health maintenance in nursing home patients
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Management
- screening
- history & physical examination yearly
- required by regulations
- yield is debated; focused exam may be more appropriate
- weight monthly
- generally required by regulations
- persistent weight loss should prompt a search for treatable causes
- functional status assessment yearly
- includes balance & gait assessment
- mental status examination
- screen for depression
- generally done more frequently by nursing staff
- visual screening yearly
- acuity
- intraocular pressure
- auditory screening yearly
- dental screening yearly
- podiatry screening yearly
- more frequently in diabetics & patients with peripheral vascular disease
- tuberculosis
- at time of admission & yearly
- all residents & staff should be tested
- control skin tests & booster testing (2-step) generally recommended for nursing home patients
- laboratory testing yearly
- history & physical examination yearly
- monitoring
- all residents:
- vital signs & weight monthly
- more often if unstable or subacutely ill
- diabetics
- fasting & post-prandial glucose monthly
- hemoglobin A1c every 3 months
- patients on diuretics or with renal insufficiency
- chem 7 every 2-3 months
- nursing home residents are prone to dehydration, hyponatremia & hypokalemia
- patients receiving non-steroidal anti-inflammatory agents
- hemoglobin, creatinine & BUN every 2-3 months
- anemic patients with hemoglobin < 10 g/dL
- hemoglobin monthly until stable, then every 2-3 months
- therapeutic monitoring of specific drugs
- every 3-6 months, or more frequently when adjusting dose
- agents
- all residents:
- prevention
- influenza
- influenza vaccine yearly
- all residents
- staff with close resident contact
- oseltamivir within 24-48 hours of suspected outbreak of influenza A
- influenza vaccine yearly
- pneumococcal vaccine
- once & again after age 75
- aggressive dental care may reduce nursing home pneumonias 35-40%[3]
- tetanus booster
- every 10 years
- every 5 years with tetanus-prone wounds
- tuberculosis
- isoniazid 300 mg QD for 1 year + pyridoxine 25 mg QD
- skin test conversion in selected residents
- antimicrobial prophylaxis
- dental procedures
- genitourinary procedures
- most operative procedures
- chronically catheterized patients should not be treated with continuous antibiotic prophylaxis
- body positioning & range of motion for immobile patients
- frequent turning is necessary to prevent pressure sores
- semi-upright position to prevent aspiration
- range of motion to immobile limbs & joints to prevent contractures
- infection control & surveillance (ongoing)
- policies & protocols should be in effect in all nursing homes
- surveillance of all infections should be continuous to identify outbreaks & resistance patterns
- environmental safety
- appropriate lighting & colors
- removal of hazards for falling
- routine monitoring of potential safety hazzards & accidents
- influenza
More general terms
Additional terms
References
- ↑ Ouslander, JAMA 262:2582, 1989
- ↑ Ouslander JG, Osterweil D. Physician evaluation and management of nursing home residents. Ann Intern Med 120:584, 1994 PMID: https://www.ncbi.nlm.nih.gov/pubmed/8116998
- ↑ 3.0 3.1 Journal Watch 25(4):31, 2005 Quagliarello V, Ginter S, Han L, Van Ness P, Allore H, Tinetti M. Modifiable risk factors for nursing home-acquired pneumonia. Clin Infect Dis. 2005 Jan 1;40(1):1-6. Epub 2004 Dec 01. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15614684 Terpenning M. Prevention of aspiration pneumonia in nursing home patients. Clin Infect Dis. 2005 Jan 1;40(1):7-8. Epub 2004 Dec 01. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15614685