PRESSURE ULCERS

Pressure ulcers occur when the pressure on the skin reduces the blood flow to the area.

Some risk factors include:

-          Malnutrition

-          incontinence

-          Disease That Affects blood flow, vascular disease or diabetes Including

-          Stay in bed for a long time

-          Fragile skin

Valuation

The patient must be evaluated through the scales valuation of risk for identify the elderly patient with risk of developed a pressure ulcer.

The Braden and Norton's scales are the most used.

When already has developed a pressure ulcer need a comprehensive evaluation that includes the location and number of lesions. The most common sites of pressure ulcers are the trochanters, sacrum, buttocks and heels.

Pressure sores are grouped by their severity.

-          Stage I: A reddened area on the skin that, when pressed, does not turn white.

-          Stage II: ulcer-like abrasion bleb or shallow crater

-          Stage III: There is damage to the tissue below the skin.

-          Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes to tendons and joints.

The worst complication in this hurt is the infection, bacteria multiply, the healing is disrupted and damaged tissues.

The symptoms typical are inflammation, pain, hot and blush.

The cleaning must be realised with physiological saline.

Debridements are the removal of necrotic tissue by a surgical technique. This technique is not performed if there are circulation disorders, infection...

The dressings used in pressure ulcers depends wound exudate and the presence or absence of infection.

-          Hydrogels are used in necrotic tissue must be covered with a secondary dressing.

-          Hydrocolloids are used in the treatment of vascular and pressure ulcers. These dressings form a gel to absorb the wound exudate.

-          Alginates not be used on dry wounds, are very absorbent so used to heavily exuding wounds.

-          Foam may be adhesives or not. Retain large amounts of exudate.

-          Hidrocapilares serve low and high level of exudate, are very adaptable. They have a pad covered with a water resistant material, their most important characteristic is that they are capable of absorbing large amounts of exudate

In my opinion is very important know all the different characterist dressing to can choose the better in which tipe of ulcer. Also it is important change the dressing when it is necesary.
I think that will be important stabilish a norms of the ulcers´s traments for all the healh peronal could be trated the same form.

As we have seen most importantly in pressure ulcers is from my point of view, the prevention of the same. Preventing ulcers is much easier to treat, for it can be proposed guidelines:

-          Change position At least every 2 hours to relief pressure

-          Use items That Can help reduce pressure: pillows, sheepskin, foam padding, and powders from medical supply stores

-          After urinating or having a bowel movement, clean the area and dry it well

-          Keep skin clean and dry

When the ulcer is already the most important thing will be treated as early as possible and so we will have to assess the ulcer, cleaning and studying the best way to act.

In my view thanks to the advances that have occurred in the different types of dressings and different techniques, has helped to work more efficiently.

But we must not forget that the best treatment is prevention.

Bibliography

http://www.nlm.nih.gov/medlineplus/ency/article/007071.htm

GERIATRIC SYNDROME

There are few illness that only affect old people, a lot of of there appear before 65 years old.

There are several elements which designate the carefulness.

The most difficult in the aging illness is the presentation of them furthermore different illness could different organ or system; it is very common chronic or degenerative disorder which cause dependence.

One of the objectives in aging will be the upkeep of autonomy thought the early rehabilitation.

The pain is an important point for the nurses, they must know the stage of it. The scale EVA is used to measure the pain in aging.

Urinary and digestive problem are common in aging are important, constipation, heartburn and belching.

Respect to urinary problems appear more in people with prostatic hypertrophy and originate more infections.

In my opinion, the problems there more affect this patient are shake which increase with activity and senility. And the mental problem disorder, because they are aware about their problem and fell lest and lest rewarding.

Geriatric syndrome

The term "geriatric syndrome" is using to highlight the unique features of common health condition in the elderly.

Based on a review of the literature, four shared risk factor-older age, baseline congenitive impairment, baseline funtional inpairment, and impaired morbility - were identified across five common geriatric syndromes like a pressure ulcers, incontinence, falls, funtional decline, and delirium.

 The geriatric syndromes are defined by Kane, in 1989 in his book Essential of Clinical Geriatrics like a geriatric problems, allowing its memorization by the rule of ies:

-          immobility

-          instability and falls

-          urinary and faecal incontinence

-          intellectual impairment

-          inanition

-          impairment of vision and hearding

-          irritable colon

-          isolation

-          iatrogenesis

-          immune deficiency

-          impotence

From my point of view, Kane, explains very well in his book the principal problems that the geriatric patients suffer and which the family and sanitary personnel has to face.

Some of the complications which we can meet the nurses with the geriatric patients can be, to part of the syndromes described by Kane, the osteoporosis, sores, constipation or retention of secretions which we will have to learn to treat them

Bibliography

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409147/

NURSING PROCESS ATTENTION

Nursing Process Attention

The nursing process objetive is to identificate the patient and the problems that may habe to estabilish and achieve goals and improve the health status

Maslow's pyramid

Valuation

We will perform the valuation directly (patient, family, friends) or indirectly, through interviews and physical examination.

Diagnosis

Contains conclusions on the state of the patient, so we can see the actual and potential problems

Planning

Here we find activities goals and we want to achieve in each patient

Execution

Implementation will be done by patients, nurses and family and leads to changes in the patient's health to achieve the objectives

Evaluation

Evaluation allows us to know the patient changes

From my point of view, Virginia Henderson gives definitions nicest nursing, defined as support for the activities that the person would if I had the strength and knowledge, and also help you to be independent.

Attributed to all human beings 14 basic needs

1.      Breathe normally.

a.       we try to avoid tiring the patient, we will make efforts to reduce weight and inform them about the problems of snuff 

2.      Eat and drink adequately.

a.       we control your diet and help them in feeding

3.      liminate body wastes.

a.       treat constipation and incontinence with care and exercise

4.      Move and maintain desirable postures.

a.       we will make personal exercise routines

5.      Sleep and rest.

a.       we will establish guidelines to improve sleep and dream

6.      Select suitable clothes--dress and undress

a.       we recommend the best clothing and value their ability to dress and undress.

7.      Mintain body temperature within normal range by adjusting clothing and modifying the environment.

8.      Keep the body clean and well groomed and protect the integument.

9.      Avoid dangers in the environment and avoid injuring others.

a.       prevent accidents such as falls, burns and help them to have a suitable environment

10.  Communicate with others in expressing emotions, needs, fears or opinions.

a.       We always do an active listening and encourage their communication

11.  Worship according to one's faith.

12.  Work in such a way that there is a sense of accomplishment.

13.  Play or participate in various forms of recreation.

14.  Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

GERIATRIC GLOBAL VALUATION

Geriatric global valuation is a process to identify problems and needs of the elder, for that are strategies of intervention that was realized in the long term to achieve a better quality of life, we need an anamnesis, physical examination and rating scales

Is very important to make an overall assessment to study all areas and know which will be more deteriorated or that more afetada to work on it.
For that we have different scales in different parts of the valuation.

In anamnesis I think that could be important to consider the limitations of each patient, so that would be nice short interviews, speak out and be clear in our explanations and also be patient for them to make their responses

Moreover, the realization of physical examination will be like an adult but need more time; it will take constant and explore the skin for pressure sores or lesions

Also be used to evaluate functional, in my opinion, is one of the most important because it examines their ability to perform activities of daily living. There are two tipes:

-          basic activities of daily living, for study that we have different scales

o       index of activity of the daily lifeàKatz

o       index of Barthel

o       scale of physical disability of Cruz Roja

o       scale of Plutchik

-          instrumental activity

o       index of Lawton and Brody

Finally be used to evaluate the patient's mental state and this point is so important to undertake screening methods using scales and test to value:

-          Short portable mental status of Pfeiffer test Pfeiffer

-          Mini-mental state examination of Folstein

-          Mini examen cognoscitivo de LOBO

-          Clock test

In some study was found that the mini-mental examination of Folstein to be a reliable, valid and stable cognitive screening instrumental in the stroke population.

Bibliography

• Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr  Soc. 1975;23(10):433-41.
• http://www.ncbi.nlm.nih.gov/pubmed/7733842