ASSISTANCE LEVELS

For a correct attention it is needed a good coordination with the different level of assistance.

-          primary care

-          general hospital

-          geriatric unit

Primary health care

From my point of view the primary health care is one of the most important levels in geriatric. The primary health care will take care first to perform a primary prevention.

This will get help seniors to improve their daily lives by guidelines, exercises, advice and vaccines.

Also takes care of healthy or sick patient and has an important part to teach prevent cancer or know when to see your doctor to explain the symptoms of new appearance.

The frail elderly or high risk, should be of primary importance in the different programs or systemic action.

General Hospital

Responsible for the elderly patient who is not a geriatric patient and requires input for a disease.

Specialized attention

In my opinion is the other most important level of care in geriatrics.

This is destined for the entry of geriatric patients for valuation and management of their pathologies.

1. Acute geriatric unit: geriatric patients with acute disease to become independent in daily living activities

2. Medium unit stay: to restore the functioning of medical procedures, surgical or traumatic

3. Residence

4. Day hospital: patients who need physical recovery and health care and training in daily living activities

PALLIATIVE CARE NURSING

Palliative cares are those who are going to make a terminally ill patient or his prognosis is not good.

In my opinion the care of these patients begins in knowing how to communicate their status, to know when they do not want to receive more information and know how to treat the family.

I think the most difficult cases are those in which your family will not tell the truth or when patients do not want to see their reality.

To achieve proper communication professional must overcome:

anxiety to give bad news

fear of the reaction the patient

fear of overidentifying

fear of ignorance to questions

To communicate the bad news, there Buckman communication strategy:

• Stage 0: explain that the results may not be good
• Stage 1: the diagnosis must be certain and not suspicion
• Stage 2: before reporting must know who knows the patient
• Stage 3: what want the patient to know?
• Stage 4: The finely share with the patient. We know how to give depending on the patient information
• Stage 5: responding to the patient's feelings
• Stage 6: Plan of care

I think the most important stages 3 and 4, they must identify when the patient does not wish to receive information but does not say so directly. We will also have to know how to give the information, their desire and ability of acceptance.

INCONTINENCE URINARY

Urinary incontinence (UI) is the involuntary loss and objective at a time and unsuitable place and toilet is a problem, social and psychic

There are several types of incontinence, form my point of view the most important and interesting in elderly are:

-          IU acute, transient or reversible is of sudden onset and is associated with acute conditions

o       It may be for urinary tract infections or alterations in motility, this type of incontinence is solved when these disorders are referred.

-          IU chronic:

o       IU of effort or stress is produced with Valsalva manoeuvre (coughing, sneezing, and laughing). It is the most common in women.

In this case of incontinence will be advisable to make kegel exercises to strengthen pelvic muscles.

o       IU urgency: irreversible urge to urinate. It is the most common in the elderly. Can be of different types:

-          IU detrusor unsteadiness

-          IU sensitive instability of detrusor

Treatment

-          Residue <100 ml. à Kegel exercises.

o       Two or three daily sessions of about 20 to 25 repetitions (rounds 3-4 were held in each session)

-          Residue >100 ml

o       There will be a probing or reconstructive surgery

o       If incontinence is acontractile, we use behaviour modification techniques (probes or diapers)

I believe that nurses have an important role in the education of the patient who suffers from incontinence. We must teach the exercises to be performed and explain the correct way. Also we have the family because in the event that the patient was independent family should know what to do and as is the case for example of diapers and toilet of the patient.

http://www.observatoriodelaincontinencia.es/

PATHOLOGIES OF THE DIGESTIVE SYSTEM

The pathologies of the digestive system are a serious problem from the standpoint of psychosocial. The prevalence of these pathology increases from sixty years, and so one of the great problems of geriatrics. Some of the most common are:

- Constipation

- Ostomy

- Faecal incontinence

- Dysphasia

All of them are really old issues affecting both physically, socially and mentally.

From my point of view the problems that can affect and what more we can help nursing are constipation and faecal incontinence.

CONSTIPATION

Constipation is excessively dry stool evacuation, rare or uncommon

Complications such as fecal impaction may occur, which normally MUST be extracted so the patient does not feel violent and maintain their privacy.

I believe that with constipation what we do first will change the habits of life:

- Correct the diet, increasing fiber, water consumption, and maintain a diet rich in vegetables and fruits

- Regular exercise is important

- Establish a few hours to go to the toilet

In my opinion will be secondary pharmacological treatment because many elderly take many drugs

FAECAL INCONTINENCE

Faecal incontinence is one of the most geriatric syndromes affects the quality of life of elderly and caregiver.

This condition is a physical and economic impact.

There are different types of incontinence, nursing is very important to improve the quality of life of these patients.

It will be important:

- Increase the intake of fluids to prevent dehydration

- Avoid using toilet paper or towels

- Realised gentle washing with warm water

- Daily physical exercise

- Habitat modification

INSTABILITY AND FALL

The falls are a common phenomenon among the elderly, they are a major cause of injury, disability or even death.

The elderly generally have more problems with balance, this is manifested by the march senile

- Rigid stance and flexion

- Short and slow steps

- Rotating block

- Imbalance

- Wide base stall

- Less oscillation of the arms

In my opinion is important, that when a falls, in addition to the physical, psychological may also appear (post fall syndrome) and even social by isolation or dependence

The alarm indicators that indicate risk of falls are:

- Ocular

- Hearing impairment

- Nervous system disorders

- Emotional disorders

- Depression

- Denial of physical limitations

I think that one of the most important can be the ocular, because vision problems are important for the functions of daily life, and sometimes the elderly do not give importance to their vision loss. Also are very important hearing problems because notified of what may be going around so we will have to be revised in order to detect problems.

Some of the most common triggers from my point of view are:

- Age over 75 years

- Patients with 4 or more medications

- Previous falls

- Muscle devilidad

There are 3 types of prevention that we perform nursing

- Primary prevention: is to improve the circumstances of patients to prevent falls

          - Maintain functional capacity and exercise programs

          - Safety at home

* Risk Score Dowton

What nursing should consider is, avoid dangerous floors, good lighting, safety clamps elderly

            - Secondary prevention: will be held once produced the fall

      - We ask questions about how and where he was and what he was doing at the time

      - Assess the state of the elderly and possible injury

           - Third prevention: the finaliadd is to reduce the consequences of caira

      - Teach the elderly to rise

      - Restore stability

      - Retrain gait

 

Care Plan

- pain

- Impaired physical mobility

I believe that the three caveats are important, and we put the same interest in all. It is so important to get a security atmosphere in the elderly, in their daily lives as teaching the old man to get up when they suffer a fall.

COGNITIVE IMPAIRMENT

Dementia is one of the cognitive problems that affect the elderly.

The elderly often complain of memory loss, we as nurses we perform a rating to these patients. The most important that are affected are memory, difficulty performing complex tasks and language ability.

I think it is very important to identify few before dementia cases to act as soon as possible. Should not be detected it is more difficult to recover the functions that have been lost.

Nursing has rating scales:

- Mini mental state examination of Folsteina (MMSE)

- Memory impairment screen (MIS)

- Review of 7 minutes

In my opinion the most complete scale to detect dementia is the MMSE as it includes all fields that are affected in patients with dementia such as:

- Orientation

- Memory

- Language

- Calculation

ALZHEIMER

Alzheimer's is a type of dementia.

I think it might be hard to detect at first because in each patient symptoms vary.

It begins with the loss of short term memory. The middle stage the patient is having trouble recognizing objects and things or to communicate. And the final stage is the absence of memory and intellectual capacity.

Alzheimer's is a type of dementia.

I think it might be hard to detect at first because in each patient symptoms vary.

It begins with the loss of short term memory. The middle stage the patient is having trouble recognizing objects and things or to communicate. And the final stage is the absence of memory and intellectual capacity.

I believe that nurses have a very important function and beautiful. We must improve as much as possible the quality of life of patients with outbuildings and teach your family also guidelines to assist in the care.

Some nursing goals and interventions that will make are:

- Increase independence in basic activities

- Increase safety and prevent accidents

- Replace gas cooker by hob

- Replace bathtub by shower

- Protection of doors and windows

- Indicate what each medication and point when this taken

INMOBILITY

I believe that mobility is one of the most important indicators of health status at any age and that determines independence. In the elderly depend on specific factors:

- Motor Skills

- Degree of health and self-confidence

- Personal and environmental resources

Two types of immobility

- Relative: sedentary life but able to move

- Absolute: chronic bedridden, in which there may be problems for the patient as pressure ulcers and for caregivers and burnout syndrome

Some of the most important causes of immobility are the changes that the elderly suffer in their bones, muscles, heart and lungs and nervous system, either by physiological changes or diseases of age that may affect mobility.

From my point of view I think that the most important may be the decrease in muscle mass, osteoporosis and diseases like Parkinson's.

In patients with mobility problems we realize a rating, first try to get the maximum possible information possible with the help of family and caregivers to know the type of activities conducted scales we can help like Brathel and Lawton.

Also we will inform us about the drugs because some drugs can alter motility.

In my opinion is very important to conduct a home visit to determine the presence of architectural barriers as well as the family and social environments. Then I would conduct a physical exam comprehensive malaria, with special emphasis on the respiratory system, mucular, cardiac and neurological.

For the valuation are recommended two scales:

- Time up and go test

- Tinetti scale

Once the valuation will be proposed and relaistas individual goals, the main objective is to recover the baseline situation

The priority that we have in terms of the objectives of bedridden patients will be the prevention of skin problems by postural changes, hydration, hygiene and massage

Aids in immobility