Escolar Documentos
Profissional Documentos
Cultura Documentos
Geriatrics
the study of old age includes the
Gerontology
study of the aging
care of the elderly. provided in acute care, skilled and assisted living, community, and home settings.
Goals:
promoting and maintaining functional status and
helping older adults to identify and use their strengths to achieve optimal independence
Nurse gerontologist
comprehensive nursing care to older persons by combining the basic nursing process (ADPIE) with a specialized knowledge of aging. helps the older person to maintain dignity and maximum autonomy despite physical, social, and psychological losses.
Life expectancy
the average number of years that a person can be
expected to live
Aging
the normal process of time-related change, begins
Universality
the major criterion used to distinguish normal from
abnormal aging
Intrinsic aging
from within the person those changes caused by the normal aging process
Extrinsic aging
results from influences outside the person Ex. Illness and disease, air pollution, sunlight can be eliminated or reduced through effective
change in physical appearance and a decline in function. Measurable changes in shape and body makeup occur. The bodys ability to maintain homeostasis becomes increasingly diminished with cellular aging, and organ systems cannot function at full efficiency
they accumulate a pigment known as lipofuscin. Degradation of elastin and collagen causes connective tissue to become stiffer and less elastic. Well-being of an aged person depends on physical, mental, social, and environmental factors.
Total assessment
includes an evaluation of all major body systems,
social and mental status, and the ability of the person to function independently despite a chronic illness.
Old age
A normal occurrence that encompasses all
experiences of life Care and concern for the elderly cannot be limited to one discipline, but is best provided through a cooperative effort. An interdisciplinary team, through comprehensive geriatric assessment, can combine expertise and resources to provide insight into all aspects of the aging process. Collaboration with the interdisciplinary team to obtain non-nursing services and provide a holistic approach to care.
HEALTH PROMOTION:
AGE-RELATED CHANGES IN BODY SYSTEMS AND HEALTH PROMOTION STRATEGIES
heart valves -- thicker and stiffer heart muscle and arteries lose elasticity. Calcium and fat deposits accumulate within arterial
respond to stress Heart rate and stroke volume do not increase with maximum demand Slower heart recovery rate; increased blood pressure
Subjective and Objective findings: Complaints of fatigue with increased activity Increased heart rate recovery time Normal BP 140/90 mm Hg
A serious risk factor at all ages for cardiovascular disease and stroke:
Hypertension
Health promotion:
Exercise regularly; pace activities; Avoid smoking; eat a low-fat, low-salt diet; participate in stress-reduction activities;
MI
diagnosis of hypertension
made only after it has been confirmed by at least two
subsequent readings.
systolic reading 140 mm Hg; diastolic measurement is normal or near normal (less than 90 mm Hg) Primary hypertension: the diastolic pressure is 90 mm Hg regardless of the systolic pressure Secondary hypertension: hypertension due to an underlying cause
position avoid straining when having a bowel movement; consider having five or six small meals each day, rather than three, to minimize the hypotension
showers and whirlpool baths. Yard work limited to no more than 20 minutes on hot summer days. Avoid exposure to wind or cold weather -- risk of dizziness or falling associated with slower adjustments of blood pressure. Use elastic compression stockings to minimize venous pooling edema
Health promotion:
Exercise regularly; avoid smoking Take adequate fluids to liquefy secretions; Receive yearly influenza immunization;
reminded to cough and take deep breaths, particularly postoperatively (decreased lung capacity and decreased cough efficiency predispose them to respiratory infections and atelectasis.)
exposure; Decreased protection against temperature extremes; Diminished secretion of natural oils and perspiration
Health promotion:
Avoid solar exposure (clothing, sunscreen, stay
indoors) Dress appropriately for temperature Maintain a safe indoor temperature Shower more preferable than tub bath Lubricate skin
decreased vaginal secretions Male: Decreased size of penis and testes Male and female: Slower sexual response
disappear.
Health promotion:
Exercise regularly eat a high-calcium diet limit phosphorus intake
prescribed
A high calcium intake, 1500 mg/day. Dairy products and dark green vegetables ; soups and
broths made with a soup bone and cooked with added vinegar to leach calcium from the bone. Calcium supplements Low-phosphorus diet. A calcium-to-phosphorus ratio of 1:1 is ideal; Avoid red meats, cola drinks, and processed foods that are low in calcium and high in phosphorus Weight-bearing exercise. Reduce caffeine and alcohol.
raloxifene (Evista)- preserve bone mineral density without estrogenic effects on the uterus(indicated for both prevention and treatment of osteoporosis) Although hormone replacement therapy (HRT) has been the mainstay of therapy for perimenopausal women, recent studies have demonstrated greater risks than previously recognized The bisphosphate drugs (e.g., Fosamax, Actonel)- bind to mineralized bone surfaces to inhibit osteoclastic activity and promote bone formation.
Changes in kidney function a decreased filtration rate diminished tubular function with less efficiency in
resorbing and concentrating the urine, and a slower restoration of acidbase balance in response to stress.
incontinence, or both. Benign prostatic hyperplasia (enlarged prostate gland) a common finding in older men -causes a gradual increase in urine retention and overflow incontinence.
alcohol, artificial sweeteners) pelvic floor muscle exercises, preferably learned via biofeedback; consider urologic workup
alcohol, artificial sweeteners); pelvic floor muscle exercises, preferably learned via biofeedback; consider urologic workup
bladder irritating substancescaffeinated, carbonated, and acidic beverages, Nutra-sweet, and alcohol ; increase water intake
exercises (first described by Kegel) Teach patient how to do the exercises ; begins with
identifying the pubococcygeus muscle, which is the same muscle used to hold back flatus or to voluntarily stop the flow of urine without contracting the abdomen, buttocks, or inner thigh muscles.
KEGELS EXERCISES:
-The pelvic muscles are first tightened and then
relaxed, maintaining a 5-second contraction with 10second rest interval; routinely practiced for 30 to 80 repetitions each day; additional repetitions are discouraged because of the risk of fatigue of the muscle
drink adequate fluids, and increase mobility to promote regular bowel function.
older women.
Why women?
reasons: effects of decreased estrogen, which shortens the urethral length, allowing easier passage of bacteria into the bladder; less overall fluid consumption, which causes a concentrated urine in which bacteria can proliferate; introduction of bacteria from the rectum as a result of poor bathroom hygiene secondary to impaired mobility and joint changes.
Health promotion: Use ice chips, mouthwash; brush, floss, and massage gums daily receive regular dental care eat small, frequent meals sit up and avoid heavy activity after eating limit antacids
Health promotion:
Pace teaching with hospitalization, encourage visitors enhance sensory stimulation
confuses colors
of the eye, the older central cells accumulate and become yellow, rigid, dense, and cloudy, leaving only the outer portion of the lens elastic enough to change shape (accommodate) and focus at near and far distances.
focus gets farther away. This condition, presbyopia, usually begins in the fifth decade of life, and requires the wearing of reading glasses to magnify objects. the yellowing, cloudy lens causes light to scatter and makes the older person sensitive to glare. The ability to discern blue from green decreases.
of increased stiffness of the muscles of the iris the older person takes longer to adjust when going to and from light and dark environments or settings and needs brighter light for close vision
devices such as glasses and hearing aids. Sensory deprivation- the absence of stimuli in the environment or the inability to interpret existing stimuli ; can lead to boredom, confusion, irritability, disorientation, and anxiety.
and interpreting stimuli. The nurse can enhance sensory stimulation in the environment with colors, pictures, textures, tastes, smells, and sounds. meaningful if they are interpreted to the older person and if they are changed often Cognitively impaired persons respond well to touch and to familiar music
Health promotion:
Wear eyeglasses, use sunglasses outdoors; avoid abrupt changes from dark to light; use adequate indoor lighting with area lights and
nightlights use large-print books use magnifier for reading Avoid night driving use contrasting colors for color coding avoid glare of shiny surfaces and direct sunlight
sounds
Subjective and Objective findings:
Gives inappropriate responses asks people to repeat words
Health promotion:
Recommend a hearing examination Reduce background noise face person; enunciate clearly
in midlife. Older people are often unable to follow conversation because tones of high-frequency consonants (letters f, s, th, ch, sh, b, t, p) all sound alike.
inappropriately, misunderstand conversation, and avoid social interaction. This behavior may be erroneously interpreted as confusion. Wax buildup or other correctable problems may also be responsible for major hearing difficulties. A properly prescribed and fitted hearing aid may be useful in reducing hearing deficits.
Taste and smell: Decreased ability to taste and smell Subjective and Objective findings:
Nutritional Health
Decreased physical activity and a slower metabolic
rate reduce the number of calories needed by the older adult to maintain an ideal weight Education regarding healthy versus empty-calorie foods is helpful.
Health promotion:
encouraging a diet that is low in sodium and
saturated fats and high in vegetables, fruits, and fish. Maintain balanced nutrition. Reduce salt intake Protein intake should remain the same in later adulthood as in earlier years
supply the diet with 55% to 60% of the daily calories Simple sugars should be avoided and complex carbohydrates encouraged. Potatoes, whole grains, brown rice, and fruit provide the person with minerals, vitamins, and fiber and should be encouraged.
is recommended unless contraindicated by a medical condition. A multivitamin each day helps to maintain daily nutritional needs
SLEEP DISTURBANCES
sleep hygiene behaviors: avoiding daytime napping eating a light snack before bedtime
fewer hours of sleep needed than when the patient was younger
developed over the course of a lifetime and remain consistent later in life. Experiencing success in younger adulthood helps a person develop a positive self-image that remains solid through even the adversities of old age. A persons abilities to adapt to changes, make decisions, and respond predictably are also determined by past experiences. A flexible, well-functioning person will probably continue as such. Losses may accumulate within a short period of time, however, and become overwhelming.
Common stressors of old age: normal aging changes that impair physical function,
activities, and appearance; disabilities from chronic illness; social and environmental losses related to loss of income decreased ability to perform previous roles and activities; the deaths of significant others.
beliefs for comfort during stressful times. Lack of social engagement (interaction with people within their environment) may be a modifiable risk factor for death in older persons residing in nursing homes.
Erikson (1963)
achieve ego integrity or suffer despair. ego integrity: accepting ones lifestyle believing that ones choices were the best that could be made at a particular time, being in control of ones life. Despair results when an older person feels dissatisfied and disappointed with his or her life, and would live differently if given another chance.
Havighurst (1972)
tasks of the older person include; adjusting to retirement after a lifetime of
employment with a possible reduction of income decreases in physical strength and health the death of a spouse establishing affiliation with ones age group adapting to new social roles in a flexible way establishing satisfactory physical living arrangements
Havighurst:
developmental tasks for the older adult: (1) maintenance of self-worth (2) conflict resolution (3) adjustment to the loss of dominant roles (4) adjustment to the deaths of significant others (5) environmental adaptation (6) maintenance of optimal levels of wellness.
aging requires maintaining the active lifestyle of middle age (Havighurst, 1972). CONTINUITY THEORY- successful adjustment to old age requires continuing life patterns across a lifetime (Atchley, 1989; Neugarten, 1961).
maintained through a continuation of wellestablished habits, values, and interests that are integral to the persons present lifestyle.
scores and that certain types of intelligence (eg, spatial perceptions and retention of nonintellectual information) decline problem-solving ability based on past experiences, verbal comprehension, mathematical ability do not decline Cardiovascular health, a stimulating environment, high levels of education, occupational status, and income all have a positive effect on intelligence scores in later life.
adult, particularly after the seventh decade of life. Motivation, speed of performance, and physical status all are important influences on learning. The components of memory, an integral part of learning, include short-term memory (5 to 30 seconds), recent memory (1 hour to several days), and long-term memory (lifetime). Acquisition of information, registration (recording), retention (storing), and recall (retrieval) are essential components of the memory process. Sensory losses, distractions, and disinterest interfere with acquiring and recording information. Age-related loss occurs more frequently with short-term and recent memory; in the absence of a pathologic process, this is called benign senescent forgetfulness.
Supplies mnemonics to enhance recall of related data Encourages ongoing learning Links new information with familiar information Uses visual, auditory, and other sensory cues Encourages learners to wear prescribed glasses and hearing aids Provides glare-free lighting Provides a quiet, nondistracting environment Sets short-term goals with input from the learner Keeps teaching periods short Paces learning tasks according to the endurance of the learner Encourages verbal participation by learners Reinforces successful learning in a positive manner
clients present and future health care and living needs. ; provides valuable information regarding factors that can radically affect the individuals health care and quality of life. often requested for individuals with catastrophic injuries or illness (eg, traumatic brain injury, amputation, multiple sclerosis) who will require ongoing rehabilitative and medical services. A life care plan may also serve as the blueprint for what will be expected in long-term care.
needs Recreational equipment Aids for independent function Home/facility care Transportation needs Architectural renovations Potential medical complications Compromised financial status
medications in the body, including the processes of absorption, Distribution, metabolism, and excretion.
Nursing Implications
The nurse administering medications to older people must be aware of the following: Medications removed from the body primarily by renal excretion remain in the body for a longer time in people with decreased renal function. Often dosages must be reduced, because overdosage and medication toxicity at usual therapeutic dosages are common. Medications with a narrow safety margin (eg, digitalis glycosides) must be administered cautiously. A decline in cardiac output may decrease the delivery rate to the target organ or storage tissue.
requires asking the patient questions and requesting return demonstrations to ensure that learning has occurred.
manual dexterity, can affect the patients ability to carry out instructions properly, and the teaching plan will need to be adjusted to meet each patients needs.
The following steps taken by the nurse can help the patient to manage his or her medications and improve compliance:
Explain the action, side effects, and dosage of each medication. Write out the medication schedule. Encourage the use of standard containers without safety lids (if there are no children in the household). Suggest the use of a multiple-day, multiple-dose medication dispenser to help patients adhere to the medication schedule Destroy old, unused medications. Review the medication schedule periodically. Discourage the use of over-the-counter medications and herbal agents without consulting a health professional. Encourage the patient to take all medications, including over-the-counter medications, with him or her regularly when visiting the primary health care provider.
gastric emptying Effect: Rate of drug absorptionpossibly delayed Extent of drug absorptionnot affected
Effect: Serious alterations in drug binding to plasma proteins (the unbound drug gives the pharmacologic response); highly protein-bound medications have fewer binding sites, leading to increased effects and accelerated metabolism and excretion
Oral anticoagulants (warfarin) Oral hypoglycemic agents (sulfonylureas) Barbiturates Calcium channel blockers Furosemide (Lasix) Nonsteroidal anti-inflammatory drugs (NSAIDs) Sulfonamides Quinidine Phenytoin (Dilantin
Decreased perfusion
Increased percentage of body fat Proportion of body fat increases with age,
medications; this causes drug accumulation prolonged storage, and delayed excretion
Phenothiazines (antipsychotics)
Ethanol Morphine
medications
Digoxin
Lithium Procainamide
mortality and morbidity in older adults. -major cause of trauma in the elderly -not often fatal but do threaten health and the quality of life. -Normal and pathologic consequences of aging that contribute to increased falls:
Cognitive changes
Musculoskeletal changes include altered posture and
and alcohol precipitate falls by causing drowsiness, incoordination, and postural hypotension. Osteoporosis-related fractures can have a negative effect on the individuals ability to maintain an independent living arrangement
DEMENTIA VS DELIRIUM
(SEE TABLE)
Nursing interventions:
aimed at maintaining the patients physical safety;
reducing anxiety and agitation; improving communication; promoting independence in selfcare activities; providing for the patients needs for socialization, self-esteem, and intimacy; maintaining adequate nutrition; managing sleep pattern disturbances; and supporting and educating family caregivers.
and use of memory aids and cues give the patient a sense of security. Prominently displayed clocks and calendars may Color-coding the doorway may help the patient who has difficulty locating his or her room. Active participation may help the patient to maintain cognitive, functional, and social interaction abilities for a longer period. Physical activity and communication ( to slow some of the cognitive decline of Alzheimers disease
A safe environment -- all obvious hazards are removed. Nightlights are helpful. Monitor patients intake of medications and food Smoking is allowed only with supervision. A hazard-free environment allows the patient maximum independence and a sense of autonomy Because of a short attention span and forgetfulness, wandering behavior can often be reduced by gently persuading or distracting the patient. Restraints are AVOIDED because they may increase agitation. Doors leading from the house must be secured. Outside the home, all activities must be supervised to protect the patient, and the patient should wear an identification bracelet or neck chain in case he or she becomes separated from the caregiver.
declining ability. The environment should be kept uncluttered, familiar, and noise free. Excitement and confusion can be upsetting and may precipitate a combative, agitated state known as a catastrophic reaction (overreaction to excessive stimulation). remain calm and unhurried. Measures such as listening to music, stroking, rocking, or distraction may quiet the patient. Frequently, the patient forgets what triggered the reaction. Structuring of activities Becoming familiar with the patients predicted responses to certain stressors Dementia education for caregivers
IMPROVING COMMUNICATION
To promote the patients interpretation of messages, the
nurse remains unhurried and reduces noises and distractions. The nurse uses clear, easy-to-understand sentences to convey messages, because Lists and simple written Patient can point to an object or use nonverbal language to communicate. Tactile stimuli, such as a hug or a hand pat, are usually interpreted as signs of affection, concern, and security
independent for as long as possible. --- simplify daily activities by organizing them into short, achievable steps Direct patient supervision is sometimes necessary, but maintaining personal dignity and autonomy is important for Encourage patient to make choices when appropriate and to participate in self-care activities as much as possible.
INTIMACY NEEDS
visits, letters and phone calls are encouraged. Visits should be brief and nonstressful; limiting visitors to one or two at a time helps
to reduce overstimulation. Because recreation is important, the person is encouraged to enjoy simple activities. Realistic goals that provide satisfaction are appropriate. Hobbies and activities such as walking, exercising, and socializing can improve the quality of life. Nonjudgmental friendliness of a pet may provide a lonely person with stimulation, comfort, and contentment. Care of the pet by the patient can also provide a satisfying activity and an outlet for energy. The patient and his or her spouse may or may not continue to enjoy sexual activity. Simple expressions of love, such as touching and holding, are often meaningful.
asleep, music, warm milk, or a back rub may help the person relax. During the day, the patient should be given sufficient opportunity to participate in exercise activities, because a regular pattern of activity and rest will enhance nighttime sleep. Long periods of daytime sleeping are discouraged.
because of reduced acuity of touch, alterations in neural pathways, and diminished processing of sensory data. . Acute abdominal conditions, such as mesenteric infarction and appendicitis, often go unrecognized in elderly people because of atypical signs and absence of pain
about 1F lower than it is for younger people. In the event of illness, therefore, the body temperature of an older person may not reach a sufficient elevation to qualify as a traditionally defined fever. A temperature of 37.8C (100F), in combination with systemic symptoms, may signal infection. A temperature of 38.3C (101F) is almost certainly a serious infection that needs prompt attention.
indicates a poor prognosis. Elevations in temperature rarely exceed 39.5C (103F). The nurse must be alert to other subtle signs of infection: mental confusion, increased respirations, tachycardia, and changed facial appearance and color
imminent threat to well-being. Admission to the hospital is often feared and actively avoided. Economic concerns and fear of becoming a burden to the family often lea to high anxiety in older people. The nurse must recognize the implications of fear, anxiety, and dependency in elderly patients. Autonomy and independent decision making are encouraged. A positive and confident demeanor in the nurse and the family promote a positive mental outlook in the elderly patient. In addition to anxiety and fear, older people are at high risk for disorientation, confusion, change in level of consciousness, and other symptoms of delirium if they are admitted to the hospital
effectively to an acute illness or, if a chronic health condition is present, he or she may be unable to sustain appropriate responses over a long period. The older persons ability to respond to definitive treatment is impaired. Nurse must monitor all of the older adults body system functions closely, being alert to signs of impending systemic complication.