Автор работы: Пользователь скрыл имя, 20 Мая 2011 в 10:32, реферат
General care for a sick elderly is quite complicated and requires more time and attention. The basic principle of care is respect for the individual patient, taking it for what it is, with all his physical and mental disabilities, irritability, talkative, sometimes - dementia, etc. Please note that appropriate, care can improve the condition of patients.
Introduction
General care for a sick elderly
Overview
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Elderly patients in hospital
Summary
Literature
REPORT
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How to Care for the Sick & Elderly
General care for a sick elderly is
quite complicated and requires more time and attention. The basic principle
of care is respect for the individual patient, taking it for what it
is, with all his physical and mental disabilities, irritability, talkative,
sometimes - dementia, etc. Please note that appropriate, care can improve
the condition of patients.
Preserving mental health is impossible without sufficient information.
It should be remembered that the lack of permanent training of mental
abilities as pernicious as the prolonged absence or drastic reduction
of motor activity. Life does not look attractive, yet retains the ability
to learn and maintain relationships with society, even if the person
alone. Communication with family and friends - a key incentive to save
the desire to live and be healthy.
For the right to care for sick elderly need to know the behavior of
these individuals as they age-related changes in the functions are closely
intertwined with the symptoms of disease and in most cases - multi-age
diseases.
In the aging process significantly changes the function of the apparatus
of urine and kidneys: increased urination at night, often because of
increased sensitivity and irritation of the bladder sphincter, and men
and because of the presence of BPH. In patients with cardiovascular
insufficiency increase nighttime diuresis - a compensatory phenomenon
caused by improved blood flow in the kidney and the horizontal position
and at night.
If the patient often wakes up at night to urinate, you should give him
a "night-ware" to prevent the frequent walking to the toilet
and significant sleep disturbance.
In addition, frequent nocturnal diuresis can be recommended, the patient
did not receive fluids shortly before bedtime. However, it is necessary
to carefully consider the water balance, considering that the excretion
of metabolic products in the urine daily urine output should be not
less than 1 liter.
Despite produced since age care, accidents with elderly and older people
- a fairly common occurrence. They are not only on slippery sidewalks,
streets, and homes, in bathrooms, toilets and other facilities.
Fall quite frequent in older people, the causes are different. This
decrease in vision and hearing, poor motor coordination, impaired ability
to maintain balance, muscle weakness legs, dizziness. And the age-related
changes in bone tissue (osteoporosis) can easily cause arising "senile"
fractures.
The rooms should not be unnecessary furniture. Should not rearrange
furniture without putting a notice to the elderly or old people, because
they move around the room, they rely more on habit than on vision. It
should be remembered that the fall in older people may be the rapid
transition from horizontal to vertical position, or when rising from
a chair. This is especially true for those who take antihypertensives,
which may have episodes of transient cerebral insufficiency, and coronary
blood flow due to a decrease in blood pressure.
Frequent accidents associated with bathing in the bath (in a slippery
tub or on a wet floor).
Possible burns if a mistake is only open hot water tap. It must be remembered
that you first need to adjust the water temperature, and then take a
bath or getting into the shower. Better to use a shower instead of bath,
sitting, and in the presence of someone from home, providing the necessary
assistance. The water temperature should not exceed 36-37 degrees, especially
should not send a hot shower on your head and heart area in order to
avoid acute disorders of coronary or cerebral circulation. Near a bath
tub on the floor it is desirable to bed, and a rubber mat. It is recommended
to arrange for a support device in a toilet and a bathroom.
Older people are not stable when walking, have difficulty in passing
a standing position. Sometimes for them to acquire moving on wheels,
bearings, movable chairs.
Requires attention and a device for the bed of an old man. It should
be not less than 60 cm, if necessary, be fitted with devices to transfer
the patient to a sitting position (so-called functional bed). Desirable
or overbed bedside table, providing convenient meals for patients and
some of his classes. More appropriate two small than one large cushion,
lightweight, but warm blanket. For the prevention of bedsores in bedridden
patients is of great importance elasticity of the mattress, it must
be sufficiently malleable to be the backbone for a large area of the
body and eliminating the pressure on the relatively small area.
Chair for an elderly person should be soft, have a low, comfortable
armrests and be shallow, to the edge do not put pressure on the popliteal
region of pits and did not break leg circulation. Backrest should be
high enough to be a support for the head. Must be convenient individual
lighting for reading in a chair and bed.
Mature and old people are more sensitive to cold drafts. Many of them
are muscle pain, aggravated by cold, skin temperature is lowered due
to reduced microcirculation-tion, the subcutaneous fat layer is often
less than the young. All this leads to coldness, poor tolerance of low
temperature, an objection to airing.
Optimum temperature of the room for patients who are on bedrest, is
20 ° C, normally 22-23 ° C. It should be remembered that the dry air
in rooms with central heating poorly tolerated by patients with chronic
pulmonary diseases (particularly chronic bronchitis) and contributes
to coughing. To make the air more humid on radiators or near them you
can put containers with water.
Age-related changes of skin aging begins with 40. In 60 years, much
thinner, and after 75 years, abruptly thinner all skin layers. Significant
changes are as hair, sebaceous and sweat glands. Due to marked changes
of blood vessels and nerves of the skin decreases its protective function,
changes the reaction to mechanical, thermal and chemical stimuli. Therefore,
the bathtub or shower with soap in the elderly and those older people
often cause dryness and itching of the skin. Only one bath a week. It
is recommended to use soap and water with a high fat content.
If you frequently shampoo and soap may appear dry scalp, dandruff and
itchy skin. In this case, it is recommended to wash the hair soap 1-2
times a month, rubbed into the scalp liquid "for hair growth.
Very beneficial effects have rubbing and massage of the body, but require
caution due to the thinness and light skin in the elderly. Dry skin
should be lubricated with mineral oil, emulsions or creams for dry skin.
Should pay attention to foot care, as the skin on them very early changes
in the deterioration of the peripheral circulation. Nails become hard
and brittle, so before ostriganiem soften their warm poultices oil (preferably
from castor oil). Nail Care legs, remove the calluses of great importance,
as changes in the feet, restricting the mobility of an old man, adversely
affect his physical and mental health. Inflammation caused by traumatization
of skin and the introduction of infection can be cured with difficulty
and can lead, especially in the presence of diabetes, often latent,
to serious complications, up to the limb gangrene.
Should be encouraged care of elderly patients about their appearance.
A neat haircut, shave regularly, neat clothes by themselves increase
the mood of patients, contributing to the improvement and general condition.
For many diseases (eg pneumonia, myocardial infarction, circulatory
failure) patients were elderly
children are forced to comply with prolonged bed rest, which may also
lead to some adverse effects. Prevention of these complications includes
the use of complex events.
Prolonged bed rest - a particularly important issue in practice. Until
recently it was thought that the old man must "protect its forces
and as long as possible to be in bed, especially in case of complaints
and diseases. It was found that prolonged bed rest in older people pretty
quickly leads to significant changes in the function of internal organs
and lead to complications such as hypostatic pneumonia, thromboembolism,
difficulty urinating and urinary tract infections, pressure sores, decreased
appetite, which leads to a decrease in body weight and general weakness,
the development of muscular atrophy.
Prolonged bed rest in older groups is often the cause of joint stiffness,
constipation, insomnia, mental disorders and depression. It is therefore
necessary to reduce the possibility of a period of bed rest, not allowing
the patient to remain immobile for longer than is absolutely necessary.
However, there are a number of diseases in which patients of older age
groups need to be fairly prolonged bed rest. This is mainly of the disease,
accompanied by a rise in body temperature (pneumonia, , influenza, etc.),
severe chronic diseases (circulatory failure, severe anemia, etc.),
acute myocardial infarction, etc. However, careful ongoing care for
older people can reduce the negative impact of inactivity (lack of physical
activity) on the overall condition of the patient.
Bedsores and urination disorders most frequently observed in patients
with impaired cerebral circulation, and dementia (senile dementia),
etc.
Bedsores occur in patients who were forced to lie on his back for a
long time, while playing the role and overall health - poor diet, exhaustion,
dehydration.
Contributes to the development of bedsores awkward, uneven bed, bad
perestilaemaya, the presence of scars, wrinkles on the sheet, shirt,
sick, lack of bathing and drying the skin after urination and defecation.
The most commonly sores are formed on the sacrum, buttocks, sometimes
in the blades - these body parts should be inspected daily for seriously
ill patients. To prevent the formation of bedsores apply rub and massage,
which must be conducted very cautiously, given the delicacy and vulnerability
of the skin in elderly patients. Essential food (the introduction of
a sufficient number of high-grade protein diet, multivitamin complexes)
and the elimination of deficit of the liquid (water schedule, if necessary
- an intravenous infusion of normal saline).
In order to apply preventative and special bed-rubber wheels, which
are placed under the areas of the body that are exposed to prolonged
pressure (for example, under the sacrum).
Need to constantly change the position of the patient, turning in bed
8-10 times a day, wash in cold water with soap 2-3 times a day the right
places, wipe camphor spirit or eau de cologne, talcum powder.
Treat bedsores much more difficult than to prevent their occurrence.
First, lubricate the affected area with a solution of potassium permanganate,
brilliant green; use irradiation (UHF, UFO). The surface pressure sores
covering aseptic bandage. Then used for healing various ointments)
Require careful care of patients with urinary incontinence, which can
occur in elderly and senile patients from urogenital diseases or due
to cerebrovascular events, or, for example, dementia (senile dementia).
If normal urination is impossible to recover, you must always use a
rubber bed-inflatable craft for bedridden patients and special urinals
(of various shapes for men and women) - for walking or anatomical diapers
for adults in either case.
Constipation, delayed bowel movement is often a serious problem for
the elderly and the old man, forced to comply with bed rest. They are
caused mainly intestinal atony due to lack of motion, receiving, as
poor, coarse-fibered devoid of ballast substances (found in vegetables,
fruits, whole grain bread, etc.), lack of fluid intake, intake of drugs
(hypnotics, sedatives, painkillers) . In the treatment of constipation
should be aware that - enemas in older people more likely to cause irritation
of the intestine, than in younger (as well as the rectal suppository).
The main method of treatment for constipation should be diet: lacto-vegetarian
diet rich in vegetables and fruits (apples, plums, prunes, raisins,
apricots, etc.) and the correct mode: walking as possible. 120
Where necessary, use laxatives of vegetable origin (drugs buckthorn,
senna), slightly alkaline mineral water, small (150-200 g) enemas of
weak chamomile decoction in the morning, sometimes bowel may contribute
to drunk on an empty stomach a glass of tap water.
In the presence of elderly patients hemorrhoids need to pay attention
to falling hemorrhoids are not traumatized rough toilet paper. After
each act of defecation should wash the anal area, the use of trays with
a decoction of camomile, special rectal suppositories.
Fecal incontinence is often mistakenly perceived as an inevitable manifestation
of old age. Causes of incontinence are diverse: the use of laxatives,
proctitis, rectal prolapse, etc. Clinically, incontinence is manifested
frequent or constant dribbling half-formed stool or the passage of formed
stool 1-2 times a day in bed or on clothing.
In most cases, when relevant events are painful for the patient and
surrounding phenomenon can be reduced or even eliminated. For example,
you should try to prevent a reflex bowel. Thus, if the chair is, after
breakfast, then taking it to be combined with a stay on a toilet bowl
or vessel. But in general, treatment of symptoms of fecal incontinence
requires joint efforts and medical personnel and patients, and his relatives.
In a forced prolonged stay on bed rest an extremely negative role played
by physical inactivity. In this regard, of the complex therapeutic measures
should definitely include physiotherapy exercises, but only by appointment
and under supervision of a physician.
Patients with elderly rehabilitation process is slower than the young
people that defines and longer-term rehabilitation therapy (rehabilitation).
However, the persistent and long-term treatment and careful nursing
can make significant progress in the rehabilitation of persons who have
suffered even a very severe disease.
Taking on the responsibility to care for the sick and elderly is a large commitment time wise, financially and emotionally. You are assuming the responsibility of care for another person, one who likely cannot do much on her own. Make sure that you take the time to plan for the care, and choose the necessary help, medical care and type of care that you'll be giving. With the right support and attitude about caring for the sick and elderly, you can have a fulfilling experience.
Make a care plan with the elderly person's family. If you are the family, talk to your siblings and parents about what should be done, and who can help. Taking on all of the care for the sick and elderly is a big responsibility, and you may be able to take shifts with other family members. Map out how much care should be given, and what can be done to make the sickly person's life easier and more comfortable.
Arrange the home for comfort. If you are caring for the sick and elderly person in his own home, you may need to remove some of his furniture or move his bedroom to the main floor for ease and comfort. Make sure that he is still surrounded by his favorite things, and that you've done what you can to make the house safer and more comfortable, suggests "U.S. News and World Report."
Allow for as much independence as humanly possible. If the sick person you are caring for is bedridden, but still likes to take her own baths, do what you can to make that possible. You'll find that she is much more agreeable and easy to deal with when she doesn't feel like you are taking over her entire life.
Visit with the individual's doctor and take him to doctor visits so that you stay up to date on his condition and what should be done. If you are not a family member, you may need permission from a family member to attend doctor's visits and medical consultations first. Keep your own file on the sick and elderly person so you remember which medications need to be administered, rehabilitation tactics and warning signs to bring him to the hospital or call a doctor.
Ask for help if you need it, the AARP recommends. The 24-hour care of another person is a huge commitment, and there are services that make it easier. Elderly day care, home hospice services and even meal services can all be employed to lighten your load so that you're able to care for the elderly person and yourself simultaneously.
It is generally accepted that
elderly people fare best when care is provided in their own homes. However,
some conditions require more intensive management than can be provided
in the community. The admission of elderly patients to hospital, their
treatment and subsequent discharge can prove challenging. Whilst self-sufficiency
depends a lot on the underlying condition, delivering a package of care
to an acceptable standard can make the difference between an individual
who is a self-sufficient functioning member of the community and one
who is disabled and dependent.
The Department of Health recognise the importance of providing quality
care to the elderly and has produced a raft of guidelines outlining
the sort of issues which need to be considered when planning services.
Many of these are enshrined in the National Service Framework for Older
People. A White Paper addressing the social aspects of elderly care,
'Our health, our care, our say: a new direction for community services',
was published in 2006.2
Concerns have been expressed about the standard of nutrition which elderly
patients have received in hospital. This has prompted Age UK to issue
its guidance 'Seven Steps To End Malnutrition'.
Age discrimination
Patients should be treated according to clinical need rather than age. This might seem self-evident but may present pragmatic difficulties. Some clinicians might balk at the idea of referring an 85 year-old for coronary artery bypass surgery but, if the patient is otherwise fit for surgery and wants the operation, they should be offered the chance to have it. A report, 'Achieving Age Equality in Health and Social Care', was published in 2009 containing various recommendations supporting the concept of equality in healthcare for the elderly.
Person-centred care
Patients should be treated
as individuals and empowered to make choices about their own care. This
involves providing information in a form that patients can understand
and listening to their views and the views of their carers. Preserving
dignity in a hospital setting is a major objective and includes separate
toilet and washing facilities, single-sex wards and safe care for patients
will mental disorders. The Government has announced that it will end
the indignity of mixed-sex wards by the end of 2010.
Another raft of guidance involves the provision of end of life care
and, whilst this may be of more relevant to community and palliative care services, it also impacts on community
hospitals.
Intermediate care
The aim here is to relieve pressure on acute hospital beds and provide care in a more community-based setting. The principles are the same whether care is provided by intermediate care teams in the patient's own home or in an intermediate care facility. The goal is to restore the patient to full function and avoid the need for long-term care by providing integrated rehabilitative support.
Specialist care whilst in hospital
With the change in demography in the UK, a significant proportion of people in hospital are now aged over 65 and secondary care needs to provide services tailored to the needs of its elderly population. The emphasis has been on improving access to care and the last few years have seen a significant increase in the number of elderly patients being admitted for cataract surgery, hip or knee replacements and interventional cardiac surgery. In addition to traditional geratologists and consultants in care of the elderly, many hospitals have set up specialist multidisciplinary teams led by nurses ('modern matrons' or nurse consultants) focusing on the needs of the elderly whilst in hospital and on discharge.
Stroke care
Evidence suggests that stroke patients fare best when admitted to specialised stroke units. The aim is to provide rapid access to diagnostic services, care provided in stroke units led by specialised physicians and multidisciplinary intervention to enable early discharge, rehabilitation and secondary prevention. Provision has been patchy but the release of the National Institute for Health and Clinical Excellence (NICE) guidelines on stroke in 2008 has helped to standardise care across the UK.
Management of falls
Falls are the leading cause of mortality in the over-75 age group. All patients who have had a fall should be offered a multifactorial risk assessment and multifactorial interventions. NICE recommends the following:
Some clinical issues relevant to the care of older patients
Elderly patients may have a different pattern of disease and different response to treatment than younger patients.
Hospital discharge
A significant proportion of
patients who experience delayed discharge are elderly. Poor hospital
bed management and a failure of communication between health and social
care are the principle contributing factors. Hospital discharge should
be a planned event and the planning of a discharge care package should
begin at the point of hospital admission in partnership with the patient
and their carer(s).
Issues to be considered
include:
End of life care
Doctors are continually being reminded of the importance of obtaining consent for treatment and of involving patients in decisions about their care. However, difficulties can arise when patients are unable to understand decisions or give informed consent. In such situations, clinicians should take into account the following:
Western culture depicts American
character as strong, smart, and physically well. Thus, the elderly and
the sick are an outcast in the pool of society mobilizers. Not until
the dawn of affirmative action where the minority is endowed the right
to live normally in the American territory. It has given the elderly
and the sick right to protection, security, and welfare in the society.
In 1965, The Social Security Act was signed into law to respond to the
needs of the sick and the elderly. Under the Social Security Act, people
whose age is 65 years old and above, as well as the physically disabled,
are given health insurance by the American government. They automatically
became members of the Medicare Program, and each will receive a Medicare
card as proof of their membership.
Moreover, the program also covers expenditures for a nursing home. These
nursing homes provide services for those who need personal care while
recovering from an injury and sufficient attention for those who need
long-time service caused by of chronic illness and disability.
Related Coverage
The government has instituted
centers and agencies which help older adults and caregivers find a nursing
home suitable for them.
There are different kinds of nursing services covered in the supplement Medicare
plans . The most
common types are community services and home care services. Community
services are organized and managed in villages and municipalities which
provide communal care services. Some of these are given in Adult Day
Care and Senior Centers. Conversely, some arrange for specific services
like shopping and transportation support, meal programs, and friendly
visitor programs.
On the other hand, home care services of supplement
Medicare plans
cater to individual needs in the comfort of ones home.
Every disease, especially severe
and prolonged, accompanied by
appearance of symptoms (fever, pain, shortness of breath, appetite loss
etc.), restriction of physical activity and the ability to self-service,
impaired ability to meet basic needs (food,
drinking, the release of bowel, bladder, etc.). Along with treatment,
aimed at combating the disease, the patient requires proper care
it (the physical regime, sanitation, nutrition, care for
administration of physical needs and carrying out various procedures,
aimed at alleviating the manifestations of the disease).
In addition, for many chronic diseases can afflict or
provoked exacerbation of disease, such as the presence of harmful habits
(Smoking, alcohol, tea, coffee, certain dishes), and
negative psycho-emotional influences, etc. It is important to identify
these factors and
try to fix them.
It is important to also provide patients with not only physical but
also moral support,
it also affects their health and speedy recovery.