NURSING CARE OF THE ELDERLY (MED-SURG).pptx
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NURSING CARE OF THE ELDERLY (MED-SURG).pptx
- 1. NURSING CARE OF THE ELDERLY Prepared by: Sonali Kujur Nursing Tutor
- 2. TERMINOLOGY • GERIATRICS: Geriatric is defined as the branch of medicine concerned with medical problems and care of old people. • GERIATRIC NURSING: Geriatric nursing is the specialty that concerns itself with the provision of nursing services to geriatric or aged individuals.
- 3. • GERONTOLOGY: Gerontology is defined as the scientific study of the process and problems of aging. • ELDERLY CARE: Elderly care or simply elder care is the fulfillment of the special needs and requirements that are unique to senior citizens.
- 4. ASSESSMENT OF THE ELDERLY Functional assessment Physical assessment Nutrition assessment
- 5. FUNCTIONALASSESSMENT • The functional assessment is the measurement of patient’s ability to complete functional tasks and used to evaluate the older adult’s overall well being and self care abilities.
- 6. PHYSICALASSESSMENT • The physical assessment focuses on the following aspects: • Obtaining health history • Current health status • Medical history • Review of body systems
- 7. NUTRITION ASSESSMENT Clinical data: coexisting medical diagnosis Anthropometric measurement medications Nutrition history: usual food choices/pattern of eating Use of alcohol Vitamin/mineral supplements Weight history Other components: activity/ exercise history Psychological issues Knowledge of nutrition
- 8. AGING • Aging is defined as the time from birth to the present for a living individual. • The chronological age refers to the number of years a person has lived.
- 9. MYTH AND REALITIES • MYTH: • MOST OLDER PEOPLE FEEL MISERABLE AND DEPRESSED MOST OF THE TIME. • OLDER PEOPLE CANNOT LEARN COMPLEX NEW SKILLS • MOST OLDER PEOPLE ARE SICK AND NEED HELP WITH DAILY ACTIVITIES
- 10. THEORIES OF AGING Immunological theory Wear and tear theory DNA damage theory
- 11. NORMAL AGING PROCESS • Aging is a normal part of human development. • The pattern of aging – what happens, how and when- vary greatly among older people. • Aging is a normal, progressive, universal, and irreversible process.
- 12. FACTORS INFLUENCING AGING Hereditary factors Environmental factors : a. Abiotic factors b. Biotic factors Socio economic factors
- 13. • Hereditary factors: some families live longer than others, given the same environmental circumstances. This is related with genetic factors. • Environmental factors: • Abiotic factors: examples such as climatic influences, pollutants, and radiation. • Biotic factors: examples such as pathogens, parasites, and the quality and availability of food products. • Socio economic factors: stress factors, income, and poverty affect aging.
- 14. AGE RELATED BODY SYSTEM CHANGES • Musculoskeletal system • Integumentary system • Cardiovascular system • Respiratory system • Gastrointestinal system • Endocrine system • Neurological system • Sensory system
- 15. Musculoskeletal system • Decrease muscle mass • Decrease muscle tone • Decrease range of motion • Decrease joint mobility • Slower muscle response • Shortening of height • Osteoporosis • Synovial fluid becomes more viscous
- 16. Integumentary system • Increase dryness of skin • Thinning in the layer of skin • Wrinkles appears • Age spot appears • Gray hair • Thickening of nasal and ear hair
- 17. Cardiovascular system • Slowed heart rate • Increase blood pressure • Less blood circulation in heart
- 18. Respiratory system • Increased respiratory rate with decreased lung expansion. • Impaired gas exchange • Increased chest rigidity
- 19. Gastrointestinal system • Decreased saliva production • Changes in taste and smell • Decreased peristalsis in stomach • Decreased production in GI secretion • Delayed gastric emptying
- 20. Genitourinary system • Decreased in kidney size, function and output • Decreased glomerular filtration • Decreased number of nephrons • Decreased bladder size • Incomplete bladder emptying • Increased ease of backflow of urine • Decreased bladder capacity • Increased incidence of UTIs • Increased residual urine
- 21. Endocrine system • Alteration in hormone production: • Decreased secretion of estrogen, FSH and LH • Decreased secretion of progesterone and testosterone
- 22. Neurological system • Progressive loss of brain cells • Decreased blood flow • Decreased number of neurons
- 23. Sensory system Eyes Ears Tongue Nose Skin
- 24. Eyes: • Decreased visual acuity • Eyelids lose their elasticity • Quantity of tears decreased • Impaired color vision • Diminished night vision
- 25. EARS: • Diminished hearing acuity • Decreased ability to hear high-pitched sounds • Slowly progressive deafness
- 26. TONGUE: • Decreased taste perception • Reduction in number of functioning taste buds • Decreased amount of saliva
- 27. Nose: • Decreased sense of smell
- 28. Skin: • Decreased touch sensation
- 29. Psychosocial aspects of aging RETIREMENT ROLE CHANGES LONELINESS DEPRESSION AND SUICIDE
- 30. RETIREMENT: • Retirement often leads to psychological stress. • The most powerful factor that influence the retired person’s satisfaction with life are health status, the option to continue working and sufficient income. • Retirement alters identity, power, status and friendship. • Retirement also is viewed as the beginning of old age.
- 31. ROLE CHANGES • Aging is associated with many role changes and transitions. • Some rules- such as spouse, friend or employee- maybe lost, while new role- such as widow or volunteer- may arise. Such changes require role adjustment. • By age of 70, most people take on a grand parenting role.
- 32. LONELINESS: • Any lose that creates a deficit in intimacy and interpersonal relationships can lead to loneliness. • The older adult needs caring, personal contact to avoid loneliness.
- 33. DEPRESSION AND SUICIDE • Depression increases in frequency and intensity with age. • Risk factors for depression include a recent major loss, isolation from family/friends, feeling of hopelessness.
- 34. COMMON HEALTH PROBLEMS NEUROLOGICAL SKIN SENSORY ORGANS ENDOCRINE GENITOURINARY GASTROINTESTINAL CARDIOVASCULAR RESPIRATORY MUSCULOSKELETAL
- 35. MUSCULOSKELETAL SYSTEM • Osteoarthritis: • Osteoarthritis is a degenerative joint disease, in which the tissues in the joint break down over time. • It is the most common type of arthritis • People with osteoarthritis usually have joint pain and, after rest or inactivity , stiffness for a short period of time.
- 36. ENDOCRINE SYSTEM • DIABETES MELLITUS: • A serious disease in which a person’s body cannot control the level of sugar in blood. • Type 1 is caused by lack of insulin production by beta cells. • Type 2 is caused by deficiency or inadequacy of insulin receptors in cells. • SIGN AND SYMPTOMS: • Polydipsia • Polyphagia • Polyuria
- 37. • Lethargy • Blurred vision • Stupor • Nausea • Vomiting • Glycosuria • Abdominal pain • MANAGEMENT: • Check the current weight of the patient. • Assess for signs of hyperglycemia • Check for any foot injury or trauma • Maintain adequate fluid intake
- 38. • Assess for skin turgor and mucous membrane for hydration • Monitor laboratory data: blood sugar. • Intravenous fluid replacement helps to maintain fluid and electrolyte balance. • Reassure the patient for anxiety.
- 39. Cardiovascular disease Coronary artery disease Hypertension
- 40. Coronary ARTERY disease • A narrowing of the coronary arteries that prevents adequate blood supply to the heart muscle is called as coronary artery disease.
- 41. hypertension • Hypertension (high blood pressure) is when the pressure in your blood vessels is too high (140/90 mmHg or higher). • It is common but can be serious if not treated. • People with high blood pressure may not feel symptoms. • The only way to know is to get your blood pressure checked.
- 42. GENITOURINARY SYSTEM • URINARY INCONTINENCE: It is the loss of voluntary bladder control. STRESS URGE MIXED OVERFLOW
- 43. • Types : • Stress incontinence- it is the urine leakage during activities that increase abdominal pressure, such as coughing, sneezing, laughing, and other physical activities. • Urge incontinence- it is the ability to delay urination with an abrupt and desire to void. • Functional incontinence- it is also called as mixed incontinence. It refers to urinary incontinence where symptoms of both stress and urge incontinence are present. • Overflow incontinence- when your bladder is never completely empty, you might experience urine leakage, with or without feeling a need to go.
- 44. • SIGN AND SYMPTOMS: • Dysuria • Urinary hesitancy • Urinary frequency • Urinary urgency • Nocturia and hematuria • Poor or slow urine stream • Dribbling • Perineal soreness • Urine leakage during laughing, sneezing, or coughing
- 45. • MANAGEMENT: • Assess for perineal area for signs of skin breakdown such as redness. • Assess for change in incontinence pad immediately after an episodes of urinary incontinence. • Use for mild soap and warm water to wash the perineal area • Assess for sign and symptoms of dehydration. • Increase for fluid intake which dilutes the urine and reducing the risk for infection • Obtain urine analysis and culture as ordered. • Assess the patient for nocturia.
- 46. GASTROINTESTINAL SYSTEM • CONSTIPATION: it refers to irregular or infrequent stool passage. Stools may become hard, making passage difficult and painful. Hypertonic bowel • Marked by abdominal cramps. Stool stays in colon and water is reabsorbed resulting in small, hard stools. Hypotonic bowel • It results from decreased peristalsis. Reduced fluid intake, lack of dietary fiber, and decreased
- 47. • SIGN AND SYMPTOMS: • Hard stool • Pain and discomfort during defecation • Straining at defecation • Stomach cramps • Enlarged stomach • Decreased appetite • Indigestion • Nausea • Vomiting
- 48. • MANAGEMENT: • Assess the patient’s bowel pattern by recording bowel movements • Perform rectal examination and assess for anal fissures or hemorrhoids • Assess the patient for signs of depression or dementia. A depressed patient may lack the energy or interest to use the bathroom. A dementia patient may forgot when or how to use the bathroom, may not feel the urge to defecate. • Assess for patients medication and use of enemas and laxatives. • Avoid foods and beverages with a diuretic effect such as coffee, tea and grapefruit juice.
- 49. NEUROLOGICAL SYSTEM • ALZHEIMER’S DISEASE: Alzheimer’s disease is a progressive degenerative disorder that attacks the brain and results in impaired memory, thinking, and behavior. • It is characterized by gradual loss of memory and a least one other cognitive function such as language, abstraction or spatial orientation. • SIGN AND SYMPTOMS: • Forgetfulness • Memory loss • Difficult learning • Poor concentration • Deterioration in personal hygiene
- 50. • MANAGEMENT: • Provide calm environment • Ask the caregiver to describe the patient’s usual routine at home, to help plan a similar schedule of daily activities during the hospital stay. • Speak to the patient slowly in a soft, and calm voice. • Give the patient plenty of time to complete task. (ADL)
- 51. Elder abuse
- 52. • It is any form of mistreatment that results in harm or loss to an older person. • The abuse of older people, also known as elder abuse. • It is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.
- 53. Types of elder abuse: Healthcare fraud and abuse Physical abuse Financial exploitation Psychological abuse Neglect Sexual abuse Emotional abuse
- 54. Physical abuse • It is a non accidental abuse use of force against an elderly person that results in physical pain, injury. • Physical abuse includes physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints or confinement.
- 55. SIGN AND SYMPTOMS • Unexplained signs of injury such bruises, welts or scars. • Broken bones, sprains or dislocations • Report of drug overdose or apparent failure to take medication regularly • Broken eyeglasses in frames • Signs of being restrained
- 56. Emotional abuse • In emotional abuse, people speak to or treat elderly persons in ways that cause emotional pain or distress.
- 57. • It includes: • Intimidation through yelling or treats • Humiliation and ridicule • Habitual blaming • Ignoring the elderly person
- 58. SIGN AND SYMPTOMS: • Threatening • Belittling
- 59. SEXUALABUSE • Sexual elder abuse is contact with an elderly person without the elder’s consent. • Such contact can involve physical sex acts, but activities such elderly person pornographic material, forcing the person to watch sex, acts or forcing the elder to undress are also considered sexual elder abuse.
- 60. SIGN AND SYMPTOMS: • Bruising on inner thighs • Bruises around breasts or genitals • Genital or anal bleeding • STDs
- 61. NEGLECT OR ABANDONMENT • Neglect is the failure of a caregiver to fulfill his or her giving responsibilities. • It can be intentional as well as unintentional.
- 62. SIGN AND SYMPTOMS: • Unusual weight loss, malnutiriton
- 63. LEGALAND ETHICAL ISSUES Euthanasia Advance directives Informed consent Autonomy Withholding of food and fluid Confidentiality $ disclosure
- 64. Informed consent • The constitutional right to privacy, as well as the concept of personal liberty and restraints on state interference with independent action and choice, allows capacitated persons to choose individually appropriate medical care from among available treatment options. • Self-determination (the concept that "every adult of sound mind has the right to decide what shall be done with his own body"), or autonomy, is the foundation of the legal and ethical doctrine of informed consent. When decision making is preceded by discussion with a health care practitioner who provides the patient with the information necessary for choosing among options, the patient's consent or refusal is said to be informed and is ethically valid and legally binding. All states require that informed consent of the capacitated patient precede medical intervention. The patient has the legal and ethical right to make an informed choice, i.e, to consent to or refuse care, even if the likely outcome of the refusal is death. The physician is legally and ethically obligated to promote this right to all patients, even to those who are unsophisticated or difficult to inform.
- 65. Autonomy • Autonomy is the personal freedom and independence to direct one's own life & make choices for and about one self. • Autonomous people are capable of rational thought and problem solving. Loss of autonomy and independence is a real fear among older people. • A nurse has the responsibility to encourage the older person's autonomy in any way possible. • This can be done by supervision and education of staff to listen & allow the person time to make choices and discussions with family members about what is occurring and how they can enhance the older person's autonomy.
- 66. Confidentiality $ disclosure • Ethical oaths and specific statutes protect the confidentiality of physician-patient communication, ethical and legal bedrock of the therapeutic relationship. Even well- meaning family involvement without the patient's consent violates the patient's right of confidentiality. Protection of private patient information is essential to encouraging patient candor in revealing symptoms and behaviors relevant to diagnosis and treatment. Protection of a patient's secrets, private thoughts, and feelings is also required by decency. • Patient utterances are also protected by the doctrine of privilege, which grants patients the right to exclude otherwise relevant and admissible testimony in a court of law. This privilege can be invoked only by the patient. Additionally, most states have professional licensing statutes that incorporate the ethical and legal confidentiality mandates and make them a clear part of professional practice. All patients are entitled to confidentiality unless they give permission for disclosure or they clearly can no longer express a preference (e.g., a severely confused, comatose, or decisionally incapacitated patient). Even in these cases, secrets should be guarded, although decisions about care may require discussion with appropriate surrogates. When a patient can no longer make health care decisions, prior expressed preferences should be respected whenever possible.
- 67. Advance directives Living wills Durable power of attorney for health care
- 68. Living wills • A living will lists the interventions the patient would request, accept, or reject in the future, usually at the end of life. Physicians often have difficulty accepting a patient's choice to abandon aggressive care and permit death. • Most patients use living wills to refuse life-sustaining care when the prognosis for improvement or recovery is hopeless and the ability to relate to others is severely diminished or destroyed. However, as managed care becomes more pervasive and as patients become concerned about being denied care, living wills that request care are becoming more common.
- 69. Durable power of attorney for health care • A durable power of attorney for health care differs from a regular power of attorney, which addresses decision making concerning financial matters or property rights. A durable power of attorney for health care, or healthcare proxy, is a legal document that allows the patient to appoint a person, called a healthcare agent or proxy, to make health care decisions should the patient become temporarily or permanently incapacitated or be declared legally incompetent. • This legal appointment places a loving, concerned, trusted person in a dialogue with the physician to reach an appropriate decision. The agent's decisions are guided by specific instructions from the patient, by notions of substituted judgment (what the patient would likely want under the circumstances), and by the concept of best interest. The agent can discuss the patient's diagnosis, prognosis, treatment alternatives, and likely outcomes with the physician, respond to the patient's changing condition, and base a decision on current circumstances in light of known patient preferences and values.
- 70. Euthanasia • Euthanasia, an action taken by a health care practitioner intended to result in a patient's death, is illegal in the USA. Some patients whose life expectancy is reduced and who are suffering severely request euthanasia. • Traditionally, euthanasia has been forbidden in medical practice, and purposeful intervention to end life disturbs most physicians and patients. However, in certain clinical situations involving hopelessness and suffering, death is the end of pain, not of meaningful life.
- 71. Community and institutional health care services • Home care is a range of health & supportive services provided in the home for people who require assistance in meeting their health care needs. • These agencies may be governmental, private or voluntary. Care is provided by professional nurses or non-professional staff, such as homemaker aids. • Home health care is covered by medicine and health insurance. Services include skilled nursing, physical therapy, occupational therapy, speech therapy, social work, nutritional counseling and provision of some medical supplies & equipment.
- 72. • A hospice is a resource for the terminally ill. A hospice can be an independent unit within the community that provides support to the client & family in the home or it may be contained within an institution. The program focused on meeting the needs of the dying patient & family. • The goal of the hospice care is to keep the individual as comfortable & pain-free as possible. Physical, psychological, social and spiritual care are given to the dying person & the family by a team of doctors, nurses, social workers, clergy & volunteers.
- 73. • Day care provides an alternative to institutionalization. Offering health & rehabilitative services. Day care center clients are usually not seriously ill, although they may have chronic conditions or disabilities that limit independence. • These individuals cannot be left alone during the day when family members are at work or are unavailable. • They come to day care programs & return home in the evening. Day care offers a variety of services ranging from health care to social programs.