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Healthcare 101

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1 1 Medical Issues For People Who are Homeless Ellen M. Brown, RN, LCSW DHHS Program Manager Health Care for Homeless Danielle Jacques, RN, MSN Community Health Nurse
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Page 1: Healthcare 101

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Common Medical Issues For People Who are Homeless

Ellen M. Brown, RN, LCSW

DHHS Program Manager

Health Care for Homeless

Danielle Jacques, RN, MSN

Community Health Nurse II

Health Care for the Homeless

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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

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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.

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Homeless

Homelessness can be the cause of poor health

Poor health can lead to homelessness

Homelessness makes management of any health problem more

difficult

Health

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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

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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

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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

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Common Cold vs. Serious Respiratory Infection

Routine visit Send to clinic ASAPend

Send to ER

Runny nose,Dry cough or small amt sputumGradual onset

Coughing up sputumNormal breathingCoughing up

Breathing rapidlyHas high feverSudden onsetSkin color not normal

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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

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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

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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

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Fungal Infections

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

Athlete's foot

                                                                                              

        

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Bacterial infections

Pus-filled blisters (“pustules”) or open wound draining purulent drainage

May have swelling, redness, warmth

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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

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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

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Skin ProblemsRoutine visit Send to clinic

ASAPSend to ER

Bleeding stopped with pressure

Itchy lesions that don’t disturb sleep

Cut or sore: red puffyHuman bite that breaks skinSmall burn on top layer of skinItchy lesion, wet with blisters, trouble sleepingOpen wound that is draining

Deep cut and bleeding not stopped with pressureBurn over large areaItchy lesion with swelling, can’t breath

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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

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Teeth/Mouth ProblemsRoutine visit Send to Clinic

ASAPSend to ER

ToothacheNeeds dental cleaning

Bleeding gumsTooth knocked out and doesn’t have itToothache with swelling, bleeding,fever

Bleeding gums and takes blood thinnerTooth knocked out and has toothMouth sores-can’t eat or drinkSwollen face, can’t talk or can’t swallow

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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

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Hypertension: The keys to treatment

Try to avoid salt Avoid alcohol and drugs Take prescribed Medications Monitor BP

HCTZ Verapamil

Lisinopril Atenolol

Clonidine

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Heart and Circulation Problems

Routine Visit Send to Clinic ASAP

Send to ER

Running out of blood pressure pills in a few daysRunning out of blood thinner pills in a few days

Shortness of breath with movement or liftingIs out of meds

Chest pain & weakness, numbnessShortness of breathPale skinSweating

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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

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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

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Diabetes Routine visit Send to Clinic

ASAPSend to ER

Blood sugar less than 120 and feels well. Is taking meds regularly.

Running out of meds.

Blood sugar is getting higher.

Increased urination.

Out of meds.

Change in mental status, with either high or low sugar

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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

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Management of Asthma Inhalers

Oral meds

Control environment as possible

Flu vaccine, pneumonia vaccine

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Asthma Triggers Tobacco

Cold air

Perfume, paint, cleaning fluids

Allergens such as mites, pollen, cockroaches

Common cold, flu, other respiratory illness

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Asthma

Routine visit Send to Clinic ASAP

Send to ER

Can breath OK if uses inhalerHas enough meds/inhaler and is taking them

Trouble breathingIncreased use of “rescue” inhalerMore frequent coughing

Trouble breathing and unable to converseChange in skin color

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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

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Cellulitis as a result of PVD

Contributing factors: Malnutrition Lack of adequate rest Exposure to the

elements Limited access to

showers/hygiene Psych issues/substance

abuse

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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

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Peripheral Vascular Disease

Routine visit Send to Clinic ASAP

Send to ER

Swelling in feet or ankles by the end of the day, goes down in the AM

Persistent swelling of feet, ankles, legs

Swelling of feet, ankles, legs with shortness of breath or other symptoms

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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…

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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.

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Management of Allergies

Oral antihistamine medications (Benadryl, Loratadine)

Skin creams

Nasal sprays

Control of environment

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Allergies

Routine visit Send to Clinic ASAP

Send to ER

Sneezing.

Rash but skin unbroken.

Swelling of an arm or leg

Skin rash with excoriation.

Sneezing, coughing

Swelling of the face or throat

Difficulty breathing or swallowing

Weakness

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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.

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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

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Management of Seizures

Requires good relationship with a primary medical care provider

Compliance with Medications

Controlling environmental factors

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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.

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Seizures

Routine visit Send to Clinic ASAP

Send to ER

Takes seizure meds but has had no seizures.

Is out of meds.

Reports having seizure

Witnessed seizure, esp. if for first time.

Prolonged seizure.

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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

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Joint PainRoutine visit Send to Clinic

ASAPSend to ER

Past injury causing discomfort; still has feeling, joint can be used

New injury that is bruised, swollen, and painful; still has feeling, joint can be used

New injury. Bone is sticking outNo feelingCan’t move part of bodyChange in skin color

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Flu!

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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

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“High Risk” Medical Conditions Susceptible to

Flu Pregnancy Diabetes Heart problems Kidney Disease Immunosuppression Age over 65 Chronic lung disease

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Is it flu or a common cold?

Influenza Sudden fever, lasts 3-4

days Headache is common,

can be severe Aches and pains are

common and can be severe

Fatigue is common and can be severe

Common cold Fever is rare

Headache is rare

Aches and pains are rare

Sometimes mild fatigue

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Is it flu or a common cold?

Influenza Nausea, vomiting,

diarrhea in children, esp < 5 years old

Watery eyes rare Sneezing rare in early

stage Stuffy nose rare Chest discomfort

common and can be severe

Common cold Nausea,vomiting,

diarrhea are rare

Watery eyes is common Sneezing is common

Stuffy nose is common Chest discomfort rare

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Is it flu or a common cold?

Influenza Complications:

respiratory failure, worsening of chronic conditions

Can be fatal

Common Cold Complications: Earache,

congestion

Not fatal

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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

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Influenza

Routine visit Send to Clinic ASAP

Send to ER

Needs vaccine Underlying medical condition

Has had symptoms for 5 days and no better

Shortness of breath

Poor color

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Primary Medical Providers for Homeless

Community 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

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Primary Medical Providers for Homeless

Kaseman 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

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When you need help… Call DHHS Health Care for the Homeless

Danielle Jacques, RN, MSN240-777-3104 office240-277-1003 cell

Ellen M. Brown, RN, LCSW-C240-777-3963 office240-380-7717 cell

The National Health Care for the Homeless Council website: www.nhchc.org


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