Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2).
– In your reply posts, include how the information you learned from your peer’s initial post will help you to provide care to a patient. The expectation is not that you “agree” or “disagree” with your peers but that you develop a reply post with information that is validated via citations to encourage learning and to bring your own perspective to the conversation.
– Use at least two scholarly references per peer post.
Please, send me the two documents separately, for example one is the reply to my peers Post #1, and the other one is the reply to my other peer Post #2.
– Minimun 350 Words per peer reply.
– TURNITIN ASSIGNMENT (FREE OF PLAGIARISM)
Note: My background for you to have as a reference: I am currently enrolled in the Psych Mental Health Practitioner Program, I am a Registered Nurse, I work at a Psychiatric Hospital.POST # 1 MEGAN
A traumatic crush injury occurs when an external force directly impacts the body (Godat et al., 2019). Examples of incidents that cause these injuries are natural disasters, agricultural accidents, industrial accidents, construction accidents, and MVAs. In a traumatic crush injury, prolonged compression causes trauma and ischemia of the affected areas (Godat et al., 2019). Once the force is removed, blood flow is restored, but there is further injury during reperfusion. Swelling in the area can contribute to muscle necrosis and neurological dysfunction (Godat et al., 2019). As a result, patients with traumatic crush injuries are at risk for many complications. Crush syndrome is a life-threatening condition related to the systemic effects of traumatic crush injuries. Following these injuries, there is a massive fluid shift from the ECF to the damaged cells and the damaged cells release potassium, phosphorus, and myoglobin (Godat et al., 2019). This leads to hypovolemia, acid-base imbalance, and electrolyte imbalance, which can cause many problems. Some of these problems include hypovolemic shock, arrhythmia, cardiomyopathy, renal failure, and metabolic acidosis (American College of Emergency Physicians, n.d.). There is also a risk for compartment syndrome. Compartment syndrome is a medical emergency in which extensive swelling in an area causes local ischemia, and as a result, cellular anoxia (Godat et al., 2019). The swelling must be reduced immediately. This is often done by fasciotomy, a surgical incision that goes through the skin and fascia to quickly relieve pressure in the area (Godat et al., 2019).
Trauma to the skeletal muscle would have permanently disabling effects in the elderly. This is related to some of the musculoskeletal changes that individuals undergo with increased age. Older adults have reduced muscle mass, poor muscle quality, weakened muscle contractions, and less flexibility (Hubert et al., 2018; Taffet, 2019). After a certain age, muscle deteriorates, and subcutaneous and connective tissue infiltrate into old muscle (Taffet, 2019). Muscle fibers cannot be replaced so these changes are degenerative (Hubert et al., 2018). This takes a toll on mobility, and because the individual cannot move as much, there is more atrophy. The loss of subcutaneous tissue offers a poor layer of protection to the muscles. In addition to muscle changes, older adults experience bone changes. Osteoporosis is caused by decreased calcium intake or compromised calcium absorption in the years leading up to late adulthood. Inefficient calcium levels prevent healthy bone formation, leading to bones with decreased mass and density (Hubert et al., 2018). Formation of new bone declines with age (Taffet, 2019). This leaves individuals with bones that are porous, brittle, and likely to fracture (Hubert et al., 2018). Individuals often present with abnormal spine curvatures which compromise ventilation and mobility (Hubert et al., 2018). If an older adult sustains a traumatic crush injury, he or she is very likely to have prolonged, or incomplete, healing of the musculoskeletal structures.
As APRNs, it is important that we take action to prevent elderly patients from the effects of traumatic crush injuries. The best way to do this is to help them avoid these injuries in the first place. This can be done by gathering information about the patient’s home environment and ADLs. We can ask questions such as “Are you still working?”, “Do you still drive?”, and “Describe the setup of your house/apartment.” This will reveal hazards and allow us to provide safety education. To prevent elderly patients from traumatic crush injury complications, we can also educate them on maintaining adequate health. This way, if they do sustain an injury, they will make the best possible recovery. One healthy habit to recommend to the elderly is low-impact, moderate exercise (Hubert et al., 2018). Examples of this type of exercise are swimming and walking. It should be practiced a few days per week. For this age group, nutritional emphasis should be on proteins, minerals, and vitamins (Hubert et al., 2018). This will slow the musculoskeletal body changes that are related to aging.
American College of Emergency Physicians. (n.d.) Crush injury and crush syndrome.
Godat, L. N. & Doucet, J. J. (2019). Severe crush injury in adults. UpToDate.
Hubert, R. J. & VanMeter, K. C. (2018). Gould’s pathophysiology for the health professions.
(6th ed.). Elsevier.
Taffet, G. E. (2019). Normal aging. UpToDate.
https://www-uptodate-com.regiscollege.idm.oclc.org/contents/normal-aging?search=effects%20of%20aging&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H584138046POST # 2 ANITA
Anita’s Topic: Physiological changes related to constipation and the elderly The process of aging is irreversible, and the rate and effects of aging vary from person to person (Hubert & VanMeter, 2018). Aging and the changes that occur within the body do not necessary correlate to chronological age so as clinician’s it is important to understand the effects of aging on the various systems within the body and use age as a relative marker (Hubert & VanMeter, 2018). This post will explore the physiological changes related to constipation and the elderly, along with guidance on assessment and management of constipation within this patient population. Prior to understanding gastrointestinal changes that contribute to constipation it is important to also understand how the digestive system and nutrition impact constipation. Maintaining a balanced diet and good nutrition is a challenge for many older adults (Hubert & VanMeter, 2018). Environmental, physical and personal choices impact food choices and intake which can lead to nutritional deficiencies, reduced intake, and reduced consumption of certain foods, like protein (Hubert & VanMeter, 2018). Physical changes include losing teeth due to periodontal disease and decreased salivary secretions (Hubert & VanMeter, 2018). These physical changes impair chewing options for elderly persons and fragile gum tissue in the mouth may be irritated by denture use which can lead to infection from food residue or altered nutritional status (Hubert & VanMeter, 2018). The need for a soft diet also affects nutritional status and intake (Hubert & VanMeter, 2018). Constipation is a common issue in the elderly (Rao, 2020). The definition of constipation varies across clinicians and patients. Following the Rome IV criteria, functional constipation includes straining, hard stools, sensation of incomplete evacuation, using digital manuevers to remove stool, sensation of an anorectal obstruction or blockage, and/or a decrease in stool frequency (usually less than three bowel movements a week) (Rao, 2020). The patient must experience these symptoms for at least three months with symptom onset for six months prior to the diagnosis (Rao, 2020). The prevalence of constipation in older adults occurs between 24-50 percent (Rao, 2020). Rao (2020) states that laxative use in older adults can be up to 74% in nursing home residents (compared to 10-18% in community residents). Rao (2020) outlines risk factors that may lead to constipation include age, female gender, physical inactivity, low socioeconomic status, concurrent medication use, depression and educational status. Other risk factors include meal frequency, caloric intake, co-morbid illnesses and nursing home residence (Rao, 2020). The pathophysiology of constipation in the older adult is mainly due to two reasons: colorectal dysfunction or secondary constipation as result of various organic and inorganic causes (Rao, 2020). One important note Rao (2020) makes is that constipation in the elderly is usually multifactorial. Some pathological reasons for constipation include colorectal dysfunction (Rao, 2020). Primary colorectal dysfunction can be broken down into three major subtypes: slow transit constipation (STC), dyssynergic defecation, and irritable bowel syndrome (Rao, 2020). STC could be caused by a primary dysfunction of the patient’s colonic muscle (myopathy) or neuronal innervation (neuropathy). The motor functions of the colonic and anorectal area is coordinated by enteric, sympathetic and parasympathetic nerves (Wald, 2020). The distal colon receives parasympathetic innervation from sacral nerves that go through the pelvis and enter the bowel wall in the rectum (Wald, 2020). Disruption of those nerves can result in constipation associated with hypomotility, colonic dilation, decreased rectal tone and sensation, distal colonic stasis, and impaired defecation (Wald, 2020). Dyssynergic defecation (DD) is caused by difficulty or inability to expel stool from the anorectum due to anal sphincter dysfunction and slow colonic transit (Rao, 2020). Secondary causes of constipation, typically more prevalent in older persons, include endocrine or metabolic conditions, neurologic disorders, myogenic disorders or medication (ie. Opioid induced constipation, laxative overuse). Older adults are predisposed to malignancies in the digestive tract (Hubert & VanMeter, 2018). Carcinogenic substances become more hazardous because of the prolonged exposure of the tissues due to longer transit times (Hubert & VanMeter, 2018). Constipation in older adults is also seen with decreased fluid intake and subsequent dehydration (Hubert & VanMeter, 2018). Decreased physical activity affects gastrointestinal motility as well as decreased fiber intake (Hubert & VanMeter, 2018). Exercise promotes normal muscle contractions in the bowel wall, so decreasing physical activity, results in an increased risk for constipation for elderly persons (Wald, 2020). When conducting an history and physical a complete review of medications, medical history, physical activity, 24-hour diet recall, and nutritional status must be reviewed with your patient. A comprehensive physical exam, including a rectal exam is important, to assess for hemorrhoids, fissures, sphincter tone, push effort during defecation, prostatic hypertrophy, and posterior vaginal masses (Wald, 2020). Lab testing would include a complete metabolic panel to assess for diabetes, nutritional status, electrolyte imbalances, and kidney and liver function (Wald, 2020). A complete blood count, thyroid function tests are also important to assess for anemia and thyroid disorders (Wald, 2020). The main thing to consider when assessing a older person to include a thorough history and physical. References Hubert, R. J., & VanMeter, K. C. (2018). Gould’s: Pathophysiology for the Health Professions (6th ed.). St. Louis, Missouri: Elsevier. Rao, S. (2020). Constipation in the older adult. Retrieved from UpToDate: https://www.uptodate.com/contents/constipation-in-the-older-adult?search=constipation%20adult&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 Wald, A. (2020). Etiology and evaluation of chronic constipation in adults. Retrieved from UpToDate: https://www.uptodate.com/contents/etiology-and-evaluation-of-chronic-constipation-in-adults?search=constipation%20adult&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3