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NetCE is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. NetCE is approved to offer continuing education through the Florida Board of Nursing. Books and Chapters by Myopain Seminars Faculty Books Co-edited by Jan Dommerholt. Case Reports. add links to case studies here (case studies should be added on new pages using the case study template) Generalized anxiety disorder and clinical worry episodes in young women. Resources. National Institue of.
Course Content - #9. Geriatric Failure to Thrive: A Multidimensional Problem.
Undesired weight loss in the elderly causes a reduced quality of life and contributes to. Elderly residents of nursing facilities who lose 5% of their body weight in. Poor prognosis is also associated with low prealbumin and cholesterol. Malnutrition in the elderly can result in pressure sores, functional decline, longer.
The "baby boomers" will account for a substantial increase in the elderly population. Figure 1). By 2. 06. There will also be an increase in the "oldest.
This course will explore current trends in cancer screening among racial and ethnic minority women, their cultural beliefs and perceptions about cancer and health care, attitudes toward cancer screening, how. References • [1]↑Goodman, Snyder. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis Missouri. 2007. • [2]↑LeGrove L. Polymyalgia rheumatica: management guidelines. Practice Nurse [serial.
More elderly persons will be dependent on others for. Healthcare providers should become prepared for the projected growth of the.
NUMBER OF PERSONS IN THE UNITED STATES 6. YEARS OF AGE OR OLDER, 1.
The term "failure to thrive" was originally used to identify. The term was borrowed from pediatrics.
Failure to. thrive is a common diagnosis in geriatrics and has been a principle diagnosis for hospice. However, as of October 2. Centers for Medicare and Medicaid Services (CMS) no. Failure to thrive is defined by the. Institute of Medicine as "weight loss of more than 5%, decreased appetite, poor nutrition. It is not a single. Rather, it is a multidimensional problem that requires a.
The four chief characteristics of geriatric. Failure to thrive is.
After the diagnosis is made, it stimulates further assessment and interventions. Each. of the domains of geriatric failure to thrive should be evaluated to determine areas in. Geriatric practitioners often order extensive diagnostic work- ups for these patients, which do not always reveal a reversible cause. It is a challenge to differentiate disease states common for older patients versus "normal aging." Furthermore, large amounts of Medicare dollars are paid to hospitals at the very end of the patient's life [6].
This raises the ethical dilemma of providing "futile care" that is cost intensive and yields few benefits. Despite costly, time- intensive medical evaluations, 2. If weight loss is attributed to the normal aging process, this can prevent early interventions from being employed. Sarcopenia can be defined as an age- related loss of skeletal muscle mass and strength that usually occurs after 6. Decreased strength leads to decreased function, and this functional decline can result in multiple complications, including falls, fractures, cognitive impairment, depression, and loss of independence.
Nursing home residents are at special risk, as inactivity and immobility lead to muscle wasting [9,1. This wasting is accelerated when nutritional deficits are present, and studies report that 1. Cachexia is a physical wasting with weight and muscle mass. AIDS), and chronic obstructive pulmonary disease (COPD). An estimated. 1. 6 million nursing home residents in the United States have cachexia [1. Cachexia is a hypermetabolic state in. The mechanisms that cause cachexia.
Cachectic patients often have a poor. Anorexia of aging, also known as age- related wasting, is a complex problem with physical, psychological, and sociological causes [1.
Physical causes: Medical illness, comorbidities, functional decline, sensory loss, reduced smell and taste, water and sodium imbalance, reduced thirst and ability to concentrate urine, medication side effects, and early satiety. Psychological causes: Cognitive impairment, delirium, depression, and/or psychiatric illness. Sociological causes: Poverty, lack of family support, isolation, dependency, substandard living conditions, and elder abuse. In addition, there is usually a component of sarcopenia and/or cachexia present.
When undesired weight loss and/or malnutrition occur in the elderly patient, it becomes a complex problem requiring a multidisciplinary approach. Unless this syndrome is identified early and interventions begun, the prognosis can be quite poor. An age- or illness- related weight loss or physical decline can quickly progress to a terminal hospice diagnosis. REGULATORY AND LEGAL ISSUESWeight loss is a serious issue in nursing facilities, and state and federal regulatory agencies monitor undesired weight loss as a quality indicator. It is also an area of focus for plaintiff attorneys, and advertisements may encourage loved ones to sue facilities/care providers for weight loss, accusing neglect.
Furthermore, inadequate treatment and monitoring of the dysphasic patient has become a malpractice litigation issue. Plaintiffs may accuse the nursing home or staff members of inadequate screening, evaluation, and/or treatment of the patient with dysphagia [1. Plaintiff attorneys may assert that adequate treatment and supervision could have prevented aspiration and death. Undesired weight loss can usually be attributed to medical illness, terminal condition, food. Careful communication with the patient and.
Nursing facilities can protect themselves by responding quickly and appropriately. Advance healthcare directives allow the patient and family to determine what medical care is desired. State regulations vary regarding how and when advance directives can be used. It is important for healthcare providers to be familiar with laws governing the use of advance directives in the state in which they practice [1. While it is desirable for a patient to have an advance directive, it may never be a condition of admission or continuance of their stay in a nursing facility. When caring for any patient with failure to thrive, it should. If no advance directives exist, it should be determined if the patient is capable.
This is called a determination of capacity. If the patient is deemed incapable of. A healthcare proxy is a person that is chosen by the patient/family to make. If there is not a surrogate designated, a close family.
There are many types of medical care that a living will can address [1. A do not resuscitate (DNR) order is a pre- hospital determination stating that the patient does not want cardiopulmonary resuscitation (CPR), ventilatory support, or other heroic lifesaving measures. It is important to note that this does not prevent other life- sustaining treatments (e. The concept of living wills grew from the limitations of DNR. These legal documents predetermine the medical care that will be accepted and. It may also designate a healthcare proxy or organ donation.
If life- saving or. The living will should be as detailed as. A nutrition/hydration directive may be created in order to ensure that. This. clarifies whether a feeding tube may be inserted or IV fluids administered.
In some cases. patients may refuse a gastric feeding tube but allow IV hydration or blood transfusion [1. If a patient/proxy and healthcare provider determine that further hospitalizations would not be beneficial, a do not hospitalize (DNH) order may be made. A DNH allows care to be provided in a nursing facility or home. These orders are often made when further hospitalizations would most likely cause further pain, suffering, or complications, and the patient would rather be cared for by familiar caregivers.
If a patient's/proxy's wishes are contrary to a healthcare professional's recommendations, he or she may be required to sign a refusal of treatment. This document indicates that the patient or responsible party has received informed consent regarding treatments, procedures, specialty referrals, diagnostics, and recommendations and has declined the recommendation. In addition, a waiver of responsibility may be necessary. This form is designed to relieve responsibility of the nursing facility when a patient does not follow recommendations. It is most commonly used when the patient/proxy refuses fluid restrictions, dietary modification, or thickened liquids.
Many facilities do not allow waivers, as they may not adequately protect from litigation. At times, advance directives may be difficult to implement due to pressure from family or the facility. When a patient has a living will and has clearly communicated end- stage desires and wishes to family, problems following a directive should be minimal. In other cases, there may be no advance directive and family members must make these difficult, and often divisive, decisions without knowing the patient's last wishes. Family members who may or may not have a close relationship with the patient can revoke living wills, DNRs, and other directives; they may be in denial of the patient's declining condition or have a personal agenda. Social workers are instrumental in the process of determining advance directives and communicating with families.
Medically futile care consists of medical diagnostics, treatments, or procedures that most likely will not provide a meaningful benefit to the patient. This is a difficult issue, particularly when the physician recommends withdrawing or withholding treatments and the family wants everything possible done. Ethics committees are useful resources when there is conflict that cannot be resolved. It can take several hospitalizations or trips to the emergency room before family members or patients will be ready to sign DNR or DNH directives.
In addition to debilitating illness, patients may be physically restrained at the hospital, usually to prevent them from falling or pulling out IVs or tubes. Physical or chemical restraint causes a forced immobility, potentially leading to pressure sores and muscle wasting. Long- term care facilities have regulations and practices regarding physical restraints and have protocols to be followed when a restraint is required; some pride themselves on being a restraint- free environment. These facilities can utilize creative means to keep patients from harming themselves, including bed and chair alarms, activity programs, and low beds with mats on either side to prevent injury should the patient get up unassisted and fall.
Physical and occupational therapists can be instrumental in initiating programs to promote patient safety and prevent falls. The least restrictive method of physical restraint is the most desirable for patients and facilities. Gastric feeding tubes are commonly seen in nursing.