Discharge And Home Healthcare Guidelines

PATIENT AND FAMILY TEACHING. Teach the family that botulism is a preventable disorder. Explain that patients should discard any canned food that has a broken seal or an expired date or is swollen. Home-canned foods should be boiled, not warmed, before eating. Boiling for 20 minutes destroys botulism bacteria and spores. Instruct patients living in high altitudes to use a pressure cooker to boil foods adequately. Teach patients to use new cap seals with each canning session if they can at home. Teach the family to recognize the complications of botulism. If the patient survives the poisoning, teach patients and families that residual effects might be present for a year or more. Intensive, multidisciplinary rehabilitation and follow-up may be required to restore full function.

Brain Cancer

DRG Category: 010

Mean LOS: 6.7 days

Description: MEDICAL: Nervous System

Neoplasms with CC DRG Category: 001 Mean LOS: 9.6 days Description: SURGICAL: Craniotomy Age > 17 Except for Trauma

Primary brain tumors develop from various tissue types within the intracranial cavity and are named for the tissue in which they originate (e.g., astrocytomas originate in the astrocytes). Tumors are customarily described as benign or malignant; however, all brain tumors may be considered malignant because without treatment the patient dies. Even tumors that are well contained may lead to serious consequences because they compress or invade neighboring structures within the enclosed skull. Brain tumors cause their symptoms directly by destroying neurons or indirectly by exerting pressure, displacing brain structures, and increasing intracra-nial pressure. Besides primary tumors arising from intracranial tissue, metastatic tumors may also migrate to the area by hematogenous spread. Common sources for brain metastases are the lung, breast, and colon. Advances in diagnosis, surgical techniques, and adjunctive therapy have greatly improved the outlook for patients with brain cancer. About 50% are treatable with a hopeful prognosis.

Brain and spinal cord malignant tumors account for 1.4% of all cancers and 2.4% of all cancer-related deaths. Because of the difficulty with pathological discrimination and absence of metastasis, the clinical staging method is not used to describe brain cancer. Rather, tumors are classified as low grade or high grade. Although there are a wide variety of histologic types (Table 3), a small number of tumor types account for most morbidity and mortality. Average survival time for persons with a low-grade astrocytoma is 6 to 8 years; the average survival time for a person with a glioblastoma is 12 months.

• TABLE 3 Primary Intracranial Tumors
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