AUXILIARY ELEMENTS FOR THE MOBILIZATION.

The nurse will have to teach to the old patient the correct form of use of the auxiliary organizational elements for the mobilization: cane, walker and crutch.

A correct use, would improve the quality of life of anciano.y its capacity of mobilization. Also the power consumption would improve doing an suitable use of these elements.

With the cane:

-To be placed the cane in the hand opposed to the affected extremity, to extend the support base and to reduce the voltage on the extremity.

-To advance with the cane at the same time as it forwards moves the affected leg.

-To be placed the cane sufficiently near the body to avoid the inclination.

-To lean on the cane when the affected extremity does not initiate the phase of balance.

With the walker:

-To lean in the bed or a chair to rise, never to lean in the walker to put itself still on.

-To take the walker by the handles to obtain major stability.

-To raise the walker placing it against if while it pushes its body slightly forwards.

-To walk with the walker, being supported the weight of the body in the hands when advancing with the weak leg but.

-To balance by itself on the feet.

-To raise the walker and to return it to place to the front.

-To watch at the front while it walks.

  

          

With the crutches:

- It should have the size and length adapted for its weight and charts. It to place the crutches stuck to the body from the feet, when taking them with the hands the shoulders do not have to rise nor to lower, is , it is called anatomical position.

-Advice:

-To use a footwear with nonskid, comfortable and closed sole.

 -To use comfortable clothes that allow freedom him of movements.

 -To watch at the front and to stay raised.

 -To forwards place the crutches next to each foot and a little.

  If he can support feet both:

  -Being standing up it must have three supports of     the four possible ones.

           -Left crutch>>>>Right foot.

           -Right crutch>>>Left foot.

  -In order to walk it must advance both crutches to the same height.

  -To advance to a foot and the other soon.

   If he only can support one:

  -Being stopped it must have three supports of the four possible ones, and drop the weight of the body on the healthy extremity.

                   -Left crutch.

                   -Right foot.

                   -Right crutch.

                   -Left foot.

  -In order to walk it must advance the first crutches and the affected extremity.

  -Next, letting fall the weight of the body on the crutches, advance with the healthy extremity

THE INTEGUMENTARY SYSTEM.

The deep effects of the aging on the skin are not demonstrated until the end of the fifth decade of the life.

The majority of these changes takes place in the dermis.

Pictures. Thinner and fragile skin. The thickness of the dermis falls in a 20%. The skin becomes almost translucent and provides less protection against the invasive organisms.

Another changes that take place are that the skin heals worse and are more susceptible to the development of diseases like cancer most leather, itching and ulcers.

*The nurse have to watch and to control the skin of the old patient. Realising the necessary valuations.

The sebaceous glands diminish their size: greater incidence of insolations in old.

*To get a suitable hydration. To maintain a suitable temperature.

The reduction of collagen production. It produces that the skin is less flexible implying greater susceptibility to the tear injuries.

*Valuation of the skin.

The reduction of the function of the gland sudorípara, contributes to the dryness of a skin, that is broken.

*To hydrate skin. These injuries can become vestibules of entrance of bacteria and cause to cutaneous injuries majors.

GERIATRICAL SYNDROME.

Syndrome: defined like “a group of signs and symptoms that appear together and characterize in particular to an anomaly”.

The geriatrical syndromes talk about to multi-factor, own conditions of health of the old patient, that happen when the effects of the accumulation of deteriorations, in multiple systems, return to a vulnerable person against physiological or physiopathological demands.

                       

Geriatrical syndromes of greater prevalence exist, are the great calls geriatrical syndromes, these are urinary Incontinence, falls, Immobility and the mental deterioration. Others exist like; sensorial deprivation, constipation, pressure ulcers, insomnia, depression, social isolation, malnutrition, hypothermia and fainting.

So that, a cause can derive in several geriatrical syndromes, and the other way around, several causes can cause one or more syndromes.

The nurse will have an important paper as far as the prevention and precocious detection of the possible syndromes.

Also of the pursuit of these syndromes to manage a greater rehabilitation and one to improve its quality of life.

ALZHEIMER.

The Alzheimer is a demential disease that takes a loss of intellectual capacity.

The symptoms, that appear generally in adults of 65 years, can include losses in the abilities of the language, like difficulty in the spoken expression, problems in the abstract thought, capacity of judgment, disorientation in the time and space, upheavals of conduct and personality.

The general result is a reduction of the personal activities and in the performance of the work. The fact that the people who suffer Alzheimer face daily to this disease have an important effect on the quality of life of the people who suffer it and in the life of their familiar since, although some patients with Alzheimer live in geriatrical, the majority are taken care of by their familiar.

As the patients are become less independent, she falls a greater responsibility on the figure of the caretaker/assistant that it is exposed as well to a high risk of physical and psychological diseases being able to accelerate the internment of the patients in geriatrical institutions.

By all these reasons, fodder that is a fundamental necessity, to enable to the personnel of infirmary in this area to be able to do against this terrible situation which every day old ones face our and logically all.

                           

PALLIATIVE CARE

In my last practice rotation I was fortunate to work in a team that I didn’t know: the ESAD (Equipment Homecare Support). It is an important element to provide palliative home care.

The WHO defines palliative care as the active, total care of patients whose disease is not responsive to curative treatment.

The way to deal with family and patients is very different from the Primary Care. The psychological aspects, the  necessary empathy and the way in which we transmit knowledge have a degree of complexity that I hadn’t faced before.

In this team I learned:

·      To make independent valuation of immobilized patients. They use many scales for the complete evaluation of patients:

o   For functional status: Barthel, Karnofsky and ECOG.

o   For cognitive status: Pfeiffer.

They value sociodemographic, clinical variables, ethical –clinical dilemas, assessment of the symptoms severity...

·      To provide advice and information to the caregiver. To give psychological, social and spiritual support.

·      Subcutaneous way handling. Knowing hoy to explain to the family their proper use.

·      The treatment of cancer pain and other symptoms.

·      Nutritional assessment and monitoring in immobilized patients.

·      Dressings uses and cures of skin lesions.

It's a team that plays a very important role: to get a good quality of life to the patient during the terminal phase and very a very important support to the family at this critical moment.

CONSTIPATION IN THE ELDERLY AND LAXATIVES.

Constipation is considered one of the most common health problems in the elderly.

As a measure to solve the problem, they tend to abuse of laxatives because they are the fastest way.

As future nurses, we must leave laxatives as the last option, trying to change the elder’s  life habits:

• ·      Diet, including a higher intake of fiber substances.
• ·      Increasing water intake to 1.5 l per day.
• ·      Increasing exercise and mobility.
• ·      Checking the drugs they take and can cause constipation: opiates, anticholinergics, antiacids, NSAIDs, antihistamines, calcium, iron salts, calcium supplements...
• ·      Encouraging bowel habit as routin.

Laxatives must  be used for a limited time as they may cause patient’s tolerance or colon irritation.

The nurse plays a key role in patient education and in monitoring their evolution.

PRESSURE ULCERS

Pressure ulcers are avoidable in 95% of cases. A nurse has an important function in preventing them and in their correct treatment.

Many years ago I was at a nursing home in a small town and I saw for the first time a pressure ulcer in a patient. What I was surprised of, apart from the size of it, covering the entire back, was how the nurse was spreading honey all over the ulcer to heal it.

In our practice as future nurses we see the use of techniques that are not correct because they are not based on scientific evidence.

I’m going to make a reflection on the mistakes we that tend to make when we don’t follow the scientific evidence.

The most usual mistakes in prevention:

• Not using the Norton scale à You must use the Norton scale for assessing the risk of pressure ulcers.
• Applying alcohol on the skin àYou must not apply it, because it produces dryness.
• Massaging red areas and bony prominences à Don’t do it.  AGHO should be applied in areas exposed to friction, pressure or shear.
• Not to do postural changes à postural changes must be scheduled, programmed and individualized and wehave to teach the patient or caregiver to do them.
•   Raise the bed 30 ° à It must not be done.
•  Use floats as a seating surfaces à Don’t do it, because pressure is concentrated on the body area in contact with the float and produces a compressive effect.
• Bandages on the heels à foam heels are more effective than padded bandages.
• Carelessness on the sterility of productsàWe must maintain sterilit.

Most common mistakes in treatment:

• Changes on treatment before 8-10 days à We must keep it a minimum of 8-10 days to make sure it is useful.
• Dry cure à Moist wound healing provides the level of temperature and humidity suitable for biological remediation and a semipermeable barrier that prevents the evaporation of excess moisture and acts as a wall to bacteria.
• Cleaning  wound bed with antiseptic products à It must not be done. These are inactivated by contact with organic matter. They can irritate the granulation tissue. They need a minimum operation time. And the residual effect is short-lived.
• Touching wound bed when we dry  the ulcer à Do not touch, dry surrounding skin only.

·      Debridement:

o   Mixing collagenase + silver à silver is inactivated. Correct choice: collagenase + hydrogel.

o   Debridement on the heel à It’s not necessary, there is risk of osteomyelitis.

·      In Infection:

o   Using antibiotic ointments à Antibiotic treatment must be oral. Use silver dressings.

o   Improper dressing Size à it must be put on the wound and about 2-3 cm of healthy skin.

o   Placing gauze under dressings à it difficults the exudate management and can it adhere.

o   Placing adhesive dressings after applying hyper-oxygenated fatty acids à  they don’t adhere properly.

o   Putting silicone net dressing  with healing dressings for moist evironment so that the injury doesn’t stick à It only increases costs.

o   Setting cures regardless of wounds evolution à We should Schedule them depending on the state of the wound.

o   Not recording properlythe size of the lesions à We don’t have objective data of the lesion evolution.

o  Not thinking about an extra protein intakeà It should be administrated if there is no contraindication to have a protein diet with supplements of vitamin C.