Janice T Hoff

Frailty is a life-limiting medical syndrome associated with morbidity and mortality in older adults. The concept of frailty as a syndrome adds to our knowledge of aging and helps to expand the identification of risk factors and interventions to reduce disability and improve outcomes. Early identification through the use of validated risk assessment tools and targeted management of the frailty state in older adults is clinically important for nurse practitioners. Primary care and specialty care nurse practitioners are optimally positioned to facilitate comprehensive assessment and management of this evolving phenomena in the care of older adults.

Diabetes management continues to present challenges in the long-term care setting. Hypoglycemia, poor glycemic control, and high costs are associated with use of sliding-scale insulin. Evidence supporting the use of basal insulin in combination with prandial bolus and or oral agents is now available, but actual guidelines for practice are lacking for long-term care residents. Best practices are essential to achieve glycemic control and reduce costs associated with diabetes and diabetic complications in the elderly long-term care resident. A basal-bolus insulin regimen is presented that can improve management of diabetes and be cost-effective.

Purpose: To present an overview of the prevalence of genital herpes in older women and to present case studies of older women diagnosed with genital herpes in a geriatric practice in the southeastern United States.

Data sources: Review of current scientific literature and treatment/practice guidelines. Specific descriptive cases are reviewed to illustrate the clinical problem.

Conclusions: Genital herpes is an important differential diagnosis to include when assessing and treating older women for recurrent genital symptoms.

Implications for practice: Given the large numbers of older individuals potentially infected with genital herpes, the nurse practitioner (NP) is well positioned to accurately diagnose and initiate treatment that can improve quality of life. The NP’s skill in education and counseling is essential to the ongoing management of genital herpes infections.

The purpose of this chapter is to provide practical information and the useable tools necessary for the professional nurse to be instrumental in the diagnosis of cancer. The information presented is meant to assist the nursing professional in identifying clinical and psychosocial issues faced by the patient and family when a cancer diagnosis is made.Skill in this area is essential in promoting a confidence level for professionals as they work with this population.

It is critical that direct efforts be made at the time of admission to focus on planning and providing adequate and continuous care before the patient is discharged. Health care professionals today are challenged to use the changes affecting hospital stays positively and move toward making the transition from the hospital to the community a high-quality, cost-effective, patient-centered process. This challenge was the impetus behind a plan to integrate the various disciplinary approaches to discharge planning already in place at West Florida Regional Medical Center (Pensacola) into a more organized process. Each nursing unit would establish a multidisciplinary team specific to its service and meet weekly to implement appropriate discharge planning. The discharge planning rounds were found: 1. to improve productivity, 2. promote more effective communication among health care team members, 3. decrease duplication of work, and 4. facilitate more efficient discharging.