Nursing care of the older adult
Elder mistreatment is defined as
"intentional actions that cause harm or create serious risk of harm to a vulnerable elder by a caregiver or other person who is in a trust relationship to the elder." - Types of elder mistreatment include physical abuse, emotional abuse, financial exploitation, sexual abuse, neglect (intentional and unintentional), and abandonment.
The way that older adults present themselves influences body image and feelings of isolation.
'Consequences of illness and aging that threaten an older adult's body image include invasive diagnostic procedures, pain, surgery, loss of sensation in a body part, skin changes, and incontinence. Nurses influence the older adult's appearance by helping with grooming and hygiene.
depression
-1/3 of older adults experience symptoms -Most common, yet most undetected and untreated impairment in older adulthood -Frequently co-occurs with stroke, dementia, Parkinson's, heart disease, cancer, and pain-provoking diseases like arthritis -Geriatric Depression Scale (GDS) has been tested and used extensively in older adults: 30-item yes/no about how they felt over past week -Clinical depression warrants prompt intervention and treatment
Most older adults are active and involved members of their communities.
-A smaller number have lost the ability to care for themselves, are confused or withdrawn, and/or are unable to make decisions concerning their needs. Most older adults live in noninstitutional settings. However, a smaller number have lost the ability to care for themselves. -Aging does not inevitably lead to disability and dependence. Most older people remain functionally independent despite the increasing prevalence of chronic disease.
delirium
-Acute confused state- potentially reversible -Cognitive impairment that often has a physiological cause -Physiological causes such as infection -May be caused by environment such as sensory deprivation, sleep deprivation or unfamiliar surroundings or stress -Delirium requires prompt assessment and intervention -Cognitive impairment usually reverses once cause treated
developmental tasks
-Adjusting to decreasing health and physical strength -Adjusting to retirement and reduced or fixed income -Adjusting to death of spouse, children, siblings, friends -Accepting self as aging person -Maintaining satisfactory living arrangements -Redefining relationships with adult children and siblings -Finding ways to maintain quality of life
myths and stereotypes about older adults
-As people age, they become more irritable and demanding -Old people are always sick and end up in nursing homes -Old people should just retire -Old people like to talk about their illnesses -Old people don't like change -Old people don't have sex or engage in sexual activity These myths and stereotypes suggest that older adults are ill, disabled, boring, unfriendly, unable to learn and understand new information, and not interested in sex or sexual activities. These myths and stereotypes also demonstrate ageism which is discrimination against people because of increased age.
it is important to
-Assess your own attitudes toward older adults, your own aging, and the aging of your family, friends, and patients -Form positive attitudes toward older adults -Learn about aging and the health care needs specific to the older adult population -Promote older adults' independence with their activities of daily living (ADL) -Nurses need to recognize and address ageism by questioning prevailing negative attitudes and stereotypes and reinforcing the realities of aging as they care for older adults in all care settings. -It is critical for you to learn to respect older adults and actively involve them in care decisions and activities.
Auditory changes are often subtle.
-Common change is presbycusis, which affects the ability to hear high-pitched sounds and conversational speech and is typically bilateral, -affecting more men than women. -Inspect the external auditory canal for the presence of cerumen.
elder mistreatment
-Complex and multifaceted -Elder may not reach out in fear -Nurses must screen (Elder Mistreatment form) and assess -"red flag" if caregiver refuses to leave -State law required reporting suspected abuse
gerontological nursing
-Comprehensive assessment take more time -Allow rest periods -Communication techniques depend on visual or hearing impairments -Provide culturally competent care -Recognize early indicators of an acute illness -Note changes in mental status, occurrence and reason for falls, dehydration, decrease in appetite, loss of function, dizziness, and ----incontinence
restorative care
-Continuation of recovery after acute illness or surgery and support of chronic conditions which affect day-to-day functioning -Promote return to independence -Include older adult in planning of restorative care measures if possible -Adapt to individual needs, i.e. pt. with dementia can physically do ADLs but may not have cognitive ability to perform safely
nursing interventions
-Correct underlying physiological alterations -Keep a routine; limit choices -Unconditional positive regard -Modify the environment -Compensate for sensory deficits -Encourage fluid intake -Drug interactions or reactions -Activate bed and chair alarms -Assist family caregivers
The fear of becoming dependent is overwhelming for an older adult who is experiencing functional decline as a result of aging.
-Educate older adults to promote understanding of age-related changes, appropriate lifestyle adjustments, and effective coping. Factors that promote the highest level of function include a healthy, well-balanced diet; paced and appropriate activity; regularly scheduled visits with a health care provider; regular participation in meaningful activities; use of stress-management techniques; and avoidance of alcohol, tobacco, or illicit drugs.
Malignant neoplasms are the second most common cause of death among older adults. Nurses educate older adults about early detection, treatment, and cancer risk factors.
-Encourage them to report nonhealing skin lesions, unexpected bleeding, change in bowel habits, nagging cough, lump in breast or another part of body, change in a mole, difficulty swallowing, and unexplained weight loss. - Nurses need to carefully distinguish between signs of normal aging and signs of pathological conditions.
dementia
-General impairment of intellectual functioning -Umbrella term includes -Alzheimer's disease and vascular dementia -Gradual, progressive, irreversible -Cognitive deterioration leads to a decline in ability to perform basic ADL (activities of daily living- bathing, toileting and dressing) and IADL (instrumental- writing checks, preparing meals)
variablility among older adults
-Great variations in physiological, cognitive, and psychosocial health -Vary widely in functional ability -Most remain independent -Aging does not inevitably lead to disability and dependence Key concept: chronological age often has little relation to the reality of aging for the older adult
heart and vascular system
-Hypertension is common but not normal change of aging and predisposes to heart failure, stroke, renal failure, CAD, PVD
Obtaining a complete assessment takes time; older adults have longer life and medical history. Allow rest periods; be sure to review prescribed and over-the-counter medications. Take into account vision and hearing constraints.
-If an older adult is unable to understand your visual or auditory cues, your assessment data will likely be inaccurate or misleading, leading you to incorrectly conclude that the older adult is confused.
extra notes on selecting a nursing home
-Nurses help older adults and their families by providing information and answering questions as they make choices among care options. Your assistance is especially valuable when patients and families need to make decisions about moving to a nursing center. -The best way to evaluate the quality of a nursing center in a community is for the patient and family to visit that facility and inspect it personally.
polypharmacy
-Older adults consume 31% of nation's prescribed drugs -Some drug classes have high likelihood of adverse effects in older adults: analgesics, antidepressants, antihistamines, antihypertensives, sedative-hypnotics, muscle relaxants -Have pts and family caregivers be sure one MD or NP knows all prescribed meds -If a new behavior or clinical change occurs, consider meds and consult MD or pharmacist In long-term care settings, med should be reviewed monthly -In long-term care settings meds may be prescribed without determining underlying causes of condition. Use nonpharmacological treatments when possible.
health promotion and maintenance
-Participation in screening (BP, Mammograms, Pap smears, depression, vision and hearing, colonoscopy) -Regular exercise -Weight reduction if overweight -Eating a low-fat, well-balanced diet -Moderate alcohol use -Regular dental visits -Smoking cessation -Immunizations
physiological changes
-Physiological changes are normal -The changes are not always pathological but may make older adults more vulnerable to some clinical conditions and diseases -Some adults experience all of these changes and others only a few An initial inspection reveals if eye contact and facial expression are appropriate to the situation and if universal aging changes (e.g., facial wrinkles, gray hair, loss of body mass in the extremities, an increase of body mass in the trunk) are present.
Visual acuity declines with age. This is often the result of retinal damage, reduced pupil size, development of opacities in the lens, or loss of lens elasticity.
-Presbyopia, is common. -Glare effects increase. -Pupils are smaller and react slower. -Difficulty with going from bright to dark environments. -Changes in color vision makes it difficult to distinguish between blue and green. -Diseases include cataract, macular degeneration, diabetic retinopathy, and retinal detachment.
functional status
-Refers to capacity and safe performance of ADLs (bathing, dressing, toileting) and IADLs (writing checks, preparing meals, making phone calls) essential to independent living -Sensitive indicator of health or illness -Sudden change often signals onset of acute illness or worsening of chronic condition -Nurses intervene to maintain, restore, and maximize while preserving dignity! -Hospital Admission Risk Profile (HARP) can identify patients at risk for functional decline during and after acute hospital admission
dehydration and malnutrition
-Risk due to limiting intake due to tests and meds that decrease appetite -Risk increases when unable to reach beverages -Interventions include- getting the patient out of bed, offer fluid and food frequently, and including favorite foods and beverages
acute care setting: delirium
-Risk for delirium increases with immobilization, sleep deprivation, infection, dehydration, pain, sensory impairment, drug interactions, anesthesia, and hypoxia -Other causes- unfamiliar surroundings, staff, bed rest, separation from family, stress and impaired vision or hearing contributes to confusion and attempts to reorient -Interventions- family visits, memory cues, compensate for sensory deficits
HAIs
-Risk for health care-associated infection is associated with age-related reduction in immune system response -CAUTIs most common Others include- surgical site, pneumonia, and bloodstream infection Prevention- Hand hygiene #1 Increased risk for health care-associated infections in older adults is associated with age-related reductions in immune system responses.
skin
-Risk for skin breakdown and development of pressure ulcers is related to changes in aging skin and to immobility, incontinence and malnutrition -Prevention is key- avoid pressure, proper positioning, reduce shearing and friction, skin care, moisture management and nutrition support
incontinence
-Risk for transient incontinence due to delirium, untreated UTI, medications, restricted mobility or need for assistance -Interventions include - provide voiding opportunities, access to toilet -Avoid catheters
smooth, brown, irregularly shaped spots (age spots or senile lentigo) initially appear on the backs of the hands and on forearms.
-Small, round, red or brown cherry angiomas occur on the trunk. -Seborrheic lesions or keratoses appear as irregular, round or oval, brown, watery lesions. -Years of sun exposure contribute to the aging of the skin and lead to premalignant and malignant lesions. Rule out these three malignancies related to sun exposure when examining skin lesions: melanoma, basal cell carcinoma, and squamous cell carcinoma.
Many older adults have witnessed...
-The adventures of the international space station -Electricity and nuclear power replacing gaslights and steam power -Computers and copier machines replacing typewriters and carbon paper -The many changes in health care and the uncertainty of the future of Social Security and Medicare
Because of changes in the musculoskeletal system, the configuration of the thorax sometimes changes
-Vertebral changes caused by osteoporosis lead to dorsal kyphosis, the curvature of the thoracic spine. - Calcification of the costal cartilage causes decreased mobility of the ribs. -The chest wall gradually becomes stiffer. -- Lung expansion decreases, and the person is less able to cough deeply. If kyphosis or chronic obstructive lung disease is present, breath sounds become distant. Older adult is more susceptible to pneumonia and other bacterial or viral infections.
dealing with hearing and visual issues
-When a person has a hearing impairment, speak directly to the patient in clear, low-pitched tones and move to a quiet area to reduce background noise. -When caring for people with visual impairments, sit or stand at eye level and face them. Always encourage the use of assistive devices such as glasses and hearing aids.
Studies of alcohol abuse in older adults report two patterns:
-a lifelong pattern of continuous heavy drinking and a pattern of heavy drinking that begins late in life. The continuum of interventions ranges from simple education about risks to formalized treatment programs that include pharmacotherapy, psychotherapy, and rehabilitation.
Cigarette smoking is a risk factor for the four most common causes of death:
-heart disease, cancer, lung disease, and stroke. -If a patient rejects smoking cessation, suggest at least a reduction in smoking. Set a quit or reduction date and a follow-up visit with the older adult to discuss the quit attempt.
thorax and lungs
-kyphosis -Calcification of the costal cartilage causes: Stiffer chest wall Lung expansion decreases Less able to cough Susceptible to pneumonia and other bacterial or viral infections
early indications of acute illness
1. Mental status changes- drug related or disease process 2. Falls- environmental/symptom of new-onset 3. Dehydration - decreased intake r/t reduced thirst response 4. Decrease in appetite- common with pneumonia, heart failure and UTI 5. Loss of function- subtle vs sudden
Therapeutic communication skills enable you to perceive and respect the older adult's uniqueness and health care expectations. Attentive nurses provide care in a timely fashion, meeting a patient's expressed or unexpressed needs.
A caring nurse expresses attitudes of concern, kindness, and compassion. Knowledgeable nurses not only demonstrate procedural competence but recognize needs and relay information skillfully.
nurses encounter older adults in a variety of settings
Acute care hospital Long-term acute care Rehabilitation hospital Home Retirement communities Adult day care centers Assisted Living Skilled Nursing Facilities
Neurotransmitters, chemical substances that enhance or inhibit nerve impulse transmission, change with aging as a result of the decrease in neurons
All voluntary reflexes are slower, and individuals often have less of an ability to respond to multiple stimuli. Sleeping difficulties occur.
Dementia is characterized by a gradual, progressive, irreversible cerebral dysfunction. It interferes with social and occupational activities and is an umbrella term for many conditions, including Alzheimer's
Assess carefully to rule out the presence of delirium whenever you suspect dementia. Nurses should consider the safety and physical and psychosocial needs of the older adult and the family. Individualize nursing care to enhance quality of life and maximize functional performance by improving cognition, mood, and behavior.
cognitive status
Common misconception about aging and cognitive impairments Forgetfulness, disorientation, loss of language skills, poor judgment, lack of ability to calculate are NOT normal changes and should be explored for underlying causes Delirium, dementia, and depression are conditions that affect cognition There are standard assessment forms for determining a patient's mental status, including the Mini-Mental State Exam-2 (MMSE-2), the Mini-Cog, and the Clock Drawing Test. .
Screen for elder mistreatment and assess for physical and emotional signs of abuse.
Complete the interview and assessment privately away from the caregiver. Some states require mandatory reporting.
Neurological System
Decrease in # and size of neurons begins in mid 20s Neurotransmitters that affect nerve impulse transmission change as neurons decrease Decreased velocity of nerve impulses Voluntary reflexes are slower Less of an ability to respond to multiple stimuli Alterations in sleep-wake cycle result in difficulty falling asleep, staying asleep, waking too early and excessive daytime napping
The physical and psychosocial aspects of aging are closely related. A reduced ability to respond to stress, the experience of multiple losses, and the physical changes associated with normal aging combine to place people at high risk for illness and functional deterioration.
Do not assume that all older adults have signs, symptoms, or behaviors representing disease and decline or that these are the only factors you need to assess.
It is important to assess both the nature of the psychosocial changes that occur in older adults as a result of life transitions and the loss and the adaptations to the changes.
During your assessment ask how an older adult feels about self, self in relation to others, and self as one who is aging and which coping methods and skills have been beneficial.
key concept
Every older adult is unique We will make generalizations about the aging process and its effect on individuals
All patients are screened for fall risk in the hospital.
Falls are a measure of quality at hospitals, in that the hospital's performance may be measured by the number of falls. It is EVERYONE's responsibility to prevent falls.
preventing falls
Falls risk assessment Offer frequent toileting Well lighted area Non-skid footwear Call bell within reach and remind No clutter Alarms Assistive devices Up with assist Toilet near by Bed in low position Answer call be promptly Reorient Assess frequently
Salivary secretion is reduced, and taste buds atrophy and lose sensitivity.
Health conditions, treatments, and/or medications often alter taste. It is often a challenge to promote optimal nutrition in an older patient because of the loss of smell and changes in taste.
addressing health concerns
Heart disease Cancer Stroke Smoking Alcohol abuse Nutrition Dental problems Exercise Falls Sensory impairments Pain Medication use
risk factors for falls
Hx Falls Impaired vision Postural hypotension or syncope Mobility impairments Gait and balance Alterations in bladder function Cognitive impairment, agitation, confusion Adverse med reactions Slowed reaction times Deconditioning Poor lighting Slippery flooring Items on floor Furniture placement Sidewalks and stairs in poor repair Inappropriate footwear Unfamiliar environment Improper use of assistive devices Side effects of meds equipment
Pay attention to the exercise regimen, wound care regimen, medication schedules, vital signs monitoring, and blood glucose monitoring.
Include the patient and family members. The aim is to stabilize their condition while promoting health and independence.
Acceptance of personal aging does not mean retreat into inactivity, but it does require a realistic review of strengths and limitations.
Need to cope with retirement, residence change, and death of loved ones. All require an extended period of adjustment, during which assistance and support from health care professionals, friends, and family members are necessary. Deaths represent both losses and reminders of personal mortality. Coming to terms with them is often difficult. By helping older adults through the grieving process.
gerontology research
Negativity among healthcare providers can affect the quality of care Noninstitutionalized assess their health excellent or very good Centenarians- optimistic, good memories, and social Life long learners- need to use principles for promoting older-adult learning (creates bias)
it is important to recognize early indicators of acute illness in older adults.
Note changes in mental status, occurrence and reason for falls, dehydration, decrease in appetite, loss of function, dizziness, and incontinence because these symptoms are not frequently present in younger adults. -Mental status changes commonly occur as a result of disease and psychological issues.
Cerebrovascular accidents (CVAs) are the fourth leading cause of death in the United States and occur as brain ischemia or brain hemorrhage.
Nursing interventions ranges from teaching older adults about risk-reduction strategies to teaching family caregivers the early warning signs of a stroke and ways to support a patient during recovery and rehabilitation.
Although we essentially screen all of our patients for safety, the elderly are especially vulnerable.
One idea is to accompany client to a test or ask the caregiver to leave in order to provide privacy for exam ANY suspected case MUST be reported according to state law
selecting a nursing home
Patients and families will often ask nurses What we need to know to assist them First consult case management But advise them Find out if Medicare and Medicaid certified Suggest they go visit and ask facility about Visitation policy, socialization, daily plan of care, resources
The psychosocial stresses of retirement are usually related to role changes with a spouse or within the family and to loss of the work role. Preretirement planning is an important advisable task.
People who plan in advance for retirement generally have a smoother transition. Retirement also affects the spouse, adult children, and even grandchildren. In the adjustment to retirement an older adult has to develop a personally meaningful schedule and a supportive social network. Factors that influence a retired person's satisfaction with life are health status and sufficient income.
head and neck
Presbyopia- decreased ability to accommodate from near to far vision Presbycusis- age-related change in auditory acuity, affects ability to hear high-pitched sounds Cataracts-loss of transparency of the lens Altered taste and smell changes-nutrition problem
Falls are complex and often cause injury. You need to investigate every fall carefully to find out if it was the result of environmental causes or the symptom of a new-onset illness.
Problems with the cardiac, respiratory, musculoskeletal, neurological, urological, and sensory body systems sometimes present with a fall as a chief symptom of a new-onset condition.
Validation therapy is an alternative approach to communication with a confused older adult.
Reality orientation insists that the confused older adult agree with your statements of time, place, and person; validation therapy accepts the description of time and place as stated by the confused older adult. Validation does not involve reinforcing the older adult's misperceptions; it reflects sensitivity to hidden meanings in statements and behaviors.
A common misconception about aging is that cognitive impairments are widespread among older adults.
Reduction in the number of brain cells, deposition of lipofuscin and amyloid in cells, and changes in neurotransmitter levels occur in older adults both with and without cognitive impairment.
Symptoms of cognitive impairment, such as disorientation, loss of language skills, loss of the ability to calculate, and poor judgment, are not normal aging changes and require you to further assess patients for underlying causes.
Remember that forgetfulness is an expected symptom of aging, but confusion is not.
psychosocial
Retirement Social isolation Sexuality Housing and environment Death/loss -When assessing these five changes, make sure to also assess older adults' family situation, intimate relationships, past and present occupations, finances, housing, social networks, normal activities, health and wellness, and spirituality.
just a few of the complex thought processes involved in selecting, understanding, and using health-related information about medications
Retrieving prescriptions and referrals, selecting providers from a list of names and addresses, calculating when to take multiple medications, interpreting medical terminology, comparing different insurance plans, and sifting through the myriad of health-related information available in magazines, on the Internet, and on television
The body tries to compensate for decreased cardiac output by increasing the heart rate during exercise; takes longer for an older adult's rate to return to baseline
Systolic and/or diastolic blood pressures are sometimes abnormally high. Although a common chronic condition, hypertension is not a normal aging change and predisposes older adults to heart failure, stroke, renal failure, coronary heart disease, and peripheral vascular disease.
Many older adults have lived through...
The Great Depression of 1929 Korean War 1950-1953 Vietnam War 1959-1975 Persian Gulf War 1990-1991 Terrorist attacks on September 11, 2001 War on terrorism 2001-present
Memory deficits, if present, affect the accuracy and completeness of your assessment; may need to enlist help of family member or caregiver.
The additional person supplements information with the consent of the older adult, but the older adult remains the primary source of the interview. Provide culturally competent care.
psychosocial health concerns
Therapeutic communication Touch Reality Orientation Validation Therapy Reminiscence Body-Image Interventions Elder mistreatment
Older adults have to deal with the death of family, friends, and their spouse. Nurses need to help them cope with loss.
They are concerned with being a burden, experiencing suffering, being alone, and the use of life-prolonging measures. Nurses should have knowledge of the grieving process, excellent communication skills, understanding of legal issues and advance care planning, familiarity with community resources; and awareness of one's own feelings, limitations, and strengths as they relate to care of those confronting death.
Classic S/S of disease are absent, blunted, or atypical in elders
This is due to age-related changes in organ systems and homeostatic mechanisms, loss of physiologic and functional reserves, coexisting acute or chronic conditions Examples: 1. UTI- confusion, incontinence, elevation of temp within normal limits 2. Pneumonia- Tachycardia, tachypnea, confusion, decreased appetite and functioning 3. MI- Sudden onset dyspnea, anxiety, confusion Signs and symptoms normally seen with disease processes may not present as they would in the elderly. This is why it is highly important to perform a thorough assessment and know your patient in order to detect suptle changes
Decrease in appetite is a common symptom with the onset of pneumonia, heart failure, and urinary tract infection (UTI).
Thyroid disease, infection, cardiac or pulmonary conditions, metabolic disturbances, and anemia are common causes of functional decline. Nurses play an essential role in early identification, referral, and treatment of health problems.
A sudden change in function with ADLs is often a sign of onset of an acute illness or worsening of a chronic illness.
When planning and implementing care for older adults, you will want to develop interventions aimed at maintaining, restoring, or maximizing their functional status, while maintaining independence and preserving dignity.
Nursing assessment provides valuable clues to the effects of a disease or illness on a patient's functional status.
When you assess older adults, you will need to identify their strengths, weaknesses, and abilities when developing a plan of care. -identify an older adult's strengths and abilities during the assessment and encourage independence as an integral part of your plan of care
With aging the skin loses resilience and moisture. The epithelial layer thins, and elastic collagen fibers shrink and become rigid.
Wrinkles of the face and neck reflect lifelong patterns of muscle activity and facial expressions, the pull of gravity on tissue, and diminished elasticity. Spots and lesions are often present on the skin.
In the U.S. social policy defines old age as beginning at
age 65. People who are 65 years old are in the lower boundary for "old age" in demographics and social policy within the United States. However, many older adults consider themselves to be "middle-age" well into their seventh decade. Chronological age often has little relation to the reality of aging for an older adult. Each person ages in his or her own way. Every older adult is unique, and as a nurse you need to approach each as an individual. America is aging. The number of older adults in the United States is growing, both absolutely and as a proportion of the total population. There has been a 21% increase in the older adult population since 2002. Part of this increase is caused by the increase of the average life span. The aging of the baby-boom generation and the growth of the population segment older than 85 years contribute to the projected increase in the number of older adults. When caring for this group of patients, nurses must consider cultural, ethnic, and racial diversity. The challenge is to gain new knowledge and skills to provide culturally sensitive and linguistically appropriate care.
presbycusis
age-related change in auditory acuity, affects ability to hear high-pitched sounds
The increased risk for skin breakdown and the development of pressure ulcers is related to changes in
aging skin and to situations that occur in the acute care setting such as immobility, incontinence, and malnutrition
Restorative care measures focus on activities that
allow older adults to remain functional within their living environments. Collaborate with an older adult to establish priorities of care and patient goals, determine expected outcomes, and select appropriate interventions.
The facial features of an older adult sometimes become more pronounced from loss of subcutaneous fat and skin elasticity;
appear asymmetrical because of missing teeth or improperly fitting dentures.
The increased risk for skin breakdown and the development of pressure ulcers is related to
changes in aging skin and to situations that occur in the acute care setting such as immobility, incontinence, and malnutrition
Restorative nursing interventions stabilize
chronic conditions, promote health, and promote independence in basic and instrumental activities of daily living.
The extent of an older adult's ability to live independently influences housing choices. The goal of your assessment of a patient's environment is to
consider resources that promote independence and functional ability. -Assess their activity level, financial status, access to public transportation and community activities, environmental hazards, and support systems. -When helping patients consider housing, plan for the future. -The environment supports or hinders physical and social functioning, enhances or drains energy, and complements or taxes existing physical changes such as vision and hearing. --------Furniture needs to be comfortable and safe.
Causes of incontinence include
delirium, untreated urinary tract infection, medications, restricted mobility or need for assistance to get to the bathroom, and constipation or stool impaction.
Delirium is potentially a reversible cognitive impairment that often has a physiological cause, which can include
electrolyte imbalances, untreated pain, infection, cerebral anoxia, hypoglycemia, medication effects, tumors, subdural hematomas, and cerebrovascular infarction or hemorrhage. -May accompany systemic infections, pneumonia, or UTI. -----May also be caused by sensory deprivation or overstimulation, unfamiliar surroundings, or sleep deprivation or psychosocial factors such as emotional distress. -It is possible for delirium and dementia to occur at the same time. The presence of delirium is a medical emergency and requires prompt assessment and intervention.
Thoughtful assessment and planning lead to
goals of care that consider the influence of normal aging changes, facilitate an optimal level of comfort and coping, and promote independence in self-care activities.
The risk for delirium increases when hospitalized older adults experience
immobilization, sleep deprivation, infection, dehydration, pain, sensory impairment, drug interactions, anesthesia, and hypoxia.
presbyopia
impaired vision as a result of aging- decreased ability to accommodate from near to far vision
There are standard assessment forms for determining a patient's mental status,
including the Mini-Mental State Exam-2 (MMSE-2), the Mini-Cog, and the Clock Drawing Test.
The cause of a fall is typically multifactorial and composed of
intrinsic or extrinsic factors.
The number of older adults in the US
is growing. Nurses need to approach each older adult as an individual.
All older adults, whether healthy or frail, need to express their sexual feelings. Sexuality involves love, warmth, sharing, and touching, not just the act of intercourse.
knowing an older adult's sexual needs allows you to incorporate this information into the nursing care plan. Not all nurses feel comfortable counseling older adults about sexual health and intimacy-related needs. Be prepared to refer older adults to an appropriate professional counselor.
Each older adult is unique and chronological age often has
little to do with the reality of aging for each older adult.
Reality orientation is a communication technique that
makes an older adult more aware of time, place, and person.
Depression is the most common, yet most undetected and untreated, impairment in older adulthood. Suicide in older adults accounts for 20% of all suicides. Treatment includes
medication, psychotherapy, or a combination of both. Electroconvulsant therapy (ECT) is sometimes used for treatment of resistant depression when medications and psychotherapy do not help. White men, age 85 and older, have the highest suicide rate in the U.S.
The purposes of reality orientation include
restoring a sense of reality; improving the level of awareness, promoting socialization; elevating independent functioning; and minimizing confusion, disorientation, and physical regression. The key elements of reality orientation include frequent reminders of person, place, and time; the use of familiar environmental aids such as clocks, calendars, and personal belongings; and stability of the environment, routine, and staff.
integumentary system
senile lentigo (age spot) Cherry angiomas- Years of sun exposure contribute to premalignant and malignant lesions
Touch provides
sensory stimulation, induces relaxation, provides physical and emotional comfort, orients the person to reality, shows warmth, and communicates interest.
Social isolation can occur voluntarily or involuntarily. The nurse assess patients' potential for social isolation by identifying their
social network, access to transportation, and willingness and desire to interact with others. Outreach programs are available, including Meals on Wheels, daily telephone calls, and volunteer opportunities.
Older adults are at greater risk for dehydration and malnutrition during hospitalization because of
standard procedures such as limiting food and fluids in preparation for diagnostic tests and medications that decrease appetite.
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in those 65 and older.
tobacco smoke is a key factor in the development and progression of COPD. It is important to provide patients with information about quit smoking programs. Teach proper exercise, how to use inhalers, techniques for the removal of mucus from the airways, and exercise training.
Heart disease is the leading cause of death in older adults, followed by cancer, chronic lung disease, and stroke. Common cardiovascular disorders are hypertension and coronary artery disease. Nursing interventions for hypertension and coronary artery disease address...
weight reduction, exercise, dietary changes, limiting salt and fat intake, stress management, and smoking cessation. Patient teaching also includes information about medication management, blood-pressure monitoring, and the symptoms indicating the need for emergency care.
increased risk for health care-associated infections in older adults is associated
with age-related reductions in immune system responses.
