IMMOBILITY

The immobility is the decreased ability to perform activities of daily living impairment of motor functions.

The main systems affected are the cardiovascular system and musculoskeletal system. But they are not unique, they are also affected: the respiratory system, nervous system, digestive system, the genitourinary system, the endocrine system and skin.

In the cardiovascular system, what happens is that there is a decreased energy expenditure and therefore left ventricular distensibility.

In the musculoskeletal system, what happens is that muscle strength decreases.

The 18% of those over 65 have trouble getting around without assistance and from 75 years, over 50% have trouble leaving home, of which 20% are confined to their homes.

Numerous studies or regular daily exercise in elderly, has beneficial effects on diabetes, hypertension, falls, the level of independence, osteoporosis and blood cholesterol level, among other benefits.

We recommend aerobic, flexibility, strength and balance, adapted to the situation of each and their needs.

The immobility can lead to depressive disorders and social isolation.

The elderly who have more risk of immobility are the sedentary and frail elderly, as explained above.

I think that immobility in the elderly is a problem with epidemiology and rises as nurses have an obligation to act against this, trying to prevent it, supporting patients and their families. If we do means many patients end up bedridden shortly.

So the make a proper comprehensive geriatric assessment is the best way to detect the risk of immobility.

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Bibliography:

1. Torres Haba R, Nieto de Haro MD. Inmovilidad. Tratado de Geriatría para residentes. Madrid: Sociedad española de geriatría y gerontología. 211-216.

SKIN INTEGRITY AND ULCERS

It called for pressure ulcer: "any area of damage to the skin and underlying tissue caused by prolonged pressure on a hard surface, not necessarily strong, and independent of the position".

According to WHO pressure sores "are an indicator of the quality of care techniques".

The pressure ulcers do not heal by themselves, must be the cause and implement adequate care.
The nursing staff should be able to identify ulcers, heal them, but above all to make a good prevention.

Pressure ulcers require time and effort, affecting mostly older people with limited mobility or who are bedridden.

The Braden Scale and Norton, are used to identify the risk of developing a pressure ulcer.

According to the AHCPR, based on original classification Byrne and Field, ulcers can have four stages.

The most common areas are pressure ulcers are:

It is also important to assess the area, the volume and the surrounding skin.

Some of the measures we must take to prevent are:

1. Postural changes every two hours in bed.
2. Avoid sitting in a chair too long, mobilize every hour. And do not place any cushion or anything that increases the pressure in the area.
3. Place protections bony prominences, plus heel, elbow.
4. Place a pillow or foam between your legs so you do not rub your knees and ankles.
5. Raise your legs with a pillow or foam pressure not to make the bed heels.
6. Use a decubitus mattress.
7. Protein diet.
8. Examine the skin daily. Wash and dry daily.
9. Cotton clothes.
10. Use of absorbents.
11. Properly hydrate skin with cream.
12. Apply skin barrier.
13. Apply hyperoxygenated fatty acids to any redness and foam if required, dressing pad.

MACERATION

According to the study by Gago et all, maceration is the most common problem when using dressings based on moist wound healing. Occurs when the exudate is poorly controlled, which saturates the surrounding skin and cause pain, slowing the evolution of the wound, increasing its size.

It is important to know all the factors maceration triggers, and in this way to address it and prevent it.

We must also choose the dressing based on the cure humid environment regarding variables perilesional skin, as most appropriate considering the not aggressive or traumatic.

The dressings based on moist wound healing must maintain a proper balance for both premises as the absorption of exudate, the phase scarring.

I totally agree with the item, but not only must try to avoid maceration of ulcers, but able to apply our knowledge well as nurses to use dressings and appropriate treatment.

I leave this video on VAC therapy, and that I found very innovative and useful precisely to avoid maceration, among other things, not being the most important.
This video is now sponsored by KCI.

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Bibliografía:

1. Ayora Torres P, Carrillo Sánchez M, Donaire Guarnido MA, López Jiménez E, Romero Castro B, Ruz Ramírez J, Segarra Valls I, Turrado Muñoz MA, Zayas Navarro C, Rich Ruiz M. Protocolo de cuidados en úlceras por presión. Hospital Universitario Reina Sofía. Córdoba.

2. Correa Román L, Moreno Rojo M, Jiménez Vinuesa ND. Manual de procedimientos de medidas de prevención de Upp. Fundación Pública Residencia de Mayores San Luís. Motril. Granada.  Disponible en: http://www.gneaupp.es/app/adm/documentos-guias/archivos/51_pdf.pdf

3. Guía-Protocolo de Prevención, Tratamiento y Apósitos en Úlceras por Presión. Comisión de úlceras por presión del departamento15. Centros sociosanitarios-Primaria-Especializada. Disponible en: http://www.a14.san.gva.es/hos/enfer/prevencion%20upp%20guia%20de%20enferferia%20departamento%2015.pdf

4. Gago Fornells M, García González RF, Rueda López J, Muñoz Bueno AM, Vega Águilar J, Gaztelu Valdé V. La maceración. Un problema en la piel perilesional de úlceras por presión y heridas crónicas. Cádiz. 2004. Disponible en: http://www.gneaupp.es/app/adm/publicaciones/archivos/38_pdf.pdf

GENERAL IN DISEASES OF THE ELDERLY

In the elderly are given many physiological changes due to aging. But not always as easy to detect these changes at first, which makes the diagnosis and treatment.

In elderly patients it is important to take into account in order to provide appropriate assistance:

Heterogeneity in over sixty-five years.

Peculiarities of disease.

Fragility.

Comorbidity and polypharmacy.

Tendency to chronicity.

Less favorable forecasts disease.

Increased use of health resources.

Diagnostic and therapeutic difficulties.

Increased need for rehabilitation.

Frequent need social resources

Common ethical problems.

GERIATRIC SYNDROMES

We talk about Geriatric Syndromes, when presented a series of health problems in elderly and destabilizing.

These depend on various factors, become chronic, and complex treatment involving impaired autonomy.

Large geriatric syndromes are:

- Immobility                             

- Instability

- Incontinence 

- Intelectual impairment 

- Infection

- Inanition

- Impairment of vision and hearing 

- Irritable colon

- Isolation

- Insomnia

- Iatrogenesis

- Immune deficiency

- Impotence 

PAIN

Pain is one of the most important symptoms defining geriatric syndromes.

The pain is a manifestation linked to different situations: bone, respiratory, cardiac, etc. In these patients is usually chronic.

In pain we must consider:

- Location.

- Duration.

- Intensity. (By visual or verbal scales)

- Factors that increase and decrease.

- Interference with ADL.

- Physiological, psychological, communication problems.

- Physiological adaptation to pain.

- Family pose.

- Personal knowledge of the situation, anxiety or fear.

- Denial of pain.

To assess pain using the VAS scale:

To better understand what we mean when we speak of pain, this video explains it very visual. Made by the HNEAHS. 

I leave here the link HNEAHS, if anyone wants more information.

http://www.hnehealth.nsw.gov.au/pain

Bibliography:

1. Infermeravirtual.com [Internet]. Síndromes geriátricos. Col-legi oficial Infermeres i infermers Barcelona. Disponible en: http://www.infermeravirtual.com/es-es/situaciones-de-vida/vejez/informacion-relacionada.html

2.Solare. A, C.A, Valenzuela. T, P.S, Carrillo. G. Manejo del paciente Terminal. [Internet]. México. Unidad de Medicina del Dolor y Paliativa. Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”; 2006.  Disponible en:  http://www.incan.org.mx/revistaincan/elementos/documentosPortada/1172291086.pdf