Care of Aging Skin and Mucous Membranes.

I would like to emphasise the importance of this issue, because during my internships in both health center and in the hospital, I saw the large number of patients who needed to undergo skin care.

From my point of view the skin is the largest organ of our body and perhaps one of the least importance we give. Many times when we get injured or receive a hurt, we do not pay much importance as we thought "Bah! It will heal". But in the case of the elderly and people with some form of paralysis (paraplegia, quadriplegia, hemiplegia ...) things change. An injury in these patients can go from acute to chronic. These people have reduced sensitivity so you do not realize the damage that can occur in the skin. By this I mean for example, an elderly disabled who spend much time in one position, the skin being damaged end and it came to produce a pressure ulcer if there are no suitable remedies. 

From the viewpoint nurse, ulcers is a subject that takes a great burden in caring for the elderly, in patients who remain during a long hospital stay or even when they are institutionalized or still at home, often end up developing some degree of skin damage. For all these reasons, to prepare future nurses about the treatment and prevention of ulcers is something of vital importance and that many universities do not consider.

Bibliography

• Hoffmann G. Care of aging Skin and Mucous Membranes. Basic Geriatric Nursing 5th Edition. Missouri: Elsevier; 2012. p 266-284. 

Geriatric Syndromes : Constipation.

The prevalence of constipation increases especially after 60años, and is more common in women than in men. Represents a major geriatric syndromes because of its prevalence, its serious complications and their significant impact on the quality of life of elderly. Only 5% of the elderly have fewer than three bowel movements a week.

Constipation can reach producer serious problems, among them are: fecal impaction anal fissure, circulatory disorders, fecal incontinence and urinary retention.

Additionally, this problem not only afflicts the elderly. Many people suffer from constipation mostly due to poor diet and lifestyle. In most cases, the constipation is caused by a lack of dietary fiber, vegetable, fruit etc. and inactivity and lack of exercise. For these reasons constipation, except it is caused by some gastroientestinal or nervous pathology , it's easy to put a solution changing lifestyles.

I think that nursing plays an important role in informing the public about appropriate changes to treat this condition. Although my personal experience on raising public awareness are not too positive.

When I was in the Health Center, elderly patients with diabetes or obese, were very difficult to convincing  about diet and daily exercise at least in order to have controlled their blood glucose levels and weight respectively, but it seemed that they cared enough little. Many of them put the excuse that they were too old to change his life and if they want to eat a sweet then ate it. The problem comes when the damage occurs, because they want to go to the hospital to treat them and cure their disease in two days to be home again. So we must not only inform, we have to raise the elderly that the problem of not following a proper lifestyle can cause many diseases that can leave them disabled for life.

Bibliography

• FMC. Estreñimiento en el anciano. Formación médica continuada en atención primaria. 2011 ; 18:22-42. Available from:  http://www.elsevierinstituciones.com/ei/ctl_servlet?_f=1012&id_articulo=90065700&idinst=16

Geriatric Syndromes : Dementia and Delirium

So far we have been talking about diseases that affect the elderly physically, but what about those that affect the brain. Cognitive impairment and dementia are the issues most important in Public Health in developed countries.

Although it is the most important problem Has it given the importance it should? from my point of view I say categorically that NO.

In general, our society tends to remove seniors who begin to lose cognitive abilities. When an old man starts not fend for himself for a physical or psychological problem we institutionalize him in order to he disturb as less as possible. In addition, we call the doctor in order to give them drugs that make them recover from their condition, the problem is that people do not understand that this exacerbates the problem.

I think the first thing to do is detect in an early way, the beginning of cognitive impairment to put an effective remedy (both pharmacological and non-pharmacological). Promoting independence to perform basic daily activities is critical to not increase the dependency of the elderly. The activities that we will do must aim for the elderly use mental processes to not atrophy and thus delay the onset of dementia. For example: prevent the patient is isolated at home, a proper diet, trying to performs most activities alone (though it cost), encouraging social relations etc.

Many times doctors are determined to extend the life trying those physical problems and put aside the psychological area that often have to be prioritized. A person mentally impotent, for example with a advantage Alzehimer , is much worse than the diseases that could incapacitate an elderly fitness, due to the latter will still be able to understand and comprehend everything that surrounds him.

Bibliography

• Baztán B, Rexach S. Orientación y tratamiento del anciano con demencia. Sistema Nacional de Salud. 2002 ; 26(3):65-76. Available from: http://www.msc.es/biblioPublic/publicaciones/docs/200203-01.pdf

Geriatric Syndromes : Falls and Instability.

Who has not had a grandfather/mother or a elderly acquaintance who has had an accident and has fallen to the ground? We all know that aging produce a deterioration of our bodies: we become more rigid, our agility decreases, osteoporosis occurs in many cases, we see no good etc.

When we are young a fall is not a major problem that any scratch or numbness, but in the case of elderly things change and it is a factor of high morbidity and mortality.

Come to my mind a patient who I was for two months in MAZ Hospital. She was a 67 year old woman with osteoporosis. Someone tried to steal her purse and when that person removed it, she fell to the ground, this woman only broke a shoulder but due to the operation was complicated, she was in the ICU for 4 weeks, but finally came out and stayed on the for 2 months more in the hospital. Fortunately not all the elderly who fall, end up in the ICU, but it is an example of what can lead a fall for an older person.

For all these reasons we must prevent falls, it is the only way to prevent that our health get worse. I would like to mention some things we could do as preventive measures:

1. Avoid slippery floors, uneven or wet.
2. Good lighting
3. Smoothly and orderly environment
4. Immobilizers: as safety restraints in the elderly (abdominal belt, vest holding and fixing sheets). Such mechanisms will be used in specific situations always.
5. Lowering the bed as much as possible.
6. Install handrails in bathrooms, stairways and corridors
7. Using support measures: walkers, canes, crutches for greater base of support.

Bibliography 

• Hoffmann G. Meeting Safety Needs of Older Adults. Basic Geriatric Nursing 5th Edition. Missouri: Elsevier; 2012. p 166-169. 

Urinary incontinence in the elderly

For many people, a trip to the bathroom is something they can easily delay. But for people who suffer from urinary incontinence-the involuntary leaking of urine-holding it in isn't an option.

Although incontinence can happen at any age, it is more common in older adults. According to the National Association for Continence, one in five individuals over the age of 40 suffer from overactive bladder or urgency or frequency symptoms. In the nursing home population, at least 50 percent of residents have elderly urinary incontinence. so we can see that the directo cost of urinary incontinence 8€ billion annually) is greater than the cost of breast, cervical, uterine and ovarian cancers combined.

I remember leaving the Health Center to treat those patients who were in nursing homes. If I saw 20 patients, 15 were bedridden and with diapers. It's amazing that occurs many problems of incontinence in older people, especially in women. I have to highlight a comment that said our Clinical Nursing teacher, she claimed that Asian women were least had incontinence problems because in schools and hospitals, women were taught a series of exercises to strengthen the pelvic muscle (Kegel exercises). This demonstrates how culture influences in health status. If we could only raise awareness to undertake a series of exercises would be saving millions of euros in its infancy, operations and drugs.

For that the physician, nurses, nursing assitans, physical therapists, occupational therapists and facility management need to be actively involved in the development, communication, and implementations of hte plan.However, no staff memebers should consider themselves too important to respond to the needs of patients. A succesful plan can improve the seld-esteem of residents and enhance the perceptions of the level of care held by family members and the community.

As we see, again preventing acquires a major role in health, I always say, through prevention, education and change bad lifestyles, we would get to increase life expectancy, we would have a much healthier life and many of the diseases affecting our society today (especially cardiocirculatory) will become extinct.

Bibliography

• Ouslander J. Urinary Incontinence in the Elderly. PMC. 1981 December ; 135(6):482–491. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1273322/

• Lily A. Urinary Incontinence in the Elderly. 2004: Available from: http://www.med.upenn.edu/gec/user_documents/UIinelderly_Arya_Geriatrics.pdf

Health education in the geriatric patient

Health education is a basic tool in promoting health and preventive action. It is a method of intervention that is also part of the care provided.

Preventative measures are classified according to the disease stage where it develop. Thus, we can speak of::

• Primary prevention, when we try to prevent the occurrence of injuries and disease acting through risk factors and promoting healthy lifestyles.

• Secondary prevention, which try to detect and treat early asymptomatic disease and existenes although so far.

• Tertiary prevention, which attempts to avoid consequences, relapse, and promote the rehabilitation and recovery of the same.

In the elderly all types of prevention are important, although most measures will be included among the secondary prevention, having injuries or diseases at an early stage in an attempt to prevent its progression, and between tertiary prevention, tryinh to prevent disabilities and provide recoveries.

Nowadays prevention is relegated to the background in health, most people prefer to go to the doctor to find a remedy to their problems rather than trying to prevent these problems before it happen. For example, many patients before reducing the large amounts of salt on the food, they prefer to go to the doctor and receive a pill for blood pressure. For this reason we must learn good tactics of persuasion and conviction to try that patients change their harmful habits.

Especially in this group, it has been shown that due to communication problems that they present and their many complaints and vague description of symptoms, patients tend to be put aside preventive activities.

The thing is that the information comes to them in a way that they understand and be easy in order to  they can carry out these tasks.

Bibliography

• González Sánchez, R. Educación para la Salud. Influencia en ancianos hipertensos, 1999. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21251999000400003

Paliative care

According to the website Get Palliative Care:

"Palliative care is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family.

Palliative care is provided by a team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment."

From my point of view, in palliative care, the fact of having to break the news to a patient  who has been diagnosed by a disease that is terminal, is the event / situation more difficult to manage within healthcare. Not everyone is qualified for this work, because even something that you can learn it and end up dominating over time, you have to be mentally capable of performing this task. We could say that "this skill is born and made."

Apart from that "innate ability" other elements we should learn are:

• Silence: a tool for information and therapy. It can be hard to respond to a "sometimes I think I wont get better." A silence reaffirms the patient believe that reflection and silence reports. Also, if you do not know what to say in a very emotional situation is better shut up.

• Active listening: we should listen the words of patients because sometimes silence gives more information than verbal expression. In many cases doctors tend to saturate the patient offering solutions. If a patient cries, would better facilitate the expression of emotion.

• Empathy is emotional solidarity "anyone in your place would suffer". An empathetic attitude towards patients gives us especially professional satisfaction and therefore reduce our suffering.

• Assertiveness: not enough to know what to do, the patient must perceive that we are sure of ourselves professionals. Even in situations of uncertainty.

Bibliography

• Ayarra M, Lizarraga S. Bad news and emotional support. Grupo de Comunicación y Salud de Navarra. 2001 ; 2. Available from: http://www.cfnavarra.es/salud/anales/textos/vol24/suple2/suple7a.html

• What Is Palliative Care?. Get Palliative Care. 2012. Available from: http://www.getpalliativecare.org/whatis/

Acute Myocardial Infarction

Acute myocardial infarction (AMI) occurs because heart cells leave (for any reason) to receive enough blood and all its contents (oxygen, nutrients, ions etc..) Finally, if the situation is not reversed quickly, it eventually causes the death of heart cells.

It is clear that age is one of the major factors in the onset of AMI as in Spain, average age of patients hospitalized with acute coronary syndrome is around 69 years, and the patients admitted to coronary care units AMI in 65. Although athletes and young people is also likely to suffer an AMI, numerous studies show that 75% of deaths occur in patients older than 70 years due to both biological changes that occur in old age and by the multiple pathologies that these patients usually present.

Patients who arriving to the emergency room, have a rather alarming symptoms: often restless, pale, sweaty and tachycardic addition, when performing an electrocardiogram (ECG) is clearly displayed this pathology.
The main problem is that the symptoms produced by the IAM it is not usually present when it suddenly starts, since the first stage is asymptomatic. For these reasons, in many cases, when ischemia is very large and irreversible, is required surgical treatment because the drugs are not effective enough.
The recommendations I can mention about this issue is:

• Recognizing the symptoms of AMI to go as fast as possible to the hospital
• Know how to perform basic CPR
• PREVENTION through a healthy lifestyle (diet, sport, eliminate toxic habits ...)
• Try to be as quiet as possible (to reduce tachycardia)

Bibliography

• Bolooki M, Askari A. Acute Myocardial Infarction. Cleveland Clinic. 2011. Available from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/acute-myocardial-infarction/

• Mauro V, Rodriguez M, Charask A et al. Infarto agudo de miocardio en el anciano. ervicio de Cardiologia. Clinica Bazterrica. 2002 March.