Peer’s posts responses from an FNP perspective

Please respond to your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

Do you agree with your peers’ assessment?
Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
Share your thoughts on how you support their opinion and explain why.
Present new references that support your opinions.

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Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature. Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Also, be sure you are italicizing titles of online sources. No more than 200 words maximum.

In subsequent posts compare and contrast your findings with your fellow classmates.(initial post is in attachment)

Sarah’s Response

Geriatric Syndromes

Frailty, falls and dizziness are common geriatric syndromes. Frailty is a geriatric syndrome defined as a state of increased vulnerability to both acute and chronic stressors as a consequence of reduced physiologic reserve, functional decline, loss of independence, and mortality (Ham, 2014). Patients with frailty may experience increased fatigue, loss of appetite, and limited physical abilities. In the United States, about three fourths of deaths resulting from falls occur in the thirteen percent of the population that is aged sixty-five and older, making injurious falls a true geriatric syndrome (Ham, 2014). Dizziness is a geriatric syndrome that affects multiple body systems. Dizziness in the elderly can root from depression, cataracts, gait changes, postural hypotension, diabetes, cardiac issues, and polypharmacy (Ham, 2014). All three of these geriatric syndromes affect quality and quantity of life in the geriatric patient.

Patient with Fall

I had the pleasure of caring for an eighty-five-year-old patient who recently sustained a slip and fall in the shower at home. She was living independently, cooking, cleaning, and driving before the injury. She sustained a fractured pelvis and left hip. Her hospital stay was extended after surgery because she acquired a surgical infection to the hip incision site. She unfortunately was widowed three years ago and has no family, but does have two close female friends. The patient began to experience asthenia, depression, stopped eating, and ultimately lost her will to live.

Interventions

Falls predispose geriatric patients to injury, loss of independence, decreased mobility, hospitalization, and early death (Phelan, Aerts, Dowler, Eckstrom, & Casey, 2016). Screening for fall-risk and fall prevention is consistently overlooked by primary care providers. Implementing a fall assessment screening to elderly patients and initiating a discussion about safety in the home can be beneficial interventions for the prevention of falls and injuries in geriatric patients. Healthcare providers should assess physical factors such as the presence of postural hypotension, muscle weakness, visual acuity, gait pattern, environmental hazards, shoes, vitamin D deficiency, and polypharmacy (Phelan, Aerts, Dowler, Eckstrom, & Casey, 2016). If these interventions were implemented in the patient mentioned above, maybe she could have been spared a fall, and ultimately her life.

References

Ham, R. (2014). Ham’s Primary Care Geriatrics: A Case-Based Approach. [VitalSource Bookshelf].

Retrieved from https://bookshelf.vitalsource.com/#/books/97803230…

Phelan, E. A., Aerts, S., Dowler, D., Eckstrom, E., & Casey, C. M. (2016). Adoption of evidence-

based fall prevention practices in primary care for older adults with a history of falls.

Frontiers in Public Health, 4, 190. doi:10.3389/fpubh.2016.00190

Vivek’s Response

Geriatric syndrome is a term used to umbrella unique features of common health conditions in the elderly. Gerontology accepts geriatric syndrome as multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render a person vulnerable to situational challenges (Senn & Monod, 2015). Such impairments can impact day to day living and put a geriatric patient at a greater health risk. Studies show the most common geriatric syndromes are cognitive impairment, pressure ulcers, incontinence, falls, functional decline, affective disorders, visual and hearing impairment, and malnutrition (Senn & Monod, 2015). These often reflect the chief complaint during primary visits, in my experience. To a lesser extent, eating and feeding problems, sleeping problems, dizziness and syncope, self-neglect and elder abuse have also been classified as geriatric syndromes (Senn & Monod, 2015). When it comes to the aging process, impairments can impact the day to day activities and put the patient at risk for health complications. An example of one I have had experience providing care for is skin breakdown due to lack of mobility.

Skin breakdown is the result of multiple syndromes acting together. For example, visual impairment and gait issues (functional decline) may confine a patient to staying at rest. In addition, malnutrition can contribute towards skin breakdown. Comorbidities such HTN and DM can also contribute. The pathogenesis of PU is a multifactorial process involving inflammatory factors, hormonal changes, reduced immune protection, impaired blood perfusion and degenerative changes (Jaul,Barron, Rosenzweig & Menczel, 2018). Interventions to combat this include providing adequate nutrition and hydration, and assisting and/or moving the patient every so often. Identifying the key risk factors and impact of comorbidities and associated geriatric conditions on the susceptibility of the elderly patient is of critical importance for the prevention of pressure ulcers (Jaul,Barron, Rosenzweig & Menczel, 2018). If the patient was at risk for skin breakdown because of lack of mobility- providing movement would be the intervention. If the risk identified was dehydration, the priory intervention for that risk would be adequate hydration.

Reference

Jaul, E., Barron, J., Rosenzweig, J. P., & Menczel, J. (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatrics, 18(1). doi: 10.1186/s12877-018-0997-7

Senn, N., & Monod, S. (2015). Development of a Comprehensive Approach for the Early Diagnosis of Geriatric Syndromes in General Practice. Frontiers in Medicine, 2. doi: 10.3389/fmed.2015.00078

Dr. Brown’s Response

Geriatric syndrome refers to multi factorial clinical conditions that are common in the elderly which do not fit into discrete disease categories. These syndromes greatly impact the life of the elderly patients and may lead to decreased functioning and poor quality of life.

The 5 most common geriatric syndromes in the elderly are:

Pressure ulcers
Incontinence
Falls
Functional decline
Delirium

What is the potential impact if we screening for these symptoms and incorporated a proactive prevention plan to reduce negative outcomes related to these symptoms? Last week we discussed the impact of the APRN on health outcomes. This week we will discuss ways to improve certain conditions.