Research Korner: Elder Care

A Brief Literature Review on Positive Ageing

A Brief Literature Review on Positive Ageing   Active ageing is an emerging global policy that refers to the process of facilitating opportunities for the participation, health and security of people in order that the quality of their lives will be enhanced as they age. The World Health Organization’s (WHO) Active Ageing Framework that was launched in 2002 has generated various policy  interpretations and implementations by member countries of the Organization for Economic Cooperation and Development (OECD) including Australia, Canada, New Zealand, Sweden, the United Kingdom and the U.S.A. The broad determinants of this approach include culture, gender and economic determinants, and allied to this is “The Solid Facts” WHO publication in 2003 which touches on the social determinants of health across a lifespan including social gradient, stress and work.[1]   Canada and Mexico developed the document “A Guide for the Development of a Comprehensive System of Support to Promote Active Ageing” (2003), which focuses on a comprehensive system of support to promote active ageing. The Policy Research Initiative’s (PRI) report, “Encouraging Choice in Work and Retirement Project Report” (2005), seeks to find out the social and economic implications of ageing in the Canadian labor market. The OECD report, “Ageing and Employment Policies: Canada 2005”, calls for increased workforce participation by older workers and combining pensions with work income.[2]   The “New Zealand Positive Ageing Strategy” (2001) seeks to provide policy and service in broad areas and form a positive ageing society, where people 65 years and older are given opportunities to participate as they desire in society.[3] Sweden’s public health policy in 2003 calls for the improvement of public health equally across the entire population. The public health report, “A Healthier Elderly Population in Sweden” (2004), suggests creating strong social networks among the elderly to reduce isolation, encouraging older people to participate in social and cultural activities and providing them safe housing and communities.[4]   The white paper, “Our Health, Our Care, Our Say: A New Direction for Community Services”, in the United Kingdom, holds that reforms will enable the creation of a framework for the rapid delivery of health and social care services to the people who need them. The briefing, “Life Long Learning” (2002), stresses the commitment of the Better Government for Older People (BGOP) committee to establishing links between learning and policies, while the “Older and Bolder” government measure works for making education programs relevant and accessible to older people.[5]   The “Older American Act” (OAA) created by the U.S.A. in 1965 which remain relevant today have the objectives of providing the elderly with adequate income in retirement, the best physical and mental health in all economic groups, and suitable and affordable housing, among others. The U.S.A. also launched the ten year health promotion program, “Healthy People 2010”, in 2000, which seeks to eliminate health disparities based on such factors as gender, race and income and education. It also recognizes that the way people have led their whole lives impacts the quality of their life as they age.[6]   The Australian Capital Territory (ACT) issued its “Health Action Plan” in 2002, which calls for a broad, cross-sectoral approach to address the social determinants of health and wellbeing including the social gradient, stress, early life, work and social support. The “Healthy and Meaningful Ageing: Strategic Plan 2006-2008” of 2006 identifies priority areas for action and research including community recognition of the dignity and worth of older people, the providing of programs for the enhancement of the physical and mental health of the elderly and the facilitation of affordable housing and safe living for them. The “Improving with Age: Our Ageing Plan for South Australia” issued by the government of South Australia (SA) in 2006 concentrates on allowing seniors choice and independence on where they live, staying healthy and linking with the community, and on recognizing their work contributions as grandparents, care-givers and volunteers.[7]   The “Tasmanian Plan for Positive Ageing 2000-2005” issued by Tasmania in 1999 addresses such issues as promoting more positive attitudes toward ageing and older people in the community, and increasing seniors’ participation in community employment, voluntary service and recreation.[8] 	   	 	 		 		 		 		 		[1] Terese Hutchison et al, “A 		Review of the Literature on Active Ageing”, University of Canberra, 		pdf, 		 		September 2006, <http://www.canberra.edu.au/centres/healthpact/attachments/pdf/active-ageing.pdf> 		 		[accessed 10 June 2011] 	 		 		 		 		 		[2] ibid 	 		 		 		 		 		[3] ibid 	 		 		 		 		 		[4] ibid 	 		 		 		 		 		[5] ibid 	 		 		 		 		 		[6] ibid 	 		 		 		 		 		[7] ibid 	 		 		 		 		 		[8] ibid

A Brief Literature Review on Positive Ageing

A Brief Literature Review on Positive Ageing Active ageing is an emerging global policy that refers to the process of facilitating ...

A Brief Literature Review on Positive Ageing

A Brief Literature Review on Positive Ageing

A Brief Literature Review on Positive Ageing Active ageing is an emerging global policy that refers to the process of facilitating ...

Anatomical and Physiological Changes

Anatomical and Physiological Changes   Structure and Posture             According to  (1981) and  (1996) one loses one and half to 3 inches or 1.2 cm. of height every 20 years as aging occurs. Obvious manifestations, which are an interaction of many factors such as age, sex, race, and environment, occur in the fifth decade of life. Long bones take on the appearance of disproportionate size because the stature decreases. Vertebral disks become thin due to dehydration, causing a shortening of the trunk. Many aged persons assume a stooped, forward-bent posture, with hips and knees somewhat flexed and arms bent at the elbows, raising the level of the arms. Posture and structural changes occur primarily because of calcium loss from bone and as a result of atrophic processes of cartilage and muscle. Excessive leaching of calcium from the bone matrix creates the condition called osteoporosis. This type of degeneration is four times more prevalent in women ( 1985), becoming apparent as estrogen declines in older women.   Skin, Hair, and Nails             Epidermal cell renewal time increases by one third after 50 years of age. The normal young adult renews epithelium every 20 days, whereas an older person requires 30 or more days because of diminished mitotic epidermal activity. Because of this slow replacement of epidermal cells, wound healing is approximately 50% slower than at 35 years of age ( 1978). The amount of collagen decreases approximately 1% per year, causing the skin to "give" less under stress and tear more easily ( 1988). The dermis becomes thinner in the absence of subcutaneous fat ( 1983).             Hair becomes gray because of the decrease in melanin production in hair follicles. Regardless of sex, 50% of the population over 50 years of age has gray or partly gray scalp hair. Body and facial hair becomes gray later. Hair loss is prominent in men, beginning in the second decade for some.   Facial Changes             Facial changes occur as a result of altered subcutaneous fat, dermal thickness, decreased elasticity, and lateral surface compression of underlying muscle contractions. Loss of bone mass, particularly the mandibular bone, accentuates the size of the upper mouth, nose, and forehead. Indented "loss of lip" appearance of the mouth occurs with tooth loss when uncorrected by dentures or other oral prostheses. Eyelids appear swollen as a result of the redistribution of fat deposits. Conversely, eyes that look sunken are the result of the loss of orbital subcutaneous fat. Loss of elasticity accentuates jowls and elongated ears and contributes to the formation of a "double" chin.   Loss of Tissue Elasticity             Tissue elasticity is most easily observed in skin integrity and reflects the progressive, universal, and intrinsic nature of age changes. The aged skin loses resilience and moisture, taking on a characteristic dryness.       Anesthesia in the Elderly             Many geriatric surgeries are performed as a result of increasing longevity. In geriatric patients there is reduction of cardiovascular, respiratory, renal and liver functions, These in very little functional reserve which is safety margin available to the patient during anesthesia and the post-operative period and contributes to the increased morbidity and mortality. The major risk factors in the elderly are: <ul style="margin-top: 0in; margin-bottom: 0in" type="circle"> <li class="MsoNormal"> Poor general condition</li> <li class="MsoNormal"> Severity of co-morbid conditions</li> <li class="MsoNormal"> Major surgery</li> <li class="MsoNormal"> Emergency surgery</li> </ul> Anesthesia should be safe with smooth induction, maintenance and quick reversal without producing any CVS, RS, and CNS complications. The choice of anesthesia depends on the general condition of the patient, the nature of surgical procedure and the experience of the Anesthetist.   Type of Anesthesia             Regional Anesthesia             Regional anesthesia is commonly administered in elective surgeries in the elderly. Regional anesthesia involves blockade of major nerve trunks which innervates the site of surgery. The two types of regional anesthesia are spinal and epidural. In spinal anesthesia the drug is injected into the subarachnoid space and in epidural anesthesia the drug is injected into epidural space. In elderly surgery, regional anesthesia is preferred for the following reasons: <ul style="margin-top: 0in; margin-bottom: 0in" type="circle"> <li class="MsoNormal"> Advantageous in debilitating respiratory disease patients</li> <li class="MsoNormal"> Reduces bleeding, postoperative respiratory problems and deep vein thrombosis</li> <li class="MsoNormal"> Diminishes stress response and CNS complications</li> <li class="MsoNormal"> Decreases convalescence time and facilities early ambulation</li> <li class="MsoNormal"> Minimizes requirements of postoperative analgesia</li> <li class="MsoNormal"> Reduces mortality  </li> </ul>               Disadvantages include:   <ul style="margin-top: 0in; margin-bottom: 0in" type="circle"> <li class="MsoNormal"> Technically difficult</li> <li class="MsoNormal"> Epidural is less reliable</li> <li class="MsoNormal"> Supplemental sedation carries great dangers like air way obstruction, pulmonary aspiration and agitation</li> </ul>   General Anesthesia   Causes of Failure to Breath after General Anesthesia <ul style="margin-top: 0in; margin-bottom: 0in" type="circle"> <li class="MsoNormal"> Obstruction of the airways</li> <li class="MsoNormal"> Central sedation from opium drugs or anesthetic agents</li> <li class="MsoNormal"> Hypoxia or hyoercarbia of any cause</li> <li class="MsoNormal"> Persistent neuromuscular blockade</li> <li class="MsoNormal"> Pneumothorax from pleural damage during anesthesia surgery</li> <li class="MsoNormal"> Circulatory failure leading to respiratory arrest</li> </ul>

Anatomical and Physiological Changes

Anatomical and Physiological Changes Structure and Posture According to (1981) and (1996) one loses one and half to 3 i...

A Brief Literature Review on Positive Ageing

A Brief Literature Review on Positive Ageing

A Brief Literature Review on Positive Ageing Active ageing is an emerging global policy that refers to the process of facilitating ...

AGED CARE

AGED CARE   1.         Mrs. Chan is diagnosed as having congestive heart failure caused by excessive fluid overload and leading to foot edema and acute cellulites on the leg. Other than that, she also feels anxiety caused by frequent admission and decreased in physical mobility and uncertainty of the disease.             Congestive heart failure is a clinical syndrome in which the heart fails to maintain an adequate output, resulting in diminished blood flow to the tissues, and congestion in the pulmonary and/or the systemic circulation. The causes of congestive heart failure are diverse. Adverse consequences of the series of physiologic events that initially compensate for the reduced performance of the heart as a pump lead to the symptoms and signs of clinical congestive heart failure ( 2004).             Congestive heart failure can best be understood by first reviewing normal heart function. The amount of blood pumped per minute (the cardiac output), is controlled by an intricate balance of variables including stroke volume, heart rate, preload or inflow volume and pressure, myocardial contractility, afterload or systolic pressure, and the sequence of ventricular activation and contraction. Frank and Starling showed that cardiac stroke work is directly proportional to the length or degree of stretch of the myocardial fiber, and it is useful to describe cardiac function in terms of the ventricular function curve, the Frank-Starling relationship (2000).             The manifestations of heart failure range from sudden death, through cardiogenic shock, to chronic congestive heart failure depending upon the degree of circulatory inadequacy and the rapidity with which it develops. The manifestations include edema, particularly of the dependent portions of the body; a prolonged circulation time; hepatic enlargement (hepatomegaly); a sensation of shortness of breath and suffocation (dyspnea); and distention of the neck veins (2001). A detailed clinical history is crucial and should address not only current signs and symptoms of heart failure but also signs and symptoms that point to a specific cause of the syndrome, such as coronary artery disease, hypertension or valvular heart disease. It is important to determine whether the patient has had a previous cardiac event, in particular a myocardial infarction (2000). Hypertension and a history of congestive heart failure are two clinical histories that could point out why Mrs. Chan has at present the condition.             Early diagnosis of heart failure is essential for successfully addressing underlying diseases or causes and, in some patients, preventing further myocardial dysfunction and clinical deterioration. However, initial diagnosis may be difficult because the presentations of heart failure can change from no symptoms to pulmonary edema with cardiogenic shock. Mrs. Chan’s feeling of anxiety is understandable given her situation. Anxiety is uneasiness or uncertainty resulting from anticipating a threat or a danger (2004). On study examined the prevalence of anxiety and its impact on clinical outcomes in patients with congestive heart failure. Clinical implications of the study show that identifying congestive heart failure patients with moderate to high levels of anxiety, using a standard diagnostic tool, may be helpful in improving their long-term prognosis.   2.         Aging is a general physiologic process that is as yet poorly understood. Aging affects cells and the systems made up of them, as well as tissue components such as collagen, and numerous theories have been advanced to explain the phenomenon. In aging humans, there are declines in the circulating levels of some sex hormones, the adrenal androgen dehydroepiandrosterone and its sulfate, and growth hormone ( 2001).             The aging process affects all cells, organs and systems of the body. The earliest noticeable signs of the process are usually exhibited by the muscoloskeletal system; thinning and wrinkling of the skin, graying and/or loss of hair, loss of bone mass, increase in body fat, decrease in muscle mass and strength, and joint pains and stiffness that is worse in the morning. The sensory organs become less acute; reading glasses become necessary; the ear is unable to hear high pitch sounds: food tastes more bland; and the sense of smell becomes less discriminating.             The liver which is the major metabolic organ in the body show levels of activity drop in relation to aging. This decreased activity could result in slowed detoxification of some compounds and reduced excretion rates, which can result in higher effective circulating levels and longer half-lives (2005). The reflexes become duller and motor responses get delayed. The deterioration of the heart and lungs manifest as increasing difficulty to perform strenuous activities; climbing stairs become an ordeal. All the other organs also weaken. They lose most of their reserve capacities and are unable to perform their assigned functions as efficiently. The immune system becomes less active and the person becomes more susceptible to infection (2004).             Digestion becomes less effective the person is unable to tolerate many foodstuffs and becomes susceptible to malnutrition. Females go into menopause and lose their ability to reproduce. Males retain their reproductive capacity but develop erectile and/or other sexual dysfunctions. The elimination of toxicants and their metabolites is affected by age-related changes in hepatic function, described above, and by decreased kidney function. A decrease in the rate of renal clearance results in an increase in the elimination half-life of a compound. Renal changes observed with age include a decrease in mass of the kidneys, a reduction in the size and number of nephrons, a decrease in renal blood flow, and reductions in glomerular filtration rate, renal plasma flow, and tubular function. In addition, the alterations in pulmonary function that affect absorption of gases and volatile compounds also will affect their excretion through the pulmonary route. There is also evidence that bile flow and biliary transport is reduced with aging, thus reducing excretion through that route ( 2005).        Another potential area of concern is changes in the blood-brain barrier with aging, resulting in increased permeability of the cerebral microvasculature to toxicants that could result in neurodegenerative disease. Most data currently indicate that there are no significant changes in permeability with normal aging. Diseases often associated with aging, however, such as diabetes, hypertension, and cerebral ischemic events, may compromise this barrier function. This may be important in understanding the environmental etiology of conditions such as Parkinsonism, which has been linked to exposure to some compounds that ordinarily show limited penetration of the blood-brain barrier ( 2005).             Major physiologic changes occur with aging of the heart. Heart functions begin to slow down with age. The aging process reduces the heart muscle strength. So its pumping power declines, and the maximal heart rate also decreases. When the amount of blood pumped by the heart in a minute declines, systolic blood pressure tends to rise. The left ventricular wall thickens, systolic function decreases, and heart rate response to exercise is blunted. Maximal oxygen consumption declines, left ventricular filling declines, cardiac output remains normal or declines and the cardiothoracic ratio increases (1998).             There are some common problems associated with the heart as an effect of the aging process. One of these is atherosclerosis. Arteriosclerosis is the hardening or clogging of the arteries due to excessive build up of fat and cholesterol known as plaque. Fatty plaque deposits inside the blood vessels cause it to narrow and can totally block blood vessels and also cause the valves that control the direction of blood flow to thicken and become stiff. Arteriosclerosis in turn is the underlying cause of most cardiovascular diseases (2001).             With aging, the heart has to work harder due to decreased blood supply ( 2001). Greater force is necessary to push blood through narrowed vessels due to plaque build up. So high blood pressure develops and this buildup and shortage of oxygenated blood over time, leads to heart attacks. In a heart attack, a part of the heart muscle becomes starved for oxygen and dies.             Congestive heart failure, that which Mrs. Chan experienced, is also very common in the aging population. In people older than 75, heart failure occurs 10 times more often than in younger adults (1998).   3.                     The assessment of heart function involves a review of signs and symptoms from the medical history, pulse assessment, and direct examination of the heart. A patient who has signs and symptoms of cardiac problems may be suffering a life-threatening condition requiring immediate attention.             When such is the case, health care professionals should act quickly and decide on the portions of examination that are absolutely necessary for the patient. When the patient’s condition is stable, a more thorough assessment can reveal baseline heart function and any risks for heart disease.             To establish the diagnosis of congestive heart failure, a physical examination should be performed which should include exam for jugular venous distention, cardiac auscultation, pulmonary exam and peripheral edema. Jugular venous distention and bilateral leg edema are both observed in Mrs. Chan, clearly indicating a possible congestive heart failure. Initial diagnostic tests to confirm the diagnosis includes an echocardiogram performed for patients with symptoms highly suggestive of congestive heart failure due to the lack of sensitivity of physical findings in some patients with congestive heart failure. Patients with mild symptoms such as fatigue or peripheral edema should only undergo echocardiography if there are physical or radiologic findings suggestive of heart failure. The constellation of the patient's symptoms and the findings from a physical examination, chest radiograph, and echocardiogram clearly establish a diagnosis of congestive heart failure (2003).             The performance of a 12-lead electrocardiogram (ECG) is essential in the evaluation of a patient with congestive heart failure. Evidence of myocardial infarction or conduction abnormalities such as left bundle-branch block and other abnormalities serve to heighten the suspicion of left ventricular systolic dysfunction. An ECG evaluation also is needed to role out arrhythmias that can worsen symptoms of congestive heart failure or predict potential complications such as sudden cardiac death. Since atrial tachyarrhythmias such as atrial fibrillation with uncontrolled ventricular response may be the sole cause of congestive heart failure and left ventricular dysfunction, the early identification of this arrhythmia is crucial (2003). Patients with a confirmed diagnosis of congestive heart failure should have the following tests performed to screen for the underlying causes of the heart failure: ECG, CBC, UA, serum creatinine, serum albumin, and echocardiogram. If the patient has an atrial fibrillation or flutter or is over 65 years old, a T4 or TSH should also be obtained. A newer tool being used in the diagnosis and assessment of CHF is the measurement of blood levels of B-type natriuretic peptide (BNP). BNP is a peptide that is secreted by the left ventricle in response to stretch and can be used to differentiate dyspnea due to congestive heart failure from that caused by COPD, obesity, or other chronic illnesses. The patient presented, however, has fairly classic signs and symptoms of congestive heart failure, so a BNP level would predictably be elevated and would add little to the diagnosis. On the other hand, a BNP level at the time of this patient's initial presentation would likely have allowed for an earlier diagnosis (2003).             The management of heart failure is based on its physiologic concepts. Therapy includes rest, oxygenation, measures to improve myocardial contractility, correction of arrhythmias, diuresis, sodium restriction, and reduction of afterload if possible. Even in the most urgent situation, the cause of the heart failure must be determined, any correctable conditions searched for, and contributing factors eliminated (2003). Robust clinical trials have demonstrated the benefits of therapy with various [beta]-blockers in patients with congestive heart failure. Bisoprolol, long-acting metoprolol, and carvedilol have all been shown to improve survival and to decrease hospitalizations for heart failure. In the instance of severe congestive heart failure, only carvedilol thus far has been demonstrated to improve survival and is also well-tolerated. Although several small trials have demonstrated differences among patient responses to these agents, a large, randomized direct comparison trial demonstrating the superiority of one over another has not yet been completed (2003). For a patient with congestive heart failure, left ventricular dysfunction, the same approach to the initial medical management should be taken. The consideration of surgical revascularization, however, should be undertaken soon after the patient presents, especially if the patient has chest pain or objective evidence of ischemia. The assessment of myocardial viability using the noninvasive techniques described above is important, particularly since the patient's risk of surgery is usually quite high. If extensive myocardial scarring were found with little evidence of viability, surgical or mechanical revascularization would be inadvisable. If the expected improvement does not occur and the patient’s symptoms worsen, other therapies, including transplantation should be considered. If Mrs. Chan’s ECG findings demonstrate a marked intraventricular conduction delay, cardiac resynchronization with a biventricular pacing device may be beneficial. Should transplantation prove to be the only viable option, evaluation for any concomitant diseases that would preclude transplantation (eg, cancer and severe renal dysfunction) should be undertaken. The decision regarding listing the patient for cardiac transplantation can be facilitated by an assessment of a patient's exercise-induced maximal oxygen uptake. A peak oxygen uptake of < 14 mL/kg/min (or < 50% of predicted normal values) or the need for continuous therapy with IV inotropic agents generally identifies the need for transplantation. The placement of an implantable left ventricular assist device is sometimes needed as a "bridge" to cardiac transplantation for a patient who requires a greater degree of hemodynamic support (2003).

AGED CARE

AGED CARE 1. Mrs. Chan is diagnosed as having congestive heart failure caused by excessive fluid overload and leading to f...

Evidence base for a nursing care of nasogastric tubes

Evidence Base for a Nursing Care of Nasogastric Tubes Introduction             The care of older adults poses special challenges because of great variation in their physiological, cognitive, and psychosocial health. Older adults also vary widely in their levels of functional ability. Addressing the health concerns of the elderly specific for their age should be a health care priority. For this paper, caring for the elderly would be the focus of discussion. Given the developmental differences and changes, the elderly patients would somehow require a different approach in medication administration.             This paper focuses on developing the best practice guidelines for a patient with nasogastric tubes. Using various literatures, a plan for a patient is developed. Basically, this involves five phases, which are outlined in the concept map in the previous page. Artificial airways need to be maintained in the correct position to prevent airway damage. To illustrate, nasogastric tubes, if not properly administered and handled can create complications for the patient such as infections. The passage of food and air in the nasogastric tube is a difficult process which also requires expertise and care. There are certain guidelines that should be followed during suctioning and these are outlined below. However, even if there are recommended guidelines, sometimes these guidelines fall short of what should be expected or completely does not work at all for a certain situation. Thus, the nurse still has to apply critical thinking skills at all times when performing patient care. Discussion             The presence of an artificial airway places a patient at high risk for infection and airway injury. Sterile technique is used in caring for and maintaining an artificial airway to prevent nosocomial infections. Artificial airways need to be maintained in the correct position to prevent airway damage.             Nasogastric tubes are used as short-term artificial airways to administer mechanical ventilation, relieve upper airway obstruction, protect against aspiration, or clear secretions. Nasogastric tubes are generally removed within 14 days; however, they may be used for a longer period of time if the patient is showing progress toward weaning from mechanical ventilation and extubation. The care of a patient with an nasogastric tube has five steps (2004).             A patient with an artificial airway is at an increased risk due to an inability or difficulty controlling secretions and due to pressure points of the artificial airway thus the rationale for observing signs and symptoms of need to perform care of the artificial airway. This could include soiled or loose tape, pressure sores, unstable tube, and excessive secretions (2004).             Identifying factors that increase risk of complication from nasogastric tubes includes the checking the type and size of the tube, movement of tube up and down the trachea, cuff size, and durations of placement. A tube moving up and down the nasal and gastric cavities disposes the patient to nasal trauma or dislodgement. Cuff underinflation may allow aspiration, whereas overinflation may cause ischemia or necrosis of nasal and gastric tissue. Loner duration increases risk of lower airway complications such as pneumonia (2004).      The next step is to suction the nasogastric tube. Suctioning of gastric secretions may prevent postoperative atelectasis and, if properly carried out, may avoid the necessity for further nasal treatment. In my own opinion, the most important provided in the literature review is this: Suctioning exhausts the patient and can cause cardiac arrest. Therefore, the duration of the total suctioning period should be brief so as not to exhaust the patient. Suctioning must be done with a fresh sterile catheter and tube to prevent contamination or infection (2006). Risks for infections and other complications are always a possibility for any patient. Thus, the nurse has to be utterly careful when performing suctioning. Additionally, a patient should not be thoroughly exhausted after the procedure because the patient may not be able to do that which is required of him to ensure continuity of care. The concept map is a very simple one which contains the five basic steps in the care of an nasogastric tube patient, including suctioning. There are five branches of the concept map corresponding to the five basic steps. There are no more tertiary branches. The sub-steps for each of the basic step are then outlined in the literature review. The rationales for each step are also discussed in the literature review. The design of the concept map used for this paper is very simple. There are two reasons for this choice. First is that this type of concept map is easier to create and modify. This saves time on making the concept map and delegates more time to the search for the best practice guidelines. The second reason is that a concept map on nasogastric tube suctioning does not require a complex one but a simple one to be able to fully illustrate the steps. Further information on each step is contained in the literature review instead. Overall, the concept map serves its purpose. It is simple and easy to understand. Conclusion Thus, a nurse’s critical thinking skills are also very useful when faced with a situation that cannot be acted upon with recommended guidelines. Others who will read this will able to get the basic idea of how to provide nasogastric tube suctioning and care. If at some point, the recommended guidelines do not work, then the nurse has to rely on her critical thinking skills to solve upon a problem. The references that have been quite helpful for this endeavor are listed below. All of them are important and have contributed to attaining the goal for this paper. Furthermore, The health care professional must work collaboratively with the older adult to ensure safe and appropriate use of all medications that the elderly needs. This includes both prescribed and over-the-counter medications. The older adult should be taught the names of all drugs being taken, when and how to take them, and the desirable and undesirable effects of the drugs. If for some reason the elderly cannot understand, then it is better that another family member or a caregiver must be taught. The health care professional must also teach the elderly patient how to avoid adverse effects or interactions of drugs and how to establish and follow an appropriate self-administration pattern.

Evidence base for a nursing care of nasogastric tubes

Evidence Base for a Nursing Care of Nasogastric Tubes Introduction The care of older adults poses special challenges bec...