ATTENDANCE LEVELS

 INTRODUCTION.

The care of the adults that before was a familiar obligation, at present, has happened to be competition of very different social estates. This happened cause the changes that has produced in the family unity and the changes in our profesional lyfe style that is more and more exhausting.

By the other hand, the aged that live more years, represents a great group in our population that has his own and specifics needs that the modern society have to attend.

From the sanitary point of view, the residences of majors and the geriatrical hospitals among others, are those that already comprise significant of our social surroundings and, in this evolution, they are become jumbled so much average physicists as sanitary personal. In my opinión, in all these nevels in the aged care the nurse has an inportant function.

NURSERY ACTIVITIES IN HOSPITABLE ATTENTION.

The objective is to carry out a progressive care of the old patient from the acute phase of the disease to securing the greater degree of independence.

1.- General hospital and Geriatrical Hospital.

At present in Spain, the hospitals specialized in geriatrical attention are few, in the majority of the times the services of geriatrics or the geriatrical units are integrated in the general hospitals. As much in a case as in the other, the nursing activities are the following:

            -To receive and to accompany to old and the familiar ones. To teach to them to the norms and the operation of the different services.

            -Initial valuation of the old patient processing the history of infirmary based on the model of Virginia Henderson and applying the scales of geriatrical valuation.

            -To apply well-taken care of of infirmary during the entrance of the patient.

            -To fulfill the facultative prescriptions and to supervise the activities of the auxiliary personnel of its unit.

            -To take responsibility of the organization of the rooms and plants and the other general services for a suitable operation of the center.

            -To try that it is provided to them to the old ones entered a comfortable atmosphere, clean and safe.

            -To guard the medical histories at any moment taking care of the update and exactitude of the data written down in these documents.

2.- Day Geriatrical Hospital.

The day Geriatrical Hospitals are diurnal centers of operation, whose purpose is to guarantee the clinical stability of the old ones and to apply rehabilitating processing directed to the recovery of the activities of the daily life.

There are assistan services between the Hospital and the aged home.

The type of subsidiary patient of this modality of hospitalization is old with neurological pathologies (Parkinson, Alzheimer), cerebrovascular accidents, bony fractures, rheumatisms, …

Activities of nursing in the day Geriatrical Hospital:

            -Integral Valuation of the patient.

            -Taken care of of the corporal hygiene and feeding.

            -Drug control and you rule therapeutic

-Control and taken care of of the surgical wounds and ulcerations.

            - Sanitary education to patients and relatives.

3.- Hospitalization at home.

This modality of hospitalization must like objective guarantee the continuity of the attendance by means of Primary the Hospital-Attention coordination.

Activities of nursing in the Domiciliary Hospitable Attention:

            -Sanitary education that enables to the old one and/or to the family to assume the precocious possible self medication and to obtain a greater autonomy and a smaller dependency of the sanitary personal.

            -To identify signs and symptoms of risk.

            -To value the conditions of the address: accessibility, security and general cleaning, etc. Sometimes will be necessary to adapt the surroundings to the sanitary needs.

            -To support psychological to the old one and the family.

            - Communication with other services: social assistants, services of aid at home.

PAE.

PAE. Characteristics:

1.- VALORATION.

2.- DIAGNOSIS.

3.- PLANIFICATION.

4.- EJECUTION.

5.- EVALUATION.

It is necessary to consider that a geriatrical patient has different pathologies and characteristics that the other patients. Diverse pathologies, chronic enfermerdades, different needs that the patients from other ages.

The nurse must have all this in account, at the time of realising of PAE destined to geriatrical patients. The interview, observation and physical examination will have to go related to the geriatrical syndromes.

It is fundamental that the nurse, realises one complete valuation, exploration and anamnesis of the patient, as well as of his surroundings.

URINARY INCONTINENCE.

Urinary incontinence is any involuntary loss of urine that originates a hygienic and/or psycho-social problem and that can be demonstrated objectively.

The nurse will have to know and to know how to explain the exercises of kegel as one first form of processing in incontinence. The processing will have to be individualized.

It is important that the nurse verifies that they have understood since they become, he realises a demonstration and he asks the patient who repeats it.

Exercises of involution of the pelvic ground of Kegel, they constitute the processing of forward edge in the boarding of the effort incontinence slight-you moderate, but also they can be useful in the processing of the hyperactive bladder and in the processing of the IU after a dical prostatectomía ra- or a trasuretral prostate resection (RPTU).

It consists of contracting vigorous mind the pubococcígeos muscles without using muscles of the abdomen or glutei. It is important to teach to the patient how to do or during a digital inspection.

It is considered that most effective is to realise of 40 to 80 contractions per day with 5 rest s after each contraction to allow the reoxigenación of the muscle.

Also one is due to teach to the patient how to tighten its pelvic ground before coughing or raising weights. The minimum duration required to secure benefits is of 15-20 weeks.

FALLS.

A fall is a precipitation to the ground, sudden, involuntary and nonawaited, with or without secondary injury, confirmed by the patient or a witness.

By their frequency, consequences and complications, constitute in case single a geriatrical syndrome of great importance.

           

The nurse will have to value the different advice and changes to realise in the home and the routines of the aged one.

I think that this has an important paper in the falls, since she is the one that can influence in the prevention of these. It must be very observant to detect all the possible causes and to know how to explain it so that old or the their caretakers understand the changes that are due to do.

She will have to recommend in:

-Postural recommendation: To rise in two times.

-Medication: To reduce hipotensivos doses, drugs and review interaction between medicaments.

-Sedatives: to diminish dose. Not to mix with alcohol. To advise nonpharmacological

measures.

-If there are muscular problems: training in transferences and march, exercises, learning of the correct use of technical assistance for the march

-Modifications of the surroundings: illumination. To avoid obstacles, to eliminate carpets, to avoid slippery grounds, to avoid electrical cables in zones of transit, telephone surround or tele-help, positioning of objects to medium altitude, to place railings, use of footwear and suitable clothes…

AGING THEORIES.

All of we, have an idea about what is became an ancient. However, define what is the aging is not easy.

In general, the majority of specialists define the aging like all the physics, metabolic, mental and functional processings that take place along the time that supose the reduction of adaptation capacity and more dificulty for our mean internal maintenance. This process is continous and inevitable so that, in the end the death arrives.

This chages are named "physiological aging", which there are to add the chages that cause the different styles from life, the environment and the suffered diseases, that is to say the "patological aging". This last one is different for each individual and each device and system. It gives the "biological os functional age us", in contrast with the "chronological age". All we know people who represent an age different from hers, sometimes less, sometimes more young people.

To age is not a disease, but an inseparable change of the life.

There are several aging theories but we have wanted to speak about the free radicals theory.

The definition of this theory is: "Accumulated cellular damage produced by the exhibition to free radicals, highly toxic substances that are generated like products collaterals of the aerobic life".

It was postulated for the first time by Harman in 1950.

The free radicals suppose a cellular and consequently tissue damage, affecting to the yield of the devices. Damage at DNA level will taje place, with the consequent worsening concerning production of proteins and injures in membrane lipids altering the fluidity and in this way making difficult to a good comunication intra and cellular inter. We will as much have therefore a damage at structutal levels as functional of the cells (signals of molecule growth, apoptosis, neurotransmition,...)

It implies a worsening of the organism to respond to stress and to maintain the homeostasis (to respond before oxidating stress, thermal shock, radiations,etc)

GLOBAL AGING VALUE.

An important part of the global geriatrical valuation is the valuation of the functional sphere. In this two concepts are valued: Activities of Daily Living and Instrumental Activities of Daily Living.

ACTIVITIES OF DAILY LIVING. (ADL).

Routine activities that people tend to do everyday without needing assistance. There are six basic
ADLs : eating, bathing, dressing, toileting, walking and continence. An single ´s ability to perform ADLs is important for determining what type of long-term care and coverage the individual needs.

Theres several scales for value the ADL, most used: Katz and Barthel Index.

INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL).

Instrumental Activities of Daily Living refer to a series of life functions necessary for maintaning a person´s inmediate environment. They include managing money, shopping, telephone use, travel in community, housekeeping, preparing meals and taking medications correctly. It measures and elderly or mentally handicapped or terminally ill person´s ability to live independently. Increasing inability to perform IADLs may result in need for care facility placement.

The scale more used for instruments of daily living is Lawton and Brody index.

In primary attention, the nurse has an important paper in the valuation of the aged one. She will have to know the different scales and the different sections from these, to be able to realise in an adress if it is precise.

The nurse will have to be able of:

-To value the importance of the functionally and autonomy for the greater adult.

-To identify the scales for the functional evaluation of the adults.

-To evaluate the functionally of the adults majors using appropiate sclaes to measure the activities of the daily life, the instrumental activities of the daily life and, to evaluate the march and the balance.

-To design strategies to improve or to maintain the functional state of the elderly people.

HEALTH EDUCATION IN GERIATRIC PATIENTS

The preservation of health and functional independence are the most important aspects of health promotion in older adults.

There are some risk factors that may go associated with other problems or be the trigger of the disease that we have to bear in mind at home as well as in the health center. These factors may be organic (because of the disease), environmental (architectural barriers, inactivity) or relational (loneliness).

The objectives we must follow in the prevention of geriatric patients are mainly to keep their functional independence, to improve their quality of life, To reduce mortality and to increase life expectancy, providing individual attention to the old man and his environment.

To achieve these objectives, we are going to incide on a series of parametres to promote health.

•   Blood pressure control at least once a year both supine and in standing.

•    Lipid control every five years in asymptomatic patients to prevent dyslipidemia.

•   Annual EGC over 75 years to prevent arrhythmias to decrease the risk of stroke.

•   prolonged.

•   Annual fasting glucose to prevent diabetes melitus especially in patients with a family history of obesity, hypertension or glucose intolerance.

•   Annual review of the mental state by Pfeiffer or MEC tests to prevent cognitive decline and to apply preventive measures as soon as possible if necessary.

•   Mood annual review to prevent depressions and to initiate early treatment.

•   TSH control every five years to prevent hypothyroidism, especially in women.

•   Control of vitamin B12 every five years to prevent pernicious anemia, responsible of many irreversible neurological lesions.

•   Annual monitoring of fecal occult blood to prevent colon cancer, making screening in patients from  75 to 80 years ( patients with good health).

•   Mammography every 1-2 years to prevent breast cancer untill 70 years if life expectancy is from five to ten years.

•   Pap smear every three years to prevent cervical cancer, interrupting the controls at age of 65 in explored women without having been ever positive, and in no explored women after two exams without alterations within one year.

•   DRE and PSA testing for prostate cancer prevention.

•   Annual audiometric study to prevent hearing loss and fitting a hearing aid as soon as possible.

•   Study to prevent presvicia yearly eye, cataracts, glaucoma, diabetic retinopathy and macular degeneration, and to perform necessary preventive treatments.