LEVELS OF CARE

To get a continuous care and detect problems early is important to detect problems early and to be acted on them fairly quickly so it is important specialized care at different levels.

Having these different levels of assistance the results that we can obtain are maxima.

The levels of care are:

- General Hospital Care

- Community and Primary Care

- Specialized care: geriatric unit

These levels are maintained by the coordination of: interdisciplinary work, proper use of appropriate levels of care and expertise.

PRIMARY:

At this level, it will be developed promotion and prevention activities, should be a force composed of different professionals to get a role so as to assist and maintain the patient in appropriate health conditions.

At this level health will be promoted, valued, different preventive activities will be carried, the patient will be conducted and if needed palliative care.

GENERAL HOSPITAL:

Level that does not treat the geriatric patient as such, but the patient admitted for an illness.

It highlights the home-hospital units that depend on hospital continuing of hospital care set in the hospital

Nursing undertake activities such as: education, treatments, sampling, hygiene, oxygen, drilling ...

SPECIALIZED CARE:

They are interdisciplinary units to specifically treat geriatric patients, highlighting different units:

- Acute geriatric unit: patients with acute illnesses

- Average stay unit: restore functionality after medical procedures

- Long unit or residence

- Day Hospital Geriatric: day hospitals.

SOCIAL SERVICES:

Functions of the role of social worker assessing the psychosocial factors that influence the elderly and perform projects of intervention at family, group and community.

                              Vanessa Palomares Garcia

BIBLIOGRAPHY:

- Health Promotion in the elder. The fragile elderly, detection, prevention and intervention in situations of weak and deteriorating health. Institute of Public Health. http://www.imsersomayores.csic.es/documentos/documentos/gomez-anciano-01.pdf

- Comprehensive geriatric assessment: differences in the profile of patients of different assistance levels.Valero, C.; Regalado, PJ, Gonzalez Montalvo, JI; Alarcon Alarcon, MT; Salgado, A. Posted in Rev Esp Geriatr Gerontol. 1998, 33:81-90. - Vol.33 No. 2

- Treaty of geriatrics. Spanish Society of Geriatrics and Gerontology. http://www.imsersomayores.csic.es/documentos/documentos/segg-tratado-01.pdf.

HEALTH EDUCATION IN THE GERIATRIC PATIENT

Maintaining health and functional independence is THE MOST IMPORTANT of promoting health in geriatric patients.

In the elderly, sick forms have particular characteristics, increasing degenerative diseases such as: heart disease, cancer, chronic obstructive pulmonary disease, pneumonia, pulmonary edema, vascular disease (ACV, peripheral vascular disease), arthritis, skin diseases , and accidents (falls, burns, poisoning) causing all long periods of incarnation in hospitals.

There are a number of conditions of life that trigger negative situations: organic, environmental and relationships, can coexist pathological problems.

Nursing should establish a set of objectives to these patients:

- Reduce mortality

- Maintain the independence

- Increase in life expectancy

- Improve the quality of life

 

Promote different types of preventive interventions in these patients can be effective to reduce or delay disease and disability.

Programs of health promotion for the elderly population have the ability to improve the health of this group.

Psychosocial intervention with elders and carers through educational activities for group, forming health support groups, can have great benefits in improving the quality of life of these patients.

BIBLIOGRAPHY:

- Torres Egea Mª Pilar, Ballesteros Pérez Esperanza, Sánchez Castillo Pablo David.. Programs and interventions to support informal carers in Spain. Gerokomos [serial on the Internet]. 2008 Mar [cited 2013 Apr 07], 19 (1): 9-15. Available at: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-928X2008000100002&lng=es. http://dx.doi.org/10.4321/S1134-928X2008000100002

- Hervas A., Arizcuren MA, Garcia de Jalon E, Tiberio G, Forcén T. Influence of socio-sanitary situation in cognitive status and mood in geriatric patients of a health center. Annals Sis San Navarra [serial on the Internet]. Aug 2003 [cited 2013 Apr 07], 26 (2): 211-223. Available at: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1137-66272003000300003&lng=es. http://dx.doi.org/10.4321/S1137-66272003000300003

- Gómez Juanola Manolo, Machín Díaz Mario Jesús, Roque Acanda Kenia, Hernández Medina Guillermo. Considerations of the geriatric patient. Integr Gen Rev Cubana Med [magazine on the Internet]. 2001 Oct [cited 2013 Apr 07], 17 (5): 468-472. Available at: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21252001000500010&lng=es

- Strategies for Improving the Quality of. Care of the El

PALLIATIVE CARE

Palliative care according to WHO is "active care of the diseases that have no cure response, and aims to increase the quality of life of patients and their families"

The main aim in palliative is care to relieve suffering and greatly improve the quality of life of these patients.

Nurses must provide palliative care to patients both at hospital and at home, these, have a high need and demand for health care with the involvement of all levels of care in the health system.

Nursing must meet a number of objectives with these patients:

- Comprehensive care accessible

- Teamwork

- No discrimination based on age, sex ...

- Actions based on the best available evidence

- Open communication

- Assistance to the patient and the family

Staff should be trained to communicate "bad news" in the best way possible and as clearly, for that there are different models such as: technical, paternalistic, accommodating and deliberative, the latter being the most recommended.

Nursing will use theoretical strategy to communicate bad news BUCKMAN, which are six stages traversed by order not advance if you have not passed the previous.

The reactions that occur in the family to receive this kind of news are: feeling of disorientation, feeling threatened by the loss of a family member, disorder, grief.... Being the set of all what will condition the situation of the patient.

Once released to the patient his diagnosis will begin to meet the stages of grief according to Dr. "kueler-ross"; these phases contemplate:

- Negation

- Anger / rage

- Negotiation / agreement

- Depression

- Acceptance

Patients receiving palliative care:

- Neoplastic pathologies

- Pathologies chronic, progressive and infectious

- Neurological degenerative pathologies

Nursing care of the terminally ill symptoms:

- PAIN: Subjective and changing experience which is valued by the “Eva´s Scale"

- ORAL CAVITY DISORDERS

- INTESTINAL RATE CHANGES

- NAUSEA AND VOMITING

- CONFUSION

- INSOMNIA

- ANXIETY

- DEPRESSION

- PRESSURE ULCERS

- Incontinence / URINARY RETENTION

- AGONY

To alleviate many of the symptoms associated with terminal illness nursing will use subcutaneous routes to do the less pain added to the patient, contemplating the scale of the WHO analgesia.

In conclusion I would emphasize that the situation terminal and death are part of life's natural way, the nurse should perform the necessary care for the patient to leave considering the patient holistically. It should convey the patient and family that he can decide where to die so respecting patient rights.

VIDEO "LEARNING TO FAREWELL"

                             Vanessa Palomares Garcia

BIBLIOGRAPHY:

- F. Diaz Garcia. Bad news in medicine: recommendations to make a virtue of necessity. Intensive Med [serial on the Internet]. 2006 Dec [cited 2013 Apr 07], 30 (9): 452-459. Available at: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0210-56912006000900006&lng=es

- Http://escuela.med.puc.cl/publ/arsmedica/ArsMedica8/Art01.html "GERONTOLOGIA MORE TO HUMAN"

- Criteria for inclusion of a patient with stage dementia syndrome in hospice care. Arriola Manchola, E*.; González Larreina, R**.; Ibarzabal Aramberri, X***. y Buiza Bueno, C****.* Médico geriatra. Unidad de Memoria y Alzheimer (UMA). Matia Fundazioa. ** Médico geriatra. Unidad de Cuidados Paliativos. (UCP). Matia Fundazioa. *** Médico internista. Magister en Bioética. Comisión de Ética Asistencial. Matia Fundazioa. **** Psicólogo. Unidad de Memoria y Alzheimer (UMA). Matia Fundazioa.

- SciELO. "NEW PERSPECTIVES IN PALLIATIVE CARE." Leo Pessini * and Luciana. BERTACHINI. Acta Bioethica Interfaces 2006, 12 (2) Revised May 2012.

URINARY INCONTINENCE IN THE ELDERLY.

"Involuntary loss of urine, objectively demonstrable, which causes a social or hygienic problem as it comes at a time and place unfit"

It is a dysfunction in both healthy people as associated with different diseases that is originated by different causes, is a major health problem by psychological, social and economic connotation although his prognosis is not serious.

The most important risk factor is age although there are a number of factors that can maximize.

All studies on the quality of life of people suffering from this show that is lower than those without incontinence.

It highlights different types of urinary incontinence:

- In effort or stress

- Urgency

- Overflow

- Functional

- Mixed

It is diagnosed by: clinical background asking questions to investigate which factors predispose and trigger the incontinence; urinal analysis, questionnaires, physical examination and most special procedures performed by the specialty of urology and gynecology.

Treatment:

- Note that the patient is informed of the possibilities of healing that exist

- The patient should take extra hygiene

- Explain the patient self-training measures as habits, routine to evacuate ...

- Rehabilitation of the muscle of the pelvic floor

- Medication

- Surgery

BIBLIOGRAPHY:

- Monitoring for five years of urinary incontinence in the elderly in a Spanish rural population. Atención Primaria, Volume 35, Issue 2, Pages 67-74 F. Gavira Iglesias, J.M. Caridad y Ocerín, J.B. Guerrero Muñoz, M. López Pérez, M. Romero López, M.V. Pavón ArangurenHelp

- EAU guidelines on Urinary Incontinence Urologic Spanish Proceedings, Volume 35, Issue 7, Pages 373-388 J.W. Thüroff, P. Abrams, K.-E. Andersson, W. Artibani, C.R. Chapple, M.J. Drake, C. Hampel, A. Neisius, A. Schröder, A. Tubaro

DIGESTIVE PATHOLOGY

Within digestive pathology, certain entities have a particular importance in the geriatric patient, either by being more prevalent, by presenting an atypical clinic or by having a different treatment from the adult.

The nursing staff must know the key nutrients that must be present in the diet of a person, to ensure proper nutrition which will lead to the prevention of some digestive diseases.

It stands out as most important pathologies: constipation, fecal incontinence, ostomy and dysphagia.

Constipation: stool output excessively dry and scanty or infrequent. Represents one of the major geriatric syndromes. From mechanical etiology, functional, pharmacological, metabolic and neurological.

This constipation can complicate causing:

- Fecaloma: fecal impaction

- Anal Fissure

- Circulatory disorders

- Fecal incontinence

- Urinary retention

Stoma - ostomy: surgical creation which get outside the digestive tract. The goal with ostomy patients will be regulate their traffic preventing diarrhea and restore a good nutritional status.

These elders have a greater chance of complications and absorption of nutrients, you must administer the drugs so it has less chance of causing complications.

Fecal incontinence: not part of normal aging, affects the quality of life of elderly. Several types are distinguished by the type of incontinence major / minor as are; minor: soiling, gas incontinence, urgency and incontinence of liquid stool; and major: pelvic floor injury, drugs, prolapse, cancer ...

Nursing will undertake a number care for incontinent patients such as hygienic-dietary measures, discomfort treatment and fecal impaction.

Dysphagia: difficulty of swallowing liquid elements. It is very common in the elderly population oropharyngeal involvement. Nursing will undertake a number of general measures regarding these patients doing: respecting the taste, small quantities, do not mix, avoid contact with the spoon, quiet atmosphere, thick textures, delayed in swallowing reflex start ...

       Vanessa Palomares Garcia

BIBLIOGRAPHY:

• More frequent digestive conditions in the elderly. .MsC. Odalys María Álvarez Guerra,1 MsC. Beatriz Ulloa Arias,2 MsC. Jesús Fernández Duharte,2 MsC. Teresa Castellanos Carmenatte3 y MsC. José E. González de la Paz4.

• Gastrointestinal disorders in the geriatric patient. Gastroesophageal reflux disorders. Bowel disorders. Diagnostic evaluation and therapeutical attitude. C. Verdejo Bravo,M Montiel Carbajo. MC Sevilla Mantilla. A Ruiz de León San Juan.Medicine 2003 08:58

GERIATRIC SYNDROME OF FALL

WHO defines drops as "a result of any event that precipitates the patient down against your will." The falls result in elderly patients with high morbidity and mortality (88% of hip fracture). It´s, along with urinary incontinence, bedsores, paralysis, cognitive impairment, one of the major geriatric syndromes.

A fall is an interaction between risk factors, nursing should identify these risk factors valuing the elderly:

1. Geriatric Assessment:

a. Biomedical Assessment: history

b. Functional Rating: With rating scales as Barthel, Katz Index and scale of the Red Cross (valued ADLs). Also widely used WHO questionnaire for falls in the elderly.

c. Mental Evaluation: The mentally diseases are considered risk factors.

d. Social Assessment: important to assess their family unit, how is their home and their environment.

2. Physical Exploration:

a. Neurological exploration

b. Cognitive Impairment

c. Exploration of the different gadgets and degenerative diseases

3. Exploration of the organs

4. Exploration of balance and march

5. Register in the medical history the number of patient falls.

It´s important that nursing gets to the patient that falls are preventable, prevention and treatment, as they depend on both external and internal factors that can be modified to avoid the result of the fall.

We will teach the patient a health education promoting healthy habits, reducing the risks that may be around and teach them to know how to fall and rise.

Finally is equally important technical aid we can give them in certain situations such as: prevention in the bathroom, prevention when there is instability and especially prevent these falls in the home giving a correct light, avoid carpets, etc ...

BIBLIOGRAPHY:

-          Formiga F., Rivera A., Nolla J.M., Pujol R. Characteristics of falls producing hip fracture in an elderly population. Gerontology. 2004; 50:118-9.Pubmed

-          Formiga F., López-Soto A., Duaso E., Ruiz D., Chivite D., Pérez-Castejón J.M., et-al. Differences in the characteristics of elderly patients suffering from hip fracture due to falls according to place of residence. J Am Med Dir Assoc. 2007; 8:533-7.Pubmed

NEUROLOGICAL DISEASES, COGNITIVE IMPAIRMENT AND DEMENTIA

It is defined as "cognitive impairment and dementia in particular, is the most common neurological disease and disabling in the elderly patient. It is a public health problem of the first order, only after cancer and acute myocardial infarct"

The nursing staff plays a very important role in this type of disease, as it will account for a number of alterations and changes: start, attention, collaboration, movement, level of care ...

We will have to know the difference between: DELIRIUM, DEPRESSION AND DEMENTIA.

• Delirium: acute onset clinically characterized by impairment of consciousness, changes in cognitive functions (memory, language, thought, etc..) And perceptual disorders Very common in hospitalized elderly, to be attentive to this symptoms that may appear in our patients.

• Depression: Depression in the elderly is a widespread problem, but it isn´t a normal part of aging. Often not recognized or treated. The nursing staff plays a very important role in this pathology as it must contribute to the patient's emotional support serving a great support.

• Dementia: The aging process creates this condition, rather than a specific disease is a group of symptoms caused by changes in brain function, is chronic and degenerative, influencing both the quality of life of patients and the quality of life of the carer.

Highlights and attaches great importance to Alzheimer's within these "cortical dementias;". Alzheimer's disease is a form of dementia that gradually gets worse over time and affects memory, thinking and behavior.

It is characterized by a change in behavior, thinking, cognitive skills ... its definitive diagnosis is by histopathological study, and there is no cure, the goal of treatment in this disease will alleviate progress.

We will value the patient by "global scale of Reisberg detioration", The scale identifies seven (7) stages:

1. Normal;

2. Objectively normal, but complaints of mild memory loss; \

3. Mild cognitive impairment

4. Early Dementia

5. Moderate Dementia

6. Moderately severe dementia, and

7. Severe dementia.

According to the GDS, the ability to live independently is compromised from the fourth stage. "Complex Care" is the usual care for those in stages 6 or 7.

The rapidity with which the patient gets worse varies from person to person, usually develops rapidly and therefore worsen quickly.

 NURSING ACT IN EACH STAGE AS FOLLOWS:

- Stage 1 mild. Determine when the patient needs help, keep feeding, his pattern sleep / rest, avoid stress ...

- Stage 2 moderate: Prevent injury, reduce incontinence, preservation activities, help to ADL as independent as possible.

- Stage 3 severe: to provide necessary care to protect their health and proper nutrition. Controlling the disposal / hygiene and recognize demonstrations of pain and fatigue.

VIDEO LIFE WITH ALZHEIMER 30 MIN

                          Vanessa Palomares Garcia

BIBLIOGRAPHY:

·         http://www.nureinvestigacion.es/FICHEROS_ADMINISTRADOR/PROTOCOLO/protocolo%2013.pdf

·         http://bases.bireme.br/cgi-bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&src=google&base=LILACS&lang=p&nextAction=lnk&exprSearch=396717&indexSearch=ID