Joint Pain Routine visit Send to Clinic Send to ER ASAPPast injury New injury that New injury.causing is bruised, Bone is sticking outdiscomfort; still swollen, and No feelinghas feeling, joint painful; still has Can’t move part ofcan be used feeling, joint can body be used Change in skin color 43 43
    • 44. Flu! 44 44
    • 45. Flu Symptoms Sudden onset of illness Fever higher than 100.4 Chills Cough Headache Sore throat Stuffy nose Muscle aches Feeling of weakness and fatigue Diarrhea, vomiting, stomach pain, esp in children 45 45
    • 46. “High Risk” Medical Conditions Susceptible to Flu Pregnancy Diabetes Heart problems Kidney Disease Immunosuppression Age over 65 Chronic lung disease 46 46
    • 47. Is it flu or a common cold? Influenza Common cold Sudden fever, lasts 3-4  Fever is rare days Headache is common,  Headache is rare can be severe Aches and pains are  Aches and pains are rare common and can be severe Fatigue is common and  Sometimes mild fatigue can be severe 47 47
    • 48. Is it flu or a common cold? Influenza Common cold Nausea, vomiting,  Nausea,vomiting, diarrhea in children, esp diarrhea are rare < 5 years old Watery eyes rare  Watery eyes is common Sneezing rare in early  Sneezing is common stage Stuffy nose rare  Stuffy nose is common Chest discomfort  Chest discomfort rare common and can be severe 48 48
    • 49. Is it flu or a common cold? Influenza Common Cold Complications:  Complications: Earache, respiratory failure, congestion worsening of chronic conditions  Not fatal Can be fatal 49 49
    • 50. What to do for flu Prevent spread of flu to others:  Wash hands  Dispose of tissues properly  Clean counters/surfaces with usual products Get a Flu Shot If you get sick, rest, drink fluids, and treat symptoms 50 50
    • 51. Influenza Routine visit Send to Clinic Send to ER ASAPNeeds vaccine Underlying Shortness of medical condition breath Has had Poor color symptoms for 5 days and no better 51 51
    • 52. Primary Medical Providers for HomelessCommunity Clinic Inc.  Serves uninsured men, women and children  Contracted with HHS for uninsured homeless adults  Participates with MA, PAC and Medicare  3 locations:  Gaithersburg Clinic 200 Girard St. Gaithersburg 301-216-0880 /Ride On #61  Silver Spring (Progress Place) 8210 Dixon St. Silver Spring 301-585-1250 / one block from SS Metro  Takoma Park 7676 New Hampshire Ave. 301-431-2972 / Ride On # 15, 16, 17, 18 52
    • 53. Primary Medical Providers for HomelessKaseman Clinic Inc.  Serves uninsured men and women  Contracted with HHS for uninsured homeless women  Does not participate with any insurance  Kaseman Clinic 8 West Middle Lane, Rockville, MD 301-917-6800 /Ride On # 46 53
    • 54. When you need help… Call DHHS Health Care for the Homeless  Danielle Jacques, RN, MSN 240-777-3104 office 240-277-1003 cell  Ellen M. Brown, RN, LCSW-C 240-777-3963 office 240-380-7717 cell The National Health Care for the Homeless Council website: www.nhchc.org 54 54

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