sábado, 25 de mayo de 2013

GERIATRIC SYNDROMES: IMMOVILITY

Immobility is a common pathway by which a host of diseases and problems in the elderly produce further disability. Persons who are chronically ill, aged, or disabled are more susceptible to the adverse effects of prolonged bed rest, immobilization, and inactivity.
The effects of immobility aren’t confined to only one body system.
It could be pshyical:  Muscle wasting, Contractures, Muscle pain, Osteoporosis, Pressure sores, Hypothermia, Aspiration pneumonia, Constipation, Incontinence, Deep vein thrombosis and Anorexia ect.
Or Psychological and Social : Isolation, loss of independence, Sensory deprivation, depression, delirium and dementia

It may later cause a lot of complications.
Immobility in the elderly often cannot be prevented, but many of its adverse effects can be.
 Improvements in mobility are possible for the immobile older adults:  A small improvement in mobility can decrease the incidence and severity of complications.




Would be usefull to  develop and implement a care plan that specifically addresses immobility.

* nursing should also document range-of-motion exercises and progressive mobility activities in the medical record. They should periodically summarize the results, noting the resident's overall progress and whether the old person is using assistive devices.
* Nursing staff should teach residents little ways to get exercise even while bedridden.
* Staff at the nursing home should avoid putting a resident on bedrest: the elderly  should be on bedrest for only the shortest amount of time possible.
* If a old person is not progressing as expected, the nursing home staff should find out why
*  It's necessary Advice about  a well-balanced diet rich in proteins and minerals.

Another cares could be: postural changes, massage, good hygene…


CARE OF AGING SKIN AND MUCOUS MEMBRANES: PRESSURE ULCERS

 Pressure ulcers are a type of injury that break down the skin and underlying tissue. They are caused when an area of skin is placed under pressure.


HOW PRESSURE ULCERS DEVELOP?

Pressure ulcers can develop when a large amount of pressure is applied to an area of skin.

The extra pressure disrupts the flow of blood through the skin. Without a blood supply, the affected skin becomes starved of oxygen and nutrients and begins to break down, leading to an ulcer forming.

WHO IS AFFECTED?

Pressure ulcers tend to affect people with health conditions that make it difficult to move, especially the bend – bound patients or  people who spend a lot of time  sitting because they have movility disorders.

Conditions that affect the flow of blood through the body, such as type 2 diabetes increase the risk.

 

WHERE IT COULD DEVELOP?

The parts of the body most at risk of developing pressure ulcers are those that are not covered by a large amount of body fat and are in direct contact with a supporting surface:

The bed bound patients have the risk to develop it in:
·         shoulders or shoulder blades
·         elbows
·         back of head
·         rims of ears
·         knees, ankles, heels or toes
·         spine
·         tail bone

People who use the wheelchair could develop pressure ulcers in:
·         buttocks
·         the back of arms and legs
·         the back of  hip bone


WHAT IS THE TREATMENT ?

Treatment for pressure ulcers includes the use of dressings, creams and gels designed to speed up the healing process and relieve pressure. For the most serious cases, surgery is sometimes recommended.
.
Pressure ulcers can be unpleasant, and challenging to treat. Therefore, there are techniques to prevent pressure ulcers developing in the first place. These include:
·         regularly position changes
·         using equipment, such as specially designed mattresses and cushions, to protect vulnerable parts of the body

Unfortunately it is not always possible to prevent pressure ulcers in particularly vulnerable people, but it’s the first stage of the treatment and nursing have a very hight responsibility with this.


STAGES:




CHARACTERISTICS OF DISEASES IN THE ELDERLY. THE GERIATRIC SYMDROMS



A geriatric syndrome is a illness situation expressed by a multiple symptoms caused by a variety of disease.

GERIATRIC SYNDROMES are common clinical conditions that don't fit into specific disease categories but have substantial implications for functionality and life satisfaction in older adults. Besides leading to increased mortality and disability, decreased financial and personal resources, and longer hospitalizations, these conditions can substantially diminish quality of life.1
It’s necessary to value the meaning of these symptomps and where they are coming.

The Geriatric Symdroms are:

  1. Inmovility
  2. Falls
  3. Incontinence
  4. Intellectual Impairment
  5. Infections
  6. Inanition
  7. Impairement of vision and hearing
  8. Irritable colon
  9. Isolation
  10. Iatrogenesis
  11. Inmune deficiency
  12. Impotence



There are a serie of elements that are important to consider when you have to work with elderly:

The heterogeneity of the older population because there are differents characteristics between all of them.
Also, the disease presentations are atypical, it has differents symptoms comparing with adult population.
They are fragile people and all the risk factors are increased.
More over, elderly have a lot of diseases at the same time and takes a lot of medications which produces secondary effects and affect  a lot of organ functions.
Their diseases have tendence to chronicity and are related to discapacity.

Nurses must recognize geriatric syndromes and apply best practices to the care of older adults to achieve the best outcomes possible

NURSING CARES

As is well know for student’s nursing, there are 14 basic human needs as told once Virginia Henderson.

Explaining all of them could take a very long time. In fact of this, Here I will go to explain with more details just the need of sleep and rest.


Knowing if a older people is independent to do this activity is important to revise if they are able to sleep easily and.feel rested after to be sleeping during 6 – 8 hours. Also, they have to prepare confortable areas without noise and lights.
Realise some moderate physic activitie may improve their sleeping quality.
They should known they have to consult the geriatrician if they feel acute changes in their sleeping patron.

They are dependent if their sleeping is under 5 hours and they have sleep interruptions in the night.
During the day, the could feel irritable and tired to do the daily routine.
Also, they doesn’t know how prepare a confortable area with conditions to sleep and they self medicate and do any physic activity.


The nursing assessment on these case is to advise about the intake of liquids and how get the ideal conditions to sleep and .improve the physic activity.






    GLOBAL GERIATRIC ASSESSMENT


    The MNA is a scale of assessment of nutritional status. Used to view the nutritional status of the elderly and is so important because it can make research studies. 

    For example: 

    The objective of a study was to determine the prevalence of the risk of undernutrition by evaluating the nutritional status in a representative sample of older people in Ourense. The total sample was 728 subjects (63,6% woman and 36,4% men) with a mean age of 80,7±7,4 years old. Anthropometric parameters (weight, distance heel-knee, calf circumference and mid-arm circumference) were determined and the MNA (Mini Nutritional Assessment) was applied and 70% of individuals with nutritional problems were identified (57.5% with nutritional risk and 12.5% malnourished). The subjects aged between 65 and 70 years old, 81 and over, and females presented higher nutritional problems. The items that were observed most frequently in the studied population and therefore responsible for this nutritional situation were the involuntary loss of weight, consumption of at least one serving of protein per day, low daily liquid intakes, loss of appetite, taking more than 3 prescription drugs per day and to have a limited mobility.

    The research is in this page, I recommend to read it because it's very interested.  

    viernes, 24 de mayo de 2013

    THEORIES OF AGING. The Somatic Mutation Theory of Aging

    This theory states that an important part of aging is determined by what happens to our genes after we inherit them. From the time of conception, our body's cells are continually reproducing. Each time a cell divides, there is a chance that some of the genes will be copied incorrectly, this is called a mutation. Additionally, exposures to toxins, radiation or ultraviolet light can causes mutations in your body's genes. The body can correct or destroy most of the mutations, but not all of them. Eventually the mutated cells accumulate, copy themselves and cause problems in the body's fnctioning related to aging.


    PHYSIOLOGIC CHANGES. Aging changes in skin

    Sking disorders are so commun among older people that it is often difficult to tell normal changes from those related to a disorder. More thatn 90% of all older people have some type of skin disorder.



    Skin disorders can be caused by many conditions, including:
    - blood vessel diseases such as arteriosclerosis
    - diabetes
    - heart disease
    - nutritional deficiencies
    - obesity
    - reactions to medications
    - stress

    Other causes of sking changes:
    - allergies to plants and other substances
    - climate
    - clothing
    - exposures to industrial and household chemicals
    - indoor heating

    Sunlight can cause:
    - loss of elasticity
    nocancerous skin growths
    pigment changes such as liver spots
    thickening of the sking




    PREVENTION

    Because most skin changes are related to sun exposure, prevention is a lifelong prcess.
    Good nutrition and adequate fluids are also helpful. Dehydration increases the risk of skin injury. Sometimes nutritional definciencies can cause rashes, skin lesions, and other skin changes, even if you have no other symptoms.

    Keep skin moist with lotions and other moisturizers. Dont use soaps that are heavily perfumed. Bath oils arent recommended because they can cause you to slip and fall. Moist skin is more comfortable and will heal more quickly.