1/4. Restructuring the therapeutic environment to promote care and safety for the obese patient.Fifty-four percent of American adults are overweight. obesity is a chronic disease associated with a number of conditions, such as diabetes, heart disease, hypertension, certain types of cancers, and breathing problems. The direct and indirect costs related to obesity exceed $70 billion annually. Because of the many cost and quality issues related to obesity, national attention is turning toward the special needs of this population. Strategies to restructure therapeutic intervention with attention to risk management, economic implications, and patient satisfaction are important considerations when managing the obese patient.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/4. Approach to skin ulcers in older patients.OBJECTIVE: To provide family physicians with an approach to managing skin ulcers in older patients. SOURCES OF INFORMATION: Clinical practice guidelines and best practice guidelines were summarized to describe an evidence-based approach. MAIN MESSAGE; Preventing ulcers is important in frail older patients. Using guidelines can help prevent ulcers in institutions. Clarifying the cause and contributing factors is the first step in management. pressure and venous ulcers are common in elderly people. Poor nutrition, edema, arterial insufficiency, and anemia often impair wound healing. Adequate debridement is important to decrease risk of infection and to promote healing. There are guidelines for cleaning ulcers. Choice of dressings depends on the circumstances of each wound, but dressings should provide a moist environment. Options for dressings are summarized. CONCLUSION: family physicians can manage skin ulcers effectively by applying basic principles and using readily available guidelines.- - - - - - - - - - ranking = 0.25keywords = environment (Clic here for more details about this article) |
3/4. Physical and surgical examination of patient after 6-year coma.A patient with head trauma who had been comatose for 6 years and residing in a nursing home, began to respond to her environment and subsequently underwent rehabilitation that resulted in significant recovery. speech and psychologic functions that had been severely affected improved considerably after 9 months training. Surgical release of immobilization contractures that had prevented significant use of any extremity, resulted in healing of several decubitus ulcers and allowed the patient to regain some ADL skills in a wheelchair. Further urethral erosion was prevented by adequate hygiene and release of adductor spasticity. After 14 months of intensive rehabilitation and family teaching, the patient was able to live at home with her family.- - - - - - - - - - ranking = 0.25keywords = environment (Clic here for more details about this article) |
4/4. pressure ulcers in nursing home patients.pressure, moisture, shear forces and friction lead to skin ulcer formation. nursing home and home-bound patients with restricted mobility, poor nutrition, incontinence and chronic conditions such as anemia, diabetes and dementia are at risk for ulcer formation. Bedridden patients should be turned from side to side at 30-degree angles at least every two hours. Mattress and chair cushions, splints and cradle boots may reduce pressure. Good hygiene and barrier ointments, condom catheters, absorptive products and scheduled toileting for incontinence may control moisture. Calorie and protein supplements, feeding assistance and serial weight measurements are essential in the management of malnourished patients. Treatment should be based on the stage of the ulcer and the presence of conditions such as necrotic debris, infection and drainage. Saline wet-to-dry dressings and enzymatic and surgical debridement are necessary to remove necrotic tissue. Saline-soaked gauze, hydrogel preparations and occlusive dressings provide the physiologic environment for fibroblasts to grow and form granulation tissue. patients with sepsis may require hospital admission for both further evaluation and systemic antibiotic therapy.- - - - - - - - - - ranking = 0.25keywords = environment (Clic here for more details about this article) |