Care of the Older Person

Maria Thresa Jader Princes Joy Labanza Anjelika Eurelle Mapili Bryan Sadol

Developmental Aspects of Aging

Risk for Activity Intolerance related to Deconditioned Status (Aging)

Note presence of medical diagnosis and/or therapeutic regimens Determine current activity level and physical condition with observation, exercise tolerance testing, or use of functional level classification system (e.g. Gordons) Discuss with client the relationship of illness or debilitating condition and ability to perform desired activities. Provide information regarding potential interfering factors with activity Instruct client in unfamiliar activities and in alternate ways of doing familiar activities

Acute Confusion related to Over 60 years of age

Note presence of agitation, fear, and anxiety Evaluate sleep and rest status, noting insomnia, sleep deprivation, and over sleeping. Evaluate mental status, noting extent of impairment in orientation, attention span, ability to follow directions, ability to send and receive communication, appropriateness of response. Monitor/adjust medication regimen and note response. Determine medication that can be changed or eliminated. Orient client to surroundings, staff, necessary activities, as needed. Avoid challenging illogical thinking.

Death Anxiety

Determine how client sees self in usual lifestyle role functioning and perception and meaning of anticipated loss to the client. Ascertain current knowledge of situation Observe behavior indicative of the level f anxiety present Identify coping skills currently used and how effective they are. Be aware of defense mechanisms being used by the client. Note clients religious and spiritual orientation, involvement in religious activities, presence of conflicts regarding spiritual beliefs. Listen for expression of inability to find meaning in life or suicidal ideation Provide open and trusting relationship Direct clients thoughts beyond present state to enjoyment of each day and the future when appropriate. Encourage expression of feelings. Acknowledge anxiety/fear. Do not deny or reassure client that everything will be alright. Be honest on answering questions/providing information.

Impaired memory related to Age

Note clients age and potential for depression Perform or review results of cognitive testing Orient/reorient client as needed Implement appropriate memory-retraining techniques Provide for and emphasize importance of pacing learning activities and getting sufficient rest. Assist client to establish compensation strategies

Risk for Situational Low Self-Esteem related to Functional Impairment

Determine individual factors that could contribute to diminish self-esteem Note clients perception of threat to self in current situation. Verify clients concept of self in relation to cultural or religious ideals. Assess negative attitudes and/or self-talk.

Biophysical & Physiological Aging

Decreased Cardiac Output related to Altered Heart Rate/Rhythm

Evaluate clients reports and evidence of extreme fatigue, intolerance for activity, sudden or progressive weight gain, swelling of extremities, and progressive shortness of breath Determine vital signs/hemodynamic parameters including cognitive status. Provide for adequate rest, positioning client for maximum comfort. Monitor cardiac rhythm continuously Asses potential for/type of developing shock states

Activity Intolerance

Note clients report of weakness, fatigue, pain, difficulty accomplishing tasks, and/or insomnia. Assess emotional and psychological factors affecting the current situation Adjust activities Provide and monitor response to supplemental oxygen, medications, and changes in treatment regimen Promote comfort measures

Imbalanced Nutrition: less than body requirement related to Inability to ingest or digest food

Determine clients inability to chew, swallow, and taste food. Evaluate teeth and gums for poor oral health, and note if denture fits, as indicated. Determine psychological factors, perform psychological assessment Assess weight Encourage client to choose foods or have family member bring foods that seem appealing Assist with or provide oral care before and after meals and at bedtime.

Constipation

Review medical, surgical, and social history for conditions often associated with constipation Note general oral/dental issues Note energy and activity levels and exercise pattern Instruct in and encourage a diet of balanced fiber and bulk and fiber supplements Encourage and activity and exercise within limits of individual ability.

Risk for Impaired Skin Integrity related of extremes of age

Assess skin routinely, noting moisture, color, and elasticity Note presence of conditions or situations Change position in bed or chair on a regular schedule. Keep bedclothes dry Provide safety measures during ambulation and other therapies that might cause dermal injury Provide preventive skin care to incontinent client

Psychological Aspects of Aging

Impaired Memory

implement appropriate memory retraining techniques encourage ventilation of feelings of frustration

monitor clients behavior and assist in use of stress management techniques

assist client t establish compensation strategies to improve functional lifestyle and safety

Disturbed Thought Process

evaluate mental status note behavior such as untidy personal habit; slowing and slurring of speech assess clients anxiety level in relation to situation assist with treatment with underlying problems

Impaired Verbal Communication

review history for neurological conditions that could affect speech such as CVA, tumor, hearing loss and so forth evaluate mental status note level of anxiety level present

Chronic Sorrow related to Experiences chronic illness or disability

Look for cues of sadness Determine level of functioning Encourage verbalization about situation Encourage expression of anger, fear, and anxiety Acknowledge reality of feelings of guilt/blame Discuss healthy ways of dealing with difficulties situation Encourage involvement in usual activities, exercise, and socialization within limits of physical and psychological state.

Disturbed Sensory Perception

Identify client with condition that can affect sensing, interpreting, and communicating stimuli Assess ability to speak, hear, interpret, and respond to simple commands Observe for behavioral responses Determine response to stimuli Interpret stimuli and offer feedback Reorient to person, place, time, and events, as necessary Promote meaningful socialization Provide safety measures

Successful Aging
Death Anxiety

Determine how client sees self in usual lifestyle functioning Note physical/ mental condition

Determine ability to manage own self-care

Identify coping skills currently used and how effective they are

Risk for Loneliness

Differentiate ordinary loneliness and a state of consent sense of disphoria Determine how individual perceives/ deals with solitude Assess sleep/appetite disturbances Establish nurse/client relationship in which client feels free to talk about feelings Discuss importance of emotional bonding Encourage involvement in special interest groups

Ineffective Role Performance

Maintain positive attitude toward client Make information available for client to learn about expectations that may occur Refer to support groups as indicated by individual needs Use techniques of role rehearsal to help the client develop new skills to cope with changes

Readiness for Enhanced Spiritual Well-Being

Determine spiritual motivation for growth Explore meaning and relationship of spirituality life/ death and illness to lifes journey Determine influence of cultural beliefs Encourage client to take time to be introspective in the search of peace and harmony Discuss use of relaxation/ meditative activities

Effective Therapeutic Regimen Management

Identify individuals perception of adaptation to treatment changes Discuss present resources used by client Identify steps necessary to reach self goals Promote client/ care giver choices and involvement in planning and implementing added responsibilities Provide for follow up home visit as appropriate Mobilize support system

Geriatric Nutrition
Impaired Nutrition: less than body requirement

Determine ability to chew, swallow and taste -discuss eating habits -assess drug interactions -assess weight, age, body build, strength -note total daily intake -small feedings with snacks - use flavoring agents to enhance food satisfaction and food appetite - encourage clients to choose food that are appealing to improve appetite

Impaired Swallowing related to decrease gag reflex

Encourage a rest period before meals to minimize fatigue Determine food preferences of client to incorporate as possible enhancing intake. Ensure temperature of food/fluid which will stimulate sensory receptors Provide a consistency of food/fluid that is most easily swallowed

Impaired Oral Mucus Membrane

Determine nutrition/ fluid intake and reported changes Encourage adequate fluid to prevent dehydration Recommend avoiding alcohol, smoking/ chewing tobacco which may further irritate mucosa Encourage use of chewing gum, hard candy and so forth to stimulate saliva

Risk for Imbalanced Fluid Volume

Measure and record intake and output - monitor Blood pressure responses - assess for clinical signs of dehydration - maintain fluid/ sodium restrictions when needed

Deficient Fluid Volume

determine effects of age - assess vital signs - note strength of peripheral pulses - monitor blood pressure - observe urinary output; color, and measure amount and specific gravity

Impaired Memory r/t neurological disturbances

Observe patients thought process every after shift. Changes indicate progressive improvement or a decline in patients underlying condition. Implement appropriate safety measures to protect patient from injury. He or she may be unable to provide his/her needs. Call the patient by name and introduced your name. Provide background information (place, time and date) frequently throughout the day to provide reality orientation. Spend sufficient time with the patient to allow him/her to become comfortable discussing memory loss and establish a trusting relationship. Be clear. Be concise and direct in establishing goals to promote maximal use of patients remaining cognitive skills. Offer short, simple explanations to patient each time you carry out a medical and nursing procedure to avoid confusion.

Self care deficit r/t frustration over loss of independence

Assist patient in accepting necessary amount of dependence. If disease, injury, or illness resulting in self-care deficit is recent, patient may need to grieve before accepting that dependence is possible.
Encourage independence, but intervene when patient cannot perform. To decrease frustration.

Provide positive reinforcement for all activities attempted; note partial achievements. This provides the patient with an external source of positive reinforcement.
Set short-range goals with patient. To facilitate learning and decrease frustration.

Use consistent routines and allow adequate time for patient to complete tasks. This helps patient organize and carry out self-care skills.

Self care deficit r/t frustration over loss of independence

Assist patient in accepting necessary amount of dependence. If disease, injury, or illness resulting in self-care deficit is recent, patient may need to grieve before accepting that dependence is possible. Encourage independence, but intervene when patient cannot perform. To decrease frustration. Provide positive reinforcement for all activities attempted; note partial achievements. This provides the patient with an external source of positive reinforcement. Set short-range goals with patient. To facilitate learning and decrease frustration. Use consistent routines and allow adequate time for patient to complete tasks. This helps patient organize and carry out selfcare skills.