Geriatric Nursing in Ppt
Content
Click to edit Master subtitle style Nursing Elective Course
Geriatric Nursing
7/15/12
Terms geriatrics- study of old age
including physiology, pathology, dx., & treatment of diseases of old adults
gerontology-
broader, the study of the aging process including biological, psychological, & sociological
gerontologic or gerontic nursing7/15/12 specializes in care of the elderly
Aging
normal process of time related change starting with birth & continuing throughout life person ages influenced by ◦ genetics ◦ lifestyle ◦ availability & quality of health care ◦ socioeconomics
way
old
age- final phase of life by 2030- 69.4 Million (8 Mil. over 85)
7/15/12
predict 23%
over 65 while only 18% under 18
Terms Old Age
definition
varies with frame of
reference
society
indicates age 65 as beginning of old age ◦young-old- 65-74 ◦middle-old-7/15/12 75-84
Terms
life span- maximum number of years person can live under the best of conditions in absence of disease life expectancy- average number of years a person can be expected to live 77.7 years 80% have @ least 1 chronic illness, 50% have 2 Million older- 4.4 Million (14.5%) difficulty with @ least 1 ADL (eating, bathing, dressing, transferring, 7/15/12 toileting)
2007: over 34
Myths vs Reality
1. families do not care for elder- 80% do take care 2. elderly- alone & deserted 67% live in family setting 66%- child within 30 minutes 62%- weekly visits 76%- talk weekly 3. sickness & aging synonymous almost 50% rate health as good or 7/15/12 excellent
Myths vs Reality
4. incapable of learning- although slowed due to reflexes, capable of learning new things 5. no longer interested in sexuality/ sexual act sexuality (lifelong need) can provide intimacy & love without sexual relations 6. constipation/ incontinence- expected never normal constipation due to inactivity or diet
7/15/12 incontinence- seek medical help
Myths vs Reality
7. senility- expected result of age senility (dementia found in elderly) dementia- result of disease- not aging 8. elderly financially impoverished median net worth- $86,300 poverty rate- 12.9% median income- $28,983 9. spend last years in nursing home
7/15/12 about 5% in nursing home
1. personal hygiene
◦ bath 2-3/ week ◦ lotion prn
Health Promotion & Maintenance
◦ shampoo 1-2/ week ◦ keep nails short ◦ dental supervision ◦ try to make dressing easier (loose clothing, zippers, velcro)
2. exercise
7/15/12 ◦ individual planned
Integumentary
◦ skin thinner
Normal Aging Changes
◦ wrinkles ◦ gray hair ◦ skin drier & more susceptible to irritation ◦ change in pigmentation (age or liver spots) ◦ nails- thick & brittle ◦ less efficient cooling system 7/15/12 ◦ less tolerance to temperatures
◦ less subcutaneous tissue
Normal Aging Changes
Nervous
◦ slowed reactions ◦ altered sleep cycle ◦ short term memory loss ◦ impaired senses ◦ Recommend at risk for accidents assist ADL 7/15/12 prn
Normal Aging Changes
Sensory
◦ vision
presbyopia reading glasses problem with blue vs green difficulty adjusting to dark-light changes (night blindness) Recommend
◦ adequate lighting ◦ avoid glare ◦ vision aids
7/15/12
Normal Aging Changes
Sensory ◦ hearing
presbycusis problem with some consonants cerumen accumulation Recommend
◦ low tone speaking voice ◦ reduce background noise ◦ face person ◦ enunciate clearly ◦ moderate pace ◦ gestures prn
7/15/12
Normal Aging Changes
Respiratory
◦ decreased gas exchange & cough efficiency ◦ decreased activity tolerance ◦ more vulnerable to infection ◦ Recommend
exercise no smoking not in smoking areas force fluids flu vaccine
7/15/12
avoid exposure to infection
Normal Aging Changes
Reproductive
◦ decreased hormone production ◦ menopause in female ◦ decreased vaginal secretions ◦ penis & testes decrease in size ◦ sperm production slowed ◦ Recommend
sexual desires & activity decline but not disappear water-soluble lubricant 7/15/12 sexual counselor prn
Normal Aging Changes
Musculoskeletal
◦ osteoporosis ◦ pathologic fractures ◦ muscles lose strength, flexibility, & endurance ◦ height loss ◦ changes in posture ◦ Recommend
high Ca, low Ph exercise handle gently
7/15/12
Normal Aging Changes
Cardiovascular
◦ heart disease leading cause of death ◦ heart valves-thicker & stiffer ◦ arteries lose elasticity & accumulate deposits ◦ decreased response to stress ◦ B/P increases ◦ cardiac output decreases ◦ Recommend
exercise no smoking weight control
7/15/12
Normal Aging Changes
GI
◦ decreased motility ◦ decreased teeth ◦ ill fitting dentures ◦ decreased saliva ◦ constipation
lack of bulk prolonged use of laxatives ignore urge to defecate drug side effects
7/15/12
emotional problems
Normal Aging Changes GI Recommend
◦regular dental & oral care ◦small frequent meals ◦sit up after meals ◦no heavy activity after
meals
7/15/12 ◦antacids with supervision
Normal Aging Changes
Urinary
◦ decreased nephron activity ◦ lose of muscle tone results in more frequent voiding ◦ retention, frequency, urgency, & incontinence common ◦ Recommend
ready access to toilet, void regularly pelvic floor exercises
7/15/12 avoid bladder irritants (caffeine, ETOH, sweeteners)
Normal Aging Changes
Endocrine ◦change in hormones ◦decreased basal metabolic rate (BMR)
Immune
◦decreased function ◦more susceptible to infection & disease 7/15/12
Mental Health Disorders
1. depression
a. most common affective, mood, or functional disorder b. can be reaction to loss of independence, status or spouse c. some medications d. physical illness & changes e. nursing
encourage self expression & esteem improve appearance provide structure7/15/12 & routine
Mental Health Disorders 2. aggressive behavior a. abnormal anger, rage, or hostility b. result of anxiety, stress, guilt, insecurity, forced dependence c. nursing
7/15/12 express feelings
Mental Health Disorders
4. rehabilitation for mental problems a. reality orientation b. remotivation c. reminiscence d. cognitive training e. relaxation therapy
7/15/12
Role Changes
1. crisis- sudden, not able to plan for appropriate replacement, substitute not readily available, stress producing 2. gradual- develop slowly & allow time for preparation 3. changes generally crisis-forced retirement, loss of spouse, illness, friends move away or die, family relocate or assume new roles decreasing time for relationship
7/15/12 4. role losses- work (no longer bread winner), family (no longer decision
Alterations in Life-style
1. employment
◦ increase in number of older females working ◦ decrease in number older males working ◦ part-time employment more common ◦ early retirement ◦ involuntary limitations (health, sensory or perceptual alterations, decline in strength, endurance, & speed) ◦ strengths (reliability, dependability, 7/15/12 knowledge, expertise, experience)
2. retirement
Alterations in Life-style
◦ mandatory age raised to 70 ◦ health problems major cause of voluntary retirement ◦ increased leisure time ◦ stressful when decreased ability to handle stress ◦ tremendous anxiety ◦ loss of daily routine & income
7/15/12
Alterations in Life-style
economic
◦ fixed incomes frequently below nation's poverty levels (1 of 10) ◦ costs increase ◦ buying power decrease ◦ many not receiving full benefits due to lack of knowledge or inability to find out resources
lack of mobility health problems
7/15/12
◦ penalties of losing social security benefits
health
◦ 40% more than one chronic disease
increase
in health care needs & costs
Alterations in Life-style
7/15/12
Alterations in Life-style
housing
◦ prefer to remain independent ◦ live with spouse, alone, or with family ◦ own home ◦ alternatives (mobile homes, retirement communities, foster homes, life care facilities, nursing homes, homes for the aged, convalescent homes, rest homes, house sharing, public housing, rooming houses, hotels for single room occupancy) ◦ require special assistance (transportation, 7/15/12 meals, health hotlines, house cleaners,
Alterations in Life-style
recreation
◦ more time available ◦ problems (cost, health, decreased energy, lack of incentive, sensory losses, lack of environmental aids, lack of conveniently located facilities) ◦ most depend on family ◦ alternatives (religious, community activities, day care, senior citizen centers, adult education, cultural events)
7/15/12
Intelligence
test
scores decline but due to slowed responses not actual ability capacity continues
learning memory
◦ short term concentration & retention decline ◦ remote generally better
personality
basically unchanged
7/15/12
Drugs & Elderly
account average
for 34% of Rx. & 40% of OTC more than 11 per year
decreased
dosage due to decreased absorption, distribution, metabolism, & excretion
Recommend
◦ education ◦ administration times compatible with 7/15/12 lifestyle
Community
95% 31%
live in community live alone (40% female, 74% male)
married 48%
females widowed but only 15% males (more remarry) have living children
81%
7/15/12
Elder Abuse
active
or passive act or behavior that is harmful to the elderly violence (battering, sexual) neglect
physical personal mental
anguish (threat of institutionalization, social isolation, sensory deprivation) exploitation of rights (confinement or 7/15/12 restraint)
financial violation
Safety
accidents
◦ leading cause of death ◦ falls most ◦ also fires & MVA ◦ more likely
decreased sense increased reflex time muscle weakness confusion, forgetful
7/15/12 improper footwear
Safety
prevention
◦ short or 3/4 sleeve ◦ no long garments ◦ chairs with arms ◦ no slip wax on floors, no scatter rugs or deep pile ◦ avoid clutter ◦ rubber tips on canes ◦ tong reachers rather than stools or ladders
7/15/12 ◦ temperature controlled faucets
Safety
◦ handrails, high toilet seats, shower chairs ◦ night light ◦ side rails on bed prn ◦ telephone by bed ◦ proper lighting ◦ stair rails, colored strips on step edges ◦ no frayed wires ◦ readily available emergency numbers ◦ smoke detectors ◦ crime prevention assessment
7/15/12
Personal Space
many
are set in ways
prefer
to be in familiar place with memories allow as long as possible
7/15/12
should
Medicare
federal
social insurance program designed to provide health care to elderly entitled to social security benefits A- hospital B- medical
part part
◦ (voluntary ◦ must pay additional fee ◦ out-patient
7/15/12
7/15/12
Geriatric Nursing
7/15/12
Terms geriatrics- study of old age
including physiology, pathology, dx., & treatment of diseases of old adults
gerontology-
broader, the study of the aging process including biological, psychological, & sociological
gerontologic or gerontic nursing7/15/12 specializes in care of the elderly
Aging
normal process of time related change starting with birth & continuing throughout life person ages influenced by ◦ genetics ◦ lifestyle ◦ availability & quality of health care ◦ socioeconomics
way
old
age- final phase of life by 2030- 69.4 Million (8 Mil. over 85)
7/15/12
predict 23%
over 65 while only 18% under 18
Terms Old Age
definition
varies with frame of
reference
society
indicates age 65 as beginning of old age ◦young-old- 65-74 ◦middle-old-7/15/12 75-84
Terms
life span- maximum number of years person can live under the best of conditions in absence of disease life expectancy- average number of years a person can be expected to live 77.7 years 80% have @ least 1 chronic illness, 50% have 2 Million older- 4.4 Million (14.5%) difficulty with @ least 1 ADL (eating, bathing, dressing, transferring, 7/15/12 toileting)
2007: over 34
Myths vs Reality
1. families do not care for elder- 80% do take care 2. elderly- alone & deserted 67% live in family setting 66%- child within 30 minutes 62%- weekly visits 76%- talk weekly 3. sickness & aging synonymous almost 50% rate health as good or 7/15/12 excellent
Myths vs Reality
4. incapable of learning- although slowed due to reflexes, capable of learning new things 5. no longer interested in sexuality/ sexual act sexuality (lifelong need) can provide intimacy & love without sexual relations 6. constipation/ incontinence- expected never normal constipation due to inactivity or diet
7/15/12 incontinence- seek medical help
Myths vs Reality
7. senility- expected result of age senility (dementia found in elderly) dementia- result of disease- not aging 8. elderly financially impoverished median net worth- $86,300 poverty rate- 12.9% median income- $28,983 9. spend last years in nursing home
7/15/12 about 5% in nursing home
1. personal hygiene
◦ bath 2-3/ week ◦ lotion prn
Health Promotion & Maintenance
◦ shampoo 1-2/ week ◦ keep nails short ◦ dental supervision ◦ try to make dressing easier (loose clothing, zippers, velcro)
2. exercise
7/15/12 ◦ individual planned
Integumentary
◦ skin thinner
Normal Aging Changes
◦ wrinkles ◦ gray hair ◦ skin drier & more susceptible to irritation ◦ change in pigmentation (age or liver spots) ◦ nails- thick & brittle ◦ less efficient cooling system 7/15/12 ◦ less tolerance to temperatures
◦ less subcutaneous tissue
Normal Aging Changes
Nervous
◦ slowed reactions ◦ altered sleep cycle ◦ short term memory loss ◦ impaired senses ◦ Recommend at risk for accidents assist ADL 7/15/12 prn
Normal Aging Changes
Sensory
◦ vision
presbyopia reading glasses problem with blue vs green difficulty adjusting to dark-light changes (night blindness) Recommend
◦ adequate lighting ◦ avoid glare ◦ vision aids
7/15/12
Normal Aging Changes
Sensory ◦ hearing
presbycusis problem with some consonants cerumen accumulation Recommend
◦ low tone speaking voice ◦ reduce background noise ◦ face person ◦ enunciate clearly ◦ moderate pace ◦ gestures prn
7/15/12
Normal Aging Changes
Respiratory
◦ decreased gas exchange & cough efficiency ◦ decreased activity tolerance ◦ more vulnerable to infection ◦ Recommend
exercise no smoking not in smoking areas force fluids flu vaccine
7/15/12
avoid exposure to infection
Normal Aging Changes
Reproductive
◦ decreased hormone production ◦ menopause in female ◦ decreased vaginal secretions ◦ penis & testes decrease in size ◦ sperm production slowed ◦ Recommend
sexual desires & activity decline but not disappear water-soluble lubricant 7/15/12 sexual counselor prn
Normal Aging Changes
Musculoskeletal
◦ osteoporosis ◦ pathologic fractures ◦ muscles lose strength, flexibility, & endurance ◦ height loss ◦ changes in posture ◦ Recommend
high Ca, low Ph exercise handle gently
7/15/12
Normal Aging Changes
Cardiovascular
◦ heart disease leading cause of death ◦ heart valves-thicker & stiffer ◦ arteries lose elasticity & accumulate deposits ◦ decreased response to stress ◦ B/P increases ◦ cardiac output decreases ◦ Recommend
exercise no smoking weight control
7/15/12
Normal Aging Changes
GI
◦ decreased motility ◦ decreased teeth ◦ ill fitting dentures ◦ decreased saliva ◦ constipation
lack of bulk prolonged use of laxatives ignore urge to defecate drug side effects
7/15/12
emotional problems
Normal Aging Changes GI Recommend
◦regular dental & oral care ◦small frequent meals ◦sit up after meals ◦no heavy activity after
meals
7/15/12 ◦antacids with supervision
Normal Aging Changes
Urinary
◦ decreased nephron activity ◦ lose of muscle tone results in more frequent voiding ◦ retention, frequency, urgency, & incontinence common ◦ Recommend
ready access to toilet, void regularly pelvic floor exercises
7/15/12 avoid bladder irritants (caffeine, ETOH, sweeteners)
Normal Aging Changes
Endocrine ◦change in hormones ◦decreased basal metabolic rate (BMR)
Immune
◦decreased function ◦more susceptible to infection & disease 7/15/12
Mental Health Disorders
1. depression
a. most common affective, mood, or functional disorder b. can be reaction to loss of independence, status or spouse c. some medications d. physical illness & changes e. nursing
encourage self expression & esteem improve appearance provide structure7/15/12 & routine
Mental Health Disorders 2. aggressive behavior a. abnormal anger, rage, or hostility b. result of anxiety, stress, guilt, insecurity, forced dependence c. nursing
7/15/12 express feelings
Mental Health Disorders
4. rehabilitation for mental problems a. reality orientation b. remotivation c. reminiscence d. cognitive training e. relaxation therapy
7/15/12
Role Changes
1. crisis- sudden, not able to plan for appropriate replacement, substitute not readily available, stress producing 2. gradual- develop slowly & allow time for preparation 3. changes generally crisis-forced retirement, loss of spouse, illness, friends move away or die, family relocate or assume new roles decreasing time for relationship
7/15/12 4. role losses- work (no longer bread winner), family (no longer decision
Alterations in Life-style
1. employment
◦ increase in number of older females working ◦ decrease in number older males working ◦ part-time employment more common ◦ early retirement ◦ involuntary limitations (health, sensory or perceptual alterations, decline in strength, endurance, & speed) ◦ strengths (reliability, dependability, 7/15/12 knowledge, expertise, experience)
2. retirement
Alterations in Life-style
◦ mandatory age raised to 70 ◦ health problems major cause of voluntary retirement ◦ increased leisure time ◦ stressful when decreased ability to handle stress ◦ tremendous anxiety ◦ loss of daily routine & income
7/15/12
Alterations in Life-style
economic
◦ fixed incomes frequently below nation's poverty levels (1 of 10) ◦ costs increase ◦ buying power decrease ◦ many not receiving full benefits due to lack of knowledge or inability to find out resources
lack of mobility health problems
7/15/12
◦ penalties of losing social security benefits
health
◦ 40% more than one chronic disease
increase
in health care needs & costs
Alterations in Life-style
7/15/12
Alterations in Life-style
housing
◦ prefer to remain independent ◦ live with spouse, alone, or with family ◦ own home ◦ alternatives (mobile homes, retirement communities, foster homes, life care facilities, nursing homes, homes for the aged, convalescent homes, rest homes, house sharing, public housing, rooming houses, hotels for single room occupancy) ◦ require special assistance (transportation, 7/15/12 meals, health hotlines, house cleaners,
Alterations in Life-style
recreation
◦ more time available ◦ problems (cost, health, decreased energy, lack of incentive, sensory losses, lack of environmental aids, lack of conveniently located facilities) ◦ most depend on family ◦ alternatives (religious, community activities, day care, senior citizen centers, adult education, cultural events)
7/15/12
Intelligence
test
scores decline but due to slowed responses not actual ability capacity continues
learning memory
◦ short term concentration & retention decline ◦ remote generally better
personality
basically unchanged
7/15/12
Drugs & Elderly
account average
for 34% of Rx. & 40% of OTC more than 11 per year
decreased
dosage due to decreased absorption, distribution, metabolism, & excretion
Recommend
◦ education ◦ administration times compatible with 7/15/12 lifestyle
Community
95% 31%
live in community live alone (40% female, 74% male)
married 48%
females widowed but only 15% males (more remarry) have living children
81%
7/15/12
Elder Abuse
active
or passive act or behavior that is harmful to the elderly violence (battering, sexual) neglect
physical personal mental
anguish (threat of institutionalization, social isolation, sensory deprivation) exploitation of rights (confinement or 7/15/12 restraint)
financial violation
Safety
accidents
◦ leading cause of death ◦ falls most ◦ also fires & MVA ◦ more likely
decreased sense increased reflex time muscle weakness confusion, forgetful
7/15/12 improper footwear
Safety
prevention
◦ short or 3/4 sleeve ◦ no long garments ◦ chairs with arms ◦ no slip wax on floors, no scatter rugs or deep pile ◦ avoid clutter ◦ rubber tips on canes ◦ tong reachers rather than stools or ladders
7/15/12 ◦ temperature controlled faucets
Safety
◦ handrails, high toilet seats, shower chairs ◦ night light ◦ side rails on bed prn ◦ telephone by bed ◦ proper lighting ◦ stair rails, colored strips on step edges ◦ no frayed wires ◦ readily available emergency numbers ◦ smoke detectors ◦ crime prevention assessment
7/15/12
Personal Space
many
are set in ways
prefer
to be in familiar place with memories allow as long as possible
7/15/12
should
Medicare
federal
social insurance program designed to provide health care to elderly entitled to social security benefits A- hospital B- medical
part part
◦ (voluntary ◦ must pay additional fee ◦ out-patient
7/15/12
7/15/12
