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Nurs 1110 Care of the Older
ClientNancy Pares, RN, MSN
Metropolitan Community College Nursing Program
Most definitions= having lived a long time Aged: old or advanced in years Aging: process of growing older
We all age: not all are old in years, roles, behaviors, health or physical limitations
Aging is an ongoing developmental process that begins with conception and ends with death
Definitions of Old Age
Study of aging
Geriatrics◦ The biomedical science of old age and the
application of knowledge related to the biological, biomedical, behavioral, and social aspects of aging to the prevention, diagnosis, treatment, and care of the older persons.
Gerontology
Clinical: older adult age 65 or older Older-old adults: age 85 or older
◦ 1996 33.2 million over 65, 3.8 million >85◦ 2010-2030: baby boomers reach old age
Three generations are affected by aging◦ Parents, grandparents, great grandparents
Terminology of Today
Systematic stereotyping and discrimination Allows for separation and denial of the older
person’s humaness Allows those who practice ageism to
distance themselves from their own aging
Ageism
Socioeconomic and cultural factors◦ Roles: jobs, empty nest, spouse dies◦ Personal relationships: children live away, friends
die◦ Health: > chronic illness, ‘slow down’◦ Agility: flexibility, CNS reactions slow◦ Financial: medicare, fixed income◦ Employment: must retire◦ Independence: loss
Aging Process
Non productive Disengaged Inflexible Senile Not able to learn new things Retirement causes death Sexless Poor, disabled, ill…..
Myths of aging
Think about movies you have seen….
Think about an older relative
Visualize magazine pictures of the ‘50’s and compare to present
Describe an older adult
In the absence of disease, most aged are alert with full functional capability
Modest impairments in memory and learning after the age of ___?__ in people free of major disease.
Short term memory, progressive slowing of responses
Nervous system
Long term memory remains intact◦ Dependent on adequate O2 perfusion
May not remember planned daily activities—easily recalls childhood
Mild cognitive impairment (MCI)◦ 40% will develop Alzheimer’s disease within 3
years
Nervous system
Strategies to cope◦ Mnemonics◦ Behavioral memory training
Temperature regulation◦ Low tolerance to ______
Pain perception and tactile perception◦ Some research have found dulling, but these
results are not consistent
Nervous system
If acute disease is causing delirium, re-orient client
Depression◦ Assess and provide for treatment◦ Suicide rate high in elderly population
Assess for TIA Monitor BP Medicate as ordered
CNS interventions
Forced vital capacity, vital capacity and max breathing capacity decreases with age◦ Atrophy of muscles◦ Increase in diameter of chest◦ Vertebral loss of calcium◦ Calcification of costal cartilage
Respiratory
Loss of elastic tissue around alveoli and alterations in pulmonary circulation---decreased diffusion across the alveolar capillary membrane
Pulmonary blood flow◦ Decreases due to reduction in cardiac output
Respiratory
Exertional dyspnea◦ Shortness of breath with exertion◦ Ability to perform prolonged strenuous work
decreases with aging Lung disease
◦ Poses a threat to older adult◦ Pulmonary secretions are handled less effectively
Respiratory
Pneumonia vaccine Influenza vaccine Avoid distended bowel/bladder or
stomach Allow adequate time for cares Medications as needed Adequate hydration Lung sounds
◦ Proper breathing patterns-pursed lip breathing for COPD
Respiratory nursing interventions
Blood flow resistance increases as people age
Aging results in sclerosis of the endocardium
Heart becomes rigid-contractility impaired
Cardiovascular
Coronary blood flow reduced by 35% Valvular rigidity results in murmurs Heart cells have decreased capacity to use
oxygen Pulse increases and the pulse pressure
widens
Cardiovascular
Decrease in resting cardiac output◦ Amount of blood pumped each minute◦ Between age 25 and 65 the resting CO falls 30-
40%◦ Cerebral blood flow is maintained, but other body
systems receive a diminished blood supply
Cardiovascular
Peripheral vascular disease (PVD) Hypertension Chronic CHF (congestive heart failure)
Common CV problems
Assess peripheral pulses Evaluate lifestyle factors Teach about disease and treatment Evaluate diet Evaluate need for fluid restrictions Teach about BP monitoring Monitor BUN and creatine Teach about need for exercise
General nursing interventions
Decrease in function, cell mass and increase in extracellular fluid
Decrease in filtration rate, plasma flow rate, tubular reabsorption and secretion
Blood urea nitrogen (BUN) increases Ability to concentrate or dilute urine is
diminished Bladder capacity reduces by half
Renal
Response to the stretch receptors in the bladder wall that signal need to void may be delayed until the pressure is high
Lax muscle tone may lead to incomplete emptying◦ Residual volume may lead to UTI
Renal
Assessment for bladder management Peri care MD referral for treatment options Allow voicing of concerns Do not allow self limitation of fluids
Renal nursing interventions
Skin changes can be the most distressing Dryness, loss of elasticity, uneven
pigmentation Wrinkles
◦ Occurs when deep layer of skin loses moisture and elasticity
◦ Can be determined by genetics and sun exposure
Integumentary
Certain ethnic groups may maintain youthful appearance
Itching◦ Related to loss of oils in skin◦ Tepid baths◦ If persists, contact MD
Hair loss Nails
Integumentary
Skin assessment for pressure ulcers, or lesions
Adequate diet and fluids Dry skin is vulnerable to break down
Integumentary nursing interv.
Oral cavity◦ Decrease in taste bud function◦ Deterioration of teeth◦ Decrease in saliva
Muscles associated with chewing weaken Peristalsis is slower Gastric emptying is slower
Gastrointestinal
Glands secrete less volume and concentration of hydrochloric acid
Gag reflex decreases Gastric emptying slows Liver size decreases after age 70 Liver enzymes decrease Less Calcium is absorbed
Gastrointestinal
Constipation◦ Frequent GI complaint due to slowed motility,
altered bacterial flora, medications and lack of exercise
Common GI problems◦ Over or under nutrition◦ Constipation or diarrhea◦ Dehydration◦ Dental disorders
Gastrointestinal
General nursing interventions◦ Assess nutritional status◦ Teach about proper nutrition◦ Inform about community resources◦ Assess fluid intake/output◦ Assess use of laxatives◦ Inform about benefits of exercise◦ Teach about oral hygiene
Gastrointestinal
Muscle mass and elasticity decrease Bone demineralization Joints undergo degenerative changes Less endurance ROM changes Coordination changes
Musculoskeletal
Arthritis◦ Most prevalent in men◦ More severe in women◦ Leading cause of disability
Osteoarthritis◦ Most common form of arthritis◦ Caused by damage to the inside of joint surface◦ Large wt bearing joints most affected
musculoskeletal
Kyphosis◦ Curvature of thoracic spine
Teach benefits of weight bearing exercise◦ Walking, biking, …◦ Assistive devices to prevent falls◦ Avoid prolonged bedrest
musculoskeletal
Nursing interventions◦ Adequate Ca, pro- and vitamin D◦ Avoid smoking, alcohol◦ Estrogen replacement for females◦ Safety of environment◦ Pain control◦ Exercise◦ Correct use of assistive devices◦ Complications of surgery
musculoskeletal
Presbycusis◦ Hearing loss◦ 25% of adults over 69 and 50% >85 have hearing
loss◦ Conduction deafness
Blockage of ear canal caused by cerumen, infection or abnormal structure
◦ Sensorineural Damage to nerve tissue from exposure to loud
noises, disease, certain drugs
Sensory System
Macular degeneration◦ Affects the macula which is responsible for sharp
central vision Cataract
◦ Clouding or opacity of normal transparent lens◦ Surgical removal of the clouded lens
Sensory
Presbyopia◦ Affects the shape of the lens◦ Close work becomes difficult
Glaucoma◦ Atrophy of the optic nerve due to increased
pressure of the fluid in the eye
sensory
General nursing interventions◦ Assess ears for abnormalities◦ Evaluate medications for ototoxicity◦ Regular hearing tests◦ Monitor care of hearing aid◦ Instruct family on socialization and
communication needs of the elderly
sensory
Reduce clutter◦ Rugs, cords, furniture
Vision◦ Glasses, lighting
Reaching distance Non skid shoes, walkers, canes Skin care Environmental temperature
Safety
Risk for falls increases with◦ Changes in position◦ Unstable equipment◦ Waxed floors◦ Improper placement of food trays◦ restraints
Safety
Most at risk◦ History of falls◦ Osteoporosis◦ Prior stroke or sensory impairment◦ Anticoagulation therapy◦ Parkinson’s disease◦ Diabetes with peripheral neuropathies
Safety
Movement toward Erikson’s ego integrity is facilitated with older person◦ Recognizes and accepts changes◦ Gives up roles and develops new ones◦ Develops a different self concept◦ Revises life goals
Functional Assessment
Positive◦ Rational actions, perseverance, positive thinking,
maintaining humor Negative
◦ Loss of identity, fulfillment, self esteem
Functional coping/adaptation
ADL (activities of daily living)◦ Environmental, financial, community resources
Assess the activities they do alone Assess what they need help with Functional assessment + diagnosis=
nursing interventions
Functional assessment
Basic◦ Grooming, bathing, dressing, eating, elimination,
mobility
Instrumental◦ Prepare meals, shop, use the telephone,
housekeeping
Functional assessment
88% of older adults use > 1 medication In long term care (LTC)
◦ >75% receive 4 or more meds◦ >33% receive 7 or more meds
Age slows the clearance of drugs and increases the risk of adverse effects
Drug therapy
Decreased liver size, hepatic blood flow and reduced enzyme activity
Polypharmacy Older adults respond more vigorously to
drugs that act on the CNS◦ Postural imbalance, uncoordinated movements,
respiratory depression, mental changes
Drug therapy
Nursing interventions◦ Monitor drug regimen
Amount, duration, purpose, ability to take◦ Monitor vital signs◦ Monitor/record drug effects◦ Describe client cooperation◦ Teach no OTC without MD approval
Drug therapy
Independent living Family provided assistance in home Home health care Assisted living facilities Long term care facilities
Housing and Health alternatives