{"aaData": [["VA-SUBSTANCE ABUSE", "", "Substance Abuse\n", "\n- \n\n
\n", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ALCOHOL ABUSE SCREENING", "", "Alcohol Abuse Screening\n", "", "LOCAL\n", "", "\nThis topic represents the inquiry process done by a clinician to determine\nThe data collected in PCE reflecting activity related to the Problem\nDrinking Screening reminder, or your local sites equivalent, will be used\nby the National Center for Health Promotion and Disease Prevention in\npreparation of an annual report to Congress.\n \nThis screening topic is considered the "minimum" requirement for\nclinicians to reflect the clinical activity. If the clinician actually\nprovides education, the appropriate Education topic should be recorded,\nreflecting the education given.\nif the patient should receive Alcohol Abuse education. This topic was\ncreated as an example of a screening topic that could be used on an\nEncounter Form, for check-off by the clinician.\n \nClinicians at sites will be required to document activity related to the\n"Problem Drinking Screening" PCE reminder, or your local sites\nequivalent. The "Problem Drinking Screening" reminder was defined by\nthe National Center for Health Promotion and Disease Prevention (NCHP).\n
\n\n", "", "\nThis standard is actually a guideline. Clinicians could use this\nYou may want to ask the CAGE questions as well. Affirmitive answers on at\nleast two of the four may be a trigger for counseling.\n \n CAGE questions are:\n \n Have you ever felt you ought to Cut down on drinking?\n Have people ever Annoyed you by criticizing your drinking?\n Have you ever felt bad or Guilty about your drinking?\n Have you ever had a drink first thing in the morning to steady your\n nerves or get rid of a hangover (Eye-opener)?\nguideline as an example of the type of questions to ask the patient\nwhen the clinician needs to determine whether the patient should\nreceive Alcohol Abuse education.\n \nAsk the patient how many days a week he or she usually has alcohol and how\nmany drinks the patient usually has each day. Three or more drinks a day\nare usually a trigger for counseling. \n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-EXERCISE SCREENING", "", "Exercise Screening\n", "", "LOCAL\n", "", "\nThis topic represents the inquiry process done by a clinician to determine\n(NCHP). The data collected in PCE reflecting activity related to the\nFitness and Exercise Screening reminder, or your local sites equivalent,\nwill be used by the National Center for Health Promotion and Disease\nPrevention in preparation of an annual report to Congress.\n \nThis screening topic is considered the "minimum" requirement for\nclinicians to reflect the clinical activity. If the clinician actually\nprovides education, the appropriate Education topic should be recorded,\nreflecting the education given.\nif the patient should receive Exercise education. This topic was created\nas an example of a screening topic that could be used on an Encounter\nForm, for check-off by the clinician.\n \nClinicians at sites will be required to document activity related to\nthe "Fitness and Exercise Screening" PCE reminder, or your local sites\nequivalent. The "Fitness and Exercise Screening" reminder was defined\nby the National Center for Health Promotion and Disease Prevention\n
\n\n", "", "\nThis standard is actually a guideline. Clinicians could use this\nis optimal; less often may be a trigger for counseling.\nguideline as an example of the type of questions to ask the patient when\nthe clinician needs to determine whether the patient should receive\nExercise education.\n \nAsk the patient to describe his or her usual exercise patterns in general,\nand also in particular ask how many days per week the person engages in at\nleast moderate physical exercise like brisk walking for 30 minutes or\nmore. Moderate physical exercise of 30 minutes or more three times a week\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-NUTRITION/WEIGHT SCREENING", "", "Nutrition/Weight Screening\n", "", "LOCAL\n", "", "\nThis topic represents the inquiry process done by a clinician to\nThe data collected in PCE reflecting activity related to the Weight and\nNutrition Screening reminder, or your local sites equivalent, will be used\nby the National Center for Health Promotion and Disease Prevention in\npreparation of an annual report to Congress.\n \nThis screening topic is considered the "minimum" requirement\nfor clinicians to reflect the clinical activity. If the clinician\nactually provides education, the appropriate Education topic should be\nrecorded, reflecting the education given.\ndetermine if the patient should receive Nutrition/Weight education. This\ntopic was created as an example of a screening topic that could be used on\nan EncounterForm, for check-off by the clinician.\n \nClinicians at sites will be required to document activity related to the\n"Weight and Nutrition Screening" PCE reminder, or your local sites\nequivalent. The "Weight and Nutrition Screening" reminder was defined by\nthe National Center for Health Promotion and Disease Prevention (NCHP).\n
\n\n", "", "\nThis standard is actually a guideline. Clinicians could use this\nExcessive weight may be a trigger for nutrition counseling.\nguideline as an example of the type of questions to ask the patient when\nthe clinician needs to determine whether the patient should receive\nNutrition/Weight education.\n \nAsk the patient to describe his or her usual dietary intake, eating\nhabits, and snacking patterns. Discuss the importance of restricting fat\n(particularly saturated fat) intake and the benefits of high fiber diets.\nFor those overweight, discuss the value of reduced caloric intake.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-SEAT BELT USE SCREENING", "", "Seat Belt Use Screening\n", "", "LOCAL\n", "", "\nThis topic represents the inquiry process done by a clinician to determine\nThe data collected in PCE reflecting activity related to the Sealtbelt and\nAccident Screening reminder, or your local sites equivalent, will be\nused by the National Center for Health Promotion and Disease Prevention\nin preparation of an annual report to Congress.\n \nThis screening topic is considered the "minimum" requirement for\nclinicians to reflect the clinical activity. If the clinician actually\nprovides education, the appropriate Education topic should be recorded,\nreflecting the education given.\n \nif the patient should receive Seat Belt Use education. This topic was\nThe goal of this screening is to identify whether the patient needs\neducation for seatbelt use and accident avoidance.\ncreated as an example of a screening topic that could be used on an\nEncounter Form, for check-off by the clinician.\n \nClinicians at sites will be required to document activity related the\n"Seatbelt and Accident Screening" PCE reminder, or your local sites\nequivalent. The "Seatbelt and Accident Screening" reminder was defined\nby the National Center for Health Promotion and Disease Prevention (NCHP).\n
\n\n", "", "\nThis standard is actually a guideline. Clinicians could use this\nguideline as an example of the type of questions to ask the patient when\nthe clinician needs to determine whether the patient should receive\nSeatbelt Use education.\n \nAsk the patient if he or she usually use a seatbelt when driving or riding\nin an automobile, and if he or she usually wears a helmet when bicycling\nor riding a motorcycle. Provide education as appropriate.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-TOBACCO USE SCREENING", "", "Tobacco Use Screening\n", "", "LOCAL\n", "", "\nThis topic represents the inquiry process done by a clinician to determine\nreflecting activity related to the Tobacco Use Screening reminder, or your\nlocal sites equivalent, will be used by the National Center for Health\nPromotion and Disease Prevention in preparation of an annual report to\nCongress.\n \nThis screening topic is considered the "minimum" requirement for\nclinicians to reflect the clinical activity. If the clinician actually\nprovides education, the appropriate Education topic should be recorded,\nreflecting the education given.\nif the patient should receive Tobacco Use education. This topic was\ncreated as an example of a screening topic that could be used on an\nEncounter Form, for check-off by the clinician. \n \nClinicians at sites will be required to document activity related to the\n"Tobacco Use Screening" PCE reminder, or your local sites equivalent. The\n"Tobacco Use Screening" reminder was defined by the National Center for\nHealth Promotion and Disease Prevention (NCHP). The data collected in PCE\n
\n\n", "", "\nThis standard is actually a guideline. Clinicians could use this\nguideline as an example of the type of questions to ask the patient when\nthe clinician needs to determine whether the patient should receive\nTobacco Use (Smoking) education.\n \nAsk the patient if he or she currently smokes cigarettes or chews tobacco\non a regular basis. If not, ask if he or she ever did and how many years\nsince the person has used tobacco regularly. Current use of tobacco may\nbe a trigger for tobacco use education.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-HTN EXERCISE", "", "Exercise Education for HTN\n", "", "LOCAL\n", "", "\nThe patient will understand the importance and the role of exercise in\nthe control of hypertension.\n
\n\n", "", "\nExercise is an useful intervention for the improvement in BP control. The\ntarget for aerobic exercise should be 30 to 45 minutes per session, three\nto five times per week if possible.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-HTN NUTRITION EDUCATION", "", "Nutrition Education for HTN\n", "", "LOCAL\n", "", "\nThe patient will understand the lifestyle modifications that may help\nimprove blood pressure control including weight loss, decreased sodium\nintake, and a heart healthy diet.\n
\n\n", "", "\nPatients with HTN should receive counseling on the following nutritional\n100-proof whiskey) per day for men or 0.5 ounces of alcohol per day for\nwomen and for lighter weight men.\n \n3. SODIUM INTAKE: Sodium intake in the patient with HTN should be\nlimited to no more than 100 mmol/day (2.4 g of sodium or 6 g of sodium\nchloride).\n \n4. DIET: An adequate dietary intake of potassium, calcium, and\nmagnesium can be obtained from fresh fruits and vegetables. Other dietary\nadvice should include a heart-healthy diet such as the DASH Diet. This is\nmodifications:\none means of satisfying the dietary steps above. See the DASH Diet table\nbelow.\n \n5. HYPERLIPIDEMIA: Counsel to reduce intake of dietary saturated\nfats and cholesterol. A diet rich in fresh fruits and vegetables as well\nas low in dietary saturated fats and cholesterol is also beneficial in\nlowering blood pressure.\n \n1. WEIGHT REDUCTION: Overweight patients should reduce their weight\nto within 10 percent of their ideal body weight. However, reduction even\nof 5 to 10 pounds can be helpful in controlling HTN.\n \n2. ALCOHOL INTAKE: Alcohol intake should be limited to no more than\none ounce (24 ounces of beer; or 10 ounces of wine; or 2 ounces of\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-HTN MEDICATION ADHERENCE", "", "HTN Medication Adherence\n", "", "LOCAL\n", "", "\nThe patient will understand the role and importance of medications in the\ncontrol of BP and will understand the importance of taking these\nmedications on a regular basis.\n
\n\n", "", "", "", "", "", "", "", "", "", "", ""], ["VA-HOME TELEHEALTH-IN HOME MONITORING", "", "Home Telehealth-In Home Monitoring\n", "", "LOCAL\n", "", "\nVeteran receives care coordination and daily monitoring via an in-home \nmessaging/monitoring device of his/her chronic disease(s) by a Care\nCoordinator.\n
\n\n", "", "\n1. The Care Coordinator monitors measurements and/or individual \n \n4. Veteran and/or caregiver understand proper setup and procedure\n for in-home monitoring.\n \n5. Veteran and/or caregiver understand the confidentiality of \n health information.\n \n6. Veteran and/or caregiver understand that he/she must follow \n his/her normal emergency plan for any emergency. \n \n responses to questions directly related to the Veteran's chronic\n7. Veteran and/or caregiver understand that his/her in home\n messaging/monitoring device is not a 911 or emergency device.\n \n8. Veteran and/or caregiver understand how to contact Home Telehealth\n staff for any questions, problems with equipment, or concerns.\n disease(s).\n \n2. The Care Coordinator responds/intervenes timely to alerts \n indicating need.\n \n3. The Care Coordinator updates the Veteran's provider routinely and\n as needed.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-HOME TELEHEALTH-CAREGIVER EDUCATION/SUPPORT", "", "Home Telehealth-Caregiver Education/Support\n", "", "LOCAL\n", "", "\nThe Non-Paid Caregiver will receive both the education (via the in \nhome messaging device, telemonitor, videophone or telephone) as well\nas the support necessary to enhance the care provided to the Veteran.\n
\n\n", "", "\n1. The Care Coordinator will assign the appropriate DMP to help\n educate the caregiver on the disease process of the Veteran.\n \n2. The Care Coordinator will help coordinate the appropriate \n resources to support the caregiver.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-SUBSTANCE ABUSE LIFESTYLE ADAPTATIONS", "", "Subs. Abuse Lifestyle Adapt.\n", "", "LOCAL\n", "", "\nThe patient and family will recognize chemical dependency as a primary,\nchronic, and arrestable disease.\n
\n\n", "", "\n1. Discuss the patient's use/abuse of chemicals. Identify the drug of\nrequest help. This requirement must be met before deciding on a \ntreatment plan.\n \n5. Review treatment options available at the VA and in the community.\n \n6. Discuss the power of addiction and the need to utilize family and\ncommunity resources to help control this addiction.\nchoice.\n \n2. Discuss the attitudes towards their dependency, specifically\naddressing denial issues.\n \n3. Assess the patient's motivation for change vs. the level of denial.\n \n4. Explain that both patient and family need to acknowledge, admit and\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-HOME TELEHEALTH-MEDICATION MANAGEMENT", "", "Home Telehealth-Medication Management\n", "", "LOCAL\n", "", "\nVeteran has provided the VA with a complete list of Non VA medications \nand OTC drugs & supplements.\n \nThe Veteran understands his/her VA prescribed medications and takes \nhis/her medications as prescribed.\n
\n\n", "", "\n1. The Care Coordinator reviews all medications upon enrollment \n have about his/her medication.\n into the HT program and at regular intervals throughout the\n Veteran's active enrollment.\n \n2. The Care Coordinator reports any discrepancies to the Veteran's\n provider for reconciliation.\n \n3. The Care Coordinator routinely educates Veteran on his/her \n medications and responds timely to any question the Veteran may \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-HOME TELEHEALTH-DISEASE MGMT/PATIENT SELF-MGMT", "", "Home Telehealth-Disease Mgmt/Patient Self-Mgmt\n", "", "LOCAL\n", "", "\nThe Veteran, upon enrollment, will be assigned the appropriate \nDisease Management Protocol (DMP) that will enhance the Veteran's \nability to self manage his/her chronic disease process.\n
\n\n", "", "\n1. The Care Coordinator will assign a Disease Management Protocol\n (DMP) appropriate for the veteran upon enrollment.\n \n2. The Care Coordinator will monitor the Veteran's responses to the\n DMP questions to provide interventions when necessary.\n \n3. Interventions are designed to enhance the Veteran's ability to \n self manage his/her disease process.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-ECOE SEIZURE PRECAUTIONS", "", "VA-ECOE SEIZURE PRECAUTIONS\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ECOE DRIVING", "", "VA-ECOE DRIVING\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ECOE AED SIDE EFFECTS", "", "VA-ECOE AED SIDE EFFECTS\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ECOE TREATMENT COMPLIANCE", "", "VA-ECOE TREATMENT COMPLIANCE\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ECOE CONTRACEPTION", "", "VA-ECOE CONTRACEPTION\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ECOE BONE HEALTH", "", "VA-ECOE BONE HEALTH\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ECOE SAFETY", "", "VA-ECOE SAFETY\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ECOE MH", "", "VA-ECOE MH\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-SUBSTANCE ABUSE DISEASE PROCESS", "", "Subs. Abuse Disease Process\n", "", "LOCAL\n", "", "\nThe patient and family will recognize the disease process of chemical\ndependency and define motivation for change.\n
\n\n", "", "\n1. Review the current factual information i.e., the patient's specific\n4. Discuss a plan of care that will achieve the goal of sobriety and freedom\nfrom use of mood altering chemicals. Patient can be offered rehabilitation\nassistance but must prove an interest by attendance and follow-up with groups\nas an outpatient.\nchemical dependency.\n \n2. Provide the patient with an opportunity for discussion and referral for the\npurpose of acknowledging and understanding the diagnosis of chemical\ndependency.\n \n3. Explain co-dependency to patient and spouse or significant other.\n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-ECOE SUICIDE IDEATION", "", "VA-ECOE SUICIDE IDEATION\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ECOE SUDEP", "", "VA-ECOE SUDEP\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ECOE EPILEPSY RESOURCES", "", "VA-ECOE EPILEPSY RESOURCES\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ECOE OTHER TOPIC", "", "VA-ECOE OTHER TOPIC\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ADVANCE DIRECTIVES", "", "Advance Directives\n", "\n- \n\n
\n", "LOCAL\n", "", "\nThe patient and family will identify the implications of advance\ndirectives.\n
\n\n", "", "\n1. Explain what an advance directives is.\n5. Identify a social worker to contact for further information as appropriate.\n \n2. Explain the difference between advance directives and a living will.\n \n3. Discuss how a living will is made.\n \n4. Explain what a durable power of attorney for health care is and how to\nassign someone to have this power.\n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-ALCOHOL ABUSE", "", "Alcohol Abuse\n", "\n- \n\n
\n", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ECOE PREGNANCY", "", "VA-ECOE PREGNANCY\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-ALCOHOL ABUSE LIFESTYLE ADAPTATIONS", "", "Alcohol Abuse Lifestle Adapt.\n", "", "LOCAL\n", "", "\nThe patient and family will recognize and accept alcohol dependency as a\nprimary, chronic, and arrestable disease.\n
\n\n", "", "\n1. Discuss the patient's use/abuse of alcohol. Identify the alcohol of \nrequest help. This requirement must be met before deciding on a \ntreatment plan.\n \n5. Review treatment options available at the VA and in the community.\n \n6. Discuss the power of addiction and the need to utilize family and\ncommunity resources to help control this addiction.\nchoice.\n \n2. Discuss the attitudes towards their dependency, specifically\naddressing denial issues.\n \n3. Assess the patient's motivation for change vs. the level of denial.\n \n4. Explain that both patient and family need to acknowledge, admit and\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-SEAT BELT USE", "", "Seat Belt Use\n", "", "LOCAL\n", "", "\nThe patient will be able to identify the benefits of using and the risks of not\nusing seat belts.\n\n
\n\n", "", "\n1. Discuss the regular use of seat belts and children's car seats, obeying the\nspeed limit, and avoiding the use of alcohol while in a vehicle.\n \n2. Discuss the proper application of seat belts on adults and children.\n \n3. Discuss the current legal implications of not using seat belts.\n\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-ALCOHOL ABUSE DISEASE PROCESS", "", "Alcohol Abuse Disease Process\n", "", "LOCAL\n", "", "\nThe patient and family will recognize the disease process of alcohol\ndependency and define motivation for change.\n
\n\n", "", "\n1. Review the current factual information i.e., the patient's specific\n4. Discuss a plan of care that will achieve the goal of sobriety and freedom\nfrom use of mood altering chemicals. Patient can be offered rehabilitation\nassistance but must prove an interest by attendance and follow-up with groups\nas an outpatient.\nalcohol dependency.\n \n2. Provide the patient with an opportunity for discussion and referral for the\npurpose of acknowledging and understanding the diagnosis of alcohol\ndependency.\n \n3. Explain co-dependency to patient and spouse or significant other.\n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-ALCOHOL ABUSE COMPLICATIONS", "", "Alcohol Abuse Complications\n", "", "LOCAL\n", "", "\nThe patient and family will explain how to avoid the complications of\nalcohol dependency and slow the progression of the diesease by compliance\nwith a prescribed daily program.\n
\n\n", "", "\n1. Review the effects that the alcohol has on the body. \nEmphasize the long term effects of the patients continued use of alcohol.\n \n2. Discuss the symptoms indicative of progression of disease.\n \n3. Review the effects of alcohol dependency on all family members.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-ALCOHOL ABUSE DIET", "", "Alcohol Abuse Diet\n", "", "LOCAL\n", "", "\nThe patient and family will identify the importance of a nutritionally\nbalanced diet in relationship to recovery from alcohol dependency.\nPatients will strive to acquire and maintain a safe weight level.\n
\n\n", "", "\n1. Assess the patient's current nutritional habits. Review how these habits\n \n4. Emphasize the necessary component -WATER- in a healty diet. Reduce the\nuse of colas and coffee.\n \n5. Review the symptoms of hypoglycemia and dietary prevention.\nmight be improved.\n \n2. Discuss the importance of the four food groups, regular eating habits,\nand the possible need to increase carbohydrates.\n \n3. Emphasize the importance of limiting snack foods, fatty foods, red meats,\nreducing sodium consumption and adding more fresh fruits, fresh vegetables and\nfiber to the diet.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-ALCOHOL ABUSE EXERCISE", "", "Alcohol Abuse Exercise\n", "", "LOCAL\n", "", "\nThe patient and family will identify the role of an exercise program as\npart of rehabilitation and maintenance of sobriety.\n
\n\n", "", "\n1. Review the benefits of regular exercise i.e. reduced stress, weight\ncontrol, increased self-esteem, and overall sense of wellness.\n \n2. Refer to EXERCISE education protocol.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-ALCOHOL ABUSE MEDICATIONS", "", "Alcohol Abuse Medications\n", "", "LOCAL\n", "", "\nIf applicable, the patient and family will recognize the importance of\ncomplying with a prescribed medication regimen.\n
\n\n", "", "\n1. Review the mechanism of action of the prescribed medication.\n \n2. Discuss the side effects of prescribed medications.\n \n3. Emphasize the importance of not self-medicating for any purpose.\n \n4. Review OTC medications (e.g., cough syrup) that contain ETOH/drug additives\nand the signs/symptoms of innocent ingestion.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-ALCOHOL ABUSE FOLLOW-UP", "", "Alcohol Abuse Follow-up\n", "", "LOCAL\n", "", "\nThe patient and family will explain how participation in a support program\nmay prevent relapse.\n
\n\n", "", "\n1. Discuss the philosophy of AA, ALANON, and related groups.\n \n2. Review the nature of alcohol dependency as a primary, chronic, and\narrestable disease.\n \n3. Review the treatment and support options available to the patient and\nfamily.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-CATHETER CARE", "", "Catheter Care\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-DIABETES DISEASE PROCESS", "", "Diabetes Disease Process\n", "", "LOCAL\n", "", "\nThe patient will describe the diabetic disease process.\n
\n\n", "", "\n1. Explain how the body uses glucose as a fuel and the function of insulin in\n4. Assist the patient in understanding that diabetes is a lifelong condition\nthat can be controlled, not cured, although they may be in total remission with\nweight loss. Stress the importance of lifetime follow-up.\nconverting glucose into units of energy. Explain how hyperglycemia results\nfrom increased demand on the pancreas to produce insulin.\n \n2. Explain the role of obesity in Diabetes Mellitus and insulin resistance.\n \n3. Explain how high levels of freely circulating glucose damage blood vessels\nand highly vascular organs.\n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-DIABETES COMPLICATIONS", "", "Diabetes Complications\n", "", "LOCAL\n", "", "\nThe patient will identify the complications resulting from untreated or\ninadequately treated diabetes.\n
\n\n", "", "\n1. CIRCULATORY: Explain that uncontrolled hyperglycemia increases\n3. NEUROLOGICAL: Explain how uncontrolled hyperglycemia causes a\nthickening of the capillary membranes resulting in reduced sensation. Loss\nof sensation complicates lower limb injuries by removing normal pain\nresponses and protective reactions. Amputation may result from limb\ninjuries.\n \n4. IMMUNOLOGICAL: Explain how poor circulatory perfusion, reduced sensation\nand hyperglycemia decrease the body's ability to fight off infection that may\nresult in amputation.\n \natherosclerosis and arteriosclerosis which results in decreased circulation and\n5. ENDOCRINE: Explain how poorly controlled glucose levels may lead to\nDiabetic Ketoacidosis or hyperglycemia, the symptoms of each complication, and\nhow to prevent and treat.\n \n6. Emphasize the need for continuous diabetic surveillance to lessen and\npossibly avoid complications.\norgan perfusion. Long term impairment of the circulatory system can lead to\namputation, blindness, kidney failure, stroke, and myocardial infarcation.\n \n2. RENAL: Explain how poor perfusion of the kidneys and the increased\nworkload required to diurese large amounts of glucose and protein results in\neventual kidney failure.\n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-DIABETES EXERCISE", "", "Diabetes Exercise\n", "", "LOCAL\n", "", "\nThe patient will describe the relationship of exercise in maintaining an\nideal body weight and will strive to increase weekly exercise by an agreed\nupon amount.\n
\n\n", "", "\n1. Stress the fact that exercise is a must in any weight/loss maintenance\n3. Discuss the positive effect of exercise on metabolism and the utilization\nof carbohydrates.\n \n4. If using insulin, review the symptoms of hypoglycemia and how to treat a\nhypolglycemic reaction.\n \n5. Review the exercise programs available in the community.\nprogram.\n \n2. Review the basic recommendations of any exercise program:\n a. If any diabetic complications exist, consult with provider.\n b. Start out slow.\n c. Exercise for 20 minutes a minimum of three times a week, which\nwould include brisk walking, aerobic exercises.\n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-DIABETES MEDICATIONS", "", "Diabetes Medications\n", "", "LOCAL\n", "", "\nThe patient will recognize the importance medication compliance plays in\ncontrolling diabetes and its complications.\n
\n\n", "", "\n1. Review the two types of diabetes medications. Explain their indication,\nmechanism of action, and possible side effects.\n \n2. Review the symptoms of hypoglycemia and how to treat a hypoglycemic\nreaction.\n \n3. If using insulin, demonstrate the proper way to prepare and administer an\ninsulin injection and how to perform a finger stick to check glucose level\nusing a glucometer. Have patient return demonstration.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-DIABETES FOLLOW-UP", "", "Diabetes Follow-up\n", "", "LOCAL\n", "", "\nThe patient will describe the importance of keeping appointments.\n
\n\n", "", "\n1. Stress the individual's responsibility in controlling diabetes.\n \n2. Review the treatment plan with the patient.\n \n3. Encourage patient to seek medical care for any unusual or abnormal\ncondition e.g., foot ulcers, slow healing wounds, prolonged illness.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-DIABETES FOOT CARE", "", "Diabetes Foot Care\n", "", "LOCAL\n", "", "\nThe patient will recognize the importance of daily foot care in preventing\ncomplications.\n
\n\n", "", "\n1. Explain the importance of daily foot checks. Explain that loss of\n3. Emphasize the use of clean, non-restrictive socks/stockings and\nwell-fitting shoes.\n \n4. Stress the importance of immediate follow-up of any foot injuries or\nulcers. The patient should be non-weight bearing, whenever there are lesions on\nthe foot, to prevent further cellular damage.\nsensation leads to callouses. Callouses break down, ulcers result which,\nunchecked, may lead to gangrene and amputation.\n \n2. Stress the importance of daily foot hygiene. Warm (NOT HOT) bathing of the\nfeet, complete drying, and thorough inspection for changes in the condition of\nthe skin constitute daily foot care. Demonstrate how to do a thorough foot\ncheck.\n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-DIABETES", "", "Diabetes\n", "\n- \n\n
\n", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-DIABETES LIFESTYLE ADAPTATIONS", "", "Diabetes Lifestyle Adaptations\n", "", "LOCAL\n", "", "\nThe patient will identify the lifestyle adaptations that are necessary to\nreduce the effects of diabetes.\n
\n\n", "", "\n1. Review necessary modifications in diet, exercise, weight control, daily\nStress the individual's responsibility in controlling diabetes.\nmedication regimen, health surveillance, and an awareness for prompt follow-up\nof illness and infection using the diabetic protocols for diet, exercise,\nfollow-up, and medications.\n \n2. Discuss the methods of blood glucose control-weight control, oral\nhypoglycemics, and insulin.\n \n3. Assess the patients's lifestyle and review areas needing improvement. \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-DIABETES DIET", "", "Diabetes Diet\n", "", "LOCAL\n", "", "\nThe patient will recognize that diet and weight control are the foundation\nof diabetic management.\n
\n\n", "", "\n1. Explain the importance of weight loss in the control of diabetes and\n4. Discuss the importance of the nutritional pyramid.\n \n5. Emphasize the importance of limiting snack foods, fatty foods, red meats,\nreducing sodium consumption, and adding more fresh fruits, fresh vegetables,\nand fiber to the diet.\n \n6. Emphasize the necessary component -WATER- in a healty diet. Reduce the use\nof colas, coffee, and alcohol.\n \n7. Assess the patient's current nutritional habits and review which\ninsulin requirements.\nimprovements can be made.\n \n8. Review which VA and community resources exist to assist with diet\nmodification and weight control.\n \n2. Explain the role of diet in the control of diabetes. Review how food is\nconverted to sugar and the role of insulin in utilizing these sugars.\n \n3. Discuss the importance of eliminating "simple sugars" from the diabetic\ndiet.\n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-EXERCISE", "", "Exercise\n", "", "LOCAL\n", "", "\nThe patient will relate exercise and or physical fitness to health promotion\nand disease prevention.\n
\n\n", "", "\n1. Review the benefits of regular exercise.\n4. Review the exercise programs available in the community/VA resources.\n \n2. Discuss the three types of exercise: aerobic, flexibility, and endurance.\n \n3. Review the basic recommendations for any exercise program:\n a. If any chronic health problems exist, consult with provider.\n b. Start out slow.\n c. Exercise a minimum of three times a week.\n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-HIV TRANSMISSION", "", "HIV Transmission\n", "", "LOCAL\n", "", "\nThe patient will describe what the HIV virus is and how it is transmitted.\n
\n\n", "", "\n1. Explain what the human immunodeficiency virus (HIV) is and how it is\n5. Explain that HIV is not transmitted via casual contact.\nrelated to AIDS.\n \n2. Discuss the ways that HIV is transmitted via blood and sexual contact.\n \n3. Explain how to clean shared needles.\n \n4. Describe safe sex and safer sex.\n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-IMMUNIZATIONS", "", "Immunizations\n", "", "LOCAL\n", "", "\nThe patient will recognize the importance of routine immunizations.\n
\n\n", "", "\n1. Review the recommended schedule for tetanus, pneumovax, and influenza\nimmunizations.\n \n2. Discuss the implications of not receiving the immunizations according to\nschedule.\n \n3. Review VA and community resources available outside of the current\nfacility to obtain immunizations.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-MEDICATIONS", "", "Medications\n", "", "LOCAL\n", "", "\nThe patient will recognize accurate information about prescribed\nmedications.\n
\n\n", "", "\n1. Discuss the following information for each prescribed medication:\n \n4. Explain special precautions such as drug/food interactions. \n a. Name, generic or trade name\n b. Amount to take\n c. Route of administration\n d. Medication schedule\n \n2. Explain the purpose and effect of the prescribed medication.\n \n3. Explain common side-effects of medication.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-SAFETY/HOME/FALLS", "", "Safety/Home/Falls\n", "", "LOCAL\n", "", "\nThe patient will be able to identify ways to reduce accident risk.\n
\n\n", "", "\n1. Discuss the safe use of medications. All medications should be stored in\n4. Review the proper procedure for getting up out of chairs and beds using\nsturdy hand supports: railing, walkers.\n \n5. Discuss the extra precaution necessary when rising after taking certain\nmedications.\n \n6. Discuss the steps to take when feeling lightheaded.\n \n7. Discuss the importance of using non-slip rugs, illuminating steps, and\nproper lighting.\na safe place, in their original containers.\n \n8. Review and evaluate household risk regarding showers, bathtubs, etc.\n \n9. Evaluate support systems available for assistance and emergencies,\nincluding household members, etc.\n \n2. Review the safe use of electricity and gas.\n \n3. Identify which community resources promote safety and accident prevention. \nProvide information regarding key contacts for accidents/emergencies, e.g. 911,\nPoison Control, hospital ER.\n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-SELF BREAST EXAM", "", "Self Breast Exam\n", "", "LOCAL\n", "", "\nThe patient will recognize the importance of monthly breast\nself-examination.\n
\n\n", "", "\n1. Discuss breast anatomy and the normal changes that occurs with\n4. Discuss indications for mammography. Patients who have first degree\nrelatives (mother, sister, or daughter) with breast cancer are encouraged to\nhave baseline and follow-up mammograms.\nmenstruation and aging.\n \n2. Emphasize the importance of monthly examination in early detection of\nbreast cancer. Survival rates are markedly higher when cancer is detected and\ntreated early.\n \n3. Teach breast self-exam. Have the patient give a return demonstration.\n \n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-SMOKING CESSATION", "", "Smoking Cessation\n", "", "LOCAL\n", "", "\nThe patient and family will recognize the disease processes involved as a\nresult of smoking and identify the need for change to quit smoking.\n
\n\n", "", "\n1. Review the effects that smoking has on the body, emphasizing the long term\nreferral.\n \n5. Provide information on VA and community resources available for support\ngroups.\neffects of continued use.\n \n2. Discuss the benefits of smoking cessation.\n \n3. Disucss alternative ways to smoking cessation.\n \n4. Discuss the power of addiction and the need to utilize family and community\nresources to help control this addiction. Offer smoking cessation clinic\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-HOME TELEHEALTH (HT)", "", "Home Telehealth (Ht)\n", "\n- \n\n
\n", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-SUNSCREEN", "", "Sunscreen\n", "", "LOCAL\n", "", "\nThe patient will recognize the effects of prolonged sun exposure on the\nskin.\n
\n\n", "", "\n1. Explain how prolonged sun exposure, especially between the hours of 10AM\nfor prolonged exposure.\n \n5. Discuss the use of long sleeved shirts and using wide brimmed hats for\nscalp and face protection.\nand 2PM, damages the skin.\n \n2. Discuss the appearance of sun damaged skin.\n \n3. Explain the importance of consulting a provider for skin lesions that are\nnew, changing in appearance, painful, or not healing.\n \n4. Discuss the use of sunscreen before going outside and repeated applications\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-NUTRITION/OBESITY", "", "Nutrition/Obesity Education\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-TDI EDUCATION", "", "Teledermatology Education\n", "", "LOCAL\n", "", "", "", "", "", "", "", "", "", "", "", "", ""], ["VA-SUBSTANCE ABUSE COMPLICATIONS", "", "Substance Abuse Complications\n", "", "LOCAL\n", "", "\nThe patient and family will explain how to avoid the complications of\nchemical dependency and slow the progression of the disease by compliance\nwith a prescribed daily program.\n
\n\n", "", "\n1. Review the effects that the different chemicals have on the body. \nEmphasize the long term effects of the patients continued use of the\npatients specific dependency.\n \n2. Discuss the symptoms indicative of progression of disease.\n \n3. Review the effects of chemical dependency on all family members.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-SUBSTANCE ABUSE DIET", "", "Substance Abuse Diet\n", "", "LOCAL\n", "", "\nThe patient and family will identify the importance of a nutritionally\nbalanced diet in relationship to recovery from chemical dependency.\nPatients will strive to acquire and maintain a safe weight level.\n
\n\n", "", "\n1. Assess the patient's current nutritional habits. Review how these habits\n \n4. Emphasize the necessary component -WATER- in a healty diet. Reduce the\nuse of colas and coffee.\n \n5. Review the symptoms of hypoglycemia and dietary prevention.\nmight be improved.\n \n2. Discuss the importance of the four food groups, regular eating habits,\nand the possible need to increase carbohydrates.\n \n3. Emphasize the importance of limiting snack foods, fatty foods, red meats,\nreducing sodium consumption and adding more fresh fruits, fresh vegetables and\nfiber to the diet.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-SUBSTANCE ABUSE EXERCISE", "", "Substance Abuse Exercise\n", "", "LOCAL\n", "", "\nThe patient and family will identify the role of an exercise program as\npart of rehabilitation and maintenance of sobriety.\n
\n\n", "", "\n1. Review the benefits of regular exercise i.e. reduced stress, weight\ncontrol, increased self-esteem, and overall sense of wellness.\n \n2. Refer to EXERCISE education protocol.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["ALCOHOL USE AND MEDICAL PROBLEMS", "", "Medical Problems of Alcohol\n", "", "LOCAL\n", "", "\nThe patient will understand the medical consequences of alcohol\nconsumption.\n
\n\n", "", "\nThe medical risks of alcohol consumption will be reviewed with the\n8. psychiatric disease/depression\npatient including:\n1. liver disease and cirrhosis\n2. congestive heart failure\n3. seizures\n4. interaction with medications\n5. falls\n6. hypertension\n7. diabetes and poor glucose control\n
\n\n", "", "", "", "", "", "", "", "", ""], ["MEDICAL PROBLEMS OF ALCOHOL (SCREENING)", "", "Medical Problems of Alcohol\n", "", "LOCAL\n", "", "\nEducation done during screening - educate the patient on the medical \nproblems of alcohol.\n
\n\n", "", "", "", "", "", "", "", "", "", "", ""], ["VA-SUBSTANCE ABUSE MEDICATIONS", "", "Substance Abuse Medications\n", "", "LOCAL\n", "", "\nIf applicable, the patient and family will recognize the importance of\ncomplying with a prescribed medication regimen.\n
\n\n", "", "\n1. Review the mechanism of action of the prescribed medication.\n \n2. Discuss the side effects of prescribed medications.\n \n3. Emphasize the importance of not self-medicating for any purpose.\n \n4. Review OTC medications (e.g., cough syrup) that contain ETOH/drug additives\nand the signs/symptoms of innocent ingestion.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-SUBSTANCE ABUSE FOLLOW-UP", "", "Substance Abuse Follow-up\n", "", "LOCAL\n", "", "\nThe patient and family will explain how participation in a support program\nmay prevent relapse.\n
\n\n", "", "\n1. Discuss the philosophy of AA, ALANON, and related groups.\n \n2. Review the nature of chemical dependency as a primary, chronic, and\narrestable disease.\n \n3. Review the treatment and support options available to the patient and\nfamily.\n
\n\n", "", "", "", "", "", "", "", "", ""], ["VA-ADVANCE DIRECTIVES SCREENING", "", "Advance Directives Screening\n", "", "LOCAL\n", "", "\nThis topic represents the inquiry process done by a clinician to\ndetermine if the patient should receive Advance Directives education.\n \nThis topic was created as an example of a screening topic that could be\nused on an Encounter Form, for check-off by the clinician.\n
\n\n", "", "\nThis standard is actually a guideline. Clinicians could use this\nguideline as an example of the type of questions to ask the patient when\nthe clinician needs to determine whether the patient should receive\nAdvance Directives education.\n \nAsk the patient if he or she has ever discussed his or her wishes\nconcerning aggressive medical care during the end of life or a persistent\nvegetative state, and if these discussions have even been made formal in\nany signed document.\n
\n\n", "", "", "", "", "", "", "", "", ""]]}