The emphasis on nursing care is crucial in the chronic patient or with alterations generated over the years.
The data required by the nurse to gain knowledge of the person must go beyond the biomedical aspect. It should include the assessment of functional disorders and understanding the psychological needs of the patient being cared for. Nursing care must be oriented towards the person, who is made up of body, mind and spirit as an integrated functional unit.
In the sick subject, a series of variables are incorporated that signify an adaptation to daily needs, such as those carried out up to that moment. That is why the care and relationship between the nurse and the patient are so critical.
Relationships
The nurse must establish a helping relationship as the first intervention measure; the purpose of nursing is achieved by establishing a connection through human-to-human interactions, the one that originates from the moment of the initial encounter with the identification and development of feelings of acceptance, solidarity and affinity.
The initial greeting can be crucial.
The reciprocal relationship between the nurse and the patient is such that what one does or says affects the other and vice versa. For these reasons, in the initial greeting, the whole relationship can be put into play.
If it is about health care, certain variables must be considered that justify personalised care that meets the needs of the group in which the patient is inserted.
Understand how the fact of being an older adult influences
Social pressure with the cult of productivity, agility and competition leads to a devaluation and disqualification of the older person with severe repercussions for themself, which increases the susceptibility to the risk of getting sick.
The affective aspect is compromised by the countless losses associated with this age: (sensation of loneliness), duels, estrangement from loved ones, retirement, loss of status, roles, social ignorance and others, making their identification and differentiated treatment necessary.
Therefore, it must be remembered that chronic diseases contribute to the development of adverse psychological reactions in the elderly, reducing social interaction. The multiple losses (roles, status, etc.) accelerate mental health breakdown, leaving them at greater risk.
Ways to Promote Wellness
It is appropriate to highlight some ways to promote mental health in these patients, such as:
- Listen, talk and share feelings.
- Assure their privacy.
- Treat him respectfully, unlike a little child who can’t think for himself.
- Motivate him to exercise and move.
- Try to keep communication channels open.
- Do not create false expectations of treatment.
Establish a relationship of trust
- Create an environment of privacy
- Identify yourself clearly
- Explain the objectives of the meeting
- Allow the necessary time for the interview
How to ask the questions
- Identify the problem or situation to know how to ask
- Use clear and easily understood terms
- Avoid sensitive or intimate questions to start an interview
- Postpone questions that cause annoyance
- You can use a questionnaire to avoid omissions
How to listen
- be an active listener
- Allow the patient to finish the sentences
- Give time for it to start responding
- Focus on what you hear
- Converse synthetically and clearly
Physical exam or assessment
- Carry out a complete and systematic examination
- Record your observations, don’t trust your memory
- Write the information collected in an orderly manner
Most common problems in older people
- Older adults often present problems caused by age as a manifestation of some organic alteration. The forms of presentation and the most common problems in the elderly can be:
- Intellectual disturbance.
- Immobility.
- Instability.
- Incontinence.
- Insomnia.
- Decreased libido.
- Visual and auditory alteration.
- Isolation.
- Depression.
- Bad nutrition.
- Immune failure.
- We must be attentive to these changes that transform them into dependents; it is easier and faster to do things for them than to stimulate and train them to do them themselves.
In the elderly, the listening and questioning process presents specific difficulties: it can be tedious, which is why it is often done wrong.
In addition, on multiple occasions, they do not report their problems because they are typical of old age, due to ignorance, or because they feel that the professional who treats them is in a hurry.
Skincare
Due to the importance of this organ, the largest in the body, because it is the most exposed to injuries and in which the intervention of the nurse is most frequent, we will deal with it in a separate paragraph.
The body gradually deteriorates, but it is on the skin that the passage of time is best evidenced. In addition to biological ageing, universal and inevitable, photoaging is added due to chronic exposure to the sun.
What is most often seen in the elderly are the following injuries:
- Pruritus
- Erythema (redness) due to systemic corticosteroid treatment.
- nodular lesions
- , bullous lesions
- , skin tumours
Due to the characteristics of age, baths should be short, with water and neutral soap. Baths with vigorous soaping and subsequent rubbing with cologne should be avoided because they accentuate the peeling in most patients. For this reason, frequent and constant lubrication and periodic examination of the skin to detect pathological lesions are recommended.
Physical Examination Guide
Observe how the patient walks and sits and whether changes occur over time. Therefore, it is essential not to confuse the changes produced by diseases with the expected product of the process of age.
- high blood pressure
- Risk of cardiovascular disorder
- Changes in blood pressure when standing
- product of age
- medication product
- post feeding
- dehydration
- Irregular pulse
- Poor hygiene
- Depression
- functional alteration
- Slow to think and speak regular development of ageing
- Parkinson’s
- Depression
- ulcerations
- bad teeth
- are usually common in older age
Caution if there are sudden changes
- Fast breathing
- Always write down the respiratory rate to be able to evaluate future situations
- Weight change (A weight loss of more than 10% within three months requires comprehensive evaluation)
- oedema
- ascites
- Lesions under the tongue or on the mucosa
- skin lesions
- Monitor and control the appearance of injuries