Geriatric Resources. The levels of care

For proper health care to the elderly, it is essential to proper coordination of different stakeholders involved. This health care could be based on:

 

Primary Care. Also called health centers. One goal of these centers is to get the elderly to remain or be reinstated on the usual residence in adequate conditions of safety and security. Among the functions of the nurse in primary care include:

• Prevention activities.
• Detection frail elderly.
• Periodic examinations.
• Health education.
• Avoiding iatrogenic.
• Care of chronic diseases.
• Home care.
• Etc.

 

Acute Geriatric Unit. Intended level of geriatric hospitalization where a thorough assessment is performed, it is diagnosed and treated acute processes or flare of chronic conditions. In these units the nurse:

• Performs secondary and tertiary prevention.
• Nurse Care Process.
• Comprehensive care.
• Health education to patient and family or caregiver.
• Management indicated treatment.
• Hygiene.
• Prevention and care of pressure ulcers.
• Etc.

 

Median Unit Stay or convalescence. Level that hosts patients in subacute phase and whose pathologies are disabling but potentially reversible, they can not yet follow outpatient treatment. At this level the nurse:

• Secondary and tertiary preventive care.
• Continuing care: Patients come from the treble unit.
• Comprehensive care: Emphasis on functional care and social issues.
• Etc.

  

Long Stay Unit or residence. Hospital level for the attention of elderly patients with little or no chance of recovery and that require continuous care clinicians. Nursing in this case perfoms:

• All types of care.
• Food.
• Hygiene.
• Symptom control.
• Treatment delivery.
• Preventing falls.
• Preventing immobility.
• Quality control.
• Leisure activities.
• Etc.

 

Geriatric Day Hospital. Care Level daytime functioning without inpatient beds designed to complete clinical recovery, physical, mental and social elder, combining the advantages of hospitalization and stay at home. The nursing activities in these centers are:

• Healing of ulcers.
• Placement and probes changes.
• Metabolic controls.
• Group therapy.
• Control and monitoring of diseases.
• Etc.

 

 

 

Bibliography:

• Assists in Geriatrics Levels [Website *]. [Revised 15/05/2013, updated 10/05/2013]. Available at: www.segg.es/download.asp?file=/tratadogeriatria/PDF/S35-05%2006.

Health Education in the Geriatric Patient

The promotion of health are measures that promote an optimal state of physical, mental and social development in the population. These measures include actions in the field of health education, public health policy, disease treatment and preventive measures.

The goal of health promotion in the elderly population is to maintain the highest degree of autonomy and prevent the onset of disease. It sets a top priority to improve the quality of life by promoting behaviors that favor a style of living. However, in the elderly disease prevention has special features. In many cases the disease are already present and perhaps more important than the classic goals of reducing mortality and increasing life expectancy, are the goals of preventing and delaying functional decline, avoid dependency and maintain independence and quality of life .

 

Health education is a basic tool in promoting health and preventive action. Preventative measures are classified according to the disease stage where they develop:

• Primary Prevention. It occurs when we try to prevent the occurrence of disease through risk factors and promoting healthy lifestyles (promoting physical activity, changes in the home, abandoned toxic habits, etc.).
• Secondary Prevention. To try early detect and treat existing diseases but hitherto asymptomatic (controls blood glucose, blood pressure, lipids, etc.).
• Tertiary Prevention. To try to avoid sequels, exacerbations, relapses, and promote the rehabilitation and recovery of the same (drug treatment, rehabilitation, etc..).

 

 

In my opinion, in the elderly all types of prevention are important, although most measures will be included among the secondary prevention measures. This is due to meet existing injuries or diseases at an early stage and in an attempt to prevent its progression.

 

 

 

Bibliography:

• Wideman M.. Geriatric Care Management: Role, Need, and Benefits. Home Health Nurse; 2011.

Palliative Care

Palliative care is the attention, care and treatment, nurses and drug treatments given to patients in advanced and terminal illness in order to improve their quality of life and ensure that the patient is without pain. Palliative care doesn't anticipate or delay death but it is a real support system and integrated support for the patient and family.

 

The above paragraph I have just described is the theory, but in this blog I want off a bit of the protocol, theory and nursing procedures. I believe that if a subject has yet to be theoretical is more human than this.

 

As we have seen in the video, which for us are palliative care for the person is the last stage in this life. Therefore, if in all areas we must listen and treat them as humanely as possible, in this situation I think we should be even more so and we skip some protocol. In these final moments of the life of the person I think nothing better than to appeal to common sense and all naturally arises. With this, I mean to create a climate of trust, exchange of views, listen to the person and make him as comfortable as possible the last stage in this life. For this, we take care of all the details, both the patient and the family remaining in this life. At this stage nurses play a very important role because, as the video says, "the patient invites us to be your partner in this last stage of his life".

 

 

As reflected in the bibliography's article, I believe that whatever procedures are maintained and quality are good for the patient, but I think that, even if it means cutting corners and perform nursing procedures, what he really matter to the person is the humane treatment by the nurse at this stage of his life.

 

 

 

Bibliography:

• Scientific Electronic Library Online - SciELO. [Website *]. [Revised 14/05/2013, updated 09/05/2013]. Available at: http://scielo.isciii.es/scielo.php?pid=S1132-12962011000100015&script=sci_arttext

Geriatric Syndromes. Urinary Incontinence

Urinary incontinence is a geriatric syndrome that occurs when urine is lost involuntarily and objective, resulting in a time and place unsuitable and quantity or often enough to be a problem hygienic, social and psychic to the person suffering, as well as a possible limitation of their daily activities. There are several types of urinary incontinence: stress, functional, overflow, emergency, etc.

 

In this post, I will focus on stress urinary incontinence and, more specifically, I will give some tips to improve the quality of life of these people. This urinary incontinence occurs during physical activity like coughing, sneezing, laughing, or exercise. Then, I'm going to name a number of changes in behavior that a person with stress urinary incontinence should take to improve their quality of life:

 

• Drink less liquid (if you take more liquid than normal).
• Urinating more often to reduce the amount of urine escapes.
• Avoid jumping or running, which can cause greater leakage of urine.
• Ensure that more regular bowel movements taking dietary fiber or laxatives to prevent constipation (which can worsen incontinence).
• Quit smoking to reduce coughing and bladder irritation (and the risk of bladder cancer).
• Avoid alcohol and caffeine can stimulate the bladder.
• Lose weight if you are overweight.
• Avoid foods and drinks that irritate the bladder, like spicy foods, carbonated drinks and citrus.
• Keep blood sugar under control if you have diabetes.

 

I have chosen this disease because it is one of the most common in the geriatric spectrum, due to partial or total loss of systems such as neurological and musculoskeletal.

 

 

 

Bibliography:

• National Library of Medicine U.S. - MedlinePlus. [Website *]. [Revised 14/05/2013, updated 13/05/2013]. Available at: http://www.nlm.nih.gov/medlineplus/spanish/ency/article/000891.htm

Geriatric Syndromes. Constipation

Constipation is defined as excessively dry stool output, low (less than 50g/día) or infrequent (less than two bowel movements per week). This is most often caused by:

• .Low fiber diet
• Lack of physical activity.
• Not drinking enough water.
• Delay to go to the bathroom when you have the urge to defecate.
• Stress and travel can also contribute to constipation or other changes in bowel habits.

 

In this case, nursing through health education plays an important role. Then, I will show methods of prevention and treatment for constipation:

• Drink plenty of fluids each day (at least 8 glasses of water per day).
• Eating foods high in fiber (fruits, vegetables, legumes, etc..).
• Exercise regularly.
• Go to the bathroom when you have the urge and not wait.
• Administration of laxatives or enemas.

 

 

Bibliography:

• National Library of Medicine U.S. - MedlinePlus. [Website *]. [Revised 14/05/2013, updated 13/05/2013]. Available at: http://www.nlm.nih.gov/medlineplus/spanish/ency/article/003125.htm
• Scientific Electronic Library Online - SciELO. [Website *]. [Revised 14/05/2013, updated 09/05/2013]. Available at: http://scielo.isciii.es/scielo.php?pid=S1130-01082006000400010&script=sci_arttext

Geriatric Syndromes. Instability and falls

The fall is another important geriatric syndromes, if carried out, often leads to physical consequences (fractures), psychological (postcaída syndrome) and social (isolation and dependence in activities of daily living).

 

In my opinion, for to avoid this geriatric syndrome is very important the prevention. Therefore, the work of nurses and social workers is of great importance in this matter. Among the preventive measures can include:

 

• Primary Prevention. To detect and to correct predisposing factors, removing carpets, doing exercise programs, avoiding harmful habits, avoiding uneven floors, good lighting, orderly, bed railings, etc.. At this stage we can assess using scales such as the Tinetti scale or scale Downton risk.
• Secondary Prevention. In a fall discard loss of consciousness, syncope diseases, ask when and where it fell, what was at the time, how he got up, ask if there have been previous falls, identify gait disturbance, mental confusion, etc.. At this stage we can apply the comprehensive geriatric assessment.
• Tertiary Prevention. To reduce the consequences of the fall, both physically and psychologically. We need to teach the old man up, to restore stability, first sitting and then standing up, to reeducate the orthotics and supportive psychotherapy.

 

 

Bibliography:

• Ruddick S, Scollen C. Fracture prevention in the frail elderly. Practice Nurse; 2003.
• Scientific Electronic Library Online - SciELO. [Website *]. [Revised 13/05/2013, updated 9/05/2013]. Available at: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21251999000100011

Geriatric Syndromes. Dementia and Delirium

Dementia and delirium are geriatric syndromes caused by neurological problems. In the table below I show the most significant differences:

	DELIRIUM	DEMENTIA
Beginning	Sudden	Gradual
Course	Floating with nocturnal exacerbations	Progressive
Awareness	Decreased	Normal
Atenttion	Affected globally	Normal, except in several crises
Cognition	Altered globally	Altered globally
Perception	Hallucination common, especially visual	Hallucinations rare
Delusions	Little systematic and fluctuating	Missing
Orientation	Decreased	Gradual decreased
Psychomotor Activity	Delayed, agitated or mixed	Normal

 

 

In patients with these conditions is important that health professionals follow communication guidelines:

• Approaching with a smile.
• Look to the eyes.
• Catch up with the patient.
• Use to short words and simple sentences.
• Repeat your statements.
• Avoid unusual expressions.
• Give to directions using fewer words.
• Ask questions so that patients have to answer "yes or no" when patients have difficulty answering.
• Make distracting noises disappear.

Today, families often blamed dementia "things of old age" and not caring. Furthermore, these diseases are often hidden under a depressive process. In my opinion and as a future nurse, I would make a good assessment of the patient. Then, together with other health professionals, we explain to the patient and her family her process and treatment to improve her quality of life.

 

Bibliography:

•  National Library of Medicine U.S. - MedlinePlus. [Website *]. [Revised 12/05/2013, updated 7/05/2013]. Available at: http://www.nlm.nih.gov/medlineplus/spanish/delirium.HTML
• National Library of Medicine U.S. - MedlinePlus. [Website *]. [Revised 12/05/2013, updated 7/05/2013]. Available at: http://www.nlm.nih.gov/medlineplus/spanish/dementia.HTML
• National Library of Medicine U.S. - MedlinePlus. [Website *]. [Revised 12/05/2013, updated 7/05/2013]. Available at: http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus-spanish&query=diferencias+entre+demencia+y+delirio&x=0&y=0

Geriatric Syndromes. Immobility

Immobility is a geriatric syndrome characterized by reduced tolerance to physical activity and by progressive muscle weakness and even loss of postural reflexes that prevent wandering. In stillness, we distinguish two types: relative and absolute immobility (bedridden patient).

For absolute immobility, there will be nursing care in a patient bedridden while the relative immobility, I evaluate it with different scales such as the Tinetti scale.

Having assessed the situation of patient mobility, will be an action plan with individual goals and realistic that will focus on:

• Treatment of the cause of immobility.
• Rehabilitation plan directed to the treatment of existing immobility and prevent its progression.
• Use of aids and home adaptations.
• Prevention of complications.

 

 

In this case, I will focus on home adaptations since, in my opinion, it is essential to adapt the patient's immediate environment according to their possibilities. To do this, I will give a series of general adaptations:

• Stairs: Height can be reduced by inserting intermediate steps should have handrails on both sides and if possible be used ramps while avoiding the excessive tilt.
• Doors: Attempts to have the maximum height and facilitate the opening mechanism. They are useful delayed locking mechanisms for individuals moving slowly.
• Furniture: Should you have ample space for mobilization, useful furniture placement in strategic locations and well anchored to enable support and handrails in the hallways. The chairs are hard, with proper height to facilitate the rise, high-back exceeding the height of the head and arms, preferably covered, since extreme force with hands up. The bed height is adjusted to facilitate transfers.

 

 

 

Bibliography:

• Joanne McCloskey C, Bulechey Gloria M. Nursing Interventions Classification (CIE). 2nd edition, Synthesis, Madrid; 1999.
• Batzan J, Hob M, Rodriguez, A. Geriatric assessment in primary care. Semergen; 2000.

Geriatric Syndromes. Pressure Sores

Pressure ulcers are chronic wounds in the skin and underlying tissue caused by prolonged pressure on a hard surface, not necessarily strong, and independent of the position. To produce require microcirculation disorders in body support zones situated on a hard surface. For this reason, the areas of bony prominences are the most common sites for the appearance of these ulcers.

According to numerous studies, 95% of these pressure ulcers could be avoided and, therefore, prevention is a priority. This prevention is based on reducing the risk factors.

Then, I'm going to expose risk areas according to the position of the patient and how they can prevent pressure ulcers:

 

• Postural changes every 2-3 hours in bedridden patients and each hour in the sitting position.
• Avoid dragging.
• Prominences avoid direct contact with each other.
• Skin and mucous clean and dry. Use little irritating soaps.
• Wash with warm water, rinse and dry without friction.
• Don't use alcohol.
• Use moisturizers ensuring total absorption.
• Dressing natural fabric clothing.
• Use absorbent incontinence.
• Good nutritional support.

 

 

Bibliography:

• Scientific Electronic Library Online - SciELO. [Website *]. [Revised 10/05/2013, updated 6/05/2013]. Available at: http://scielo.isciii.es/scielo.php?pid=S1134-928X2008000200006&script=sci_arttext
• National Library of Medicine U.S. - MedlinePlus. [Website *]. [Revised 10/05/2013, updated 7/05/2013]. Available at: http://www.nlm.nih.gov/medlineplus/spanish/pressuresores.html

 



Geriatric Syndromes. Iatrogenic

In this blog post and the seven following entries discuss geriatric syndromes. One of these geriatric syndromes are iatrogenic. The iatrogenic means "created by the doctor or healer." This is a condition, disease or condition caused or provoked by doctors, medical treatments or medications. This condition may also be the result of treatments other professionals linked to the health sciences, such as therapists, psychologists, pharmacists, nurses, dentists, etc.. The condition, iatrogenic illness or death can also be caused by alternative medicines. The iatrogenic usually temporary results, the proof is the following examples:

 

 
• Phlebitis postcatéter.
• Mild urinary infection after several days keep a bladder catheter.
• Phlebitis of the legs after removal of a gangrenous appendix.
• Adverse drug reactions.

 

In my opinion, there are inevitable iatrogenic such as the adverse drug reactions, but could be improved as I show in the following example:

 

• Cough that appears in the context of a treatment with an IECA (drug to blood pressure) is given an antitussive; whether the antitussive gives constipation is a laxative (3 drugs instead of simply changing the first).

 

 

 

Bibliography:

• National Library of Medicine U.S. - MedlinePlus. [Website *]. [Revised 10/05/2013, updated 3/05/2013]. Available at: http://www.nlm.nih.gov/medlineplus/spanish/druginformation.html

Nursing Care Process in geriatrics and gerontology

To perform Nursing Care Process geriatrics and gerontology, you have to follow the same structure: assessment, diagnoses (NANDA), planning (NOC and NIC), implementation and evaluation.In this blog post, I will focus on the valuation. This can be carried out in accordance with: Virginia Henderson's 14 basic needs, Gordon patterns, Maslow's needs, etc.. In this case, I chose Virginia Henderson's needs because I think a full assessment, good structure and can help the individual to health and disease in carrying out those activities that contribute to health, recovery or death quiet activities he realized without help if you have the strength, will and knowledge needed. And do this in a way that will help them become independent as soon as possible. The Virginia Henderson's 14 basic needs in order of increasing complexity are:

          1. Breathe normally.         

          2. Drinking and eating properly.         

          3. Remove all body passageways.         

          4. Move and maintain good body alignment.

          5. Sleep and rest.         

          6. Use suitable clothing, dressing and undressing.         

          7. Maintain body temperature within the corporate limits.    

          8. Maintaining hygiene and skin integrity.         

          9. Avoid environmental hazards.         

          10. Communicate, express their sexuality and emotions.

          11. Living with their own beliefs and values.        

          12. Being busy.        

          13. Participate in recreational activities to perform.        

          14. Learn, discover and satisfy curiosity.

Once above the 14 needs, dedicate my entry to the first need (breathe normally) because, in my opinion, is of great weight in geriatric patients due to the high probability of having difficulty with your breathing pattern.

 

Manifestations of independence:

• Respiratory rate: 15 to 25 rpm
• Regulate breathing rate.
• F.C.: 70-80 l.p.m.- Amplitude respiratory diaphragmatic breathing.
• Exchange and systematic transport air right: pink skin and mucous membranes.
• Ability to cough up: keep airway clear.

Manifestations of dependency:

• Amplitude Respiratory bag or shallow breathing.
• Existence of orthopnea, shortness of breath and fatigue.
• Exchange and air transport system incorrect: bluish color of the skin and mucous membranes.
• Inability to cough up.
• Not preventive measures (risk factors, unhealthy lifestyles): vaccines, snuff, no physical exercise.
• Improper postural habits.

Nursing interventions:

• Avoid fatigue.
• Promotion of exercise.
• Exercise therapy.
• Environmental Performance.
• Weight control.
• Control of liquids.
• Teach coughing.
• Promoting lifestyles.

 

Bibliography:

• Johnson M. Interrelationships NANDA, NOC and NIC. Barcelona 2nd Ed. Elsevier Mosby, 2007. ISBN: 978-84-8174-946-5.
• Izuel C. Lopez, Nursing care. 1st ed. Madrid. Masson. 2004.
• Dillon P.M. Clinical evaluation in nursing. 2nd ed. Caracas. McGraw - Hill Interamericana. 2003.

Comprehensive Geriatric Assessment

Comprehensive geriatric assessment is a dynamic and structured diagnostic process to detect and quantify the problems, needs and abilities of the elderly in clinical areas, functional, mental, social and emotional, to develop an intervention, treatment and long term follow up with in order to optimize resources and to achieve the greatest degree of independence and quality of life. For this assessment, means are used such as the history, physical examination and a series of more specific instruments denominated assessment scales that facilitate the detection and tracking of problems and communication between the various professionals that serve the greater. In this blog I focus on effective scales for the assessment of each area.

 

Clinical Sphere:

• Interview, history, physical examination, medical history.              
• Assessment by 14 Virginia Henderson needs.
• Mini Nutritional Assessment (MNA).

 

Functional área:

• Basic Activities of Daily Living (ADL).
• Index of activities of daily living (Katz).
• Barthel Index.
• Disability Scale Red Cross.
• Scale Plutchik.
• Instrumental Activities of Daily Living (IADL).
• Lawton and Brody Index.

Mental and social sphere:

• Pfeiffer Questionnaire.
• Mini-Mental State Examination of Folstein (MMSE).
• Wolf Mini Mental State Examination (MEC).
• Test Clock.
• Social Resource Scale (ORS).
• Zarit scale (caregiver fatigue).

Affective sphere:

• Scale of Yesavage geriatric depression.

 

 

I think the rating scales are an indispensable and that help a lot, both the old man in his assessment and treatment, as health workers in diagnosis. But I argue that there are many scales complicated to perform and must always be based on common sense, never losing the human side towards patients.

 

Bibliography:

• Hoffman, G. Basic Geriatric Nursing 5th Edition. Elsevier; 2012.