Comprehensive Nursing Notes
Introduction
This work is based on professional practice in Ireland and Poland, offering knowledge to nurses starting in Ireland.
It emphasizes the nurse's role and responsibilities, the working environment, and daily challenges.
The content is relevant to geriatric nursing in English-speaking countries due to the universality of elderly care issues.
It aims to support nurses of various nationalities in adapting to new roles in English-speaking healthcare systems.
This publication is dedicated to nurses who sought opportunities abroad and contribute to the evolution of nursing globally.
Nursing Process
The nursing process is a systematic approach to person-centered nursing care.
It is dynamic and enhances communication among staff, ensuring consistent patient care during hospitalization.
It is based on assessments using professional tools.
Stages of Nursing Process
Data Collection and Analysis
Methods:
Medical interview
Observation
Measurements
Analysis of medical documents and test results
Physical examination (inspection, auscultation, palpitation, percussion)
Collected information is used to formulate nursing diagnoses and care plan outcomes.
Nursing Assessment
Includes biopsychological, sociocultural, spiritual, and financial aspects of the patient's life.
Considers the patient’s responses to their problems and their ability to cope.
Utilizes professional scales:
Barthel Scale: Measures performance in Activities of Daily Living (ADL). Lower scores indicate a greater need for nursing care.
Braden/Waterlow Scale: Assesses the risk of pressure sore development.
Cannard/Tinetti Scale: Assesses the risk of falls.
Numeric Pain Scale: Measures pain intensity for conscious patients (0-10 scale).
Abbey Pain Scale: Measures pain intensity for patients unable to rate their pain (e.g., Alzheimer's patients).
BMI (Body Mass Index): Indicates overweight or malnutrition.
BMI = \frac{weight \, (kg)}{height^2 \, (m^2)}
MUST Score: Malnutrition Universal Screening Tool to detect malnutrition risk and implement care plans early.
Norgine Scale: Assesses the risk of constipation.
Urinary Incontinence Assessment: Indicates and manages urinary incontinence.
Glasgow Scale: Assesses the level of patient consciousness.
Manual Handling Assessment: Conducted by occupational therapists to assess patient needs.
Risk of Choke Assessment: Conducted by SALT (speech and language therapist).
Nursing Diagnosis
Statements of high risk or actual problems in the patient's biopsychological status.
Professional diagnoses can refer to:
International Classification of Nursing Practice (ICNP)
NANDA classification
Should be a short statement defining the problem and its source.
Example: Risk of pressure sore related to mobility impairment.
Care Plan
A list of interventions/procedures connected to the diagnosis, aimed at resolving or minimizing patient problems, or protecting against predicted problems.
Must be preceded by realistic, achievable goals within a defined timeframe.
Includes answers to:
Who will perform the actions/procedures?
What do staff want to achieve?
When do we want to achieve the goal?
How often should procedures be performed?
What equipment is needed?
Which other staff members should be involved?
How can the family be involved?
Goals should be measurable when possible and person-centered.
Staff should respect patient needs, wishes, preferences, knowledge, and experiences.
Patients and their families are involved in planning and decision-making.
Care Plan Evaluation and Modification
Nurses determine whether the care plan has resolved the problem.
Ineffective care plans must be revised.
Nursing Process in Long-Term Care
Geriatric patients often have long medical histories.
Common nursing and caring problems in elderly care involve weight loss/malnutrition, dehydration, constipation, sleeping problems, confusion, abuse and falls.
Weight Loss/Malnutrition
Related to:
Slowdown in metabolic processes
Decreased activity and appetite
Accompanying disorders
Comprehensive care plan:
Identification of people at risk using the Malnutrition Universal Screening Tool (MUST score) and BMI calculations.
Implementation of a program to deal with underweight, including:
Medical and dietary consultations
Appropriate diet and nutritional supplements (on doctor's request)
Regular weight control
Documentation of the quantity and quality of meals taken
Monitoring water balance and bowel movements
Maximizing patient cooperation by respecting preferences and creating a pleasant atmosphere is crucial.
Commonly Used Nutritional Supplements
Fresubin 2 kcal drink: High in calories (2kcal/ml) and protein for chronic wasting disease and wounds.
Fresubin protein energy: High in calories (1.5kcal/ml) and protein for poor wound healing and weight loss.
Fresubin cream: High in calories (1.85kcal/g) and protein for increased protein and energy needs with dysphagia.
Fresubin energy drink: High in calories for wasting diseases.
Calshake instant powder: High in calories for weight loss.
Procal shot: High in calories and protein for weight loss.
Calogen: Energy supplement for weight loss.
Ensure plus drink: Calories, proteins, vitamins, and omega 3 for people at risk of disease-related malnutrition.
Fortisip drink: Milkshake-style supplement with energy, proteins, and vitamins.
Fortijuice: Energy and vitamins for the dietary management of disease-related malnutrition.
Fresubin 5 kcal shot: High in calories (5 kcal/ml) for anorexia.
Dehydration
Geriatric patients show less thirst and interest in fluids.
Signs and symptoms:
Increasing headache, drowsiness, dry mouth
Decreased urine secretion or constipation
Dry, less firm, elastic skin; cloudy eyes
Concentrated, dark urine
Hypotension, increased body temperature
Confusion
Acute dehydration: convulsions, impaired consciousness, high risk of death
Dehydration prophylaxis:
Identification of people at risk of insufficient fluid intake.
Monitoring daily fluid balance and determining daily fluid requirements.
Regular hydration at regular intervals.
Introducing meals and highly hydrated snacks.
Monitoring for signs of dehydration.
Fluid administration (I.V., S.C.) in cases of increasing risk.
Constipation
Preventive measures:
Identify at-risk individuals using the Norgine risk assessment tool.
Drugs causing constipation: aluminium antacids, diuretics, iron supplements, NSAIDs, opioids, tricyclic antidepressants, anticholinergics, anti-Parkinson drugs, calcium channel blockers, calcium supplements
Preventive program for high-risk individuals (Norgine Scale score > 4):
Daily monitoring and documentation of bowel movements
Changing the nutritional regimen (increasing fiber and fluid intake, limiting bloating foods)
Administering medications as prescribed
Increasing physical activity (if possible)
Medication review
Monitoring daily water balance
Prevention of constipation is crucial to avoid mechanical bowel obstruction.
Symptoms of constipation: no bowel movements for >2 days, stomach pain, bloating, hard abdomen, refusal to eat, vomiting
Sleeping Problems
Consequences:
Increased risk of falling
Increased risk of malnutrition and dehydration
Increased risk of constipation
Increased irritability and social isolation
Increased sensitivity to pain
Necessary measures:
Consider and implement measures to prevent and fight insomnia.
Create a rest-friendly environment.
Provide sufficient daytime activity.
Administer sleeping pills on medical order if non-pharmacological methods are ineffective.
Confusion
May be a symptom of nervous system disorders, infections, pain, etc.
Care plan:
Protect the patient against leaving the place of residence alone.
Communicate in an accessible way, using simple words and individual commands.
Mark characteristic places with drawings and signs.
Assist in everyday activities.
Organize activating activities and maintain social contacts.
Abuse
Can be physical, verbal, psychological, sexual, emotional, or financial.
Physical abuse: physical violence causing injuries
Sexual abuse
Neglect: skipping meals or medication
Emotional abuse: causing stress through tone, verbal abuse, rushing, judging
Financial abuse: using resident funds for staff needs
Social abuse: preventing social contact
Violence in nursing homes requires specific training, and staff must know the procedure for dealing with suspected abuse.
Falls
Care plan:
Assess fall risk using the Cannard fall risk assessment.
Determine mobility and create a Manual Handling chart (with OT/physiotherapist).
Create a safe environment: comfortable footwear, no obstacles, good lighting.
Visual inspection and selection of glasses.
Assist in moving, following manual handling rules.
Organize a communication system.
Use a Posey alarm mattress.
Incident/Accident Report
Staff must implement post-accident procedures, including interviewing, examining for injuries, monitoring vital parameters, and supplementing the incident report.
Additional Common Problems
Contractures
Pressure Sores
Depression
Urinary Incontinence
Swallowing Problems, Chokes
Skin Integrity and Wound Management
Common Wound Care Terms
Open wound: Exposed underlying tissue.
Closed wound: Damage without exposure.
Infected wound: Contains dirt, bacteria, or causative agents.
Blanching: Area under pressure becomes white.
Cellulitis: Inflammation or infection of tissue with redness, pain, heat, edema.
Edema: Swelling.
Epithelization: Epithelial cell formation and migration.
Exudate: Fluid from wounds (serous, sanguineous, or purulent).
Granulation: Tissue that forms in the wound base.
Maceration: Softening and whitish look to intact skin around wounds.
Occlusive: Closes the wound from the external environment.
Slough: Dead tissue, usually yellow.
Swab culture: Specimen collection to determine bacteria type and number.
Pressure Sores
Injuries to skin and underlying tissue from prolonged pressure on bony areas.
Statutory notification is required for pressure sores of grade 2 or above based on the EPUAP grading system.
Pressure Sore Classification
Grade 1: Non-blanchable erythema of intact skin; discoloration, warmth, edema, or hardness may be present.
Grade 2: Partial-thickness skin loss involving epidermis, dermis, or both; superficial ulcer.
Grade 3: Full-thickness skin loss involving damage or necrosis of subcutaneous tissue.
Grade 4: Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures.
Pressure Sore Prevention
Risk assessment using the Norton/Braden scale.
Regularly change body position.
Use pressure protection (air mattress, foam mattress, gel or foam cushion).
Adjust the bed to raise no more than 30 degrees.
Protect and monitor skin condition with mild soap and water.
Apply lotion to dry skin and inspect daily.
Prevent skin exposure to moisture and bacteria.
Provide adequate fluids.
Liaise with GP and dietician.
Examples of Dressings
Duoderm extra thin: Hydrocolloid dressing for dry to lightly exuding wounds or as a secondary dressing.
Aquacel: Excellent absorption for moderate to highly exuding wounds; may contain silver for infected wounds.
Kaltostat: Calcium Sodium Alginate dressing for moderately to highly exuding wounds, and wounds with minor bleeding.
Inadine: For prophylaxis and treatment of infection in minor burns, leg ulcers, and superficial skin-loss injuries.
Iodoflex: For chronic exuding wounds such as leg, pressure, and diabetic ulcers with suspected infection.
Biatain Adhesive: For moderate to heavily exuding wounds.
Atrauman: Easy to remove, suitable for sensitive skin, often used in burn treatment.
Skin lesions should be immediately reported. Nurses are ultimately responsible for the patient's skin condition.
Ulcerative Wounds
Caused by impaired blood flow, swelling, neglect of skin care, and inflammation.
Prevention involves compression socks, skin hydration, fluid balance, preventing skin injuries, and appropriate clothing.
In case of cellulitis, follow medical recommendations (antibiotic therapy).
Pain Management
Pain increases blood pressure and constricts blood vessels.
It decreases appetite and causes insomnia and stress.
It leads to increased risk of bedsores and complications related to immobilization.
A holistic care plan for pain management aims to eliminate or minimize pain.
Pain Ladder
A concept originated by WHO to describe it’s guideline for the use of drugs in the management of pain.
The general principle is to start with first step drug and then to climb the ladder if pain is still present.
Steps:
STEP 1. NSAID( diclofenac, ibuprofen, naproxen,aspirin, ketoprofen), Paracetamol+/-adjuvant
STEP 2. NSAID + codeine, tramadol, buprenorfine, +/- adjuvant
STEP 3. Morphine, oxycodone, fentanl,+/- adjuvant
Adjuvant Medications
Steroids,anxiolytic, antidepressants,hypnotic, anticonvulsants,sodium channel blockers
Main rules of pain management:
Oral form of medication should be prescribed whenever possible
Analgesic should be given at regular intervals
Analgesic should be prescribed according to pain intensity as evaluated by a scale of intensity of pain.
Dosing of pain medication should be adapted to the individual.
The regularity of analgesic administration is crucial for adequate treatment of pain.
International Scales:
Numeric pain scale (for patients who can verbalize the severity of pain by referring it to a scale from 1 to 10.
Abbey pain scale - for patients who are not able to determine the severity of pain (e.g. people with dementia, impaired consciousness).
Residents with Mobility Impairment
Main Reasons
Accidents, injuries, fractures
Degenerative diseases of the joints,
Inflammation of joints and muscles
Decline in mobility according to age
Social isolation, depressive states, drug states, lack of social support
Any other medical disorders affecting psychomotor performance
Problems
Increase social isolation, depression
Increase risk of skin damage/pressure sores
Nutrition disorder/ constipation
Increase risk of infections ( chest infection, urinary tract infection)
Muscle stiffness, pain, contractures
Nursing Care Plan
Should go through all these problems trying to find a way to provide the best quality of life for residents at this stage.
Frequent Diseases
Fractures and rheumatic diseases are frequent among many diseases of the locomotor system
Symptoms of a hip fracture
Inability to move immediately after a fall
Severe pain in hip or groin
Inability to put weight on leg on the side of injured hip
Stiffness, bruising and swelling in and around hip area
Shorter leg on the side of injured hip
Turning outward of leg on the side of injured hip
ARTHRITIS
Pain ( care plan for pain management)
Stiffness (care plan for risk of fall, safety)
Swelling ( care plan for a risk of skin damage, inflammation)
Redness
Decreased range of motion ( care plan for contractures prevention)
OSTEOARTHRITIS
Pain that is aggravated by exercise
Morning stiffness Joint swelling,
Enlargement of joint contours, reduced range of motion in the joint, joint deformation,
Muscle atrophy - the skin in places affected by the disease becomes thin, moist and parchment-like
May impair the eyesight, affect peripheral nerves and the heart muscle
OSTEOPROSIS
Resident can experience back pain,loss of height over time, a stopped posture, bone fracture that occurs much more easily than expected.( fall prevention)
Respiratory Disorders
COPD
Shortness of breath (initially exercise, then resting)
Loss of physical strength, decreased exercise tolerance
A chronic cough that produces sputum that may be clear, white, yellow or greenish.
A chronic cough that produces sputum that may be clear, white, yellow or greenish.
Whirring, wheezing above the lungs
The disease is accompanied by a recurrent frequency respiratory tract infection
Blueness of the lips or fingernail beds (cynaosis)
Pneumonia
Cough may be dry, or produce thick yellow, green, brown or blood-stained mucus (phlegm) fever,
Pain that increases with breathing
Auscultatory changes (murmur, crackles)
Weakness and fatigue
Atypical Pneumonia
Dry, tormenting cough
Muscle and joint pain
The presence of small amounts of mucous sputum
No high fever
Tuberculosis
Weight loss,
Low-grade fever,
Night sweats,
Hemoptysis (when pleura is involved),
Shortness of breath, pleural pain,
Poor exercise tolerance.
Pulmonary Embolism (PE)
SOB- typically appears suddenly and gets worse with exertion
Sharp chest pain (sometimes Chest pain may be comparable to a heart attack, it intensifies with deep inhalation, coughing, does not subside when resting
Fast, irregular heart beat,
Hemoptysis
Clamny or discolored skin, sweating
Leg pain, swelling or both, usually in the calf( thrombosis)
Growing anxiety
Syncope
Problem/Nursing Intervention:
SOB FEVER WEAKNESS:
monitor v/s, saturation and administer oxygen as per GP order
check and administer prn medicines, nebulization
leave a person in upright position while in bed
monitor body temp at lest twice a day and administer antipyretic as charted
give assistance with personal hygiene,clothes and bed linen change
Monitor a person for safety,check body balance and if mobility level impaired-give assistance
Monitor food and fluid intake
Circulatory System
Angina Pectoris/Heart Attack
Angina Pectoris:
Sudden onset of pain
Pain can radiate to the larynx, mandible, shoulder, hand, shoulder blade, spine,neck area,jaw
Chest discomfort usually described as a pressure heaviness, squeezing, burning sensation, choking
2 - 10 minutes, briefly, disappears after sublingual administration of nitroglycerin
Heart attack
Pain may be accompanied by breathless, sweating, nausea, vomiting, pallor, increased heart rate, blood pressure (BP), diziness
Long-term (more than 20 minutes), recurrent, does not disappear after administration of nitroglycerin
ARTIAL FIBRILLATION
AF is treated with medications to slow the heart rate to a normal range.
PERIPHERAL VASCULARD DISEASE (PVD)
Vein pain
Peripheral edema
Changes in skin warmth
Swelling and vein tenderness
Numbness, burning pain
Ischemia of the toes
Delayed capillary filling
Ulcers, gangrene
VEIN THROMBOSIS
presence of a painful thickening in the course of a vein, swelling, painful touch. - deep vein thrombosis - intensification of pain in the lower leg with passive bending of the foot
Depending on where the clot is located, the swelling may extend to the entire lower limb
HYPERTENSION
Drenching sweats, paling / reddening of the skin layers
Physical weakness
Headaches in the occipital area, the appearance of the so-called Tinnitus
In some patients; tachycardia, paroxysmal arrhythmias
CIRCULATORY FAILURE
Right ventricular failure:
Jugular vein overflow
Liver enlargement, liver pain
Peripheral cyanosis, swellings - pale, pasty, located in the lowest parts of the legs ( walking patient) or in the sacrum area ( lying patient) (also exudates to the internal cavities of the body)
Exercise or resting dyspnoea, episodes of paroxysmal nocturnal dyspnea with cough
Left ventricular heart failure is manifested by:
• chronic fatigue, especially after performing physical activities
difficulty breathing, feeling short of breath;
pallor or cyanosis;
pain in the chest;
weakness and fainting.
Nervous System
CVA ( cerebrovascular accident)
Sudden numbness or weakness of face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understaning, slurred speach
Sudden trouble seeing on one or both eyes
Sudden trouble walking dizziness, lack of balance or co-ordination
Sudden severe headache with no known cause
ALZHAIMER DISEASE
First stage:
there are memory disorders, difficulties in remembering, carrying out everyday activities (e.g. problem with finding a way back from work home), fewer abilities of logical thinking, real assessment of reality;
Confusion with time or place, lose track of dates, seasons and the passage of time
Challenges in planning or solving problems, changes in ability to develop and follow a plan or work with numbers, difficulty concentrating.
Vision problems, difficulty reading, judging distance and determining color or contrast ( photos, pictures, labels may be helpful with recognizing place)
Misplacing things and losing the ability to retrace steps, putting things in unusual place, inability to find them ( inability to keep control over vulnerable things?)
All together causes irritation, mood disorders, irritability, agitation
Second stage:
Further deterioration of the memory turns into a complete failure to remember, restore current information ,; distant memory is partially preserved;
Loss of sense of time, place, spatial confusion;
The sick person requires constant help in everyday activities;
Trouble with language,the sick person experiences a serious trouble fin ollowing or joining a conversation
Third stage:
Final stage, where walking abilities disappear, basic control functions are impaired, urinary and bowel incontinence, swallowing disorders, low level or lack of cooperation with the caregiver occur. Death, transverse, e.g. the sleeping phase, occurs mainly as a result of infection
PARKINSON DISEASE
Early Stages
Movement related symptoms like shaking, rigidity, slowness of movement and difficulty with walking and gait
Tremor of the hands, arms, legs, jaw and face
Postural instability or impaired balance and coordination
Decreased facial expression, monotonous speech, and decreased eye blinking
Thinking and behavioral problems
Sensory, sleep and emotional problems
Subsequent Stages
Speech becomes sluggish, slurred
Restriction of mobility, development of muscle stiffness, dyskinesia
Disorders related to urinary incontinence, defecation,
Impairment of the ability to drink fluids, meals; wallowing problems in later stages
Complications related to immobilization,
Breathing difficulties
The urinary system and its common disorders
Recurrent UTI
Improper hygiene of the intimate areas
Weakened immunity of patients
Accompanying disease
Anatomical structure and the transfer of bacteria from the anus to the urethra
Inappropriate catheter care
Signs and symptoms of UTI:
Flank pain, fever, vomiting, nausea
Urine may appear bloody or contain visible pyuria (pus in the urine)
Change in mental status, confusion
Temperature
Urine retention, problems with urination
Pain, burning senstion while passing a water, bladder cramps
CATHETER CARE( care plan to minimize risk of UTI)
Make sure that urine is flowing out of the catheter into the urine collection bag, make sure that the catheter tubing does not get twisted,
Keep daily control over fluid balance
Keep the urine collection bag below the level of your bladder.
Make sure that the urine collection bag does not drag and pull on the catheter.
GI system and its common disorders
MECHANICAL OBSTRUCTION
Sudden onset of abdominal cramps (repeated on average every 3 minutes),
Abdominal distension (it is important to monitor the abdominal circuit from the first symptoms, if it does not gradually increase),
Vomiting, abdominal pain,
Restlessness,
Rapid breathing
Inability to pass gas or stool,
Fever,
DEHYDRATION
Mild to moderate dehydration
Sleepiness or tiredness — children are likely to be less active than usual
Thirst, dry sticky mouth
Decreased urine output
No wet diapers for three hours for infants
Few or no tears when crying
Severe dehydration
Extreme thirst
Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults
Very dry mouth, skin and mucous membranes
Little or no urination — any urine that is produced will be darker than normal
Sunken eyes
WEIGHT LOSS
Body weight, food and fluid intake should be under permanent control.
First of all diet should be discussed with kitchen manager and such details like : size of meals, type of diet, (high or low fat), friction of meals, texture of meals, build up supplements like build up supplements, should be taken into consideration.
GI System and it's common disorders
Mechanical Obstruction A mechanical bowel obstruction is a partial or complete blockage in the intestine It is characterized by a: -sudden onset of abdominal cramps -abdominal distension -Vomiting, abdominal pain, -restlessness -rapid breathing -inability to pass gas or stool, -fever
Dehydration
Mild to moderate dehydration is likely to cause: Sleepiness or tiredness — children are likely to be less active than usual, Thirst, dry sticky mouth, Decreased urine output, No wet diapers for three hours for infants, Few or no tears when crying Severe dehydration, a medical emergency, can cause: Extreme thirst, Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults Very dry mouth, skin and mucous membranes
The urinary system and its common disorders.
Management of patients with urinary tract infections.
UTI Recurrent urinary tract infection is a major problem in long-term care. that is due in the improper hygiene of the intimate areas or weakened immunity of patients accompanied by disease or the anatomical structure and the transfer of bacteria from the anus to the urethra. Signs and symptoms of UTI are, Flank pain, fever, vomiting/nausea - urine may appear bloody or contain visible pyuria (pus in the urine) -- change in mental status and confusion if there are urine retention/problems with urination or pain and burning when trying to pass water. Also if there are bladder cramps is a strong sign of a UTI.
CATHETER CARE: In the care planned to minimize the risk of UTI. to make sure that urine is flowing out of the catheter into a urine collection bag, and also make sure the tubing does not get twisted. Its important to be aware and also make sure the urine collection bag stays below the level of the bladder.
Diabetes Mellitus
Complications for having Diabetes is like the Damage to the eyes ( diabetic retinopathy ), kidneys ( diabetic nephropathy ) or if there is Damage to the nerves of the body (diabetic neuropathy)
Life-threatening conditions include those associated with significant fluctuations in blood sugar levels: hiperglycemia ( frequent hunger, and increased volume of urination and hipoglycemia.
Medication Management* Nurse must read the prescription carefully to check or Patient's name, The date, time or administration, The name of the drug, Size of dose, The method of administration/ and the frequency of the doses
Drug Administration:
Before administration of drugs the nurse must read the prescription carefully to check the Patient with full name, the date, time of administration/ The name of the drug, the size of the dose, the method/ frequency of administration
Each time before administering the drug to the patient, the nurse must make sure that there is no documented allergy to the drug (this should also be checked when taking orders from a doctor (especially in the case of a telephone order and is able to swallow the medicines whole or requires crushing the medicines or should they use a liquid form.
Pain Management
Numeric pain scale (for patients who can verbalize the severity of pain by referring it to a scale from 1 to 10) while the Abbey pain scale is for patients who are not able to determine the severity of pain People with dementia or impaired consciousness. With good pain management comes international sales that will come and visit as well and with the scale they will know.
Stages of PainLadder
STEP 1: NSAID or Paracetamol+/-adjuvant
STEP 2: NSAID + codeine, tramadol, buprenorfine, +/- adjuvant
(or Step 3) Morphine, oxycodone, fentanl,+/- adjuvant with Adjuvant medications and Steroids,anxiolytic and antidepressants
Main rules of pain management: Administer orally whenever possible in and give analgesic every 2-3hours or regular intervals and prescribe according to pain intensity as evaluated by the scale and the dosing adapts to the individual to the patient always.
PALLIATIVE CARE:
“ an approach that improves quality of life of patients and their families facing the problems associated with life-threating illness” . and 1improve quality of life ( biopsychological well being).It is achieved through the prevention and relief of suffering by means of early identification and assessment and treatment of pain and other problems, physical, psychosocial and spiritual”.
Symptoms
anorexia, anxiety, constipation, delirium, depression, diarrhea, *dyspnea *Fatigue*, *Nausea and vomiting* and a need for Pain medication
The Five stages of Grief. Elisabeth Kübler.
Denial-refusal to accept facts
Anger-can manifest in different ways; being angry with themselves or with others. Know this helps keep detached and non-judgmental when experiencing the anger of someone who is very upset.
Bargaining-when faces with serious trauma can bargaun or seek to negotiate a compromise.
Depression being upset for a long period of time. It shows that the person has at least begun to accept the reality.
Acceptance-entering a stage a long time before the people they leave behind. Both the dying person and the family may be at different stages of accepting death(compare with Kubler-Ross), which affects the cooperation with the staff and the nurse
are taken into account and respected and Symptoms that indicate an impending death: as if there is sudden deterioration in health; as well as significant weakness or also exhaustion.
Palliative Care
The term palliative care is related to:
*The Comfort measures
*NOT FOR RESUSCITATION
Comfort Measures Only (CMO) is a care plan that includes which includes physical/symptoms of discomfort that may be implemented when death is expected. Comfort measures may include to offer pain and symptom management a quiet, private area that supports the end-of-life process by giving their spiritual care as well and Limiting how often to check or Stopping medicines that do not aid by stopping medicines, but also stopping any blood tests or any procedures like surgeries, or other tiring tests!
Infections:
Way for germs to enter the body that includes Direct, Indirect and Alimentary or Droplet. Air-Droplet contact or with blood and Fatal-by contact
In NURSING HOME it has been known to have infection by:
MRSA- Escherichia coli and Clostridium difficile
Typical Infections that are known is
UTI or urinary tract infection a Shingles a the common skin disease in the elderly and Pneumonia( the number one cause of morbidity/ cause of death amoung elderly)