5 steps for a good Informative Speech
1. Attention Getting Opener – It can either be through some rhetorical questions or through a good story and also through some shocking or exciting happenings.
2. Preview- You have to give a brief description of what you r going to follow in the speech.
3. Body- It is the longest part and it should contain visual aids , evidences, some personal experiences, facts, references, to support your body.
4. Review- You have to summarize what you said throughout the speech .
5. Memorable concluding events- It can be the final step which closes your speech with a good quotes, or some remarkable quotes or may be with some pictures and also it can be the visualizing the materials that u talked about.
Wednesday, December 3, 2008
Loneliness
Loneliness is a terrible feeling that a man has
Loneliness actually is the most terrible stage of life that a man passes through. This is one of the terrible feeling that no one ever like to be in their life. This is actually very crucial to the people. It leads the people to other continuum like Depression, stress, anxiety and so on. During this particular situation all the simple support seems to be an oasis to them. May be they will get over dependent on them or whatever it may be. This is really a apathetic situation, where all our friends will disappear, and no support and totally we will be depressed . We will feel like all the world is closed before us. Me as a person, I am going through this dreadful situation now. I am so depressed that I could not even think or do my daily routine with satisfaction. Nothing will be perfect for us . All of my friends with me before is like some aliens to me. Actually I came to the conclusion that this is one of the good situation which make you aware of what this world is and what the people is like. Also will make all the people sef dependent and will give more courage and will make you more fit in this world.Which make our motto in this world. Survival for the Fittest successful!!!!!!!!!!!!!!!!!!!!!!!!!!!
Loneliness actually is the most terrible stage of life that a man passes through. This is one of the terrible feeling that no one ever like to be in their life. This is actually very crucial to the people. It leads the people to other continuum like Depression, stress, anxiety and so on. During this particular situation all the simple support seems to be an oasis to them. May be they will get over dependent on them or whatever it may be. This is really a apathetic situation, where all our friends will disappear, and no support and totally we will be depressed . We will feel like all the world is closed before us. Me as a person, I am going through this dreadful situation now. I am so depressed that I could not even think or do my daily routine with satisfaction. Nothing will be perfect for us . All of my friends with me before is like some aliens to me. Actually I came to the conclusion that this is one of the good situation which make you aware of what this world is and what the people is like. Also will make all the people sef dependent and will give more courage and will make you more fit in this world.Which make our motto in this world. Survival for the Fittest successful!!!!!!!!!!!!!!!!!!!!!!!!!!!
major features of industrial revolution
The main features involved in the Industrial Revolution were technological, socioeconomic, and cultural. The technological changes included the following: (1) the use of new basic materials, chiefly iron and steel, (2) the use of new energy sources, including both fuels and motive power, such as coal, the steam engine, electricity, petroleum, and the internal-combustion engine, (3) the invention of new machines, such as the spinning jenny and the power loom that permitted increased production with a smaller expenditure of human energy, (4) a new organization of work known as the factory system, which entailed increased division of labour and specialization of function, (5) important developments in transportation and communication, including the steam locomotive, steamship, automobile, airplane, telegraph, and radio, and (6) the increasing application of science to industry. These technological changes made possible a tremendously increased use of natural resources and the mass production of manufactured goods.
What is Sociology?
Sociology is the scientific study of human groups. It provides tools for understanding how and why our society functions, impact of social intuitions on individual lives, and the challenges of social interaction between individuals and society. Through teaching, research, and service learning, the Department of Sociology provides critical understanding of ways people relate to one another through the organization of society and how its structures and cultures influence our lives. Subject matters of sociology ranges from family life to organizations, from crime to education, from the divisions of race and social class to the shared beliefs of a common culture, from poverty to wealth. Few fields have such a broad and exciting scope.
Sociology enables you to see the world in a new light. In a country like the United States where individualism is celebrated, it is very easy to forget that the way we behave and feel is socially produced. Whether they be friendships, families, church groups, socioeconomic classes, complex organizations, or nations, much of our lives are socially constructed. This is the basic premise of sociology.
Sociology also helps people liberate themselves. In his Invitation to Sociology, Peter Berger stated that “sociology can help people to take charge of their lives by making them aware of their situation in society and the forces acting upon them…By discovering the workings of society, they gain an understanding of how this process takes place.” The wisdom of sociology is the discovery that things are not what they seem.But sociology offers more. When people see things, they ask what they are. Sociologists ask what they
Sociology enables you to see the world in a new light. In a country like the United States where individualism is celebrated, it is very easy to forget that the way we behave and feel is socially produced. Whether they be friendships, families, church groups, socioeconomic classes, complex organizations, or nations, much of our lives are socially constructed. This is the basic premise of sociology.
Sociology also helps people liberate themselves. In his Invitation to Sociology, Peter Berger stated that “sociology can help people to take charge of their lives by making them aware of their situation in society and the forces acting upon them…By discovering the workings of society, they gain an understanding of how this process takes place.” The wisdom of sociology is the discovery that things are not what they seem.But sociology offers more. When people see things, they ask what they are. Sociologists ask what they
osteo artheiritis
Osteo Artheritis
INTRODUCTION
Osteoarthritis is a disease of the joints. Also know as degenerative joint disease, it is the most common form of arthritis, affecting more than 20 million American adults. It is a separate condition from and should not be confused with rheumatoid arthritis, another painful inflammatory condition. Osteoarthritis is caused by cartilage breakdown; cartilage provides a cushion between the bones of the joints. Healthy cartilage allows bones to glide over one another and acts as a shock absorber during physical movement. In osteoarthritis, the cartilage breaks down and wears away. This causes the bones under the cartilage to rub together, causing pain, swelling, and loss of joint motion (Spine Universe,USA, 2008). In India overall 36.1% of the elderly population was found with Arthritis, which was more prevailing in rural areas than in the Urban areas. Arthritis was observed in 35.8% in males and 36.4% of females (Ministry of Health, India, 2003).
SIGNS AND SYMPTOMS
1. Pain is the primary symptom of osteoarthritis and is linked to functional impairment and disability in osteoarthritis patients. Usually osteoarthritis pain develops gradually. With mild to moderate osteoarthritis, pain typically worsens with use of the joint and improves with rest. As the disease progresses, pain is usually more persistent and may not be relieved by rest or basic treatments for osteoarthritis (About.com, USA, 2008).
Another common signs and symptoms of the Osteoarthritis are as follows.
2. Tenderness in the joint when you apply light pressure
3. Stiffness in a joint, that may be most noticeable when you wake up in the morning or after a period of inactivity
4. Loss of flexibility may make it difficult to use the joint
5. Grating sensation when you use the joint
6. Bone spurs, which appear as hard lumps, may form around the affected joint
7. Swelling in some cases
Osteoarthritis symptoms most commonly affect the hands, hips, knees and spine. Unless you've been injured or placed unusual stress on a joint, it's uncommon for osteoarthritis symptoms to affect your jaw, shoulder, elbows, wrists or ankles.
The above picture shows how Osteoarthritis affects the normal functioning of the bone (Revolution Health, Washington, 2008).
CAUSES OF OSTEOARTHERITIS
After the years of researches the scientists found that there are several factors which leads to the cause of Osteoarthritis. They are as follows,
1. Joint Wear-And-Tear
The aging process clearly can contribute to the breakdown in the joints and cause osteoarthritis, but not all elderly people develop detectable OA. In addition, athletes and laborers often subject their joints to prolonged wear-and-tear, which places them at increased risk of developing arthritis in later years.
2. Joint Injury Or Overuse
Along with continual wear-and-tear, osteoarthritis has been linked with damaging events such as:
Fractures and infections that can harm the internal tissues of a joint. Individuals who experience repeated knee injuries - such as basketball, football, or soccer players - are much more likely to develop osteoarthritis as they get older.
In addition, people who overuse their joints by subjecting them to repeated stresses and strains are at increased risk. This is particularly evident in specific occupations such as jackhammer operators, who often develop arthritis of the hands or elbows, and ballet dancers, who develop arthritis of the feet.
3. Inactivity
Physical inactivity can be as harmful to the joints as overuse. A lack of exercise or varied movement can weaken the muscles that support the joints and decrease joint flexibility. Eventually, an underused joint may become stiff, painful, dysfunctional, and prone to injury and osteoarthritis.
4. Excess Body Weight
Heavy individuals are at increased risk of developing arthritis because their joints may be strained by excess weight. This is especially evident in weight-bearing joints such as the knees and hips, which often show the first signs of weight-related strain and injury.
Since being overweight can increase the chances of joint damage and worsen arthritic symptoms, most experts recommend weight-loss programs for overweight people who are at risk for osteoarthritis. Weight gain also should be avoided to help prevent the arthritis that may occur with aging.
5. Heredity
Current research suggests that the genes inherited from one's parents may make an individual more likely to develop osteoarthritis than someone who does not have these genes.
Osteoarthritis of the fingers occurs very commonly in families and is most common in women.
In addition, OA is more likely to develop in people who are born with heredity defects that make their joints fit together incorrectly, such as:
6. Bow legs
7. A hip dislocation
8. Laxity (double-jointedness) (e-HEALTH MD, 2008)
DIAGONOSES OF OSTEOARTHERITIS
Some of the basic diagnostic methods for the examination of the Osteoarthritis are as follows.
1. X-ray
Osteoarthritis is often visible in x-rays. Cartilage loss is suggested by certain characteristics of the images:
· The normal space between the bones in a joint is narrowed.
· There is an abnormal increase in bone density.
· Bony projections, cysts, or erosions are visible.
If the doctor suspects other conditions, or if the diagnosis is uncertain, additional tests are necessary.
It is important to note that a negative x-ray does not rule out osteoarthritis. Likewise, some people may have minimal symptoms even though an x-ray clearly shows they have arthritis.
An MRI exam of an arthritic joint is generally not needed, unless the doctor suspects other causes of pain.
2. Physical Exam
The affected joint in patients with osteoarthritis will generally be tender to pressure right along the joint line. Joint movement may cause a crackling sound. The bones around the joints may feel larger than normal. The joint's range of motion is often reduced, and normal movement is often painful.
3. Blood Tests
Blood test results may help identify other causes of arthritis (if present) besides osteoarthritis. Some examples include:
· Elevated levels of rheumatoid factor (specific antibodies in the synovium) are usually found in patients with rheumatoid arthritis
· The erythrocyte sedimentation rates (ESR, or "sed rate") indicates inflammatory arthritis or related conditions, such as rheumatoid arthritis or systemic lupus erythematosus.
· Elevated uric acid levels in the blood may indicate gout.
A number of other blood tests may help identify other rheumatological illnesses.
4. Tests of the Synovial Fluid
If the diagnosis is uncertain or infection is suspected, a doctor may attempt to withdraw synovial fluid from the joint using a needle. There will not be enough fluid to withdraw if the joint is normal. If the doctor can withdraw fluid, problems are likely, and the fluid will be tested for factors that might confirm or rule out osteoarthritis:
· Cartilage cells in the fluid are signs of osteoarthritis.
· A high white blood cell count is a sign of infection.
· High uric acid in the fluid is an indication of gout.
· Other factors may be present that suggest different arthritic conditions, including Lyme disease and rheumatoid arthritis.
· In people with known osteoarthritis, researchers may look for certain factors in synovial fluid (sulfated glycosaminoglycan, keratin sulfate, and link protein) that can suggest a more or less severe condition.
Treatment for the Osteoporosis
By treating arthritis early and following a well-designed treatment plan, you can:
Reduce your symptoms
Increase joint movement
Lessen joint-damaging effects
Osteoarthritic joints are not always painful, and when pain is present, it can vary in intensity. In some people severe osteoarthritis is completely pain-free, whereas in others even minor joint changes are quite painful. The response to arthritis pain is broad and very personal.
Because of this, it is important to have an individually designed treatment program. What works for one person may not necessarily work for another, even if both have osteoarthritis of the same joint.
1. Weight Control
Controlling your weight can:
Lessen pain by reducing stress on the weight-bearing joints (hips, knees, back, feet)
Increase self-esteem and avoid the risk of psychological suffering and/or depression that can affect overweight individuals
2. Exercise
Strengthening and stretching exercises can help by:
Relieving pain and improving joint movement
Building up the muscles around the joint, making the joint more stable and resisting further damage.
3. Heat And Cold Therapy
Heat and cold treatments are well-known to reduce the pain, stiffness, and occasional swelling associated with osteoarthritis. But this is generally temporary. There is no 'set' formula for therapy. Heat works better for some individuals, whereas others favor cold.
Heat often is used to relieve pain or relax muscles before the start of exercise.
Heating pads or hot packs can be positioned over stiff joints. Some people prefer "moist heat" in the form of warm towels, a warm shower or bath, or a heated whirlpool or hot tub.
Other heat treatments include ultrasound and immersion of painful hands into warm wax. All are able to bring soothing heat to sore joints.
Heat should be applied at a comfortable temperature and seems to be most beneficial when used over the muscles adjacent to the joint.
Cold can lessen pain in a sore joint by numbing the local tissues.
It may be applied in the form of a reusable pack or ice.
Ice and cold packs never should be placed directly on the skin, as they are likely to cause skin damage. Instead, ice and cold packs should be wrapped in a towel before they are applied.
4. Pain Medication
Medicines to control OA pain must be pain-specific, since osteoarthritis can cause both sudden and chronic pain.
If a person experiences unexpected, severe pain from a damaged joint, he or she might benefit from strong pain relievers and muscle relaxants.
By contrast, such medications usually are not useful or appropriate for chronic pain, which is more effectively treated by self-management techniques such as proper joint use, joint protection, exercise, medication scheduling, and weight control.
Medications include as follows,
1. OTC pain relievers like acetaminophen (Tylenol®) and aspirin are familiar choices for the treatment of osteoarthritis.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain as well as inflammation like Declophenac.
3. NSAID partners may be prescribed by a physician to lessen the side effects of NSAIDs like Antacids.
4. Cox II inhibitors are reasonably new medications that reduce the pain of osteoarthritis and also reduce the chance of developing ulcers, and so partially preventing the GI complaints associated with NSAIDs. These medicines, which are available by prescription only, include:
Celecoxib (Celebrex®)
Rofecoxib (Vioxx®)
5. Muscle relaxants sometimes are prescribed for osteoarthritis if muscle spasms contribute to a person's discomfort. These include:
Cyclobenzaprine (Flexeril®)
Carisoprodol (Soma®)
Methocarbamol (Robaxin®)
Other Pain Relief Options
Transcutaneous electrical nerve stimulation (TENS) is a technique that directs small pulses of electricity to specific nerves. The aim is to reduce the sensitivity of nerve endings in the spinal cord, thereby closing the pain "gates." Although TENS is not effective in all arthritis sufferers, some people find it to be a practical means of pain control. The procedure, which produces a tingling sensation at the site of the electrical pads, has few side effects (some people have reported allergic reactions to the jelly used to apply the pads). TENS instruction usually is provided by a physiotherapist, who can explain how to position the pads, select the correct electrical frequency and pulse strength, and time how long the treatment should last.
Acupuncture may provide short-term relief of pain. If performed properly with sterile needles, acupuncture can do no harm. Acupuncture therapy is believed to work by stimulating the body's own pain-relieving hormones. However, acupuncture cannot "cure" arthritis; its effects are temporary.
Therapeutic massage
Yoga
Physical therapy
Stress Control
Emotional stress sometimes causes arthritic symptoms to worsen. Repeated daily stresses - such as money problems, traffic jams, or shopping difficulties - may increase joint discomfort.
Although emotional anxiety does not appear to be as important a factor in osteoarthritis as it is in rheumatoid arthritis, osteoarthritic pain may develop after stressful life events, like the loss of a loved one or separation from a spouse.
Arthritis itself is a source of stress.
Individuals may feel trapped in a vicious cycle in which arthritic pain causes stress and stress causes more pain.
In addition, they may have a low self esteem and feel a loss of control because of arthritis-related concerns such as pharmaceutical bills, side effects from medicines, limited mobility, or unwelcome physical changes.
Stress management techniques are especially significant, because they can help people to regain a sense of control while relieving their arthritic pain.
Proven techniques for stress management include:
Muscle relaxation
Controlled breathing
Biofeedback
Self-hypnosis
Time management
Social support
Assertiveness training
Coping skills training
Injections Into The Joint
Corticosteroids, such as prednisone, are medications that lessen inflammation, swelling, and pain. These medicines generally are not used for OA; however, the direct injection of corticosteroids into an inflamed joint can markedly reduce the swelling of soft tissues and relieve pain.
Unfortunately, corticosteroids can cause adverse side effects (such as joint degradation) when injected indiscriminately over long periods of time directly into a joint. Therefore, they should be used only to treat occasional bouts of joint pain and swelling in OA, particularly in younger people.
A single injection may be sufficient to relieve OA for several months. The effect lasts for different amounts of time in different people.
They don't work for everyone
Injectable hyaluronic acid - which currently is marketed under the brand names Hyalgan® and Synvisc® - is a new FDA-approved treatment for osteoarthritis of the knee. This form of therapy, known as "visco-supplementation," involves the injection of hyaluronic acid into the joint once a week for three to five weeks, depending on the product brand.
Hyaluronic acid is a lubricating substance that is found in the normal joint fluid. If, as in osteoarthritis of the knee, inflammation breaks down hyaluronic acid within the joint, then lubrication is lost.
Hyaluronic acid injection does not cause the side effects of most oral pain relievers. Therefore it is suitable for people who still suffer discomfort after being treated by pain medication, exercise, or physical therapy.
Hyaluronic acid injection may provide relief for up to 12 months, but there is no indication that the treatment alters the progression of arthritis.
Ongoing studies are investigating whether this method is effective for the shoulders and hips, but, to date, there is little information on the long-term effects of hyaluronic acid injection.
In general, the treatment is well tolerated, and allergic reactions are rare.
Surgery
Although recent advances in joint surgery have improved the lives of millions of people throughout the world, surgery is NOT the first line of treatment for osteoarthritis.
Before surgery is ever contemplated, simpler treatments must be tried. Moreover, most surgeons prefer not to perform operative procedures in younger people unless their quality of life is severely affected by arthritis.
When surgery is necessary, it is performed by an orthopedic surgeon - a specialist in surgery of the bones and joints.
There are four main types of surgery available:
Fusion (permanent joining of the bones in a joint, preventing motion)
Osteotomy (realigning the joint)
"Scoping" the joint (washing out the joint)
Total joint replacement (replacement of a damaged joint with an artificial man-made joint)
Fusion of the joint, otherwise known as arthrodesis is a procedure in which the surfaces of the joint are removed and the bone ends are united. This provides pain relief and stability, but the joint cannot bend.
Lack of mobility is a serious disadvantage of this procedure. Nevertheless, this is the preferred surgery for some younger individuals who have a single involved joint. Mobility in the other joints often will compensate for the loss of movement in the fused joint. The joints most commonly fused are smaller joints, such as those in the toes or fingers.
Younger people with severe arthritis of the hip or knee in whom fusion was once offered, are now considered for total joint replacement though depending on the individual, a fusion may sometimes be preferable
Osteotomy is an operation in which the surgeon cuts the bone below the affected joint, realigns it, and resets it in a better position. This procedure changes and improves the contact between the remaining healthy areas of cartilage in the joint. Afterwards, the painful areas do not rub against each other.
Osteotomy provides pain relief and leaves the joint mobile; however, it can only be performed in a joint that is not already stiff. Osteotomy usually is reserved for joints with uneven damage. It is not performed frequently, although the procedure sometimes is a good choice for younger arthritis sufferers, since it can prevent further joint damage and postpone the need for joint replacement surgery. (For example, osteotomy of the tibia [shinbone] is performed to correct curvature and weight-bearing in the lower leg of adults with OA of the knee.)
"Scoping" the joint is an expression used to describe arthroscopy - the examination of the inside of a joint using a device equipped with a tiny video camera. By means of arthroscopy, the physician can look for damaged tissue directly within the joint.
A small incision is made through the skin alongside the affected joint. Then, microsurgical tools are used to remove areas of cartilage or cartilage fragments that are causing irritation and thoroughly wash out the joint. Arthroscopy is an outpatient procedure and does not require an overnight stay in the hospital.
Joint "scoping" may provide temporary relief from symptoms - especially those caused by cartilage tears or particles; however, it does not stop the progression of osteoarthritis. It may help for a month in some, six months or much longer in others, and sometimes not at all.
Total joint replacement involves the complete removal of the painful joint, which is exchanged for a man-made appliance. The artificial joint can be fashioned from a combination of materials, including stainless steel, Vitallium™ (a cobalt-chromium alloy), titanium, and high-density polyethylene plastic. Silicone rubber occasionally is used for joint replacements (hand, base of the thumb), if the surgeon elects not to fuse the joint.
The hip and knee have shown the greatest successes of all joint replacement surgery. Over 90 percent of people are free of pain and have good mobility following hip replacement surgery for osteoarthritis. Other joints that are less commonly replaced are the shoulder and elbow.
Unfortunately, joint replacements tend to last only 10 to 20 years. But another replacement generally can be performed, if needed. This repeat surgery is called a revision.
The role of Nurse in the caring of elderly with Osteoporosis
The importance of osteoporosis lies in the increased fracture risk associated with reduced bone mineral density (BMD). Although osteoporosis is not painful, osteoporotic fractures are associated with significant morbidity and mortality; furthermore the occurrence of a fracture leads to an increased risk of subsequent fracture in both women and men.
Identification of patients over 50 years of age with a history of fracture for assessment of osteoporosis is essential as these patients are at highest risk of further fractures and are likely to benefit from treatment for the 'secondary prevention' of fractures. Specialist nurses have a key role in the Fracture Liaison Service, established in 1999 in Glasgow, to provide routine assessment to all women and men presenting to orthopedics and accident and emergency with new fractures.
For patients at risk of osteoporosis there may be opportunities to reduce the risk of their first fracture, 'primary prevention'. With few exceptions, endocrinopathies adversely influence bone mineralization and are associated with increased risk of osteoporosis. Endocrine nurses have a key role in the long-term care of patients with endocrine dysfunction and are ideally placed to engage with their patients in education and management strategies to address osteoporosis, to achieve both primary and secondary prevention of osteoporotic fracture.
Conclusion
Osteoporosis is one of the leading disabilities in the elderly in most part of the world at present. It is one of the disabilities which causes some terrible effects on the elderly. It can become a risk factor as well. Because sometimes Osteoarthritis can cause the weakness and also the helplessness in the leg which even leads to the some risk factors of the elderly such as the fall and then it can leads to the fractures so it should be treated well and these patients should get additional care and a good management in coping with his disability and also the proper treatment. The main role of the nurse in such types of disability is to teach them and to support them I n managing the disease.
References
1. British Endocrine Society, http://www.endocrine-abstracts.org/ea/0009/ea0009s53.htm, London, 2005.
2. Spine Universe, http://www.google.com/search?hl=en&q=spine+universe, New York , 2008.
3. Ministry of Health, http://mohfw.nic.in/, India, 2008.
4. About.com, http://www.about.com/,USA, 2008.
5. E-Health MD, http://www.ehealthmd.com/, New York, 2008.
INTRODUCTION
Osteoarthritis is a disease of the joints. Also know as degenerative joint disease, it is the most common form of arthritis, affecting more than 20 million American adults. It is a separate condition from and should not be confused with rheumatoid arthritis, another painful inflammatory condition. Osteoarthritis is caused by cartilage breakdown; cartilage provides a cushion between the bones of the joints. Healthy cartilage allows bones to glide over one another and acts as a shock absorber during physical movement. In osteoarthritis, the cartilage breaks down and wears away. This causes the bones under the cartilage to rub together, causing pain, swelling, and loss of joint motion (Spine Universe,USA, 2008). In India overall 36.1% of the elderly population was found with Arthritis, which was more prevailing in rural areas than in the Urban areas. Arthritis was observed in 35.8% in males and 36.4% of females (Ministry of Health, India, 2003).
SIGNS AND SYMPTOMS
1. Pain is the primary symptom of osteoarthritis and is linked to functional impairment and disability in osteoarthritis patients. Usually osteoarthritis pain develops gradually. With mild to moderate osteoarthritis, pain typically worsens with use of the joint and improves with rest. As the disease progresses, pain is usually more persistent and may not be relieved by rest or basic treatments for osteoarthritis (About.com, USA, 2008).
Another common signs and symptoms of the Osteoarthritis are as follows.
2. Tenderness in the joint when you apply light pressure
3. Stiffness in a joint, that may be most noticeable when you wake up in the morning or after a period of inactivity
4. Loss of flexibility may make it difficult to use the joint
5. Grating sensation when you use the joint
6. Bone spurs, which appear as hard lumps, may form around the affected joint
7. Swelling in some cases
Osteoarthritis symptoms most commonly affect the hands, hips, knees and spine. Unless you've been injured or placed unusual stress on a joint, it's uncommon for osteoarthritis symptoms to affect your jaw, shoulder, elbows, wrists or ankles.
The above picture shows how Osteoarthritis affects the normal functioning of the bone (Revolution Health, Washington, 2008).
CAUSES OF OSTEOARTHERITIS
After the years of researches the scientists found that there are several factors which leads to the cause of Osteoarthritis. They are as follows,
1. Joint Wear-And-Tear
The aging process clearly can contribute to the breakdown in the joints and cause osteoarthritis, but not all elderly people develop detectable OA. In addition, athletes and laborers often subject their joints to prolonged wear-and-tear, which places them at increased risk of developing arthritis in later years.
2. Joint Injury Or Overuse
Along with continual wear-and-tear, osteoarthritis has been linked with damaging events such as:
Fractures and infections that can harm the internal tissues of a joint. Individuals who experience repeated knee injuries - such as basketball, football, or soccer players - are much more likely to develop osteoarthritis as they get older.
In addition, people who overuse their joints by subjecting them to repeated stresses and strains are at increased risk. This is particularly evident in specific occupations such as jackhammer operators, who often develop arthritis of the hands or elbows, and ballet dancers, who develop arthritis of the feet.
3. Inactivity
Physical inactivity can be as harmful to the joints as overuse. A lack of exercise or varied movement can weaken the muscles that support the joints and decrease joint flexibility. Eventually, an underused joint may become stiff, painful, dysfunctional, and prone to injury and osteoarthritis.
4. Excess Body Weight
Heavy individuals are at increased risk of developing arthritis because their joints may be strained by excess weight. This is especially evident in weight-bearing joints such as the knees and hips, which often show the first signs of weight-related strain and injury.
Since being overweight can increase the chances of joint damage and worsen arthritic symptoms, most experts recommend weight-loss programs for overweight people who are at risk for osteoarthritis. Weight gain also should be avoided to help prevent the arthritis that may occur with aging.
5. Heredity
Current research suggests that the genes inherited from one's parents may make an individual more likely to develop osteoarthritis than someone who does not have these genes.
Osteoarthritis of the fingers occurs very commonly in families and is most common in women.
In addition, OA is more likely to develop in people who are born with heredity defects that make their joints fit together incorrectly, such as:
6. Bow legs
7. A hip dislocation
8. Laxity (double-jointedness) (e-HEALTH MD, 2008)
DIAGONOSES OF OSTEOARTHERITIS
Some of the basic diagnostic methods for the examination of the Osteoarthritis are as follows.
1. X-ray
Osteoarthritis is often visible in x-rays. Cartilage loss is suggested by certain characteristics of the images:
· The normal space between the bones in a joint is narrowed.
· There is an abnormal increase in bone density.
· Bony projections, cysts, or erosions are visible.
If the doctor suspects other conditions, or if the diagnosis is uncertain, additional tests are necessary.
It is important to note that a negative x-ray does not rule out osteoarthritis. Likewise, some people may have minimal symptoms even though an x-ray clearly shows they have arthritis.
An MRI exam of an arthritic joint is generally not needed, unless the doctor suspects other causes of pain.
2. Physical Exam
The affected joint in patients with osteoarthritis will generally be tender to pressure right along the joint line. Joint movement may cause a crackling sound. The bones around the joints may feel larger than normal. The joint's range of motion is often reduced, and normal movement is often painful.
3. Blood Tests
Blood test results may help identify other causes of arthritis (if present) besides osteoarthritis. Some examples include:
· Elevated levels of rheumatoid factor (specific antibodies in the synovium) are usually found in patients with rheumatoid arthritis
· The erythrocyte sedimentation rates (ESR, or "sed rate") indicates inflammatory arthritis or related conditions, such as rheumatoid arthritis or systemic lupus erythematosus.
· Elevated uric acid levels in the blood may indicate gout.
A number of other blood tests may help identify other rheumatological illnesses.
4. Tests of the Synovial Fluid
If the diagnosis is uncertain or infection is suspected, a doctor may attempt to withdraw synovial fluid from the joint using a needle. There will not be enough fluid to withdraw if the joint is normal. If the doctor can withdraw fluid, problems are likely, and the fluid will be tested for factors that might confirm or rule out osteoarthritis:
· Cartilage cells in the fluid are signs of osteoarthritis.
· A high white blood cell count is a sign of infection.
· High uric acid in the fluid is an indication of gout.
· Other factors may be present that suggest different arthritic conditions, including Lyme disease and rheumatoid arthritis.
· In people with known osteoarthritis, researchers may look for certain factors in synovial fluid (sulfated glycosaminoglycan, keratin sulfate, and link protein) that can suggest a more or less severe condition.
Treatment for the Osteoporosis
By treating arthritis early and following a well-designed treatment plan, you can:
Reduce your symptoms
Increase joint movement
Lessen joint-damaging effects
Osteoarthritic joints are not always painful, and when pain is present, it can vary in intensity. In some people severe osteoarthritis is completely pain-free, whereas in others even minor joint changes are quite painful. The response to arthritis pain is broad and very personal.
Because of this, it is important to have an individually designed treatment program. What works for one person may not necessarily work for another, even if both have osteoarthritis of the same joint.
1. Weight Control
Controlling your weight can:
Lessen pain by reducing stress on the weight-bearing joints (hips, knees, back, feet)
Increase self-esteem and avoid the risk of psychological suffering and/or depression that can affect overweight individuals
2. Exercise
Strengthening and stretching exercises can help by:
Relieving pain and improving joint movement
Building up the muscles around the joint, making the joint more stable and resisting further damage.
3. Heat And Cold Therapy
Heat and cold treatments are well-known to reduce the pain, stiffness, and occasional swelling associated with osteoarthritis. But this is generally temporary. There is no 'set' formula for therapy. Heat works better for some individuals, whereas others favor cold.
Heat often is used to relieve pain or relax muscles before the start of exercise.
Heating pads or hot packs can be positioned over stiff joints. Some people prefer "moist heat" in the form of warm towels, a warm shower or bath, or a heated whirlpool or hot tub.
Other heat treatments include ultrasound and immersion of painful hands into warm wax. All are able to bring soothing heat to sore joints.
Heat should be applied at a comfortable temperature and seems to be most beneficial when used over the muscles adjacent to the joint.
Cold can lessen pain in a sore joint by numbing the local tissues.
It may be applied in the form of a reusable pack or ice.
Ice and cold packs never should be placed directly on the skin, as they are likely to cause skin damage. Instead, ice and cold packs should be wrapped in a towel before they are applied.
4. Pain Medication
Medicines to control OA pain must be pain-specific, since osteoarthritis can cause both sudden and chronic pain.
If a person experiences unexpected, severe pain from a damaged joint, he or she might benefit from strong pain relievers and muscle relaxants.
By contrast, such medications usually are not useful or appropriate for chronic pain, which is more effectively treated by self-management techniques such as proper joint use, joint protection, exercise, medication scheduling, and weight control.
Medications include as follows,
1. OTC pain relievers like acetaminophen (Tylenol®) and aspirin are familiar choices for the treatment of osteoarthritis.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain as well as inflammation like Declophenac.
3. NSAID partners may be prescribed by a physician to lessen the side effects of NSAIDs like Antacids.
4. Cox II inhibitors are reasonably new medications that reduce the pain of osteoarthritis and also reduce the chance of developing ulcers, and so partially preventing the GI complaints associated with NSAIDs. These medicines, which are available by prescription only, include:
Celecoxib (Celebrex®)
Rofecoxib (Vioxx®)
5. Muscle relaxants sometimes are prescribed for osteoarthritis if muscle spasms contribute to a person's discomfort. These include:
Cyclobenzaprine (Flexeril®)
Carisoprodol (Soma®)
Methocarbamol (Robaxin®)
Other Pain Relief Options
Transcutaneous electrical nerve stimulation (TENS) is a technique that directs small pulses of electricity to specific nerves. The aim is to reduce the sensitivity of nerve endings in the spinal cord, thereby closing the pain "gates." Although TENS is not effective in all arthritis sufferers, some people find it to be a practical means of pain control. The procedure, which produces a tingling sensation at the site of the electrical pads, has few side effects (some people have reported allergic reactions to the jelly used to apply the pads). TENS instruction usually is provided by a physiotherapist, who can explain how to position the pads, select the correct electrical frequency and pulse strength, and time how long the treatment should last.
Acupuncture may provide short-term relief of pain. If performed properly with sterile needles, acupuncture can do no harm. Acupuncture therapy is believed to work by stimulating the body's own pain-relieving hormones. However, acupuncture cannot "cure" arthritis; its effects are temporary.
Therapeutic massage
Yoga
Physical therapy
Stress Control
Emotional stress sometimes causes arthritic symptoms to worsen. Repeated daily stresses - such as money problems, traffic jams, or shopping difficulties - may increase joint discomfort.
Although emotional anxiety does not appear to be as important a factor in osteoarthritis as it is in rheumatoid arthritis, osteoarthritic pain may develop after stressful life events, like the loss of a loved one or separation from a spouse.
Arthritis itself is a source of stress.
Individuals may feel trapped in a vicious cycle in which arthritic pain causes stress and stress causes more pain.
In addition, they may have a low self esteem and feel a loss of control because of arthritis-related concerns such as pharmaceutical bills, side effects from medicines, limited mobility, or unwelcome physical changes.
Stress management techniques are especially significant, because they can help people to regain a sense of control while relieving their arthritic pain.
Proven techniques for stress management include:
Muscle relaxation
Controlled breathing
Biofeedback
Self-hypnosis
Time management
Social support
Assertiveness training
Coping skills training
Injections Into The Joint
Corticosteroids, such as prednisone, are medications that lessen inflammation, swelling, and pain. These medicines generally are not used for OA; however, the direct injection of corticosteroids into an inflamed joint can markedly reduce the swelling of soft tissues and relieve pain.
Unfortunately, corticosteroids can cause adverse side effects (such as joint degradation) when injected indiscriminately over long periods of time directly into a joint. Therefore, they should be used only to treat occasional bouts of joint pain and swelling in OA, particularly in younger people.
A single injection may be sufficient to relieve OA for several months. The effect lasts for different amounts of time in different people.
They don't work for everyone
Injectable hyaluronic acid - which currently is marketed under the brand names Hyalgan® and Synvisc® - is a new FDA-approved treatment for osteoarthritis of the knee. This form of therapy, known as "visco-supplementation," involves the injection of hyaluronic acid into the joint once a week for three to five weeks, depending on the product brand.
Hyaluronic acid is a lubricating substance that is found in the normal joint fluid. If, as in osteoarthritis of the knee, inflammation breaks down hyaluronic acid within the joint, then lubrication is lost.
Hyaluronic acid injection does not cause the side effects of most oral pain relievers. Therefore it is suitable for people who still suffer discomfort after being treated by pain medication, exercise, or physical therapy.
Hyaluronic acid injection may provide relief for up to 12 months, but there is no indication that the treatment alters the progression of arthritis.
Ongoing studies are investigating whether this method is effective for the shoulders and hips, but, to date, there is little information on the long-term effects of hyaluronic acid injection.
In general, the treatment is well tolerated, and allergic reactions are rare.
Surgery
Although recent advances in joint surgery have improved the lives of millions of people throughout the world, surgery is NOT the first line of treatment for osteoarthritis.
Before surgery is ever contemplated, simpler treatments must be tried. Moreover, most surgeons prefer not to perform operative procedures in younger people unless their quality of life is severely affected by arthritis.
When surgery is necessary, it is performed by an orthopedic surgeon - a specialist in surgery of the bones and joints.
There are four main types of surgery available:
Fusion (permanent joining of the bones in a joint, preventing motion)
Osteotomy (realigning the joint)
"Scoping" the joint (washing out the joint)
Total joint replacement (replacement of a damaged joint with an artificial man-made joint)
Fusion of the joint, otherwise known as arthrodesis is a procedure in which the surfaces of the joint are removed and the bone ends are united. This provides pain relief and stability, but the joint cannot bend.
Lack of mobility is a serious disadvantage of this procedure. Nevertheless, this is the preferred surgery for some younger individuals who have a single involved joint. Mobility in the other joints often will compensate for the loss of movement in the fused joint. The joints most commonly fused are smaller joints, such as those in the toes or fingers.
Younger people with severe arthritis of the hip or knee in whom fusion was once offered, are now considered for total joint replacement though depending on the individual, a fusion may sometimes be preferable
Osteotomy is an operation in which the surgeon cuts the bone below the affected joint, realigns it, and resets it in a better position. This procedure changes and improves the contact between the remaining healthy areas of cartilage in the joint. Afterwards, the painful areas do not rub against each other.
Osteotomy provides pain relief and leaves the joint mobile; however, it can only be performed in a joint that is not already stiff. Osteotomy usually is reserved for joints with uneven damage. It is not performed frequently, although the procedure sometimes is a good choice for younger arthritis sufferers, since it can prevent further joint damage and postpone the need for joint replacement surgery. (For example, osteotomy of the tibia [shinbone] is performed to correct curvature and weight-bearing in the lower leg of adults with OA of the knee.)
"Scoping" the joint is an expression used to describe arthroscopy - the examination of the inside of a joint using a device equipped with a tiny video camera. By means of arthroscopy, the physician can look for damaged tissue directly within the joint.
A small incision is made through the skin alongside the affected joint. Then, microsurgical tools are used to remove areas of cartilage or cartilage fragments that are causing irritation and thoroughly wash out the joint. Arthroscopy is an outpatient procedure and does not require an overnight stay in the hospital.
Joint "scoping" may provide temporary relief from symptoms - especially those caused by cartilage tears or particles; however, it does not stop the progression of osteoarthritis. It may help for a month in some, six months or much longer in others, and sometimes not at all.
Total joint replacement involves the complete removal of the painful joint, which is exchanged for a man-made appliance. The artificial joint can be fashioned from a combination of materials, including stainless steel, Vitallium™ (a cobalt-chromium alloy), titanium, and high-density polyethylene plastic. Silicone rubber occasionally is used for joint replacements (hand, base of the thumb), if the surgeon elects not to fuse the joint.
The hip and knee have shown the greatest successes of all joint replacement surgery. Over 90 percent of people are free of pain and have good mobility following hip replacement surgery for osteoarthritis. Other joints that are less commonly replaced are the shoulder and elbow.
Unfortunately, joint replacements tend to last only 10 to 20 years. But another replacement generally can be performed, if needed. This repeat surgery is called a revision.
The role of Nurse in the caring of elderly with Osteoporosis
The importance of osteoporosis lies in the increased fracture risk associated with reduced bone mineral density (BMD). Although osteoporosis is not painful, osteoporotic fractures are associated with significant morbidity and mortality; furthermore the occurrence of a fracture leads to an increased risk of subsequent fracture in both women and men.
Identification of patients over 50 years of age with a history of fracture for assessment of osteoporosis is essential as these patients are at highest risk of further fractures and are likely to benefit from treatment for the 'secondary prevention' of fractures. Specialist nurses have a key role in the Fracture Liaison Service, established in 1999 in Glasgow, to provide routine assessment to all women and men presenting to orthopedics and accident and emergency with new fractures.
For patients at risk of osteoporosis there may be opportunities to reduce the risk of their first fracture, 'primary prevention'. With few exceptions, endocrinopathies adversely influence bone mineralization and are associated with increased risk of osteoporosis. Endocrine nurses have a key role in the long-term care of patients with endocrine dysfunction and are ideally placed to engage with their patients in education and management strategies to address osteoporosis, to achieve both primary and secondary prevention of osteoporotic fracture.
Conclusion
Osteoporosis is one of the leading disabilities in the elderly in most part of the world at present. It is one of the disabilities which causes some terrible effects on the elderly. It can become a risk factor as well. Because sometimes Osteoarthritis can cause the weakness and also the helplessness in the leg which even leads to the some risk factors of the elderly such as the fall and then it can leads to the fractures so it should be treated well and these patients should get additional care and a good management in coping with his disability and also the proper treatment. The main role of the nurse in such types of disability is to teach them and to support them I n managing the disease.
References
1. British Endocrine Society, http://www.endocrine-abstracts.org/ea/0009/ea0009s53.htm, London, 2005.
2. Spine Universe, http://www.google.com/search?hl=en&q=spine+universe, New York , 2008.
3. Ministry of Health, http://mohfw.nic.in/, India, 2008.
4. About.com, http://www.about.com/,USA, 2008.
5. E-Health MD, http://www.ehealthmd.com/, New York, 2008.
Monday, November 17, 2008
Taj Mahal - memmorial of love
Taj Mahal, the monument of eternal love is the beautiful architecture that I ever seen. More than the architectural fascination. The fact that interested me is that this wonder immortalizes one man’s real love to his beloved wife . According to me the taj mahal is actually a call for the all the lovers . Love is the main aspect in the world of the passions. To love somebody is one of the very popular affection that you can show to others . Especially if it is to our partners and to someone that we love the most it will be more awesome. Mumtaz Mahal was the second wife of Shah Jahan still he loves her the most .Actually the Taj Mahal is a call for each one of us . We have to be honest and loyal with your love partners .Love should comes from your heart rather than get stick on the sexual joy. If we are able to satisfy our lovers dreams or wishes, if ofcourse the love is honest, then it will be a great pleasure to the lovers as well as the most precious moments that they will keep in their mind for ever. According to my opinion The stories of Taj Mahal and something like that is really a lesson for the modern world and the new generation where they find the love really in just sexual fulfillment.
ageing in india
India is in a phase of demographic transition. As per the 1991 census, the population of the elderly in India was 57 million as compared with 20 million in 1951. There has been a sharp increase in the number of elderly persons between 1991 and 2001 and it has been projected that by the year 2050, the number of elderly people would rise to about 324 million (Indian Journal of Community Medicine, 2008). Projected increases in both the absolute and relative size of the elderly population in many third world countries is a subject of growing concern for public policy (Kinsella and Velkoff 2001; World Bank 2001; United Nations 2002; Bordia and Bhardwaj 2003; Liebig and Irudaya Rajan 2003). The combination of high fertility and declining mortality during the twentieth century has resulted in large and rapid increases in elderly populations as successively larger cohorts step into old age. Further, the sharp decline in fertility experienced in recent times is bound to lead to an increasing proportion of the elderly in the future. Since these demographic changes have been accompanied by rapid and profound socio-economic changes, cohorts might differ in their experience as they join the ranks of the elderly (Population Health and Ageing in India, 2007). Over the past decades, India's health program and policies have been focusing on issues like population stabilization, maternal and child health, and disease control. However, current statistics for the elderly in India gives a prelude to a new set of medical, social, and economic problems that could arise if a timely initiative in this direction is not taken by the program managers and policy makers. There is a need to highlight the medical and socio-economic problems that are being faced by the elderly people in India, and strategies for bringing about an improvement in their quality of life also need to be explored (Indian Journal of Community Medicine, 2008). According to present indications, most of this growth will take
place in developing countries and over half of it will be in Asia, with the two majorpopulation giants of Asia, namely India (Irudaya Rajan, Mishra and Sarma
place in developing countries and over half of it will be in Asia, with the two majorpopulation giants of Asia, namely India (Irudaya Rajan, Mishra and Sarma
Friday, November 14, 2008
The overview of a comparison between the disabilities of elderly in nursing homes and the community residents in the republic of ireland
The overview of a comparison between the disabilities of elderly in nursing homes and the community residents in the republic of ireland
Profiling Disability within Nursing Homes: a census based Approach by Marianne Falconer and Desmond O’ Neill is a Quantitative Research focusing on the Geriatric field in Ireland. In this research they are comparing the disabilities among the elderly citizens in the Nursing homes and the Community resident elderly citizens based on a census in all homes and dwelling in the Republic of Ireland.
Ageing at all stages of development is accompanied by both growth and loss. The losses of the old age, in particular those brought about by age –related disease, give rise to increasing levels of disability in the later life. Age related disabilities continue to be one of the commonest factors precipitating admission into nursing homes. Studies in the United Kingdom showed that about 75% of the residents in the nursing homes are moderately to severely disable.
The research is performed based on the 2002 Irish National Census including people temporarily staying temporarily in the hose hold, persons in the communal establishments and persons on board vessels. To conduct this research the researchers focuses on some questions on the disabilities of the people in the questionnaire, which correspond to some everlasting conditions like blindness, deafness and some physical disabilities. Also on the difficulty of the family members to perform the activities such as learning, remembering, dressing, bathing etc. From this data the disability prevalence among the people over 65 was considered and made a comparison with the elderly nursing home residents and the elderly community residents to bring out the research.
As far as the authors are concerned this is the first Research based conducted based on a census to compare the prevalence of the disabilities of a elderly nursing home residents and the community residents. And the studies found out that the nursing homes elderly people are the majority in the disability as compared to the elderly in the community settings. The study also found out that the elderly citizens in the nursing homes have more prevalence to the memory problems which can be due to the Dementia. Also this is one of the reason which accounts for the admission of the elderly in the Nursing homes. Another aspect that the researchers found is the age differences among the elderly which can be a factor for the higher prevalence of the disabilities. The results shows that the majority of the elderly living in the Nursing homes are above 80 while the majority of the elderly in the community are below 80, which explains one of the reason why elderly in nursing homes are prone to the disabilities.
This study based on the Census report in Ireland found out that the nursing homes in Ireland are mostly occupied with the most frail group in the society who needs more care and attention. So this research emphasizes the importance of the appropriate health care resources and the facilities in the area. The studies also points that most of the people are get overcome from their disabilities by the therapies and treatments. But the adequate facilities are not provisioned to them. Challis et al noted that about 35% of the recently admitted care home residents are suffered from the Rheumatologic disorders and or stroke, conditions which are potential for active rehabilitation. And the nursing home does not have the proper therapies and the proper care staffs for the better rehabilitation. Another aspect the research found out is that the most of the disabilities of the dementia cases in the home setting are not addressed properly for the provision of the better care. These unmet needs leads to the psychological problems of the elderly such as anxiety and depression.
The results shows that the almost three-quarters of nursing home patients are unable to go outside alone compared to 15% of those in the community .Over two thirds of nursing home residents have a condition that limits one or more basic physical activity, 64% have difficulties dressing, bathing and mobilizing, while 58% have difficulties learning, remembering and concentrating, suggestive of a very high prevalence of dementia. This compares to almost20%, 11% and 8% respectively of older people living in the community. 79% of those in nursing homes with disability were limited in at least one physical activity, 83% were unable to go outside alone and 75% had difficulties dressing, bathing or getting around inside the house. This compares to 66%, 51% and36% respectively for those older people with disabilities living in the community. Of those nursing home residents with a recorded disability, 67% had difficulties learning, remembering and concentrating compared to just over a quarter of those living in the community with a disability again suggesting high rates of cognitive impairment (and to a lesser extent, dementia) within nursing homes.
Profiling Disability within Nursing Homes: a census based Approach by Marianne Falconer and Desmond O’ Neill is a Quantitative Research focusing on the Geriatric field in Ireland. In this research they are comparing the disabilities among the elderly citizens in the Nursing homes and the Community resident elderly citizens based on a census in all homes and dwelling in the Republic of Ireland.
Ageing at all stages of development is accompanied by both growth and loss. The losses of the old age, in particular those brought about by age –related disease, give rise to increasing levels of disability in the later life. Age related disabilities continue to be one of the commonest factors precipitating admission into nursing homes. Studies in the United Kingdom showed that about 75% of the residents in the nursing homes are moderately to severely disable.
The research is performed based on the 2002 Irish National Census including people temporarily staying temporarily in the hose hold, persons in the communal establishments and persons on board vessels. To conduct this research the researchers focuses on some questions on the disabilities of the people in the questionnaire, which correspond to some everlasting conditions like blindness, deafness and some physical disabilities. Also on the difficulty of the family members to perform the activities such as learning, remembering, dressing, bathing etc. From this data the disability prevalence among the people over 65 was considered and made a comparison with the elderly nursing home residents and the elderly community residents to bring out the research.
As far as the authors are concerned this is the first Research based conducted based on a census to compare the prevalence of the disabilities of a elderly nursing home residents and the community residents. And the studies found out that the nursing homes elderly people are the majority in the disability as compared to the elderly in the community settings. The study also found out that the elderly citizens in the nursing homes have more prevalence to the memory problems which can be due to the Dementia. Also this is one of the reason which accounts for the admission of the elderly in the Nursing homes. Another aspect that the researchers found is the age differences among the elderly which can be a factor for the higher prevalence of the disabilities. The results shows that the majority of the elderly living in the Nursing homes are above 80 while the majority of the elderly in the community are below 80, which explains one of the reason why elderly in nursing homes are prone to the disabilities.
This study based on the Census report in Ireland found out that the nursing homes in Ireland are mostly occupied with the most frail group in the society who needs more care and attention. So this research emphasizes the importance of the appropriate health care resources and the facilities in the area. The studies also points that most of the people are get overcome from their disabilities by the therapies and treatments. But the adequate facilities are not provisioned to them. Challis et al noted that about 35% of the recently admitted care home residents are suffered from the Rheumatologic disorders and or stroke, conditions which are potential for active rehabilitation. And the nursing home does not have the proper therapies and the proper care staffs for the better rehabilitation. Another aspect the research found out is that the most of the disabilities of the dementia cases in the home setting are not addressed properly for the provision of the better care. These unmet needs leads to the psychological problems of the elderly such as anxiety and depression.
The results shows that the almost three-quarters of nursing home patients are unable to go outside alone compared to 15% of those in the community .Over two thirds of nursing home residents have a condition that limits one or more basic physical activity, 64% have difficulties dressing, bathing and mobilizing, while 58% have difficulties learning, remembering and concentrating, suggestive of a very high prevalence of dementia. This compares to almost20%, 11% and 8% respectively of older people living in the community. 79% of those in nursing homes with disability were limited in at least one physical activity, 83% were unable to go outside alone and 75% had difficulties dressing, bathing or getting around inside the house. This compares to 66%, 51% and36% respectively for those older people with disabilities living in the community. Of those nursing home residents with a recorded disability, 67% had difficulties learning, remembering and concentrating compared to just over a quarter of those living in the community with a disability again suggesting high rates of cognitive impairment (and to a lesser extent, dementia) within nursing homes.
palliative nursing
The final care provided to the people who needs the palliative assistance
INTRODUCTION
Palliative care (pronounced pal-lee-uh-tiv) is the medical specialty focused on relief of the pain and other symptoms of serious illness. The goal is to prevent and ease suffering and to offer patients and their families the best possible quality of life.(Get Palliative care.org, 2008).
It is also defined as “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” (W H O,2008).
The goal is not to cure, but to provide comfort and maintain the highest possible quality of life for as long as life remains. Well-rounded palliative care programs also address mental health and spiritual needs. The focus is not on death, but on compassionate specialized care for the living. Palliative care is well-suited to an interdisciplinary team model that provides support for the whole person and those who are sharing the person's journey in love (Growth house.org, 2007). The term "palliative care" is increasingly used with regard to diseases other than cancer such as chronic, progressive pulmonary disorders, renal disease, chronic heart failure, and progressive neurological conditions. In addition, the rapidly-growing field of pediatric palliative care has clearly shown the need for services geared specifically for children with serious illness. Although the concept of palliative care is not new most physicians have traditionally concentrated on trying to cure patients. Treatments for alleviation of symptoms were viewed as hazardous and seen as inviting addiction and other unwanted side effects. The focus on a patient's quality of life has increased greatly over the past twenty years. In the United States today 55% of hospitals with over 100 beds offer a palliative care program and nearly one-fifth of community hospitals have palliative care programs. A relatively recent development is the concept of a dedicated health care team that is entirely geared toward palliative treatment, called a palliative care team (Wikipedia, 2008).
Characteristics of Palliative Care
The main characteristics of Palliative care by the World Health Organization are as follows,
provides relief from pain and other distressing symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten or postpone death;
integrates the psychological and spiritual aspects of patient care;
offers a support system to help patients live as actively as possible until death;
offers a support system to help the family cope during the patients illness and in their own bereavement;
uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;
will enhance quality of life, and may also positively influence the course of illness;
is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical
(WHO, www.WHO.int, 2008)
According to the Ontario Palliative care Association the main objectives for the palliative care are as follows,
providing education development opportunities to facilitate communication
being a central resource for information
being a link between local, regional, provincial and national palliative care
advocating the importance of palliative care through influencing government policy and funding
promoting standards in palliative care
participating in the evolution and implementation of standards
enhancing the work of OPCA
maintaining financial stability
(Ontario palliative care Association, 2007)
According to the European Association of Palliative care the main objectives for the Palliative care are as follows,
Increase the awareness and promote the development and dissemination of palliative care at scientific, clinical and social levels
Promote the implementation of existing knowledge, train those who at any level are involved with the care of patients with incurable and advanced disease and promote study and research
Support and give patronage to scientific and educational events promoting the dissemination and development of palliative care
Promote and sponsor publications or periodicals concerning palliative care
Bring together those who study and practice the disciplines involved in the care of patients with advanced disease (doctors, nurses, social workers, psychologists, volunteers and others)
Unify national palliative care organizations and establish an international network for the exchange of information and expertise
Address the ethical problems associated with the care of terminally
(European Association of Palliative Care, 2002)
According to the Asia- Pacific Hospice Palliative care Network the main objectives for the Palliative nursing care are,
To facilitate the development of hospice and palliative care programs (both service providers and umbrella bodies) and other relevant initiatives
To promote professional and public education in palliative care
To enhance communication and dissemination of information
To foster research and collaborative activities
To encourage co-operation with local, regional and international professional and public organizations.
(Asia Pacific Palliative Care Network, 2008)
Pain Management during Palliative Nursing
Pain management is a vital component of nursing care that presents ever evolving challenges. Nurses must keep up to date with emerging trends in order to ensure use of good pain management techniques, compliance with regulations governing handling and use of controlled substances, and be able to effectively assess, monitor and document pain management strategies and outcome (Medi- smart, www.medi-smart.com, 2005). Every palliative care patient should have the expectation that acute and chronic pain management will be an integral part of their overall care. However, in all too many instances, the pain of cancer is often grossly under-treated. This issue is of concern because more than 80% of patients with cancer pain can find adequate relief through the use of simple pharmacological methods. It is even more troubling to note that women and minority groups have their cancer pain under-treated more frequently. Physicians with the basic skills of assessment and treatment will be able to control the symptoms in the majority of cancer pain patients. However, there are still some patients who may require other modalities to control their moderate to severe pain. A thorough understanding of all pain management options will help the gynecological oncologist to maintain an acceptable quality of life for their patients throughout the therapeutic and palliative phases of care (PUBMED, www.pubmed.gov, 2001). We can classify the most widely used techniques in terms of the degree of intervention they involve:
Noninvasive non-drug pain management
Non-invasive pharmacologic pain management
Invasive pain management
Non invasive non-drug pain management
1. Exercise—physical exertion with the aim of training or improvement. Includes the McKenzie method, water therapy, flexion exercises, aerobic routines, and many others. May involve active, passive, and resistive elements. Exercise is necessary for proper cardiovascular health, disc nutrition, and musculoskeletal health.
2. Manual techniques—manipulation of affected areas by means of chiropractic adjustments, osteopathy, massage therapy and other techniques. Some evidence for the effectiveness of certain techniques is available.
3. Behavioral modification—use of behavioral methods to optimize patient responses to back pain and painful stimuli. Cognitive therapy involves teaching the patient to alleviate back pain by means of relaxation techniques, coping techniques, and other methods. Biofeedback involves the gradual alteration of neuromuscular signals for symptomatic improvement.
4. Cutaneous stimulation —superficial heating or cooling of skin. These pain management methods include cold packs and hot packs, and should be used in conjunction with exercise.
5. Electrotherapy —the most commonly known form of electrotherapy is transcutaneous electrical nerve stimulation (TENS). TENS therapy attempts to reduce back pain by means of a low-voltage electric stimulation that interacts with the sensory nervous system. Randomized controlled trials have yielded either positive or neutral results regarding the efficacy of TENS as a treatment for back pain.
Noninvasive pharmacologic pain management
Analgesics—include acetaminophen. Long-term use involves risk of renal damage.
Nonsteroidal anti-inflammatory agents (NSAIDs)—include aspirin, ibuprofen, naproxen, and the new COX-2 inhibitors.
Muscle relaxants—used to treat muscle spasms due to pain and protective mechanisms.
Narcotic medications—most appropriate for acute or post-operative pain. Since use of narcotics entails risk of habituation or addiction if not properly supervised, they are not often used for chronic conditions.
Antidepressants and anticonvulsants—used to treat neuropathic (“nerve”) pain.
Invasive pain management techniques
Injections—direct delivery of steroids or anesthetic to nerve, joint or epidural space. Injections into the facet, peripheral nerve, “trigger point” and other locations are also known as “blocks”. These may provide relief of pain (often temporary) and can be used to confirm diagnosis. Epidural injections provide temporary relief for severe back pain.
Prolotherapy—injection of solution to stimulate blood circulation and ligament repair at affected site. The effectiveness of this technique is not known.
Surgically implanted electrotherapy devices—implantable spinal cord stimulators (SCS) and implantable peripheral nerve stimulators. Clinical data offers inconclusive findings on the effectiveness of SCS.
Implantable opioid infusion pumps—surgically implanted pumps that deliver opioid agents directly to affected nerve. The appropriateness and effectiveness of these devices for treating chronic back pain is controversial.
Radiofrequency radioablation—deadening of painful nerve via heat produced by a specialized device. The efficacy of this treatment is mixed.
( Spine- health, www.spine health.com, 2001)
Nursing Processes
By applying the nursing process in the palliative care the nurse is able to cope with the strategies of the people in need of the hospice care. And also the nurse is able to collaborate with the patients and meet the basic needs of the care.
But according to a supportive care model, there is a special way of approach for providing the palliative assistance they are
Each dimension represents a standard:
1. The hospice palliative care nurse believes in the intrinsic worth of others, the value of life and that death is a natural process.
II. The hospice palliative care nurse establishes a therapeutic connection (relationship) with the person and family through making, sustaining and closing the relationship. III. The hospice palliative care nurse provides care in a manner that is empowering for the person and family. IV. The hospice palliative care nurse provides care based on best practice and/or evidence-based practice in the following areas: pain and symptom management, coordination of care, and advocacy. V. The hospice palliative care nurse assists the person and family to fi nd meaning in their lives and their experience of illness. VI. The hospice palliative care nurse preserves the integrity of self, person and family.
Nursing standards not only guide nursing practice but can be applied in the following ways:
• by developing new models of nursing care delivery, through staff orientation and continuing education programs, when evaluating performance with career planning and professional development
• by determining appropriate referrals for nursing consultation within a specialty area
• by ensuring quality of nursing care through increasing public awareness about the nursing roles of a specialty area
• by creating an environment for excellence in nursing practice .
Nursing standards are designed as benchmarks to measure a nurse’s performance but are also used as the foundation for the development of nursing competencies and guidelines for practice. Therefore, nursing standards are useful tools for nurses in determining what knowledge and skills are required to provide quality care.
(Perspectives on Hospice Palliative care, 2002)
Personal Experience
During my clinical placement in one of the clinic in Cyprus I had the experience of dealing with a Cancer Terminal stage patient from France. He had the terminal prostate cancer. But he is a special case that I had ever seen during my placement. He knows very well about the conditions that he have and he was well prepared for his last day. The other fact is that he never likes other people to feel pitty on him and to tell him the lies about his health condition. He was a retired Engineer. Also he knows very well to adjust the I-MED machine and all and he doesn’t want other nurses or others to comment on it. And since he have the terrible pain, on his request the doctor prescribed to give the morphine 120 mg. At first he was not that much co-operative with me,but later own he become my friend. He started to talk on his life and everything. And also he likes others to talk to him according to his present situation . he don’t want anybody to act and pretends to be happy on his condition. Every day the urine bottle is with blood (heamaturia). Also he wants the things done to him according to his wishes. Most probably the nurses and the doctors performed according to his wish and he felt comfort.
Conclusion
Palliative nursing is one of the major field of nursing which requires special training and special skills. It is actually one of the field dealing with the emotional , physical and spiritual well being of the patients. And also for this the profession the nurses and the professionals to be more motivated and patient. And also it requires a good mentality of human considerations. And also ability to collaborate with the people in the hospice period.
References
1. Perspectives on Hospice Palliative Care, http://palliative.info/resource_material/NursingMonographLR.pdf, USA,2002.
World Health Organization, http://www.who.int/en/, Switzerland, 2008.
Get palliative care.org, http://www.getpalliativecare.org/whatis/2,2008.
Growth house, http://www.growthhouse.org/, 2007.
Wikipedia, http://en.wikipedia.org/wiki/Palliative_care,2006.
Ontario palliative care Association, http://www.ontariopalliativecare.org/,Ontario, 2007.
European Association of Palliative Care, http://www.eapcnet.org/About/about.html,Italy, 2002.
Asia Pacific Palliative Care Network, http://www.aphn.org/,Singapore, 2008.
PUBMED, www.pubmed.gov, 2001.
Spine- health, www.spine health.com, 2001.
Own Experience.
INTRODUCTION
Palliative care (pronounced pal-lee-uh-tiv) is the medical specialty focused on relief of the pain and other symptoms of serious illness. The goal is to prevent and ease suffering and to offer patients and their families the best possible quality of life.(Get Palliative care.org, 2008).
It is also defined as “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” (W H O,2008).
The goal is not to cure, but to provide comfort and maintain the highest possible quality of life for as long as life remains. Well-rounded palliative care programs also address mental health and spiritual needs. The focus is not on death, but on compassionate specialized care for the living. Palliative care is well-suited to an interdisciplinary team model that provides support for the whole person and those who are sharing the person's journey in love (Growth house.org, 2007). The term "palliative care" is increasingly used with regard to diseases other than cancer such as chronic, progressive pulmonary disorders, renal disease, chronic heart failure, and progressive neurological conditions. In addition, the rapidly-growing field of pediatric palliative care has clearly shown the need for services geared specifically for children with serious illness. Although the concept of palliative care is not new most physicians have traditionally concentrated on trying to cure patients. Treatments for alleviation of symptoms were viewed as hazardous and seen as inviting addiction and other unwanted side effects. The focus on a patient's quality of life has increased greatly over the past twenty years. In the United States today 55% of hospitals with over 100 beds offer a palliative care program and nearly one-fifth of community hospitals have palliative care programs. A relatively recent development is the concept of a dedicated health care team that is entirely geared toward palliative treatment, called a palliative care team (Wikipedia, 2008).
Characteristics of Palliative Care
The main characteristics of Palliative care by the World Health Organization are as follows,
provides relief from pain and other distressing symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten or postpone death;
integrates the psychological and spiritual aspects of patient care;
offers a support system to help patients live as actively as possible until death;
offers a support system to help the family cope during the patients illness and in their own bereavement;
uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;
will enhance quality of life, and may also positively influence the course of illness;
is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical
(WHO, www.WHO.int, 2008)
According to the Ontario Palliative care Association the main objectives for the palliative care are as follows,
providing education development opportunities to facilitate communication
being a central resource for information
being a link between local, regional, provincial and national palliative care
advocating the importance of palliative care through influencing government policy and funding
promoting standards in palliative care
participating in the evolution and implementation of standards
enhancing the work of OPCA
maintaining financial stability
(Ontario palliative care Association, 2007)
According to the European Association of Palliative care the main objectives for the Palliative care are as follows,
Increase the awareness and promote the development and dissemination of palliative care at scientific, clinical and social levels
Promote the implementation of existing knowledge, train those who at any level are involved with the care of patients with incurable and advanced disease and promote study and research
Support and give patronage to scientific and educational events promoting the dissemination and development of palliative care
Promote and sponsor publications or periodicals concerning palliative care
Bring together those who study and practice the disciplines involved in the care of patients with advanced disease (doctors, nurses, social workers, psychologists, volunteers and others)
Unify national palliative care organizations and establish an international network for the exchange of information and expertise
Address the ethical problems associated with the care of terminally
(European Association of Palliative Care, 2002)
According to the Asia- Pacific Hospice Palliative care Network the main objectives for the Palliative nursing care are,
To facilitate the development of hospice and palliative care programs (both service providers and umbrella bodies) and other relevant initiatives
To promote professional and public education in palliative care
To enhance communication and dissemination of information
To foster research and collaborative activities
To encourage co-operation with local, regional and international professional and public organizations.
(Asia Pacific Palliative Care Network, 2008)
Pain Management during Palliative Nursing
Pain management is a vital component of nursing care that presents ever evolving challenges. Nurses must keep up to date with emerging trends in order to ensure use of good pain management techniques, compliance with regulations governing handling and use of controlled substances, and be able to effectively assess, monitor and document pain management strategies and outcome (Medi- smart, www.medi-smart.com, 2005). Every palliative care patient should have the expectation that acute and chronic pain management will be an integral part of their overall care. However, in all too many instances, the pain of cancer is often grossly under-treated. This issue is of concern because more than 80% of patients with cancer pain can find adequate relief through the use of simple pharmacological methods. It is even more troubling to note that women and minority groups have their cancer pain under-treated more frequently. Physicians with the basic skills of assessment and treatment will be able to control the symptoms in the majority of cancer pain patients. However, there are still some patients who may require other modalities to control their moderate to severe pain. A thorough understanding of all pain management options will help the gynecological oncologist to maintain an acceptable quality of life for their patients throughout the therapeutic and palliative phases of care (PUBMED, www.pubmed.gov, 2001). We can classify the most widely used techniques in terms of the degree of intervention they involve:
Noninvasive non-drug pain management
Non-invasive pharmacologic pain management
Invasive pain management
Non invasive non-drug pain management
1. Exercise—physical exertion with the aim of training or improvement. Includes the McKenzie method, water therapy, flexion exercises, aerobic routines, and many others. May involve active, passive, and resistive elements. Exercise is necessary for proper cardiovascular health, disc nutrition, and musculoskeletal health.
2. Manual techniques—manipulation of affected areas by means of chiropractic adjustments, osteopathy, massage therapy and other techniques. Some evidence for the effectiveness of certain techniques is available.
3. Behavioral modification—use of behavioral methods to optimize patient responses to back pain and painful stimuli. Cognitive therapy involves teaching the patient to alleviate back pain by means of relaxation techniques, coping techniques, and other methods. Biofeedback involves the gradual alteration of neuromuscular signals for symptomatic improvement.
4. Cutaneous stimulation —superficial heating or cooling of skin. These pain management methods include cold packs and hot packs, and should be used in conjunction with exercise.
5. Electrotherapy —the most commonly known form of electrotherapy is transcutaneous electrical nerve stimulation (TENS). TENS therapy attempts to reduce back pain by means of a low-voltage electric stimulation that interacts with the sensory nervous system. Randomized controlled trials have yielded either positive or neutral results regarding the efficacy of TENS as a treatment for back pain.
Noninvasive pharmacologic pain management
Analgesics—include acetaminophen. Long-term use involves risk of renal damage.
Nonsteroidal anti-inflammatory agents (NSAIDs)—include aspirin, ibuprofen, naproxen, and the new COX-2 inhibitors.
Muscle relaxants—used to treat muscle spasms due to pain and protective mechanisms.
Narcotic medications—most appropriate for acute or post-operative pain. Since use of narcotics entails risk of habituation or addiction if not properly supervised, they are not often used for chronic conditions.
Antidepressants and anticonvulsants—used to treat neuropathic (“nerve”) pain.
Invasive pain management techniques
Injections—direct delivery of steroids or anesthetic to nerve, joint or epidural space. Injections into the facet, peripheral nerve, “trigger point” and other locations are also known as “blocks”. These may provide relief of pain (often temporary) and can be used to confirm diagnosis. Epidural injections provide temporary relief for severe back pain.
Prolotherapy—injection of solution to stimulate blood circulation and ligament repair at affected site. The effectiveness of this technique is not known.
Surgically implanted electrotherapy devices—implantable spinal cord stimulators (SCS) and implantable peripheral nerve stimulators. Clinical data offers inconclusive findings on the effectiveness of SCS.
Implantable opioid infusion pumps—surgically implanted pumps that deliver opioid agents directly to affected nerve. The appropriateness and effectiveness of these devices for treating chronic back pain is controversial.
Radiofrequency radioablation—deadening of painful nerve via heat produced by a specialized device. The efficacy of this treatment is mixed.
( Spine- health, www.spine health.com, 2001)
Nursing Processes
By applying the nursing process in the palliative care the nurse is able to cope with the strategies of the people in need of the hospice care. And also the nurse is able to collaborate with the patients and meet the basic needs of the care.
But according to a supportive care model, there is a special way of approach for providing the palliative assistance they are
Each dimension represents a standard:
1. The hospice palliative care nurse believes in the intrinsic worth of others, the value of life and that death is a natural process.
II. The hospice palliative care nurse establishes a therapeutic connection (relationship) with the person and family through making, sustaining and closing the relationship. III. The hospice palliative care nurse provides care in a manner that is empowering for the person and family. IV. The hospice palliative care nurse provides care based on best practice and/or evidence-based practice in the following areas: pain and symptom management, coordination of care, and advocacy. V. The hospice palliative care nurse assists the person and family to fi nd meaning in their lives and their experience of illness. VI. The hospice palliative care nurse preserves the integrity of self, person and family.
Nursing standards not only guide nursing practice but can be applied in the following ways:
• by developing new models of nursing care delivery, through staff orientation and continuing education programs, when evaluating performance with career planning and professional development
• by determining appropriate referrals for nursing consultation within a specialty area
• by ensuring quality of nursing care through increasing public awareness about the nursing roles of a specialty area
• by creating an environment for excellence in nursing practice .
Nursing standards are designed as benchmarks to measure a nurse’s performance but are also used as the foundation for the development of nursing competencies and guidelines for practice. Therefore, nursing standards are useful tools for nurses in determining what knowledge and skills are required to provide quality care.
(Perspectives on Hospice Palliative care, 2002)
Personal Experience
During my clinical placement in one of the clinic in Cyprus I had the experience of dealing with a Cancer Terminal stage patient from France. He had the terminal prostate cancer. But he is a special case that I had ever seen during my placement. He knows very well about the conditions that he have and he was well prepared for his last day. The other fact is that he never likes other people to feel pitty on him and to tell him the lies about his health condition. He was a retired Engineer. Also he knows very well to adjust the I-MED machine and all and he doesn’t want other nurses or others to comment on it. And since he have the terrible pain, on his request the doctor prescribed to give the morphine 120 mg. At first he was not that much co-operative with me,but later own he become my friend. He started to talk on his life and everything. And also he likes others to talk to him according to his present situation . he don’t want anybody to act and pretends to be happy on his condition. Every day the urine bottle is with blood (heamaturia). Also he wants the things done to him according to his wishes. Most probably the nurses and the doctors performed according to his wish and he felt comfort.
Conclusion
Palliative nursing is one of the major field of nursing which requires special training and special skills. It is actually one of the field dealing with the emotional , physical and spiritual well being of the patients. And also for this the profession the nurses and the professionals to be more motivated and patient. And also it requires a good mentality of human considerations. And also ability to collaborate with the people in the hospice period.
References
1. Perspectives on Hospice Palliative Care, http://palliative.info/resource_material/NursingMonographLR.pdf, USA,2002.
World Health Organization, http://www.who.int/en/, Switzerland, 2008.
Get palliative care.org, http://www.getpalliativecare.org/whatis/2,2008.
Growth house, http://www.growthhouse.org/, 2007.
Wikipedia, http://en.wikipedia.org/wiki/Palliative_care,2006.
Ontario palliative care Association, http://www.ontariopalliativecare.org/,Ontario, 2007.
European Association of Palliative Care, http://www.eapcnet.org/About/about.html,Italy, 2002.
Asia Pacific Palliative Care Network, http://www.aphn.org/,Singapore, 2008.
PUBMED, www.pubmed.gov, 2001.
Spine- health, www.spine health.com, 2001.
Own Experience.
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