Geriatric nursing is the specialty that concerns itself with the provision of nursing services to geriatric or aged individuals. This page tries to outline the state of art guidelines for geriatric care that are useful to a nurse practitioner and clinical nurse specialist who encounters aging person in practice. Due to their complexity, aged people always deserve personal attention. Nurses address physical, psycho social, cultural and family concerns as well as promoting health and emphasizing successful aging.
Life expectancy is rising at rates which call for the proper preparation of nurses to take good care of the rapidly increasing number of the aged.
It is important to distinguish changes involved with normal aging from changes attributable to pathophysiology. Alterations in the structure and function of multiple body system may affect an older person appearance, mobility and ability to fight off infections. Geriatric medications need to be managed so as to avoid too much use of medicine since this group receives a lot of medication if poor care is taken. Multiple medications can cause a variety of drug interaction in older people. Primary drug reaction occurs when one drug causes one side effect, secondary drug reaction occurs when one medication reacts with another. This is brought about by polypharmacy. Old people should be treated in ways that are of benefit and do no harm or as little harm as possible. Principle of assessment: data regarding biomedical, functional, psychological and social issues are obtained to help in planning and implementation of individual health care.
Pressure injuries
A pressure ulcer is a lesion caused by unrelieved external pressure resulting from occlusion of the blood flow, tissue ischemia and cell death. Pressure ulcers are often viewed as a complication of an acute or chronic illness. The presence of ulcers may also be evidence of poor nursing care. Although pressure ulceration can be prevented, it may also occur despite optimal nursing care and advanced technologies. In order to provide effective nursing care for the older adult with pressure ulcers, the nurse must approach patient care within a holistic frame work. This framework should include an integration of good assessment, use of research-based intervention and methodical intervention of patience outcomes. Some specific issues of prevention, assessment and treatment of adult with pressure ulcers are aging skin: The older people have an aged skin and due to exposure to the sun the skin wrinkles, epidermis thins, blood vessels recede, dermal-epidermal ridges flatten and the skin appears thin and fragile. The age related changes may lead to ulceration. The skin which is the largest organ can help in viewing the overall functioning of the entire body. All clinicians working with older people at risk for, or suffering from pressure ulcers must be mindful of these varying relationships in using the cutaneous "window" of person to plan and implement individualized, comprehensive care.
Ulcers have different stages. Stage one ulcers are characterized by non-blancherble erythema of intact skin. It is important to note that stage one pressure ulcers are difficult to identify in darkly pigmented people and are usually indicated by discoloration, warmth, endyma, indurations and hardness. Stage two ulcers are partial lesions extending into the epidermis and the dermis. Stage three ulcers are defined as the full thickness skin loss. Stage four is characterized by extensive tissue damage which extends to the muscle, bone or the underlying structures.
Through a holistic assessment and evaluation a nurse can build a plan of care for those patients who suffer from pressure injury. When treating an ulcer wound treatment should focus on wound healing. For a chronic, non healing ulcer, comfort should be a top priority. For pressure injury careful positioning padding to reduce the risk of pressure ulceration is critical. Wound healing occurs only if the patience is physiologically able to provide needed substrate; wound cleanliness, moist and infection free and the cause of injury is removed. For older people it takes longer to heal and so extra care should be taken. When customary interventions fail to heal a pressure ulcer, surgical intervention may be the best option.
Cardiovascular disease
This is a disease that affects the heart and the blood vessels. The disease is caused by disruption in the blood circulation secondary to decreased vessel, patently (constriction, spasm and occlusion). Cardiovascular disease is common in 50% of the population over the age of 65, and accounts for 40% of deaths in this group. Because of the changes associated with normal aging and some of the unique aspects of reporting and presenting in old adults, underestimation of the seriousness, cardiac disease often occurs. This can lead to misdiagnosis, under treatment, and even death. There is different kind of heart disease: Atherosclerosis and arteriosclerosis. Arteriosclerosis is a disease of the arteries, characterized by abnormal thickening and hardening of vessel walls, it also leads to atherosclerosis. Due to advance in age the disease easily finds its way to old people and so it should be carefully diagnosed and proper treatment given. When diagnosing look out for cases of fainting, continuous chest pain, nausea, shortness of breath, rapid heart rate, rapid weight gain, pain in the abdomen, swelling of legs among others. Then address the issue of hypertension, high blood cholesterol, diabetes, obesity and overweight, smoking, hereditary issues. Treatment includes medication and physical exercises.
Respiratory issues
The following age related changes may occur in the respiratory system of an old person: diminished muscle strength in the diaphragm and thorax, stiffer chest wall, decreased elastic recoil, decreased elasticity in the alveoli reduced surface area, with diminished capacity for gas exchange, decreased vital capacity, and drier mucous membrane leading to more difficulty in mucous excretion. Tests should be carried out by doing x-ray coupled with physical examination. The following are possible diseases in old people; bronchitis, asthma, pneumonia, tuberculosis, and chronic obstructive pulmonary disease. Some of this disease leads to cardiovascular disease due to effect on the lungs by air pollution. Nurse should draw a plan for treatment which includes working with other specialties like heart experts.
No comments:
Post a Comment