Assessment 2 1500 w0rds Essay Example
NURSING IN THE OLD 7
Nursing in the Old
Assessment 2 1500 w0rds
End of life care
Dementia is a progressive, life shortening illness with neurodegenerative qualities. This is to say that it is a neurodegenerative disease. By affecting a person’s neural system, those affected are deprived of their abilities to communicate efficiently and meet their capabilities of fulfilling their daily personal needs. Patients in this condition should receive palliative care. The aim of palliative care is to make the life of the patient better in terms of quality and as a result, make the lives of his family members better too (Miller et al, 2005). Palliative care is multifaceted and includes many aspects of wellbeing. Because of the complex nature of the kind of care and medication that patients with dementia need, they often pass away in six months or less after being taken to acute hospitals and treated as emergency cases that are unplanned. The needs of dementia patients are multifaceted and they do not have adequate capability to make their needs known to those caring for them (Mitchell et al, 2004).
Palliative care involves alleviating the pain and symptoms that manifest. It is not a cure but a treatment of the symptoms. One of the most pronounced symptoms for patients with dementia is pain. The pain associated with dementia worsens as the disease progresses and the patient should be asked to equate the pain they are experiencing to a number on the scale of one to ten to learn of the severity of the condition. Pain is a constant company for these patients and so managing the pain to levels that can be tolerated is essential for them. The progression of the pain’s intensity should be monitored and direct tests like mini mental state examinations should be done often. This examination should be done by someone who is an expert in pain assessment skills and therapeutic approaches to relieving pain. The pain can then be controlled by medications in three step opioid hierarchy that inclusive of mild opioids like codeine, non opioids like paracetamol or asprin and stronger opioids like morphine. In addition, other relief methods that do not include medication can be used. Massages can be done to patients with severe headaches and hot and cold variations for those exhibiting muscle spasms (Mitchell et al, 2004).
When dementia is at an advanced stage, patients have weak immune systems and immobile and therefore are more susceptible to infections, especially inter-current ones, with the most prevalent one being pneumonia. Problems when swallowing and incontinence will make the affected patients be at more risk of infections in the respiratory tract and the urinary tract respectively. These areas of the body will most likely contract infections due to the symptoms caused by dementia. Antibiotics are recommended for dealing with these infections by reducing the circulation of the proteins that hasten the progression dementia (Shega et al, 2003). Problems when swallowing and incontinence will cause infections in the respiratory tract and the urinary tract respectively.
Due to the problems they have eating, patients should receive rehydration of nutrition artificially is important. Other contributing factors to their feeding difficulties are appetite loss and lack of food enjoyment which manifest in hunger and loss of feeling. Aspiration pneumonia is also associated with ingestion problems. Using percutaneous endoscopic gastronomy tubes to feed patients will reduce the chances of them getting aspiration pneumonia, malnutrition and other infections (Morris, 2001). The tubes will work to prevent the patient from getting aspiration pneumonia while the fact that the patient is eating will prevent cases of malnutrition. In addition, the risk of getting other infections will be lowered significantly.
During the last stages of dementia, cardiopulmonary resuscitation becomes essential in some cases and especially for patients who are rare compromised and frail. The cardiopulmonary resuscitation conducted is guided by ABC which is also known as airway breathing and circulation. In the airway, the caregiver may check for problems. If the patient’s airway has a blockade, the material or constituent that is causing the blockade is removed (Campbell et al, 2004).
When patients of dementia start to show psychological and behavioral manifestations of the disease, they will need daily care. When the symptoms start to show, the patient might start showing signs of nervousness and restlessness, also, he may start to wander off without any explanation, in addition, he may start to exhibit improper sexual behavior, he may experience delusions, become depressed and have hallucinations. The best mode of care can only be decided after enough and adequate information about the patient’s deranged mannerisms is collected. This information should include a history of the symptoms he has been showing. Gathering the information will facilitate gaining knowledge about the patient’s psychological and behavioral manifestation and their frequency, severity and effects. This is all so that the psychological and behavioral symptoms can be reduced (Campbell et al, 2004).
These symptoms could be managed using medication or not. It is up to the caregivers to decide on the best course of action for the patients. If drug therapy is done, it could include selective reuptake of serotonin, placebos that have been applied choleneterases or neuroepileptics like carbamazepine. Patients with mixed and vascular dementias should also be administered a stroke prophylaxis (Campbell et al, 2004).
Dental and nutritional concerns for patients outside healthcare institutions
Oral difficulties mostly affect older patients with manifestations like communicating problems and inability to feed which affects the life quality they have and body orientation. If the oral infections go unchecked, they could cause disfigurement especially in the facial area. The oral cavity can act as a bridge or passage for entry of microbial infections to the body and when it is affected by dental diseases, the patient is at more risk of getting these infections. Other than that, they lead to creation of blood pathogens which then spread in the body. Older patients need more specialized dental care because they are more susceptible to numerous medical complications which they may already have. Specialized treatment will reduce the cases of confused diagnosis and treatment. To facilitate dental care, regular brushing teeth frequently and dentist appointments are essential (Ahluwalia , 2004).
Older patients are more likely to get oral infections due to possible previous infections or the infections could be a manifestation of other chronic conditions. This is most common with conditions and medication that impede the production and flow of oral mucosa or saliva which disinfects the mouth. Medications could lead to complications like bleeding, lichenoid, xerostomia, hypersensitivity and tissue overgrowth. The mouth of elderly patients goes through inevitable changes and the dentin, enamel and teeth age with time. They are also incapable of accessing effective dental services mostly because the society may not understand that dental care is essential for elderly people too. In addition, those charged with caring for them may not have adequate equipment and as a result, they may not provide effective dental services to their elderly patients (Ahluwalia , 2004).
Nutritional needs for older patients are the same inclusive of vitamins, minerals, carbohydrates, proteins, water and fats. However, since their bodies change with age, functions such as digestion will not be as before. The whole digestive system will be altered and the absorption of minerals and waste product removal will alter. Their diet should, therefore, have plenty of fibers to reduce their chances of constipating. If elderly patients’ nutritional needs are not met, they may exhibit symptoms such as rapid weight loss or weight gain, frequent occurrences of diseases and infections leading to them having many medical prescriptions, experience of pain in the mouth or tooth loss and also, they need help to care for themselves. This often results in them having their nutritional needs met poorly (Robert SB, 2006).
Older people require more proteins then younger people. These proteins should be included in greater amounts in their diets because they often suffer from conditions that cause protein deficiency. Before any steps are taken to help improve their diets, information about their food preferences, allergies that re related to food, relevant cultural and religious beliefs that influence what they choose eat, problems with ingestion and the drugs they are on should be made. These will help come up with appropriate diet plans that will meet the nutritional needs of the older patients and at the same time be of their preferences. If this is ignored, they may fail to eat and end up starving or losing weight. In order to improve the lives of old people, their diet should be considered with more open minds so that they can encompass what they need and what they want. If their nutritional needs go unchecked, it will affect their immune systems making them weak and more prone to infections. After adequate information about the needs of older people has been collected, interventions can be made in terms of overseeing their diets and feeding habits, going to see them regularly and especially when they are eating so that one can assess how they are getting on with their diet and if there are any difficulties that they are facing while eating (Robert SB, 2006).
Miller SC. et al, (2005).A national study of the location of death for older persons with dementia, J Am Geriatr Soc.
Mitchell SL et al, (2004). Terminal care for persons with advanced dementia in the nursing home and home care settings, Journal of Palliative Medicine.
Hamel MB et al, (2004).Dying with advanced dementia in the nursing home, Arch Intern Med.
Shega JW et al, (2003). Palliative Excellence in Alzheimer Care Efforts (PEACE) , a program description, Journal of Palliative Medicine.
Bunch TJ et al, (2004). Impact of age on long-term survival and quality of life following our-of hospital cardiac arrest, Critical Care Medicine.
Campbell ML et al, (2004). A proactive approach to improve end-of-life care in a medical intensive care unit for patients with terminal dementia,Care Med.
Morris J, (2001). Nutritional management of individuals with Alzheimer’s disease and other progressive dementias, Nutrition in Clinical Care
Ahluwalia K., (2004). Oral Health Care for the Elderly: More Than Just Dentures, DDS, MPH
School of Dental and Oral Surgery, Columbia University, New York, NY.
Roberts SB, (2006).Rosenberg I. Nutrition and aging: changes in the regulation of energy
metabolism with aging. Physiol Rev.
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