Patients at high risk of malnutrition include those who have recently been discharged from hospital, those with chronic diseases, progressive neurological disease, acute illness, frailty, social issues, undergoing rehabilitation or end of life/palliative care (Holdoway et al, 2017). Community nurses are often the first-line of care for these patients and can play an important role in ensuring that they get the best nutritional care. This article discusses some of the areas for consideration when assessing malnutrition risk and outlines a number of new resources designed to assist nursing teams in identifying, monitoring and managing patients at risk of malnutrition.
This series has addressed the treatments for psoriasis as advised by
the National Institute for Health and Care Excellence (NICE, 2017). This condition affects between 1.3-2.2% of the population (Parisi et al, 2011). It is recognised that psoriasis can have a significant impact on mood, mental health, poor lifestyle choices (Cohen et al, 2016; Landriscina et al, 2016), reduced activities of daily living, and is linked with other comorbidities, such as diabetes (Armstrong, 2013) and cardiovascular disease (Rutter et al, 2016). NICE developed a treatment pathway, advising bland emollients, topical treatments, phototherapy, systemic medications and systemic non-biological and biologic therapy. In recent years, the latter options have increased dramatically. This article focuses on the more traditional systemic
treatments, as advised by NICE.
Nutritional intake can have an effect on many areas of a patient’s health, while malnutrition specifically has a recognised role in pressure ulcer development. In this article, the author looks at whether there is any high quality evidence to recommend specific nutritional measures when trying to prevent pressure ulcers, as well as looking at overall recommendations for malnourished patients. Nutritional screening remains essential to help identify those patients most at risk of malnutrition and allows community nurses to prepare nutritional care plans and begin to correct any nutritional deficiencies. The author recommends that community nurses perform nutritional screening at any patient contact, be that in hospital, nursing home or in the patient’s
own home. Recording the outcome of screening at regular intervals also helps to identify trends in a patient’s nutritional state and means that any reduction will be picked up quickly.
The relationship between smoking and respiratory disease has long been established and smoking is recognised as a risk factor for chronic obstructive pulmonary disease (COPD) (Fletcher and Peto, 1977), lung cancer (Doll et al, 2004) and interstitial lung diseases (Bradley et al, 2008), as well as contributing to the symptoms of asthma (Siroux et al, 2000). However, when working with patients who have lived with their disease for some time, or who may feel it is too late to benefit from change, it is important to do more than simply reiterate the risks. The link between continued smoking, progression of respiratory disease, exacerbation of the condition and the detrimental effects of continued smoking on the efficacy of some treatments should also be communicated. This article looks at the risks of smoking, as well as providing guidance for community nurses on how to bring up the topic with their patients in a non-confrontational manner.
Meticillin-resistant Staphylococcus aureus (MRSA) colonisation can lead to invasive infection and subsequently harm to patients. The prevalence of MRSA within care homes is poorly understood and, thus, the benefits of implementing a decolonisation regimen across a number of care homes was previously unknown. However, the MRSA prevalence surveillance outlined in this article showed that by proactively identifying MRSA carriers and decolonising residents, levels of MRSA fell from 10.2% in the first prevalence, to 6.8% in the second. The authors concluded that this simple strategy has the potential to reduce MRSA burden and patient harm.
Chronic obstructive pulmonary disease (COPD) is a serious, long-term and irreversible disease, which obstructs airflow to the lungs due to inflammation of the air passages and lung tissue damage. The most debilitating and frightening symptom is breathlessness, which can affect an individual's ability to walk, exercise, work, socialise, sleep and eat, thus having a major impact on all activities of daily living. This article aims to provide an overview of COPD to facilitate a general understanding of the disease, assist community nurses with early identification for prompt
detection and highlight the pathways and management options available. Due to its complexity, COPD can be challenging for both patients and healthcare professionals, thus the earlier it is diagnosed and management plans started, the sooner its progression can be slowed and any impact reduced.
This article examines malnutrition, a complex issue that has wideranging implications in terms of patient experience and resources - evidence suggests that malnourished people are repeat attendees at GP surgeries, incur higher prescription costs and experience twice as many hospital admissions than well-nourished people. While there have been many hospital initiatives targeted at reducing the risks of malnutrition, in the community the solution remains challenging. Recommendations include arranging services so that health and social care professionals can work together to overcome nutrition issues, making extra resources available to combat malnutrition and improving the monitoring of patients' nutritional state. As healthcare shifts to a more community-based model, there needs to be a reallocation of resources from hospitals to community to ensure that efforts to tackle malnutrition have a more realistic chance of success.
Health visitor, Amanda Wildbore reviews a case study of a woman who gave birth only to find that the baby had contracted the sexually transmitted disease chlamydia and looks at how this distressing scenario might have been avoided.
Amanda Wildbore, RGN, RHV, FPCert, BSc Hons is a Healthworker, Youth Offending Team, Trafford NHS Healthcare Trust, Sale.
Article accepted for publication August 2001
Amira Obeid reviews the case study of a 67-year-old man with diabetic retinopathy.
Amira Sarah Obeid MSc, BSc (Hons), RGN, RM, RHV, DPS: N(CHS), FETC, FPCert, DipCHD, CIDC is an Advanced Nurse Practitioner, Lordswood Surgery, Birmingham. At the time of writing she was an Advanced Nurse Practitioner at the Black Country Family Practice, Tipton. Article accepted for publication: June 2002
