NURSING CARE IN THE ELDERLY

A Nursing's Care Process have a five parts:

1. VALUATION based on 14 basic needs of Virginia Henderson.
2. DIAGNOSIS
3. CARE'S PLANNING
4. EJECUTION
5. EVALUATION OF THE CARE'S PLANNING

The nursing's care process is very useful to establish individualized care's plan. The objetives are:

• Identify the patient's health status.
• Establish a care's plan.
• Provide specific interventions.

VIRGINIA HENDERSON

Architect of nursing and mother of us all. (1897-1996)

"The nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the of the newly blind, a means of locomotion for the infant, knowledge and confidence for the mother, the mouthpiece for those too weak or withdrawn to speak and so on."

Virginia Henderson was a nurse who created the care model based on 14 basic needs:

1. Breathe normally.
2. Eat and drink adequately.
3. Eliminate body wastes.
4. Move and maintain desirable positions.
5. Sleep and rest.
6. Select suitable clothes-dress and undress.
7. Maintain body temperature within normal range by adjusting clothing and modifying enviroment.
8. Keep the body clean and well groomed and protect the integument.
9. Avoid dangers in the environment and avoid injuring others.
10. Communicate with others in expressing emotions, needs, fears or opinions.
11. Worship according to one's faith.
12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation.
14. Learn discover or satisfy that leads to normal development and health and use the available health facilities.

I'm going to explain carefully the need "Sleep and rest", because I consider that it's very important that people have an adequate sleep pattern, above all, the geriatric people. 
Many older people experience problems related to sleep and some of these problems result from changes that normally occur with aging, while other may be caused by acute or chronic health problems. For this reason, nurses must be able to understand normal sleep patterns and to identify common age-ralated changes in sleep patterns for to assess, plan and intervene effectively. 

A unsuitable sleep pattern would be:

• A person who sleeps < 5 hours.
• Frequent sleep interruptions (difficultly sleeping, nightmares, early awakenings...)
• The rest isn't satisfactory. The person is irritable, fatigued, without energy.
• A person who doesn't know the best conditions for sleep.
• A person who does stressful exercises before sleep.

Some nursing diagnoses used to this basic need can be:

• Alteration of the sleep pattern
• Sleep deprivation
• Acute confusion
• Chronic confusion

In these situations, nursing interventions should direct the patient toward an adequate sleep pattern: 

• Go to bed only when the patient is sleepy.
• Wake up every day at the same time.
• Avoid staying in the bed more time than necessary.
• Avoid napping during the day.
• Control the fluid intake before bedtime.
• Increase physical activity because in this way, the patient will be more tired.
• Explain to the patient the ideal sleep environment: ambient light, fresh room, without noise...
• Wear comfortable clothing to sleep.
• Perform relaxation techniques before sleep.
• Avoid the consumption of alcohol, caffeine or hypnotics.
• Avoid heavy meal before sleep.
• Explain the normal sleep changes that occur in aging.
• Consult with the doctor the possibility of prescribing medication.

SWEET DREAMS

SOME SLEEP ASSESSMENT SCALES

1. Insomnia Severity Index
2. Pre-Sleep Arousal scale