Problems
Nursing Intervention
Confusion/Dementia
Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships. They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems such as agitation, delusions, and hallucinations. 1. Spend time with the Patient 2. Use touch to convey concern 3. Provide frequent reiteration of orienting data (e.g. time, place) 4. Have clocks or calendars in the environment 5. Explain all actions, procedures and routines to the patient 6. Address the patient by his/her name 7. Keep a routine activities
Constipation
refers to bowel movements that are infrequent and/or hard to pass. 1. Increase Fluid Intake 2. Daily Exercise 3. Increase fiber intake (e.g. fruits and vegetables)
Complications associated with constipation include hemorrhoids from straining, anal fissures, rectal prolapse, and fecal impaction. Untreated constipation in institutionalized patients can lead to cemented lesions in the colon, megacolon, bowel blockage and perforation, peritonitis, and sepsis.
Osteoporosis
is a disease of bones that leads to an increased risk of fracture.[1] In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered.
1. Have adequate calcium in diet: · Milk/dairy products · Fish · Beans · Orange Juice · Cereal or read that have added calcium · Take calcium supplements 2. Get regular exercise 3. Avoid alcohol, quit smoking. Alcohol and smoking reduce bone mass. 4. Avoid large amounts of protein – rich or salty and caffeine foods. They can cause loss of calcium from the body. 5. Make the home safe to avoid accidents. 6. Practice good posture. 4. Use good body mechanics when lifting objects (e.g. bend the knees instead of the back). 5. Do back exercises to improve posture. 6. Wear rubber-soled, low-heeled shoes that grip well. 7. Don’t lift heavy objects. 8. Avoid using a stool or bending over. 9. Put items frequently used within easy reach. 10. Use handrails when going up and down stairs. 11. Hormonal Replacement Therapy (HRT) for menopausal women as prescribed.
Postural Hypotension (PH)
A drop in blood pressure (hypotension) due to a change in body position (posture) when a person moves to a more vertical position: from sitting to standing or from lying down to sitting or standing. 1. Get out of bed slowly and in stages. 2. Sleep with head of bed elevated several inches. 3. Have a daily fluid intake of 2 to 3 liters. 4. Avoid hot showers or baths, may cause venous dilatation thereby, venous pooling. 5. Avoid straining at stool. This may cause fall of BP 6. Avoid bending down and suddenly standing up again. 7. Rest for 60 minutes after meals. 8. Avoid hyperventilation. This lowers the BP. 9. Exercise regimen must be recommended. 10. Use thigh-length elastic stockings to reduce venous pooling. 11. Avoid prolonged standing. 12. Heed warning signs of PH (e.g., dizziness, faintness, visual disturbances) 13. Pharmacotherapy: Fludrocortisone (a mineralocorticoid that promotes retention of water and sodium)
Hypertension
is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. 1. Encourage stress reduction and relaxation. 2. Encourage exercise such as swimming and walking. 3. Encourage healthy diet (fresh fruits, rice, vegetable). 4. No weightlifting. 5. Quit smoking, no alcohol, 6. Reduce intake of saturated fats. 7. Reduce salt intake to 1 to 6 gm per day. 8. Take prescribed medications at regular basis.
Elder abuse 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.
There are many types of abuse used against the elderly. They include: 1. Psychologic abuse such as instilling fear, threatening or making the elderly perform demeaning tasks, 2. Physical abuse such as hitting, slapping, or burning. 3. Financial abuse such as taking their money or forcing them to sign over their assets. 4. Neglect such as withholding food, medications or basic care. 5. Infringement of personal rights such as restraining for long periods of time against their will or isolating them from normal social interactions. 6. Sexual abuse 7. The perpetrator of abuse is usually the spouse or the children of the victim. Caregivers who abuse their elderly family members are often middle-aged or older or have emotional problems such as alcoholism or substance abuse.
Vision
30% of those over age 65 have some level of visual impairment. Cataracts are the 5th most common chronic condition in adults over age 75.
Vision Changes common in older adults Presbyopia: A loss of elasticity in the lens of eye leading to a decrease in the eyes ability to change the shape of the lens to focus on near objects such as fine print and decreased ability to adapt to light. * Thickening of the lens with loss of elasticity * Decreased contrast sensitivity * Delayed recovery from glare
Vision
* Avoid disruption in the management of chronic eye conditions by obtaining past history and assuring continuation of ongoing regimens such as eye drops for glaucoma. * Notify the primary care provider of any acute change in vision. * Encourage the use of good lighting in patient rooms. Avoid glare whenever possible. * Encourage the use of the patient's eyeglasses. Have family provide lighted magnification if needed (these are the large magnifiers with a light attached. You can get them at low vision centers). * Add contrast to the fixtures in the room if light switches blend into the wall or faucets blend into the sink. * Encourage annual eye exams either with an Optometrist or Ophthalmologist. * Annual dilated exam for patients with diabetes and hypertension by ophthalmologist
Hearing
Hearing loss is the 3rd leading chronic condition affecting adults over 75 years of age.
Hearing Changes common in older adults * Presbycusis: Loss of high frequency, sensorineural hearing loss. Has a gradual onset is progressive and is bilateral. Due to gradual loss of hair cells, and fibrous changes in the small blood vessels that supply the cochlea. Difficulty hearing high pitched sounds such as s, z, sh, and ch. Background noise further aggravates hearing deficit. * Conductive hearing loss: Involves the outer and or middle ear. Causes of conductive hearing impairment include: cerumen impactions or foreign bodies; ruptured eardrum, otitis media, and otosclerosis. * Sensorineural hearing loss: involves damage to the inner ear, the cochlea, or the fibers of the eighth cranial nerve. Causes of sensorineural hearing loss include: hereditary causes, viral or bacterial infections, trauma, tumors, noise exposure, cardiovascular conditions, ototoxic drugs and Meniere's disease.
Hearing
* Assess for cerumen impactions. Request cerumen softening drops followed by irrigation (if needed) or ENT consultation. * Get the person's attention and face them before speaking to assist the individual with lip reading, a common compensatory mechanism for older adults. * Have at least one Pocket amplifier on the nursing unit to use with hard of hearing individuals. * Do not shout at people with hearing impairments, but rather use lower tones of your voice. * Provide written instructions (use large black marker if person also is visually impaired). * Assure appropriate care for hearing aids: remove batteries out at night; use brush provided to gently clean the tubes to reduce wax accumulation. Before sending bed linens or clothing to the laundry make sure the patient has hearing aid is in their ear or in their designated location (bedside table or medication cart) * Notify the primary care provider of any sudden change in hearing. * Referral to audiologist and/or ENT as indicated.
Smell and Taste
The sense of smell and ability to identify odors decreases due to normal changes in aging. This can be problematic for safety reasons. An inability to smell smoke for instance could put an older adult at risk.
Changes in smell and taste common to older adults * Common changes in smell include a decline in the sensitivity to airborne chemical stimuli with aging. * Common changes in taste include a decreased ability to detect foods that are sweet. Most changes in taste are thought to occur due to decreased sense of smell, medications, diseases and tobacco use.
Taste and Smell * Take all complaints of inability or decreased ability to smell or taste seriously. * If this is an abrupt change in taste or smell notify primary care provider. Patient may need an ENT referral. * Patient teaching should focus on safety issues with odors of gas and spoiled food. Educate seniors to have carbon monoxide detectors in their home and to evaluate food with other methods other than sense of smell and taste.
Peripheral Sensation
Peripheral neuropathy is one of the most common neurological disorders encountered in a general medical practice with estimates of 2% to 7% of all patient populations having symptoms of neuropathy (Smith and Singleton, 2004).
Changes in peripheral sensation common to older adults * Peripheral nerve function that controls the sense of touch declines slightly with age. * Two-point discrimination and vibratory sense both decrease with age. * The ability to perceive painful stimuli is preserved in aging. However, there may be a slowed reaction time for pulling away from painful stimuli with aging.
Peripheral Sensation * Examine feet daily and inform primary provider if lesions, calluses or red areas. * Clean and thoroughly dry feet prior to applying lotion. * Ensure or have family bring in adequate foot wear that protects the individual's feet. Most medical supply places carry diabetic healing shoes that have wide toe boxes and Velcro closed often under $50. * Refer diabetics to facilities with Certified Diabetes Educator. * Implement fall precautions and initiate referral to physical therapy for diabetics with peripheral neuropathy. * Refer older adults with decreased sensation to a podiatrist for ongoing foot care.