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Nurs 1110 Care of the Older Client

Nurs 1110 Care of the Older Client. Nancy Pares, RN, MSN Metropolitan Community College Nursing Program. Definitions of Old Age. Most definitions= having lived a long time Aged: old or advanced in years Aging: process of growing older

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Nurs 1110 Care of the Older Client

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  1. Nurs 1110 Care of the Older Client Nancy Pares, RN, MSN Metropolitan Community College Nursing Program

  2. Definitions of Old Age • 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

  3. Gerontology • 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.

  4. Terminology of Today • 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

  5. Ageism • 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

  6. Aging Process • 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

  7. Myths of aging • Non productive • Disengaged • Inflexible • Senile • Not able to learn new things • Retirement causes death • Sexless • Poor, disabled, ill…..

  8. Describe an older adult • Think about movies you have seen…. • Think about an older relative • Visualize magazine pictures of the ‘50’s and compare to present

  9. Physiologic Changes in Body

  10. Nervous system • 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

  11. 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

  12. 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

  13. CNS interventions • 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

  14. Respiratory • 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

  15. 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

  16. 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

  17. Respiratory nursing interventions • 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

  18. Cardiovascular • Blood flow resistance increases as people age • Aging results in sclerosis of the endocardium • Heart becomes rigid-contractility impaired

  19. 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

  20. 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

  21. Common CV problems • Peripheral vascular disease (PVD) • Hypertension • Chronic CHF (congestive heart failure)

  22. General nursing interventions • 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

  23. Renal • 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

  24. 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

  25. Renal • Incontinence • Conservative behavior treatment is first line therapy • Prostate enlargement

  26. Renal nursing interventions • Assessment for bladder management • Peri care • MD referral for treatment options • Allow voicing of concerns • Do not allow self limitation of fluids

  27. Integumentary • 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

  28. 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

  29. Integumentary nursing interv. • Skin assessment for pressure ulcers, or lesions • Adequate diet and fluids • Dry skin is vulnerable to break down

  30. Gastrointestinal • 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

  31. 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

  32. 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

  33. 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

  34. Musculoskeletal • Muscle mass and elasticity decrease • Bone demineralization • Joints undergo degenerative changes • Less endurance • ROM changes • Coordination changes

  35. 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

  36. musculoskeletal • Kyphosis • Curvature of thoracic spine • Teach benefits of weight bearing exercise • Walking, biking, … • Assistive devices to prevent falls • Avoid prolonged bedrest

  37. 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

  38. Sensory System • 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

  39. Sensory • 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

  40. 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

  41. 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

  42. Safety • Reduce clutter • Rugs, cords, furniture • Vision • Glasses, lighting • Reaching distance • Non skid shoes, walkers, canes • Skin care • Environmental temperature

  43. Safety • Risk for falls increases with • Changes in position • Unstable equipment • Waxed floors • Improper placement of food trays • restraints

  44. Safety • Most at risk • History of falls • Osteoporosis • Prior stroke or sensory impairment • Anticoagulation therapy • Parkinson’s disease • Diabetes with peripheral neuropathies

  45. Functional Assessment • 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

  46. Functional coping/adaptation • Positive • Rational actions, perseverance, positive thinking, maintaining humor • Negative • Loss of identity, fulfillment, self esteem

  47. Functional assessment • 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

  48. Functional assessment • Basic • Grooming, bathing, dressing, eating, elimination, mobility • Instrumental • Prepare meals, shop, use the telephone, housekeeping

  49. Drug therapy • 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

  50. 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

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