Congestive Heart Failure

Congestive heart failure describes the inability of the heart to adequately pump the amount of blood needed, causing fluid to leak from capillary blood vessels. The symptoms of congestive heart failure can include fatigue, shortness of breath, and swelling. It is one of the leading causes of hospitalizations nationwide. Reason for heart failure vary, however, most doctors agree that a precise diagnosis and coordinated treatment plan that often includes education, lifestyle modifications, addressing potentially reversible factors, appropriate therapies, and properly taking prescribed medications allow patients to effectively manage their condition without repeat visits to the hospital.

Our Individualized Care Plan

• Initial Consultation with the patient, family or caregiver to review the physicians prescribed plan of treatment and the patient's goals and potential outcomes
• A review of the patient's current diet regimen including salt intake, food preparation, and establishing an appropriate referral to a dietitian
• Coordination with a medical social worker to evaluate and determine the need for additional outside services
• Ongoing reviews of their prescribed medications including proper dosages, creating refill reminders to maintain an adequate supply, and educating the patient on signs and symptoms of potential drug interactions
• Teaching the patient how to recognize changes in their health and adaptive behaviors to avoid serious illness

Diabetes

Diabetes is the condition in which the body does not properly process food for use as energy. Most of the food we eat is turned into glucose for our bodies to use as energy. The pancreas makes insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use it's own insulin as well as it should, which causes sugars to build up in the blood. Causes of type 1 diabetes, also known as insulin-dependent diabetes mellitus or juvenile diabetes, include autoimmune, genetic, and environmental factors such as a virus. Causes of type II diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity.

Treatment could include diet control, exercise, home blood glucose testing, and in some cases, oral medication and/or insulin. Approximately 40 percent of people with type 2 diabetes require insulin injections. Some people, especially those with pre-diabetes, may not experience symptoms initially. In type 1 diabetes, symptoms tend to come on quickly and be more severe. Symptoms for type 1 or type 2 diabetes could include:

• Increased thirst and extreme hunger
• Frequent urination
• Fatigue and irritability
• Blurred vision
• Slow-healing sores
• Frequent infections, such as gums or skin infections and vaginal infections

Hypertension

Approximately 33% of all people in the US over the age of 20 years have hypertension and are taking antihypertensive medications, according to a study conducted by the National Center for Health Statistics. Blood pressure is the force exerted by the blood against the walls of blood vessels, and the magnitude of this force depends on the cardiac output and the resistance of the blood vessels. Hypertension is a blood pressure higher than 140 over 90 mmHg (millimeters of mercury). Blood pressure has a natural variation – it lowers during sleep, and rises in response to excitement, anxiety and physical activity. Elevated readings over an extended period of time, however, are contributing factors to a variety of illnesses including kidney disease, heart attacks, and strokes. Specific causes of high blood pressure are unknown but is most often attributed to lifestyle factors such as physical inactivity, a salt-rich diet created by processed and fatty foods, and alcohol and tobacco use. Lifestyle changes are the most regularly initiated course of treatment for hypertension, and it can be as effective as drug treatment with the added advantage of positive effects on heart health. Helping our patients to quickly adopt lifestyle changes, providing them with the necessary tools at the onset of treatment to monitor their blood pressure, and teaching them how to identify the activities that positively and negatively affect their blood pressure has resulted in significantly lower hospital readmission rates for hypertension patients, which translates to lower overall costs and happier, healthier lives-that's the Premier Point difference.

Our Individualized Care Plan

• Working with patients to make necessary dietary adjustments
• Coordinate with physical therapist to establish an exercise program and/or weight control techniques
• Teaching patients how to manage elevated blood pressure readings
• Educating patients on the hazards of smoking and excessive drinking
• Helping patients to establish a routine for taking medications, and facilitating referrals to medical social workers to assist patients having difficulty securing prescribed medications due to cost and other related factor

Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs due to a loss of elasticity in the air sacs, inflamed or thickening of the airway walls, excessive mucus in the airways, or destruction of the airway walls, and is usually attributed to exposure to irritating gases or particulate matter such as cigarette smoke. Due to the debilitating nature of COPD and the difficulties patients experience completing daily tasks, it can place a significant burden on patients and family members, and often results in higher readmission rates than other types of chronic diseases. Syptoms of COPD include:

• Shortness of breath or a lack of energy
• Wheezing
• Chest tighness
• Excess mucus in the lungs or a chronic cough that produces sputum
• Frequent respiratory infections

Our Individualized Care Plan

Premier Point clinicians actively work with referring physicians to identify patients designated as “very high risk” for hospital readmission and develop an enhanced care plan with more stringent follow-up and communication procedures for the first 30 days post discharge. Our treatment plans are executed by trained clinicians with significant experience in managing all levels of COPD and include:

• Disease education for the patient, family members, and caregivers including symptoms of asthma and emphysema, and identifying and implementing daily lifestyle modifications to avoid outbreaks or extreme exhaustion
• Assessment and coordinating with primary physicians to secure referrals for pulmonary rehabilitation or oxygen therapy which typically includes special breathing techniques and other means of coping with COPD
• Monitoring the patient for significant fluid retention that may indicate early diastolic heart failure development and assessing sputum color and amount for signs of developing pneumonia
• Providing instructions on the proper usage of short-acting bronchodilators to help relieve sudden COPD symptoms
• Capturing a detailed sleep pattern history to determine if the patient is experiencing lower oxygen saturation or obstructive sleep
• Working with the patient to develop an appropriate exercise regimen with the desired outcome of increasing energy levels, improving circulation, reducing symptoms, and increasing endurance

We also help patients adhere to medical appointment schedules including securing transportation service, if required and coordinating with providers to deliver in-home lab and diagnostic testing if the patient’s mobility is restricted. Our goal is to help COPD patients manage the symptoms of the disease by providing a higher level of education, care, and support – all in the comfort and security of their own homes.

Wound Care

Our Individualized Care Plan

Our team of wound care trained clinicians understands the holistic approach in providing the needs of patients with acute and chronic wounds. Our clinicians are trained to perform wound care on pressure ulcers, venous stasis ulcers, surgical wounds, and other types of wounds. The Premier Point team, in coordination with the patient's physician, work to promote appropriate wound care and healing, and ensure monitoring to prevent infection.

Ostomy

Our Individualized Care Plan

It takes time to become comfortable with an ostomy. At the time of discharge, many patients experience a significant number of technical, emotional, social, marital/family, and sexual difficulties. Concerns include doubt of their ability to properly care for a stoma, questions concerning their ability to return to work or school, engage in sports or recreational activities, and the stigma associated with pouching systems. The Premier Point nursing staff can help. Our clinicians will develop the plan of care to promote the appropriate care holistically in maintaining their quality of life. Most importantly, provide assistance to the patient and caregiver on how to inspect the stoma and surrounding skin for any infection indicators, identifying the appropriate ostomy supplies, and monitoring to prevent hospitalization.

Prosthetics and Orthotics

Whether through trauma, disease, or other circumstances, the loss of a limb or use of a limb is a life-altering event. Patients experience a broad range of emotions including grief, blame, self-doubt, and depression. The recovery process can also offer many challenges as patients manage post-surgery pain and relearn daily living activities such as getting out of bed, personal hygiene and grooming, and household chores. The experienced team at Premier Point can help. Our nurses, occupational therapists and physical therapists have extensive experience working with complex amputation cases, and work as a team with referring physicians and the prosthetist, when applicable, to develop customized medical care and therapy plans that address pain and proper wound healing, prevent muscle weakness, contracture, and other immobility related problems, and help the patient to establish a new, normal, healthy, and active lifestyle.

Our Individualized Care Plan

• Closely monitoring the wound for signs of infection, scrapes, cuts, sores or any other abnormalities that could compromise the healing process
• Monitoring swelling, fluid build-up, and indicators of poor circulation; administering medications, and helping the patient to manage post-surgery phantom pain
• Teaching the patient desensitizing techniques to loosen any scar tissue that may have developed
• Teaching the patient to manage bathing, shaving, toileting, dressing, hair care, oral care, and other daily living activities
• Teaching family members and caregivers how to maintain a supportive role without enabling patient activity
• Teaching lower limb amputee patients to safely manage various objects, prepare meals and perform job-related tasks
• Coordinating wih a medical social worker to assess the home environment, and secure community available support for adaptive tools and home modificatios, identify referrals for crisis intervention if necessary and assist with long term planning

Post-Orthopedic Surgery Care

Knee/Hip replacement partial or full hip or knee replacement-the most common types of joint replacement surgeries, can relieve pain, and also improve gait, balance and overall quality of life.

Our Individualized Care Plan

Premier Point clinicians can help joint replacement patients manage daily activities and minimize the risk of infection during the recovery process. Our customized care plans developed with your medical provider could include:

• Inspecting the wound site for signs of infection, taking size and depth measurements, and monitoring the healing process
• Teaching the patient how to care for the surgical staples or steri-strips including cleaning and changing the dressing
• Ensuring strict compliance with anti-coagulant medication dosages to avoid improper blood clotting, instructing patients on how to properly take all prescribed medications, and how to recognize the side effects of improper dosages
• Performing blood tests to monitor medication levels, if appropriate
• Working with the dietitian to develop a customized dietary program to avoid drug interactions and promote healthy healing Pain management techniques
• Pain management techniques
• Supporting patients in incorporating their occupational and physical therapy training into their daily routine including standing, sitting, walking and performing grooming tasks
• Identifying and removing trip hazards and other safety concerns that could impact rehabilitation progress and reinforcing instructions provided by the therapist to allow proper joint healing