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“There is an intimacy nurses and patients share which is understood. The essence of nursing is an unconditional love for mankind. To be called a nurse is an honor - a profession of the highest realm” (Donelan: 2004).
“If only attention and care were enough, any person could be a nurse” - such words were written in the university’s advertisement published in 1990 about the recruitment on the medical nursing department. Medical nursing care was presented as an intellectual trade based on the scientific approach, instead of a trade based on mercy. It seems like our society ceased to appreciate mercy and care.
Community health includes health care of elderly people. The programs of organizations for elders are aimed at maintenance of health care of older people and creation of the most comfortable conditions for receiving health care services. The target is to open accessibility for elders to get necessary qualified medical aid; to have the possibility to pay more attention to their health, go in for sports, and to take an active part in social life. It is known that health is influenced not only by the conditions of health care service but also by a set of factors, such as environment, habitation, well-being, self-realization and emotional state. The ultimate aim is to decrease the morbidity level and to increase expectancy and quality of life.
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Care is an indispensable component of treatment. Many rules and requirements of patient care had been known since ancient times. At the dawn of medicine development when the doctor was powerless, facing the majority of illnesses, only correct care could return life and health to the patients. However, in spite of the development of the scientific and technical progress, the presence of the most modern medical technologies, high-performance medications and effective surgeries, the correctly organized patient care play almost the determinative role in patient’s health recovery and working ability.
Speaking of the case of Mrs. Curran, it is possible to say that her case is aggravated with her age. Diagnostic errors during the analysis in multisystem failure of women are observed much more often than at men. It is quite clear that Mrs. Curran, having diabetes and hypertension, should be assessed taking into consideration these factors. At the inspection of the woman diagnosed with a multisystem failure, it is necessary to find out the anamnesis of disease, and also to conduct a full medical check-up.
The blood medical tests of the patient should be taken, and they may show leukocytosis - a left shift of leukogram and acceleration of erythrocyte sedimentation rate. The urine test may reveal hematuria, pyelouria, and specific gravity increase.
Dyspnea at Mrs. Curran can be caused by the pathology of cardiovascular and respiratory systems. Pains in a breast and a dyspnea can be symptoms of a sharp heart attack of a myocardium. At the development of stratification of a chest aorta dyspnea can pass in an asthma attack in connection with a mechanical obstacle of the function of the respiratory system bodies, owing to the development of a sharp heart failure.
Lisinopril was prescribed for the patient. It is usually prescribed at arterial hypertension and diabetes nephropatia. Mrs. Curran should take 5 mg of lisinopril per day. In the absence of effect, a dose can be raised each 2-3 days by 5 mg up to the average therapeutic dose equal to 20-40 mg/day (the increase of a dose over 20 mg/day usually does not lead to the further decrease of arterial hypertension). The maximum daily dose is 80 mg.
Metformin lowers the concentration of glucose (on an empty stomach and after food intake) in blood; it levels the glycosed hemoglobin and raises tolerance to glucose. It reduces intenstines glucose absorption and its production in a liver. It normalizes a lipid profile of blood plasma at patients with diabetes: reduces the maintenance of thryglicerides, cholesterol and does not change the levels of lipoproteins of other densities. Metformin stabilizes or reduces a body weight.
The patient’s medication also includes hydrochlorothiazide. It is a diuretic preparation. It blocks the reabsorption of ions of sodium, chlorine and water in distal tubules of nephrone. It increases deducing of ions of potassium, magnesium, bicarbonate; reduces deducing of calcium with urine as a result of a direct action on distal tubules that can prevent the formation of calcium nephritic concretions.
The preparation promotes the decrease of the raised arterial pressure and causes a reduction of polyuria in patients suffering from diabetes. It is prescribed at arterial hypertension. Hydrochlorothiazide is applied also for the preventive maintenance of calcium nephritic concretions, at idiopathic hypercalciurium. Hydrochlorothiazide is, as a rule, well tolerated.
Acetaminophen was also prescribed for Mrs. Curran. It possesses the properties similar to aspirin, but it does not have a periferical anti-inflammatory and antiplatelet impact. Acetaminophen directly influences the central nervous system and increases a threshold of a painful sensitivity by means of inhibition of enzymes involved in the synthesis of prostaglandines. About 85% - 90% of acetaminophen is metabolized in the process of glucuronic and sulphatic conjugation; the other part is oxidized to N-atsetil-para-benzohinonimin, and it is deduced with urine.
The application of morphine by a technique supervised by the patient in a combination to acetaminophen provides more expressed analgetic effect and promotes as much as possible fast normalization of the hormonal status and variability of a heart rhythm.
Morphine suppresses sensations of a strong physical pain and a pain of a psychogenic origin. It possesses a sedative activity, suppresses a coughing reflex. Lowering the excitability of the painful centers, it has also an antishock effect at traumas. The patient was pescribed morphine in order to relieve her dyspnea and make her sleep.
The general care is based on the creation of hygene conditions and appropriate regime, balanced diet, precise fulfillment of the medical prescriptions and permanent patient’s check-ups. The number of nursing measures depends on the state of health, according to which the physician can prescribe strict bed rest, bed rest or general rest. The former does not considerably restrict the patient’s motion activity.
The main objectives of the care of the geriatric patient include: encouraging optimistic health behaviors, enhancing functional capabilities of patients on life-sustaining devices, improving health as well as quality of life of patients via a comprehensive primary medical care as well as nursing rehabilitation services, cutting down on visits on emergency department, cutting down on time patients spend in hospitals and readmission to such institutions, providing patients with incurable diseases to die in the comfort of their home if such was their desire, offer support to informal caregivers.
“The purpose of assisted living may be viewed as twofold. It may provide housing for individuals needing a supervised living situation, in which minimal assistance is provided. Alternatively, sheltered or assisted housing may be a form of care provision itself, in which more extensive medical and personal care assistance is available. Assisted living brings into focus the sometimes conflicting priorities of the social services, housing experts, and health care providers whose emphases in residential care may vary” (Baggette, 1989).
The key rule at communication with the geriatric patient is spiritual care. Spiritual care is an essential right of each person as well as political freedoms, the right to medical aid, and equality of possibilities. The true democratic ideal should include the qualified spiritual care for each person in a number of the most essential positions.
Bioethics is based on the representations about the insufficiency of one-sided medical interpretation of corporal well-being as medical purposes. An absolute must is interdisciplinary dialogue of physicians with the representatives of a wide-range of humanities and dialogue with patients and community representatives.
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