British journal of nursing (Mark Allen Publishing)
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Care of the older person has become more specialised in Ireland particularly since the introduction of national and international healthcare standards. In this regard, older people are receiving more evidence-based quality care when living in long-term healthcare facilities in Ireland. Assessment and management of falls is currently high on the quality agenda in terms of measuring quality outcomes. ⋯ Residential care nurses caring for older people in Ireland are required to demonstrate clinical competence when assessing and managing falls in the residential care setting. Healthcare legislation, policy and in-service education, occurring in both the public and private sector, require a multidisciplinary-team approach. This article addresses the nursing priorities regarding falls assessment and management strategies that residential nurses should consider when caring for the older person at risk of falling.
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Cauda equina syndrome is a surgical emergency that requires prompt assessment and swift surgical intervention. Compression of the cauda equina can result in loss of power and sensation to the lower limbs, back pain and loss of bladder and bowel function. Research regarding timing of surgery and surgical outcome continues to be debated. Nurses have an important role in recognising symptoms of cauda equina syndrome and supporting the patient and effectively managing care based on individual healthcare needs.
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Noisy breathing or death rattle is a common clinical sign in the final days of life. When it occurs, the level of consciousness is usually low and it is generally assumed that patients are not distressed by it. Despite the assumption that patients are not distressed, death rattle is usually actively treated in palliative care settings through a combination of pharmacological and non-pharmacological measures. ⋯ Moreover, anti-cholinergic drugs can result in unpleasant side-effects such as urinary retention and dry mouth for patients who are probably unable to report symptoms. Recent research calls for prescribers to consider carefully why they are treating death rattle. Moreover, families need to be reassured and have it explained to them that it is unlikely that the patient is distressed and why this is the case.