Nursing homes

The American College of Apothecaries represents pharmacists whose practices can best be described as emphasizing prescription and related products. Some pharmacists practice as consultants and providers to long-term care health faciUties, eg, nursing homes. Both state and U.S. laws have mandated closer control of dmg products in such units. The American Association of Consultant Pharmacists has been formed to serve the needs of such pharmacists. 

The population, in teniis of nmnbers, density, and types of individuals (e.g., facility employees neighborhood residents people in hospitals, schools, nursing homes, prisons, day care centers) Uiat could be witliin a vulnerable zone tlie private and public property (e.g., critical facilities, homes, schools, hospitals, businesses, offices) that may be damaged, including essential support... 

Places where more sensitive populations might be e.xposed, such as nursing homes, hospitals, and schools. 

Some nursing homes or extended care facilities have pictures of the patient available, which allows the nurse to verify the correct patient. If pictures are used to identify patients, it is critical that they are recent and bear a good likeness of the individual. 

Mr. Park, a patient in a nursing home, has been receiving clarithromycin (Biaxin) for an upper respiratory infection for 9 days. The nurse assistant reports that he has been incontinent of feces for the past 2 days. Analyze whether this matter should be investigated. 

A patient receiving a cholinesterase inhibitor may be treated in the hospital, nursing home, or in an outpatient setting. The patient s cognitive ability and functional... 

Ms. Palmer, age 88 years, is a resident in a nursing home. Her primary health care provider prescribes a thiazide diuretic for CHF. The nurse in charge advises you to evaluate Ms. Palmer for signs and symptoms of dehydration and hyponatremia. Discuss the assessment you would make. Identify which of these signs and symptoms might be difficult to evaluate considering the patient s age... 

Many UTIs are treated on an outpatient basis because hospitalization usually is not required. UTIs may be seen in the hospitalized or nursing home patient widi an indwelling urethral catiieter or a disorder such as a stone in the urinary tract. 

Ms. Howard, age 86 years, has Alzheimer s disease and is a resident in a nursing home. She has a UTI and is prescribed cinoxadn (Cinobac). Discuss specific nursing tasks to include in a nursing care plan for this patient. What potential problems could be anticipated because of the Alzheimer s disease What drugs might the primary care provider prescribe for the Alzheimer s disease ... 

Where did the error orcur (eg, hospital, outpatient or retail pharmacy, nursing home, patient s home) ... 

Many malodorous compoimds are not only nuisance, but also a health threat under prolonged exposure [1]. Ammonia (NH3) is emitted from landfill and sewage treatment plant and associated with many agricultural activities (e.g. poultry and piggery). Ammonia is also a problem in public toilets, hospitals and nursing homes. Selective eatalytie oxidation (SCO) can convert NH3 to N2 at mild temperature (i.e. 473-673 K) as shown in equation 1, however nitrous oxides (N2O) and nitrogen oxides (NOj) are often produced cf. Eqn. 2 3). 

Dementia imposes substantial medical, social, psychological and financial costs on patients, their families and friends, as well as on health and social services. The progressive nature of the illness and the ageing of the population mean that many people with dementia will require intensive support and/or long-term residential or nursing home care. 

Contact among patients, relatives, and staff in a nursing home/hospital... 

Calderon-Margalit, R., Sheffer, R., Halperin, T., Orr, N., Cohen, D., and Shohat, T. (2005). A large-scale gastroenteritis outbreak associated with Norovirus in nursing homes. Epidemiol. Infect. 133, 35-40. 

Grima, A., Gatt, A., Zahra, G., and Gambin, A. (2009). Outbreak of norovirus infection in a nursing home for the elderly in Malta, November - December 2008. Euro. Surveill. 14, 19103. 

Grmek Kosnik, I., Peternelj, B., Pohar, M., and Kraigher, A. (2007). Outbreak of norovirus infection in a nursing home in northern Slovenia, July 2007. Euro Surveill. 12, E071011.3. 

Schmid, D., Lederer, I., Pichler, A. M., Berghold, C., Schreier, E., and Allerberger, F. (2005b). An outbreak of Norovirus infection affecting an Austrian nursing home and a hospital. Wien. Klin. Wochenschr. 117, 802-808. 

TO, a 77-year-old male nursing home resident is admitted to the hospital with a 3-day history of altered mental status. The patient was unable to give a history or review of systems. On physical examination the vital signs revealed a blood pressure of 100/60 mm Hg, pulse 110 beats per minute, respirations 14/minutes, and a temperature of 101°F (38.3°C). Rales and dullness to percussion were noted at the posterior right base. The cardiac exam was significant for tachycardia. No edema was present. Laboratory studies included sodium 160 mEq/L (160 mmol/L), potassium 4.6 mEq/L (4.6 mmol/L), chloride 120 mEq/L (120 mmol/L), bicarbonate 30 mEq/L (30 mmol/L), glucose 104 mg/dL (5.77 mmol/L), BUN 34 mg/dL (12.14 mmol/L), and creatinine 2.2 mg/dL (194.5 pmol/L). The CBC was within normal limits. Chest x-ray indicated a right lower lobe pneumonia. 

Evaluate the clinical outcomes of treatment by using the UPDRS. In addition, periodically ask patients to record the amount of on and off time they have with and without dyskinesias in a diary. There are a variety of scales that can be used to assess QOL, depression, anxiety, and sleep disorders. Patients with PD cannot be cured but treatment can delay the progression of symptoms and improve QOL. Delaying the patient s admission into a nursing home is a good outcome. 

Delaying disease progression through pharmacotherapy can reduce the total cost of treating AD and delay nursing home placement. 

FIGURE 32-1. Projected increases in the population of patients with Alzheimer s disease, Medicare nursing home spending, and total Medicare spending. (Based on data from references 4 and 5.)... 

Osteoporosis is a disabling disorder with enormous impact. In addition to the initial pain associated with a new fracture, several adverse long-term complications can occur, including chronic pain, loss of mobility, depression, nursing home placement, and death. Patients with vertebral fractures may experience chronic pain, height loss, kyphosis, and decreased mobility... 

Patients with a history of recent antimicrobial use may have altered normal flora or harbor resistant organisms. If a patient develops a new infection while on therapy, fails therapy, or has received antimicrobials recently, it is prudent to prescribe a different class of antimicrobial because resistance is likely. Previous hospitalization or health care utilization (e.g., residing in a nursing home, hemodialysis, and outpatient antimicrobial therapy) are risk factors for the acquisition of nosocomial pathogens, which are often resistant organisms. 

Residence in a nursing home or extended-care facility... 

People who live in nursing homes and other long-term care facilities that house those with long-term illnesses... 

Hutt E, Kramer AM. Evidence-based guidelines for management of nursing home-acquired pneumonia. I Fam Pract 2002 51 709-716. 

Turning and repositioning the patient at least every 2 hours can reduce skin pressure and prevent pressure sores. However, because this level of care is unattainable in most hospital and nursing-home environments, multitudes of pressure-reducing mattresses have been manufactured. Although these can help to decrease pressure on susceptible areas, they do not negate the need for position changes.37,42... 

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