The American journal of nursing
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Depression is underrecognized in older adults, especially those with chronic conditions such as heart disease and arthritis. Left untreated, depression may progress and have dramatic effects on overall health. The Geriatric Depression Scale: Short Form is a 15-question screening tool for depression in older adults that takes five to seven minutes to complete and can be filled out by the patient or administered by a provider with minimal training in its use. The questions focus on mood; the score can help clinicians decide whether further assessment is needed. (This screening tool is included in a series, Try This: Best Practices in Nursing Care to Older Adults, from the Hartford Institute for Geriatric Nursing at New York University's College of Nursing.) For a free online video demonstrating the use of this tool, go to http://links.lww.com/A101.
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Fulmer SPICES is a framework for assessing older adults that focuses on six common "marker conditions": sleep problems, problems with eating and feeding, incontinence, confusion, evidence of falls, and skin breakdown. These conditions provide a snapshot of a patient's overall health and the quality of care. The SPICES assessment, done regularly, can signal the need for more specific assessment and lead to the prevention and treatment of these common conditions. For a free online video demonstrating the use of SPICES, go to http://links.lww.com/A100.
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The prevention and treatment of pain, anxiety, and delirium in the ICU are important goals. But achieving a balance between sedation and analgesia, especially in critically ill patients on mechanical ventilation, can be challenging. Both under- and oversedation carry grave risks. ⋯ Last month, Part 1 reviewed pertinent recommendations concerning pain and delirium and discussed tools for assessing pain, delirium, and sedation. This month, Part 2 explores pharmacologic and nonpharmacologic management of anxiety and agitation in the ICU. The second in a two-part series focuses on the pharmacologic and nonpharmacologic management of anxiety and agitation in the ICU.