GERIATRIC NURSING

miércoles, 1 de mayo de 2013

GERIATRIC RESOURCES. LEVELS OF CARE

Introduction:

For proper health care, a need for adequate coordination of the different stakeholders involved.

- Primary care

- General Hospital

- Geriatrics unit

Primary care:

Develops activities of health promotion and preventive, or rehabilitative. It should work with other professionals integrated.

Function:

- health promotion

- health state valuation

- preventive activities

- early detection and assistance, especially potentially disabling process.

- tracking task

- palliatives care

Health education about the patient (healthy, sick and fragile):

1. Nursing care realization

2. identification of signs and symptoms

3. meet the needs

4. achieve less dependence on environment

5. address deficiencies valuation

Health education:

- food and nutrition

- general body grooming

- specific hygienic measures

- exercise age-appropriate physical

- toxic habits

- self-medication

- prevention of accidents and falls

- skin protection

- Cornish pathologies

General hospital:

Entry by an ailment. hospitalization units at home, dependent the hospital and have the task of continuing hospital care in the community

Nursing care:

- nursing care

- making constant

- cures

- sampling

- hygiene / demonstrations

- respiratory physiotherapy

- oxygen

- catheterization, nasogastric

- injectable

Specialized care

Geriatric services are interdisciplinary units to serve geriatric patients, in addition to providing support to primary care and play activities of teaching.

Acute geriatric unit is intended to income for valuation comprehensive geriatric patients or managing their acute or chronic pathologies.

The unit for chronic patients or nursing homes is destined to chronic impairment of functional capacity, and can not be kept at home by the care they need and means to deliver them.

Day centres interdisciplinary attention to fragile or geriatric patients, usually with physical disability, to receive comprehensive care and return home.

Personal reflection:

For proper health care is important to proper coordination.

Through teamwork, we can achieve strategies to address the problem in the best way and create different responses.

BIBLIOGRAPHY:

Treaty of geriatrics. Spanish Society of Geriatrics and Gerontology. http://www.imsersomayores.csic.es/documentos/documentos/segg-tratado-01.pdf.

PROMOTION HEALTH

Introduction:

The preservation of health and functional independence à most important aspects à health promotion in older aspects

Epidemiology:

- Hypertension

- Stroke

- Chronic lung disease

- Poliastroisis

- Insufficiency cardiac

- Ischemic heart disease

- Diabetes

- Senile dementia

- Depression and inflammatory rheumatism

Factors:

- organic

- environmental

- relations

Objectives:

- reduce mortality

- increase life expectancy

- improving the quality of life

- dependence

- disability

Dependency: functional consequences of disability with changes in activity, which causes difficulties in basic activities

Disability: partial or total decrease of the ability to perform an activity

Health promotion:

Blood pressure
Lipid control
Electrocardiogram
Bone densitometry
Fasting glucose: Annual
Mental state examination (Pfeifferm)
Examination mood
Measurement of TSH
Measurement of vitamin B12
Fecal Occult Blood
mammography
cytology smear
DRE and PSA determination
Study audiometric
Rating ophthalmological

Personal reflection:

Save geriatric patient health, proposing achievable goals.

Achieve increased quality of life and reduce dependence.

BIBLIOGRAPHY:

Hervas A., Arizcuren MA, Garcia de Jalon E, Tiberio G, Forcén T. Influence of socio-sanitary situation in cognitive status and mood in geriatric patients of a health center. Annals Sis San Navarra [serial on the Internet]. Aug 2003 [cited 2013 Apr 07], 26 (2): 211-223. Available at: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1137-66272003000300003&lng=es. http://dx.doi.org/10.4321/S1137-66272003000300003

PALLIATIVE CARE

Communication is an informative process that starts from a point of origin and arrives at a destination, irrespective of the channel or medium used.

Main fears:

▪ Death and à dying healthcare professionals and caregivers in psychological reactions that lead to the patient avoid communication terminal.

▪ Overcome à the anxiety generated disclose bad news, the fear of provoking and overreaction in sick, the fear of over identifying, fear of lack of response to questions from the patient.

Basic principles:

- speed adapted to the rate of uptake of each patient

- never tell the same session of the diagnosis, treatment and prognosis

- informing the client when the desired

- never remove the hope but also generate

Professional communication models:

- Technical: focus on à Health and disease à Ignore the psychosocial area

- Paternalistic: Intermediate between health and illness and psychosocial area

- Complacent: can not make therapeutic distance

- Deliberative: focus on à same level in health and disease in the psychosocial area.

Bad news:

Any information can drastically alter a patient's vision for the future, both in communicating the diagnosis of a disease considered deadly, as to report the failure of curative therapy.

- Chronic disease

- Neurodegenerative disease

- HIV

- Cancer

Terminal illness:

Present progressive, incurable advanced disease.

Objectives:

- attention sick integral

- symptom control

- emotional support for the family

Agony:

State that precedes death in situations that life gradually dies.

- Palliative sedation

- Sedation in agony

Stages of grief:

- negation

- ire/rage

- negotiation/pact

- depression

- acceptance

Personal reflection:

For the process of end of life, communication is very important with the patient.

Patient care in fundamental communicate bad news the best way possible and to do this in stages.

Always show our readiness for anything.

Take into account the patient's family.

BIBLIOGRAPHY:

Sociedad Española de Cuidados Paliativos. Guía de cuidados paliativos. SEPCAL

SciELO. "NEW PERSPECTIVES IN PALLIATIVE CARE." Leo Pessini * and Luciana. BERTACHINI. Acta Bioethica Interfaces 2006, 12 (2) Revised May 2012.

INCONTINENCE IN THE ELDERLY:

Introduction:

Incontinence: loss of urine involuntarily and objective, resulting in a time and place and inadequate in quantity or often enough to be a problem hygienic, social and psychic.

Types:

■ Acute, transient or reversible

■ Chronic:

▪ Stress or effort

▪ Emergency

▪ Overflow

▪ Functional

▪ Mixed

Nurse Valuation:

Anamnesis: individualized valuation at the time of occurrence of incontinence. Collect pharmacological history. Registration urination frequency.

Physical examination:

additional tests

Treatment:

General:

The nurse should assess and apply analytical and urine culture.

Correct precipitating factors favoring and incontinence

One should look for proper voiding habit

Constipation should be corrected

Residual urine <100 ml:

Pelvic floor exercises (Kegel) exercises to strengthen pelvic muscles. Recommended 3-4 batches, two or three times daily.

Residual urine> 100ml:

- Overflow: probe or reconstructive surgery

- Acontractile: modification techniques such as catheterization or incontinence pads.

Personal reflection:

The highest prevalence was found in the units where the stay is longer and especially in residential institutions. Pay more attention.

Know how to properly detect types of incontinence and the etiology for early treatment.

BIBLIOGRAPHY:

Dr. Pertusa Martinez. Servicios de Salud de medicina familiar y comunitaria. Incontinencia Urinaria en el Anciano. España. 2011. Revisado en: http://www.netdoctor.es/articulo/incontinencia-urinaria-ancianos

SPECIFIC GERIATRIC SYNDROME: IMMOBILITY

Introduction:

Mobility is essential to have autonomy, being an essential component in the life of man.

Factors:

- Skill and motor skills

- Cognitive and sensory-perceptual

- Health or confidence level

- External environmental and personal resources

Characterized:

- Marked reduction in exercise tolerance

- Progressive muscle weakness

- Loss of automatic and postural reflexes that enable ambulation

Epidemiology:

Inmobility increases with age. Half of wich are immobilized on die actuely 6 month.

Cause of immobility in the elderly:

- Physiological changes

- Recurrent disease (osteoarthritis, arthritis, osteoporosis, hip fracutras, Parkinson, visual deficit, depression, diabetes, anemia, cancer in terminal phase)

- Environmental causes

Valuation nurse:

- initial situation

- apparition form and degree of immobility

- history pharmacological

- Detect risk factors for immobility

- Analyze psychosocial factors

- Knowledge of social resources: OARS Scale

- Assess environmental conditions

Exploration:

- Postural changes and drives

- Examine the bed mobility, ability to turn and join the sitting position

- Evaluate the realization of transfers from bed to chair...

- Assess gait and balance

General care:

▪ Prevention of skin problems:

- Repositioning:

o Make changes carefully

o Divide your body weight in patients

o Lying make the change every 1-2 hours

- Hygiene

- Massage

- Padded

- Contribution of liquids

▪ Prevention of complications:

- Prevention of musculo-skeletal complications

- Prevention of cardiovascular

- Prevention of respiratory complications:

o The bedridden patient is advised to keep the head of the bed elevated.

o In uncooperative patients ket establish drainage postural

o The nurse can use the clapping, it only has effect on mucus organized mass

- Prevention of gastrointestinal complications

- Prevention of genitourinary complications

- Prevention of psychological problems

Progressive mobility:

- Bedridden patient

- Sitting on chair

- Standing

- Ambulation

- Maintenance

Technical Aids:

- Auxiliary elements for mobilization

o cane

o crutches

o walker

- Home adaptations

o Stairs

o Doors

o Furniture

o The height of the bed

People at risk for immobility syndrome:

▪ Elderly Sedentary: not incorporated in their everyday activity vigorous physical exercise

▪ Elderly fragile: has limited their extra activities, while maintaining an appropriate level for community

Personal reflection:

The mobility of the patients depends on themselves and the environment around them.

Explain to the patient that immobility anger increasing with age.

Encouragement always follows a healthy lifestyle, such as acute immobility can lead to death within six months.

Avoid potential complications of body systems

BIBLIOGRAPHY:

Doctor en Ciencias Médicas. Especialista de II Grado en Medicina Interna. Especialista de II Grado en Geriatría y Gerontología. Profesor Titular. Investigador Auxiliar. Hospital General Universitario “Dr. Gustavo Aldereguía Lima”. Cienfuego. 2010. Revisado en: http://www.insp.mx/geriatria/acervo/pdf/Romero%20cabrera.pdf

SPECIFIC GERIATRIC SYNDORME: DIGETIVE – ENDOCRINE DISEASES

Constipation:

Excessively dry bowel movement, rare or uncommon. Its more common in women with serious complications in the elderly.

Etiology:

- Mechanical: obstruction, neoplasms, hernias…

- Functional: diverticulitis, fissures, haemorrhoids…

- Pharmacological: laxatives, opiates…

- Metabolic and endocrine: diabetes, hypothyroidism, uremia…

- Neurological: injuries, central nervous system diseases…

Complications:

- Fecaloma

- Anal fissure

- Circulatory disturbances

- Fecal incontinence

Treatment:

The most recommended treatment to combat constipation is based on a high-fiber diet along with plenty of fluids and regular exercise, thus increasing fecal bulk and decreasing intestinal transit time.

It is also important to educate the patient to acquire the habit of defecating regularly.

Regular physical exercise individualized.

Ostomy:

Surgical creation of a temporary or permanent opening which lead outside the disgestive tract through the abdominal wall.

The old ostomy should follow some dietary recommendations to regulate intestinal transit and prevent both diarrhea and constipation and restore a good nutritional status.

▪ Sigmoid or transverse colostomies close to sigma, feeding it more next to normal.

▪ Right or transverse colectomy next to duodenum, avoid fats, exciting drinks, raw vegetables

Types:

- Sigmoid colostomy

- Transverse colostomy

- Ascending colostomy

- Ileostomy: liquid and continuous odor

Bags:

There are different types for the elderly ostomates.

Colostomy bag multipurpose adhesive closure and clear filter à Liquid or soft stools

Colostomy bag single use adhesive and transparent filter à Solid stool

Adhesive colostomy bag closing faucet, unfiltered and transparent à Very liquid stool

Colostomy bag ring plate and single-use filter opaque à solid stools

Fecal incontinence:

Its one of geriatric syndromes most affects the quality of life of the elderly because it is not part of normal aging. Deterioration personal and social relationships, of the patient.

Types of lower fecal incontinence:

- Soiling: dirty underwear

- Gas incontinence

- Defecatory urgency

- True to liquid stool incontinence

Types of major fecal incontinence:

- Pelvic floor injury

- Drugs: lexantes and antibiotics

- Complete rectal prolapsed

- Rectal cancer

- Neurological disorders: central, spinal or peripheral

- Myopathic diseases

- Systemic diseases

Nursing care:

- Lifestyle modifications: schedule bowel movements, increase fluid and fiber intake, physical exercise.

- Treatment of perianal discomfort: avoid soap, toilet pape. Wash with warm water and cotton.

- Treatment of fecal impaction: disimpaction manual or enemas

- Modification of architectural barriers

- Uses of absorbent

Dysphagia:

Difficulty swallowing or swallowing liquids elements and/or solids by affecting one or more phases of swallowing.

General measures of treatment:

- respect taste and experience new flavours

- presenting smaller amounts

- Do not mix liquid and solid

- Devise meals that can take with hands

- Avoid contact with the spoon

- Peacefully atmosphere

Personal reflection:

Once we have detected the etiology of the patient, we must follow up to avoid further complications.

Always inform the patient of the disease and geriatric treatment.

BIBLIOGRAPHY:

Gastrointestinal disorders in the geriatric patient. Gastroesophageal reflux disorders. Bowel disorders. Diagnostic evaluation and therapeutical attitude. C. Verdejo Bravo,M Montiel Carbajo. MC Sevilla Mantilla. A Ruiz de León San Juan.Medicine 2003 08:58

De la Llave B., Arriero Anes A. Manejo de estreñimiento en personas mayores. Boletin de enfermeria de atencion primaria. España. 2010. Revisado en: http://sescam.jccm.es/web1/gaptalavera/prof_enfermeria/boletines/boletin_enfermeria6_2008.pdf