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Psyciatric Nursing Care for Elderly

Mental Health Nursing Care for the Elderly

Nursing Care for the ElderlyEvery year the definition of elderly changes, but maybe its fair to talk about the age of 65 as being the start of elderly. While this definition is somewhat arbitrary, it is many times associated with the age at which one can begin to receive pension benefits. At the moment, there is no United Nations standard numerical criterion, but the UN agreed cutoff is 60+ years to refer to the older population.

Elderly mental health care is an important issue that affects almost one in every five American adults who are in fact known to be affected by some form of mental illness or the other. These mental illnesses include suffering from dementia and psychosis, delirium as well as depression and schizophrenia.

Elderly mental health care today suffers from many lacunae and among these lacunae is the fact the majority of elders suffering from mental ailments shirk from getting them treated. It is commonly found that such elders will suffer their condition in silence and are ready to put up with many discomforts rather than face the stigma of being known as being mentally disturbed.

In today's day and age a worrying aspect to dealing with elderly health care needs is the fact that the cause of death in the twentieth century is radically different than what was common in the previous century. In the nineteenth century deaths were caused by acute as well as infectious ailments, though in these modern times the main killers are chronic as well as degenerative ailments of old age.

In most cases, mental health problems in elders that require treatment are quite conveniently ignored. Improper treatment of mental illnesses in elders seems to the most prominent reason contributing to high suicidal rate in these people. Many of these people require specialized mental health services.

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Appendicitis - Healing Acute Pain

Nursing Care Plan for Acute AppendicitisAcute appendicitis is defined as the acute inflammation of the appendix. It is considered to be the most common cause of abdominal pain and distress in children and teenagers worldwide (ages 4-15). The appendix is a channel in its interior that communicates with the large intestine where feces semifluidas.

The appendix is a small pouch attached to your large intestine. It is thought that appendicitis begins when the opening from the appendix into the cecum becomes blocked. The blockage may be due to a build-up of thick mucus within the appendix or to stool that enters the appendix from the cecum. When the appendix is blocked by calculus and feces or it is squeezed by the lymph nodes (due to bacterial infection, the lymph nodes usually become swollen and press against the appendix), it swells and usually doesn't receive enough blood. Bacteria grow inside the appendix, eventually causing its death. In acute appendicitis, the inflammation of the appendix is serious and can lead to complications (perforation, gangrene, sepsis).

Acute appendicitis is caused in most cases, usually by a fossilized feces (fecalito) that obstructs the appendiceal channel. Acute appendicitis is the most common cause of acute abdominal pain and its treatment is surgical and emergency.

The most common symptoms of acute appendicitis are intense, continuous abdominal pain (at first it occurs in the umbilical region and later locates in the right lower region of the abdomen) that usually amplifies during movement, poor appetite, nausea, vomiting, constipation or diarrhea and fever. Vomiting and anorexia can occur after the feeling of pain. Besides, an elevated body temperature is a sign of an ongoing inflammation in the body. In atypical forms of acute appendicitis, the patients may have only one symptom or they may not have any symptoms at all! This complicates the process of correctly diagnosing acute appendicitis and the only effective means of discovering the illness are abdominal computerized tomography, blood analysis and detailed physical examination.

The most frequent complication is that the wall of the appendix is necrosa (gangrenous appendicitis), causing a perforation, with consequent generalized peritonitis, or in some cases the adjacent bowel loops are affected in such a way that causes perforation of the small intestine.

Another complication is the possibility that the omentum can join restricting peritonitis in the right iliac fossa. Fibrosis and inflammation produce a persistent right iliac fossa mass (mass apendicial). This can be solved through healing by formation of an abscess to drain to the surface or by drilling with generalized peritonitis.

The surgical intervention performed in acute appendicitis is called appendectomy. If acute appendicitis is treated in time, the patients recover quickly and effortless. Most patients are fully recovered within 4 weeks from surgery. However, in the case of complicated acute appendicitis, the patients require special monitoring before and long after the surgical treatment. Complicated acute appendicitis is life-threatening and the rate of mortality in patients with this form of illness is considerably high. Acute appendicitis requires immediate treatment.

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NCP Acute Pain related to Postoperative Thyroidectomy

Thyroidectomy is the surgical removal of the thyroid gland. The surgical procedure of thyroidectomy involves a partial or a complete removal of the thyroid (a gland, which is located in front of the lower neck, just above the trachea). The gland is formed by two cone-like lobes or wings (lobus dexter (right lobe) and lobus sinister (left lobe), and attached by a middle part (isthmus).
The surgery may be recommended for a variety of conditions including:
An overactive thyroid gland that produces extremely high levels of thyroid hormones A growth (nodule or cyst) associated with the thyroid gland Cancer of the thyroid A small thyroid growth Malignant (cancerous) thyroid tumors Benign (noncancerous) tumors of the thyroid that are causing symptoms An enlarged thyroid gland (nontoxic goiter) that makes it hard for you to breathe or swallow.

Indications for Thyroidectomy:
  • A large goiter that is unlikely to react anti-thyroid drugs, may require surgery of the thyroid gland, to avoid pressure on the trachea and esophagus, which then can cause difficulty breathing and swallowing, respectively.
  • Side effects of drug therapy or adherence to taking medication Persistent poor or non-response to radioactive iodine therapy, up to repeated episodes of hyperthyroidism require excision of the thyroid gland.
  • Thyroidectomy used to negate the need for radioactive iodine therapy, especially in children.
    In pregnant women, when drug therapy fails to control hyperthyroidism, thyroid operation organized
  • Violence and tumors of the thyroid gland require surgical excision.
  • It is also advisable in the case of clinical manifestations such as the rapid growth of the thyroid gland, severe pain, and cervical lymphadenopathy, or when there have been prior to irradiation of the neck. A fine needle aspiration cytology (FNAC) need to preformed to confirm the diagnosis and determine the type of operation.
  • Functionally or anatomically benign goiter, causing much anxiety among patients and is preferred to cut surgery for cosmetic reasons.

Common occurrence after Thyroidectomy
  • There will be episodes of pain, swelling, and bruising around the wound area.
  • Voice may be hoarse. But, this is usually temporary and tone of voice to get back to normal after a few days.
  • During the first few days, eating and drinking can be associated with some discomfort and pain.
  • You will feel a bit sluggish and tired after the surgery.
  • Area can be washed after 7 to 10 days.
  • Light jobs can be done after a period of 2 weeks.

Action to reduce the Acute Pain related to postoperative thyroidectomy
1. Study the presence of pain symptoms, both verbal or nonverbal, note the location, intensity (scale of 0-10), and duration.
Rationale: useful in evaluating pain, determine the choice of interventions to determine effectiveness of therapy.
2. Give patients in semi-fowler’s position and support the head / neck with a small pillow.
Rationale: prevent hyper-extension neck and protect the integrity of the suture line.
3. Suggest patients use relaxation techniques, such as imagination, soft music, progressive relaxation.
Rationale: help to refocus attention and help patients to cope with pain / discomfort more effectively.
4. Give & evaluation prescribed analgesic effectiveness.
Rationale: Analgesics should be at great pains to block pain.

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