HEALTH PROMOTION AND HEALTH MAINTENANCE

Health assessment of older adults can be done on several levels, ranging from simple screening to complex, in depth-evaluations, To perform assessment accurately, nurses and other health care providers who gather information regarding older aults must possess the necesary knowledge and skill to perform the assessment correctly.
Health screening are done to identify older individuals who are in need of further, more in-depth assessment. For example, screening for hypertension, hearing problems...
Health assessments includes the collection of all of the important health-related data using a variety of techniques. Data are all the information a nurse gathers about a person. Objetive data include information that can be gathered using the senses of vision, hearing, touch, and smell.

The prevention is a part of health education and it is our work. The health education is essential to prevent some diseases like hypertension, dislipemia.... For this reason we have to explain our patient the importance of following our advices.

 

In elederly, prevention is too much important to avoid geriatric syndromes. Other point that I want highlight is the atypical presentation of illnes, for this reason , health assessments and health sreening have more importance  . I want to describe some atypical presentation of illness like:

• infectious disease: presentation like absence of fever, confusion, decreased appetite or fluid intake...
• "silent" acute abdomen: presentation like mild abdominal disconfort, constipation...
• "silent"cardiac problems: presentation like no complain of chest pain, decreased functional status...

I woul speak about an article that I found to describe the importance of heath screening.The article deal with about a study that has made in Mexico to highlight the importance of health screening to prevent aging depression. The conclusion of the study shows the role of the actions to prevent the diagnostic of depressionin elderly.

I attach one article that I found very interesting because it shows how through mental exercise, establishing a suitable diet, encourage the practice of moderate activity...we could improve the quality of life of aging population.

Bibliography:

Aguilar. S.G; Fuentes-Cantú.A; Ávila-Funes.J.A;García-Mayo. E.J.Validity and reliability of the screening questionnarie of geriatric depression used in the Mexican Health and age study.  Agosto 2007. Salud pública Méx vol.49 n.4. Cuernavaca

Zhang SC, Tao FB, Ueda A, Wei CN, Fang J. The influence of health-promoting lifestyles on the quality of life of retired workers in a medium-sized city of Northeastern China. Environ Health Prev Med. 2013 May 23.Pubmed PMID: 23700274.

URINARY INCONTINENCE

Urinary incontinence is the involuntary loss of urine in sufficient amount or frequency to be a social or hygiene problem. Urinary is not a normal part of aging. Incontinence has medical, emotional, social, and economic consequences for older adults. It can result in skin irritation or breakdown and can contribute to pressure ulcers; it can lead to guilt and frustation; it can lead social isolation; and it can be costly because of the need to purchase expensive undergarments and replace or launder clothing more frequently.

I share this video to explain the kegel exercises. Kegel exexercise are helpful in improving the tone of the sphincter muscles. Improved muscle tone can help the person hold the urine until he or she can reach a toilet or obtain assistance. 

 Other important advice to reduce the episodes of urinary incontinence is modify clothing to make toileting easier. Use velcros closures and elastic waists with loops may speed undressing and reduce functional problems related to toileting.

To reduce episodes urinary incontinence a important intervention is reduce enviromental barriers by providing grab bars in the bathroom, installing toilet risers, keeping the urinal or bedpan readily available, and providing a call signal for assistance. 

Fluid restriction increases the risk for problems with fluid balance and bowel elimination. For this reason we havo to assess fluid intake patterns. 

From my point of view the most important thing related to urinary incontinence is that it is not a psysiologic change. Urinary incontinence is a unconfortable situation for elderly. Episodes of incontinence are embarrasing and can lead to frustation and loss of slelf-esteem. We have to make talking about incontinence episodes easier to the patient. 

The use of absorbent pad when they are no necessary boost urinary incontinence to patients. In case of the use of absorbent pad we have to highlight the importance of good skin care and hygiene to prevent pressure ulcers.

Bibliography:
Hoffman. G. Basic geriatric nursing. 5th edition. Ed. Elsevier. 2012 St. Louis, Missouri.
Martinez. E: Ruiz. J.L: Gómez. L: Ramírez.M: Delgado. F:Rebollo.P: González. D:Arumi. D. Prevalence of urinary incontinence and oberactive bladder in spanish population: results from EPICC study. 2009. Grupo de estudio cooperativo EPICC.

PALLIATIVE CARE

I am very interested in this topic. I think that it coul be very difficult and a nurse have to be very strongh for paliative care but the feeling of give to the patient a dignified death have to be very special.

I want highlight some points of  clinic practice handbook that on my point of view a lot of nurses haven´t into account :

• Palliative interventions should be based on needes of the patient and his family rather than within expected survival
• All terminal patients have to right to palliative cares any level care.
•  The palliative care have to be provided, preferentiall, for a suitable multidisciplinare team. 

  
I found an article that on my point of view it resume some points that I think that it is very important have into account in the palliatives care. There are that the objetive of palliative care are to relive, in patients suffering a crhonic disease or in end life, symptoms of physic, phychical, mental and spiritual levels. For this reason it is necessary a multiple and interdisciplinary team of specialist whit specific capacyties and conected between them.

An important concept in palliative care is refractory symptom, there is a symptoms that can not be controlled  by hreatment. There is one the principal problems in this patients.
In my point of view, a palliative care nurses have to :

• be comprehensive
• empathize with the patient
• get dignified death to the patient
•  accompany patient and family  in death phases

One of the most important thing about palliative care from my point of view, is that we have to get a good support to patient decreasing the suffering.
Other point that I would to explain is grief, is the emotional adaptation process that following any loss. There are physic and emotional symptoms.
Sometimes when we talk in grief only think in the loss of a person, that is important thinking in:

• chronic o terminal disease diagnostic
• a short vital prognosis or reduce in quality of life
• loss of autonomy or independence
• loss of part of the body

Bibliography:
Pessini. L: Bertachini. L. Nuevas perspectivas en cuidados paliativos.2006; Acta Bioethica. Interfaces. 
Muñoz Cobos.F; Espinosa Almendro. J.M; Portillo Strempell. J: Benitez del Rosario.M.A.Cuidados paliativos:atención a la familia.2002. Publicado en atención primaria. Vol 30 Núme 09

 

ELIMINATION

The two major systems involved in waste elimination are urinary and gastrointestinal systems.
A large percentage of the older adult population suffers elimitation problems. One of the most common elimination problems experienced by older adults is constipation. This problem may result from changes in the function of the GI system or may be related to changes in other body systems such as musculoskeletal and nervous system.
Well, I want with this introduction make a short resume of the relationship between body systems and the gastrointestinal problems.

 In this post I make a brief summary of diferents gastrointestinal problems:
Constipation, is defined as hard, dry stools that are difficult to pass. It is important bring out that constipation is not a disease but rather a symptom of some other problems. A diagnosis for constipation must include two or more of the following symptoms during 3 months:

• straining
• hard and lumpy stools
• sensation of incomplete evacuation or anorectal blockage
• less than three defecations per week
• loose stool rarely present without use of laxatives
• use of manual maneuvers such as digital stimulation to facilitate defecation

 
We have to keep in mind the importance of this geriatric syndromes because they affects patient's quality of life, and they have lots of importants consequences for older adult like fecal impactation, anal fissure....
Nurses have to help the patient and we have to give some advices to prevent or resolve constipation, some of them are:

• rich fiber diet and intake 2 liters of líquids
• make regular exercise
• go to the bathroom after breakfast
• make pelvic floor exercises
• provide privacy for elimination

ostomies, in this topic I want to bring out the importance of the education about ostomy patient. This intervention lead to suppose a great challenge fot the patient and for him social enviroment because it is a difficulty related with the disease process.As nurses we have to try to understand the difficulties that the patients could have.

Ostomy is a new "style of life" for the patient, fot this reason I think that it is important that we know some advices for the ostomy patient such as:

• eat and chew slowing
• a correct stoma hyigiene.
• increase progressively intake
• try and eat new food sparingly.
• intake 1,5 liters of water
•  do not abusse of fried food or spicy.

Bowel Incontinency, from my point of view this is the elimination problem that could produced major numbers of problems to quality of life. A lot of older adults haven't go out because they have fear for the possibilite of maybe have a bowel incontinence situation. 

Dysphagia, difficult to swallow liquids or solid food for the affectation of one or most swallowing phases. It is important in this disease adjust the differents consistency depending on lesion places.
Some general advice for the patient that suffers disfasia are:

• present small quantities of food in the dish
• no mix solid and liquids
• take food in small pieces  
• avoid contact spoon with teeth to let lose reflex to bite this.
• enrich foods
• no force
• calm enviroment

It is important bring out the most important consequences of dysphagia, they are malnutrition and dehydration. For this reason, we have to pay attention to dysphagia symptoms.
We have to improve patient's quality of life, for this it is important that we manage a good nutrition and if we observe some desnutrition symptom we have to dismiss dysphgia syndrome early.











Bibliography:
Wiskur. B; Greenwood-Van Meerveld. B. The aging colon: the role of enteric neurodegeneration in costipation. December, 2010. Springer science bussines media.
Galan. N. Recomendaciones al paciente ostomizado. 2011. Enfermería gastroenterología.
Neuman HB, Park J, Fuzesi S, Temple LK. Rectal cancer patients' quality of life with a temporary stoma: shifting perspectives. Dis Colon Rectum. 2012 Nov.