Discharge And Home Healthcare Guidelines

Be sure that the patient understands all medications, including the dosage, route, action, adverse effects, and need for routine laboratory monitoring of AEDs. Stress the need for taking medications as prescribed, even if seizure activity is under control. Ensure that the patient has basic epilepsy safety information, such as no tub baths, no swimming, and no driving without seizure control for at least 1 year. Family members should be able to verbalize what to do during a seizure. The patient should wear jewelry identifying him or her as having epilepsy.

HOME CARE. Emphasize the following management strategies:

• Maintain adequate rest and nutrition; check with a physician before dieting.

• Limit alcohol intake.

• Report infections promptly.

• Avoid trigger factors (flashing lights, hyperventilation, loud noises, video games, television).

• Brush the teeth regularly with a soft toothbrush.

• Avoid activities that precipitate seizure activity.

• Keep follow-up appointments.

• Lead as normal a life as possible.

Esophageal Cancer

DRG Category: 172 Mean LOS: 6.5 days

Description: MEDICAL: Digestive Malignancy with CC

DRG Category: 154 Mean LOS: 13.3 days Description: SURGICAL: Stomach, Esophageal, and Duodenal Procedures, Age >17 with CC

Carcinoma is the most common cause of obstruction of the esophagus. Approximately half of all esophageal cancers are squamous cell carcinomas, which usually occur in the middle and lower two-thirds of the esophagus and are often associated with alcohol and tobacco use. The remaining 50% are adenocarcinomas, which generally begin in glandular tissue of the esophagus. Adenocarcinomas are associated with Barrett's esophagus, a condition that occurs because of continued reflux of fluid from the stomach into the lower esophagus. Over time, reflux changes the cells at the end of the esophagus. Adenocarcinomas may invade the upper portion of the stomach.

Esophageal tumors begin as benign growths and grow rapidly because there is no serosal layer to inhibit growth. Because of the vast lymphatic network of the esophagus, esophageal cancers spread rapidly, both locally to regional lymph nodes and distantly to the lungs and

334 Esophageal Cancer liver. Complications include pulmonary problems that result from fistulae and aspiration; invasion of the tumor into major vessels, thus causing a massive hemorrhage; and obstruction and compression of the other structures in the head and neck. Although survival rates are improving, esophageal cancer is usually diagnosed at a late stage, and most patients die within 6 months of diagnosis. It is estimated that 14,520 new cases of esophageal cancer will be diagnosed in 2005, and 13,570 will die. While the survival rates have been improving over the last 50 years, only 15% of whites and 8% of African Americans will survive 5 years after diagnosis.

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