Nursing Care - download.e-bookshelf.de · Part 5 Normal Pressure Hydrocephalus 236. Jean B. Fahey. Part 6 Parkinson’s Disease 241. Marion Phipps. Part 7 Seizures 249. Susan R. Gavaghan

Nursing Care of the Hospitalized Older Patient

Edited by Terry Mahan Buttaro and Kate A. Barba

Nursing Care of the H

ospitalized Older Patient

Nursing Care of the Hospitalized Older PatientNursing Care for the Hospitalized Older Patient is a comprehensive, quick-reference for nurses and advanced practice nurses working with older patients in a hospital setting. Organized in a user-friendly format, the book provides vital information on all aspects of hospital care and the full range of health issues encountered by elderly patients.

Nursing Care for the Hospitalized Older Patient is organized into four major sections. The first section provides an overview of the aging patient, including demographics, normal aging changes, and the general impact of hospitalization. The second section covers proper health assessment, providing guidance on history taking and evaluating laboratory values. The third section is the largest part of the book and consists of short, similarly structured chapters dedicated to individual clinical issues ranging from burns to depression. These chapters are organized by body system to maximize ease of use. The fourth section covers special considerations that cross common clinical areas, such as palliative care, pain management, fall prevention, and discharge planning.

Special Features • Focuses on care of older patients in a hospital setting • Provides fundamental chapters on aging and health assessment • Clinical section organized by body system in a structured format for easy reference

EditorsTerry Mahan Buttaro, PhD, ANP-BC, GNP-BC, FAANP, is Assistant Clinical Professor at Simmons College, Lecturer at the University of Massachusetts Boston, and Nurse Practitioner with Coastal Medical Associates in Salisbury, Massachusetts.

Kate A. Barba, RN, MS, GNP-BC, is Clinical Nurse Specialist at Massachusetts General Hospital in Boston, Massachusetts.

Titles of InterestCase Studies in Gerontological Nursing for the Advanced Practice NurseEdited by Meredith Wallace Kazer and Leslie Neal-BoylanISBN: 9780813823782

Clinical Case Studies in Home Health CareEdited by Leslie Neal-BoylanISBN: 9780813811864

Buttaro and

Barba

Buttaro Complete Cover BC.indd 2-3 8/16/2012 6:21:06 AM

PG3628File Attachment9780813810461.jpg


Edited by

Terry Mahan Buttaro and Kate A. Barba

A John Wiley & Sons, Inc., Publication

This edition first published 2013 © 2013 by John Wiley & Sons, Inc

Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing.

Editorial Offices2121 State Avenue, Ames, Iowa 50014-8300, USAThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK9600 Garsington Road, Oxford, OX4 2DQ, UK

For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged. The fee codes for users of the Transactional Reporting Service are ISBN-13: 978-0-8138-1046-1/2013.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

Nursing care of the hospitalized older patient / edited by Terry Mahan Buttaro and Kate A. Barba. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8138-1046-1 (pbk. : alk. paper) I. Buttaro, Terry Mahan. II. Barba, Kate A. [DNLM: 1. Geriatric Nursing–methods. 2. Aged. 3. Hospitalization.WY 152] 618.970231–dc23 2012004865

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover design by Buffy Clatt

Set in 9/12.5pt Interstate by SPi Publisher Services, Pondicherry, India

1 2013

Dedication

We dedicate this book to our husbands and children who have supported us

throughout this endeavor. We always have and always will cherish the love you

have shown us.

Kate A. Barba

Terry Mahan Buttaro

vii

Contents

Contributors xiii

Preface xix

Acknowledgments xxi

1 Introduction 1

Terry Mahan Buttaro

2 Health Assessment 9

Kate A. Barba

3 Clinical Issues 22

Unit 1 Skin Disorders 22

Part 1 Overview 22

Terry Mahan Buttaro

Part 2 Burns 24

Terry Mahan Buttaro

Part 3 Cellulitis 27

Terry Mahan Buttaro

Part 4 Contact Dermatitis 31

Terry Mahan Buttaro

Part 5 Herpes zoster 33

Terry Mahan Buttaro

Part 6 Purpura 37

Terry Mahan Buttaro

Part 7 Pruritus 41

Terry Mahan Buttaro

Part 8 Acne Rosacea 44

Terry Mahan Buttaro

Part 9 Seborrheic Dermatitis 46

Terry Mahan Buttaro

Part 10 Thrush 50

Terry Mahan Buttaro

viii Contents

Part 11 Tinea 52

Terry Mahan Buttaro

Part 12 Pressure Ulcers 56

Linda Olson

Part 13 Lower Extremity Ulcers 64

Linda Olson

Part 14 Skin Tears 74

Linda Olson

Unit 2 Cardiovascular Disorders 79

Part 1 Acute Coronary Syndrome 79

Sharon Zisk

Part 2 Atrial Fibrillation 86

Theresa E. Evans

Part 3 Venous Thromboembolism 92

Eva Beliveau

Part 4 Heart Failure 99

Theresa E. Evans

Part 5 Hypertension 105

Chelby Cierpial and Susan Stengrevics

Part 6 Peripheral Vascular Disease 112

Ashley Moore Gibbs

Part 7 Heart Valve Disease 117

Theresa E. Evans

Unit 3 Respiratory Disorders 124

Part 1 Asthma 124

Marian Jeffries and Rosemarie Marks

Part 2 Chronic Obstructive Pulmonary Disease (COPD) 128


Part 3 Influenza 134


Part 4 Pneumonia 138


Unit 4 Gastrointestinal Disorders 148

Part 1 Appendicitis 148

Patricia Fitzgerald

Part 2 Diverticular Disease 152

Patricia Fitzgerald

Contents ix

Part 3 Ischemic Bowel 158

Patricia Fitzgerald

Part 4 Pancreatitis 162

Patricia Fitzgerald

Part 5 Constipation 167

Patricia Fitzgerald

Part 6 Diarrhea 173

Patricia Fitzgerald

Part 7 Gastroesophageal Reflux Disease 178

Patricia Fitzgerald

Unit 5 Genitourinary Disorders 183

Part 1 Acute Kidney Injury 183

Carol A. Tyksienski

Part 2 Chronic Kidney Disease 191

Carol A. Tyksienski

Part 3 Urinary Tract Infections 197

Terry Mahan Buttaro

Unit 6 Neurologic Disorders 202

Part 1 Dementia 202

Constance Cruz, Sara A. Fisher, Mary Lussier-Cushing

and Jennifer Repper-DeLisi

Part 2 Delirium in the Older Hospitalized Adult 209

Mary Lussier-Cushing, Jennifer Repper-DeLisi,

Sara A. Fisher and Constance Cruz

Part 3 Ischemic Stroke 221

Marion Phipps

Part 4 Dizziness 230

Jean B. Fahey

Part 5 Normal Pressure Hydrocephalus 236

Jean B. Fahey

Part 6 Parkinson’s Disease 241

Marion Phipps

Part 7 Seizures 249

Susan R. Gavaghan

Unit 7 Endocrine 255

Part 1 Diabetes 255

Susan L. Wood

x Contents

Part 2 Hypo/Hyperthyroidism 269

Susan L. Wood

Part 3 Hyperparathyroidism/Hypoparathyroidism 275

Susan L. Wood

Part 4 Syndrome of Inappropriate Antidiuretic

Hormone Secretion 283

Susan L. Wood

Unit 8 Musculoskeletal 288

Part 1 Septic Arthritis 288

Susan Bardzik

Part 2 Gout 292

Sharon R. Smart

Part 3 Joint Replacement 296

Nichole Spencer

Part 4 Osteomyelitis 303

Lesley Caracci

Part 5 Metabolic Bone Disease: Osteoporosis

and Paget’s Disease 308

Nichole Spencer

Unit 9 Hematology/Oncology 316

Part 1 The Oncology Patient 316

Kristina N. Wickman

Unit 10 Infectious Disease 324

Part 1 HIV/AIDS 324

Caroline Sturm-Reganato

Part 2 Sepsis and ARDS 337

Vince M. Vacca, Jr.

Part 3 Tuberculosis 343

Melissa Donovan

Unit 11 Multisystem Disorders 351

Part 1 Fever 351

Monica G. Staples

Part 2 Polymyalgia Rheumatica 359

Monica G. Staples

Part 3 Rheumatoid Arthritis 364

Monica G. Staples

Part 4 Systemic Lupus Erythematosus 369

Kate Roche

Contents xi

Part 5 Temporal Arteritis 376

Kate Roche

Part 6 Vasculitis 379

Kate Roche

Unit 12 The Surgical Patient 386

Part 1 The Surgical Patient 386

Deanne C. Munroe

Unit 13 Fluid and Electrolytes 403

Part 1 Dehydration and other Hypovolemic Fluid

Disorders 403

Terry Mahan Buttaro

Part 2 Hypercalcemia and Hypocalcemia 408

Nancy A. Kelly

Part 3 Hyperkalemia and Hypokalemia 416

Grace A. Good

Part 4 Hyponatremia and Hypernatremia 423

Grace A. Good

Part 5 Hypomagnesemia and hypermagnesemia 432

Nancy A. Kelly

Unit 14 Psychological Issues 440

Part 1 Anxiety Disorders 440

Constance Cruz, Sara A. Fisher, Mary Lussier-Cushing

and Jennifer Repper-DeLisi

Part 2 Depression 445

Jennifer Repper-DeLisi, Constance Cruz, Sara A. Fisher

and Mary Lussier-Cushing

4 Special Considerations 454

Part 1 Nosocomial Infections 454

Hallie S. Greenberg

Part 2 Elder Abuse and Neglect 461

Margaretta Byrne

Part 3 Advance Directives 469

Anita M. Coppola-Ash

Part 4 Nutrition and Older Adults 474

Deborah A. D’Avolio

Part 5 Fall Prevention 480


xii Contents

Part 6 Pain and Older Adults 488


Part 7 Palliative Care 494

Jennifer R. Howard

Part 8 Medications and Older Adults 501


Part 9 Sleep Disorders 506

Donna M. Glynn

Part 10 Urinary Incontinence 511

Mary L. McDonough

Part 11 Discharge Planning and Teaching 518

Arlene J. Lowenstein

Part 12 SBAR Communication 525

Eva Beliveau

Glossary 531

Selected Websites for Geriatric Information 536

Index 537

xiii

Contributors

Editors

Terry Mahan Buttaro, PhD, ANP-BC, GNP-BC, FAANP, DPNAP

Assistant Clinical Professor

Simmons College

Boston, Massachusetts

Lecturer

University of Massachusetts Boston


Nurse Practitioner

Coastal Medical Associates

Salisbury, Massachusetts

Kate A. Barba, RN, MS, GNP-BC

Clinical Nurse Specialist

Massachusetts General Hospital


Contributors

Susan Bardzik, RN-BC, MSN



Eva Beliveau, RN, MSN

Associate Professor

Department of Nursing

Northern Essex Community College

Lawrence, Massachusetts

Margaretta Byrne, MPH, MS, FNP-BC

Master’s in Nursing Student

Simmons College


Lesley Caracci, RN, MSN, ACNS-BC



xiv Contributors

Chelby Cierpial, RN, MSN, ACNS, BC

Clinical Nurse Specialist/Ellison 11

Cardiac Interventional Unit



Anita M. Coppola-Ash, RN, BSN, MSN, ANP-BC, LCSW, MSW

Anna Jacques Hospital

Newburyport, Massachusetts

Constance Cruz, RN, MSN, PMHCNS

Psychiatric Clinical Nurse Specialist

Inpatient Psychiatric Unit



Deborah A. D’Avolio PhD, BC-ACNP, ANP

Associate Professor

School of Nursing

Northeastern University


Melissa Donovan, MSN, RN



Theresa E. Evans, MS, ANP-BC




Jean B. Fahey, MSN, RN, ACNS-BC, CCRN, CNRN, CWS

Neuroscience Clinical Nurse Specialist



Sara A. Fisher, MSN, RN, PMHCNS-BC




Patricia Fitzgerald, RN, MSN, ACNS, BC




Susan R. Gavaghan, ACNS-BC




Contributors xv

Ashley Moore Gibbs, RN, MSN, ANP/GNP-BC, CHFN

Faculty, School of Nursing

University of Southern Maine

Portland, Maine

Donna M. Glynn, PhD, RN, ANP-BC

Assistant Clinical Professor

Simmons College

School of Nursing and Health Sciences


Grace A. Good, APRN, BC

Acute Care Nurse Practitioner



Hallie S. Greenberg, MS-PREP, BSN, BC

Adjunct Faculty,

Simmons College

Nurse Educator

Brigham and Women’s Hospital

Boston, MA

Jennifer R. Howard, MSN, APRN, BC

Clinical Instructor

Simmons College


Marian Jeffries, MSN, ACNS, BC, FNP-C

Clinical Nurse Specialist, Thoracic and Laryngeal Surgery



Nancy A. Kelly, GNP-BC, DNP

Patient Care Services



Arlene J. Lowenstein PhD, RN

Professor and Director

Health Professions Education Doctoral Program

School of Nursing and Health Sciences

Simmons College


Mary Lussier-Cushing, MS, RN/PC, PMHCNS


Psychiatric Nursing Consultation Service



xvi Contributors

Rosemarie Marks, RN, MSN

Clinical Nurse Educator

Signature Healthcare

Brockton, Massachusetts

Mary L. McDonough, RN, MSN

Clinical Practice Manager

Department of Urology



Deanne C. Munroe, JD, MSN, APRN-BC

Risk Management Coordinator

The Queen’s Medical Center

Honolulu, Hawaii

Linda Olson, RN, BSN, CWON

Wound, Ostomy Nurse

UMass Memorial Medical Center

Worcester, Massachusetts

Marion Phipps, RN, MS, CRRN, FAAN

Clinical Nurse Specialist, Neuroscience



Jennifer Repper-DeLisi, RN, MSN, PMHCNS-BC


Psychiatric Nursing Consultation Service



Kate Roche, MS, RN, ANP-BC




Sharon R. Smart, MS, APRN, FNP

Vital Care Services

New England Community Medical Services

Methuen, MA

Nichole Spencer, MSN, ARNP-C

Assistant Professor

Department of Nursing

William Jewell College

Liberty, Missouri

Adult Nurse Practitioner

Shawnee Mission Internal Medicine

Overland Park, Kansas

Contributors xvii

Monica G. Staples, RN-BC, MSN


General Medicine



Susan Stengrevics, MSN, RN, ACNS, BC, CCRN

Clinical Nurse Specialist/Ellison 10

Cardiac Arrhythmia Stepdown Unit



Caroline Sturm-Reganato, RN, BSN, ACRN

AIDS Clinical Trial Unit

New York School of Medicine

New York, New York

Carol A. Tyksienski, RN, DNP, APRN, BC


Nurse Practitioner

Hemodialysis Unit



Vince M. Vacca, Jr., RN, MSN, CCRN

Clinical Nurse Educator

Neuroscience Intensive Care Unit

Brigham & Women’s Hospital


Kristina N. Wickman, MSN, RN

Adjunct Faculty

Simmons College


Susan L. Wood, RN, MSN, ANP, BC

Clinical Nurse Specialist, Adult Medicine



Sharon Zisk, MSN, RN, ACNS-BC


Cardiac Surgery and Interventional Cardiology

Beth Israel Deaconess Medical Center


xix

Preface

Worldwide, older adults constitute the fastest growing demographic cohort

and comprise a large percentage of all hospitalized patients. Compared to

younger patients, older adult patients have higher acuity, use more healthcare

resources, experience more complications, and have longer length of stay

when hospitalized. Older patients are also at higher risk for experiencing an

iatrogenic event such as an adverse reaction to medication, falls, functional

decline, delirium, malnutrition, dehydration, pressure ulcers, urinary inconti-

nence, constipation and depression.

The complexity of caring for older adults, especially in the hospital setting,

cannot be understated. In addition to their presenting acute process, many

elders have multiple comorbid illnesses and are confronted with aging changes

that include visual and hearing impediments as well as cognitive, functional,

and health literacy challenges. At the same time, there are ongoing societal

and medical care changes. Today, children can live far away from their older

parents. Hospital care is often provided by hospitalists rather than the patient’s

primary care provider. In addition, patients are often quickly discharged from

the acute care setting to home or to rehabilitation, sub-acute care or long-term

care facilities.

The changes in health care delivery also present challenges for health care

providers and particularly so for nurses caring for older adults. Despite the

growing emphasis on geriatric care, many healthcare providers are not attuned

to the atypical presentation of illness in elders, nor are all providers skilled

in assessing the impact of illness on function and well–being in elders. Illness

presentations in this cohort can be subtle and precipitate a cascade of events

that result in temporary or permanent functional and cognitive changes.

Elders have complex needs and the nursing care of older adults is highly spe-

cialized. The care of the hospitalized older adult requires not only focus and

attentiveness, but also a working knowledge of the common geriatric syndromes

and illnesses affecting older adults.

This book was primarily designed for nurses caring for older patients in

hospitals and acute care settings, but it is a valuable reference for nurses

caring for older patients across varied health care environments. The orga-

nized format provides easy access to the common disorders encountered

when caring for ill elders and provides nurses with specific information related

to geriatric care. The text is organized into four sections. The first section

describes normal aging changes and the impact of illness and hospitalization

on older adults. The second section is concerned with health assessment in

xx Preface

the geriatric patient. Guidance on obtaining an accurate patient history and a

review of laboratory values are discussed in this chapter. The third and major

section of the book provides an overview of the commonly encountered health

issues that can affect the older patient during a hospitalization. These health

issues are organized by systems and the format of these chapters is consis-

tent. The sections are often bulleted affording the reader quick and easy

access to pertinent information. Each chapter gives a brief description of the

illness or disorder. Risk factors, clinical presentation, physical examination,

common diagnostics, differential diagnosis and physician consultation are

discussed to aid the nurse in the collaborative care of each patient. In addition,

the common treatment modalities and patient/family education concerns

for patients will these illnesses or disorders are described, though we realize

that organizations may have specific guidelines for the management of some

disorders and that research and evidence are continually evolving affecting

patient care management.

The final section of this book is concerned with those considerations that

commonly concern nurses caring for older patients. These include palliative

care, pain management, safety issues, and discharge planning.

xxi

Acknowledgments

Each patient teaches us more about the best way to care for ourselves and

our patients. Through them, we become better clinicians. Our colleagues

generously contributed their time, experience and wisdom in writing chapters.

In addition, many other clinicians collaborated with us on this text. Their

knowledge and experience are evident and we appreciate their expertise and

guidance. Without them, this book would not be complete.

1

Nursing Care of the Hospitalized Older Patient, First Edition. Edited by Terry Mahan Buttaro and Kate A. Barba.© 2013 John Wiley & Sons, Inc. Published 2013 by John Wiley & Sons, Inc.

Chapter 1

Introduction Terry Mahan Buttaro

Demographics

There are currently 39.6 million Americans older than age 65; most are women

(Administration on Aging [AOA], 2010 ). In another 20 years it is expected that

about one fifth of all Americans (72.1 million) will be older than age 65 and by

2050, the number of elders living in this country will likely double (AOA, 2009 ;

Vincent & Velkoff, 2010 ). This seemingly sudden onset of older citizens is

related to the aging of the “baby boomers”. The “boomers” were born between

1946 and 1964 and are a racially and ethnically diverse population that includes

healthy elders, as well as elders with a variety of co-morbidities and disabilities.

Many are foreign born; some are Vietnam War veterans. Many are still working

(AOA, 2011 ).

Older adults are the fastest growing cohort in the US and though these

elders often describe themselves as being in good health, they frequently

have many co-morbid disorders, such as hypertension, arthritis, or hyperlipid-

emia. Almost one-third (30%) live alone (AOA, 2011 ). Some are dependent on

Social Security for income, but some have private or government pensions or

carefully saved for their retirement (AOA, 2011 ).

The average income for older females was $15,282 in 2009; for men $25,877

that same year (AOA, 2011 ).

Other countries are experiencing a similar change in aging demographics. In

some of these countries, the life expectancy, especially of women, is longer

than in the US (Federal Interagency Forum on Age-Related Statistics, 2010 ). It

has been known for some time that women lived longer than men worldwide,

but this, too, is changing as life expectancy for men is projected to improve in

the future (Vincent & Velkoff, 2010 ).

Persons between age 55 and 75 are thought of as “young old” while those

over age 75 are considered “old old”. Some elders are referred to as “frail

elders”. Frail elders are more dependent, because they are less able to care for

themselves and perform their own activities of daily living (ADLs). Frail elders

are often older than 75 years of age, though illness and comorbidity can cause

frailty in any age cohort.

Buttaro_c01.indd 1Buttaro_c01.indd 1 9/3/2012 12:07:43 PM9/3/2012 12:07:43 PM

2 Nursing Care of the Hospitalized Older Patient

Patients over age 65 represent more than one third of all hospital admissions

and more than half of all hospital days (CDC, 2007 ). Men and women in the US

have similar health care disorders, though the percentages for each disorder

are quite different.

Heart disease, malignancy, and cerebrovascular disease are the top three

causes of death for all elders (Xu et al ., 2009 ).

Theories of aging

There are numerous theories about aging. Some are biologic or programmed

theories that address physiological changes that occur over time (Jin, 2010 ).

Biologic theories suggest that aging is programmed in some way. It could be

built in senescence or a gradual decrease in gene or immunologic function

(Jin, 2010 ). Wear and tear theory is an example of damage theory, another

biologic theory of aging. In wear and tear theory, it is proposed that over

time, cells fatigue and eventually cannot function appropriately. This theory

can explain some aging changes (e.g., degenerative bone disorders) and is

another example that considers aging a preprogrammed rather than random

process.

Other common theories associated with aging include psychological and

sociological theories. Psychosocial theories are primarily concerned with

explaining human personality and behavior. Erikson, a developmental theorist,

described human stages of development that ranged from infancy to old age.

In Erikson ’ s theory, at each stage of development there are specific tasks that

individuals must master. Infants learn to trust themselves and others, while at

the opposite end of the life spectrum, elders prepare for the end of life by

reviewing one ’ s life – the achievements and disappointments. This theory is

commonly considered when planning end of life care, but a different theory

(Activity Theory) encourages active, healthy engaged elders (Roy & Russell,

2005 ). There are many other psychosociological theories of aging. Some

theorize that our personalities really do not change as we age (i.e., the

Continuity theory) while other theorists describe how roles and activities

change as we age (i.e., Disengagement theory) (Roy & Russell, 2005 ).

No one theory addresses the complexity of aging, as growing older involves

physiologic changes as well as personality and attitude changes. For nurses,

understanding the interplay of these theories is very important because it

helps understand the many changes that occur with aging.

Healthy aging

Healthy aging is dependent on many factors. Genetics and lifestyle play a

significant role, but people who had fewer acute and chronic illnesses over

their lifetime may also be healthier as they age. Other factors that contribute

to healthy aging include:


Introduction 3

● Ideal weight for height

● Normal blood pressure, blood sugar, and cholesterol

● Daily exercise

● 10,000 steps per day or 30 minutes a day

● Weight training twice weekly to strengthen abdomen, back, chest, arms,

shoulders, hip and leg muscles

● Balance training each day

● Low fat, low cholesterol, low calorie diet, that includes:

● lean meats

● fruits, fiber, and vegetables

● adequate calcium and vitamin D

● 1 glass red wine per day

● Fewer medications

● Smoking cessation

● Stress reduction

● Breathing exercises

● Meditation

● Yoga

● Socialization

Many of the elements associated with healthy aging are appropriate for elderly

patients. Adults older than age 65 still need exercise, but the physician always

needs to determine if an older patient is healthy enough for exercise. In general,

if a person over age 65 is healthy and has no limiting health disorders, physical

exercise guidelines continue to recommend 150 minutes of moderate intensity

exercise (e.g., brisk walking) each week and exercise that strengthens muscles

twice weekly (CDC, 2011 ). Even for frail elders exercise can be beneficial.

Researchers learned that exercise in these patients improves well being, sleep,

decreases pain, increases mobility and helps prevent falls (Heath & Stuart, 2002 ).

It is also never too late for people to learn about healthier foods, and it is

never too late to begin an exercise regimen. The Nurses’ Health Study and

other research studies provided evidence that proper diet and exercise at

any age are beneficial, maintaining telomere length on chromosomes and

increasing cellular lifespan as well as decreasing the risk of physical or

cognitive problems (Baer et al ., 2011 ; Hu et al ., 2003 ).

In addition to the healthy behaviors described above, there are other

components of healthy or successful aging. Socialization or engagement in

life and a positive outlook on life impact quality of life and possibly cognition.

Elders themselves describe the importance of being adaptable to aging

changes and losses as they grow older.

Normal aging changes

Numerous issues affect aging and not all are physiologic. Financial concerns,

family stressors, and the loss of family and friends are important considerations


4 Nursing Care of the Hospitalized Older Patient

that impact all of us. Some physiologic changes do occur over time despite proper

diet and exercise, in most, if not all, body systems. These changes are linear, occur-

ring over time and starting around age 45. In addition, co-morbid disorders and

illness can impact aging significantly in some people. Though not all changes

affect all elders, common changes associated with normal aging include:

● Decreased body water

● Increased body weight

● Homeostasis easily affected by illness

● Temperature regulation impacted over time

● Gait changes especially after age 80 may be multifactorial

● Increased double stance time; decreased gait speed

● Cellular changes

● Diminished cell mediated immunity

● Decreased number of receptors and diminished receptor sensitivity impact

medication pharmacodynamics

● Skin: initial aging changes are seen in skin changes

● Epidermis thins, becomes dryer and less elastic

● Decreased subcutaneous fat

● Sweat glands, blood vessels, melanocytes, and nerve cells decrease in number

● Absorption of topical medications is more rapid

● Head, ears, eyes, nose, throat (HEENT)

● Visual and hearing changes

● Decreased thirst

● Diminished sense of smell and taste

● Cardiac

● Cardiac and arterial muscle stiffening results in some cardiac enlarge-

ment, hypertension

● Decreased baroreceptor sensitivity

● Decreased cardiac output affects blood flow to all organs and can affect

medication absorption, distribution, first pass effect, biotransformation,

and elimination

● Respiratory

● Possible increase in AP chest diameter

● Decreased bronchiolar smooth muscle

● Vital capacity decreases, residual volume increases

● Increased risk aspiration

● Gastrointestinal

● Atrophic gastritis

● Decreased absorption medication/nutrients is possible.

● Diminished esophageal motility

● Functional changes in swallowing (usually related to medications or neuro-

logical disorder)

● Decreased hepatic blood flow

● Genitourinary

● Decreased blood flow can cause decreased glomerular filtration and

tubular secretion; diminished creatinine clearance.


Documents

Nursing Care - download.e-bookshelf.de · Part 5 Normal Pressure Hydrocephalus 236. Jean B. Fahey. Part 6 Parkinson’s Disease 241. Marion Phipps. Part 7 Seizures 249. Susan R. Gavaghan