Professional Documents
Culture Documents
CONCEPT: GERIATRICS
I.Introduction
a. Definition
1. Late adulthood
3. Geriatric nursing
4. Gerontology
5. Gerontologic nursing
6. Senescence
7. Senility
8. Aging
1. Integumentary System
1.1.Pruritus
1.3. Psoriasis
2. Musculoskeletal System
2.1. Osteoporosis
2.3 Osteoarthritis
3. Cardiovascular System
3.1. Hypertension
3. 6. Nursing Interventions
4. Respiratory System
4.1. Asthma
4.2.Nursing Interventions
4.3. COPD
5. Neurological System
Disorders
5.1. Dementia
6. Gastrointestinal System
7. Genitourinary System
7. 4. Nursing Intervetions
8. Endocrine System
9. Immune System
Adrianne Dill Linton & Helen W. Lack, Matteson&McConnell’s Gerontological Nursing Concepts and Practice 3rd
edition, Saunders 2007
Udan, Medical and Surgical Nursing: Concepts and Clinical Application” First Edition, 2002
Suzanne C. Smeltzer & Brenda G. Bare, Brunner & Suddarth Medical and Surgical Nursing, 10th edition
Geriatrics
Definition of terms:
Late adulthood- extends from above 65 years of age
1. Geriatrics -is a sub-specialty of medicine that focuses on health care of the elderly. It aims to promote
health and to prevent and treat diseases and disabilities in older adults; the science and the study of the
physiologic and pathologic problems of individuals in their later maturity
2. Geriatric nursing- care for the elderly regardless of whether they are diseased or not
4. Gerontologic nursing – the care and attention to individuals undergoing the aging process with emphasisi
in the developmental stages of aging
7. Aging- physiologic, behevioral, and social changes that occur with increasing chronoligical age;a normal
progressive process, not a disease; norms:normal physiological changes, have not been cpmpletely
identified
General changes:
1. general tissue desiccation and slowed cell vision
4. decreased metabolism
Skin
• HAIR- decreased number of hair follicles, scant, fine, graying, hirsutism, possible hereditary
baldness
Musculoskeletal
• Muscle atrophy
• Deterioration of cartilage
• Generalized loss of 6-10 cm in stature because of: flexion of knee and hip joint, narrowing of
intervertebral disks
• Osteoporosis is common
Cardiovascular
Respiratory
1. general
3. sensory
4. motor
• Loss of memory
Gastrointestinal
• Decreased absorption
• Decreased peristalsis
Renal/Genitourinary
• Reduced GFR
• Reduced nephrons
1. genital
c. male: decreased testosterone, spermatogenesis, and size of testes, increase in size of prostate
Endocrine
• Cessatiomn of progesterone
• Reduced BMR
Sexual
Immunity
Sensory
Vision
• Loss of accomodation
Hearing
• Lack of appetite
Touch
• Safety hazard
Dental
• Recede from remaining teeth, exposing areas of teethe not covered with enamel
N.I.- assist clients to keep physically and socially active and to maintain per group interactions
Adaptation to decline in speed of movement, reaction time and increasing dependence on others may be necessary
N.I. Assist clients to cope with loss, provode necessary safety measure
N.I. Assist clients with self care as required and with maintaining as much independence as possible
Late maturity
Energy is directed toward full sexual maturity and function and development of skills needed to cope with the
environment
N.I. encourage separation from parents, achievement of independence and decision making
Psychosocial Development
- Views life with a sense of wholeness and desires satisfaction from part accomplishments
Despair
- Believes they have made poor choices during life and wish they live life loner
- Gives rise to feeling with frustration, discouragement, and a sense that one’s life has been worthless
A.Integumentary system
1. Pruritus or generalized itcching is an extremely common geriatric disorder. It is one of the most common
s/sx of patients with dermatologic disorders. Pruritus may be the first indication of a systemic internal internal
disease such as diabetes mellitus, blood dioserders, or cancer. It mas also accompany renal, hepatic, and thyroid
dses. Some common oral medications such as aspirin, antibiotics, hormones, and opioids may cause pruritus
directly or by increasing sensitivity to ultraviolet light. Certain soaps and chemicals, radaiation therapy, prickly
heat, and contact with woolen garments are also associated with pruritus. It may also be caused by psychological
factors, such as excessive stress in family or work situations.
-bath oils containing a surfactant that makes the oil mix with bath water may be sufficient for cleaning
-a warm bath with mild soap followed by application of a bland emolient to moist skin can control xerosis
-applying a cold compress, ice cube, or cool agents that contain methol and camphor may also help relieve
pruritus
Pharmacologic therapy:
Topical cortecosteroids(anti inflammatory)
Oral antihistamines-diphenhydramine(Benadryl)
hydorxyzine (atarax)
Nursing management: 1.) nurse reinforces the reasons for the prescribed therapeutic regimen and counsels
patient on specific points of care,
2.)remind patient to use tepid water and to shake off the excess water and blot between interriginous areas with
a towel,
2.) Psoriasis- is a chronic non infectious inflammatory disease of the skin in which epidermal cells are
produced at a rate that is about six to nine times faster than normal
S/Sx: lesions are as red, raised patches of skin covered with silvery scales
Medical management: Oils or coal tar preaparations can be added to bath water and a soft brush used to scrub the
psoriatic plaque gently; application of emolient creams containing alphahydroxy acids or salicylic acid will continue
to soften thick scales
Pharmacologic theraphy:
1.) topical agents-tar preparations, athralin, salicylic acid and cortecosteroids-Calcipotriene (dovonex) and
tazoretene (tazorac)
Photochemotheraphy- one treatment for severe dbilitating psoriasis is a porsalen medication combined with
ultraviloet light-A (PUVA) light theraphy
Nursing Interventions:
1. Promote understanding
B. Musculoskeletal System
1.) Osteoporosis- is so obiquitous in older age that is generally is considered a normal age realted
phenomenon rather than a disease. It is characterized by a decreased in bone mass per unit volume, producing a
porous-looking skeletal frame that fractures eaqsily when stressed
Risk factors: small framed, nonobese Caucasian women are at greatest risk
Increased age, low weight and body mass index, estrogen deficiency or menaopause, family history, low initial
bone mass, contributing coexisting medcial conditions
-routine xrays
Medical Management:
1. An adequate, balanced diet rich in calcium and vitamin D throughout life with anincreased calcium intake
during adolescence, young adulthood, and the middle years-3 glasses of skim milk or whole Vitamin D
enriched milk orother foods high in calcium
2. Calcium supplement
4. Weight training
Pharmacologic treatment:
Nursing intervention:
2. Relieving pain
4. Prevening injury
2.) Osteoarthritis- also known as generative joint disease; non inflammatory disorder of movable joints
Risk factors:
1. Increased age
2. Obesity
4. Repetitive use
5. Anatomic deformity
6. Genetic susceptibility
Clinical manifestations:
1. X-ray
Medical management:
1. Weight reduction, prevention of injuries, perinatal screening for congenital hip disease and ergonomic
modifications
Pharmacologic Treatment:
1. Acetaminophen
Surgical Management:
1. Osteotomy
2. Arthroplasty
Nursing intervention:
3. joint stiffness
5. fever, weight loss, fatigue, anemia, lymph node enlargement and raynuads phenomenon stress induced
vasospasm
3. Arthrocentesis
4. X-ray
Medical Management:
1. Education- balance of rest and exercise and referral to community agencies for support
Nutrition theraphy
Nursing intervention:
C. Cardiovascular system:
1. Hypertension
-a systolic blood pressure greater than 140mmHg and a diastolic pressure greater that 90mmHg over a sustained
period.
Clinical manifestations:
1. High BP
2. Retinal changes such as hemmorhages, exudates, arteriolar narrowing, and cottonwool spots
3. papilledema
1. smoking
2. dyslipidemia
3. DM
2. Urinalysis
3. Blood chemistry
4. 12 lead echocardiogram
5. Creatinine clearance
6. Renin level
Medical management:
-The goal of hyoertension treatment is to prevent death and complications by achieving and maintaining the
arterial blood pressure at 140/90 mmHg or lower.
-weight loss, reduced alcohol and sodium intake, and regular physical activity
Pharmacologic Theraphy:
Nursing intervention:
1. Increasing Knowledge
2. Myocardial Infarction
-usually caused by reduced blood flow in a coronary artery due to atherosclerosis, and occlusion of an artery by an
embolus or thrombus
Vlincal Manifestations
6. anxiety, restlessness
7. Denial
2. Electrocardiogram
3. Echocardiogram
Medical management:
-the goal of the medical management is to minimize myocardial damage, preserve myocardial function and prevent
complications
-cardiac Rehabilitation
Pharmacologic theraphy:
1. Thrombolytics
2. Angiotensin converting enzyme inhibitors (ACE-I)
Nursing Intervention:
4. reducing anxiety
3. Angina Pectoris
- ususally characterized by episodes or paroxysm of pain or pressure in the anterior chest
Clinical manifestations:
1. chest pain
4. shortness of breath
5. pallor
6. dizziness
Medical management:
-goal :to decrease the oxygen demand of the myocardium and to increase the oxygen supply
Pharmacologic treatment:
1. Nitroglycerin
-oxygen administration
-alternative therapies
Nursing Intervention:
1. Treating angina
2.Reducing anxiety
3. Preventing pain
D.Respiratory System
1. Asthma
- is a clinical syndrome characterized by three phenomena: recurent episodes of airway obstruction that resolve
spontaneously or in response to treatment, airway hyperresponsiveness, and iraway inflammation.
Clinical manifestations:
1. breathlessness
2. wheezes
3. intermittent cough
4. tightness in chest
6. intercostal retractions
Management:
2. COPD
E. Nervous System
1.Cognition
3. Behavior
Clinical manifestations:
2. small dificulties in work or social activities but has adequate cognitice function tgo hide the loss and can function
independently
3. Depression
2. Electroencephalography
Medical management:
2. donepezil (Aricept)
3. Rivastigmine (Exelon)
Nursing interventions:
3. Parkinson’s Disease-is a slowly progressing neurlogic movement disorder that eventually leads to
disability
Clinical Manifestations:
1. Tremor
2. Rigidity
3. Bradykinesia
2. PET scanning
Medical management:
1. Pharmmacologic theraphy
4. Dopamine agonists
6. Cathechol-O-methyltransferase inhibitors
7. anti depressants
8. antihistamines
Surgical management:
1. Stereotactic procedures
2. Neural transpalantation
Nursing Intervention:
1. Improving mobility
4. Improving nutrion
5. enhancing swallowing
7.improving communication
1. Gastric Ulcer
2. Peptic ulcer
G. Genitourinary system
a. Adult voiding dysfunction- both neurogenic and non-neurogenic disorders can cause adult voiding dysfunction.
Types of incontinence:
a. stress incontinence
b. urge incontinence
c. reflex incontinence
d. overflow incontinence
3. urinalysis
4. urine culture
Medical Management:
1. Behavioral therapy
2. Pharmacologic therapy
c. Oral estrogen
Surgical management:
b. periurethral bulking
c. Tranurethral resection
Nursing Intervention:
2. Urinary retention – is inability to empty the bladder completely during attempts to void
-in adults older than age 60, 50 to 100 ml of residual urine may remain after each each void because of the
decreased contractility of the detrusor muscle
Maniifestationsw:
1. bladder fullness
Nursing Intervention:
3. Urinary Tract Infection-is an infection that begins in your urinary system. Your urinary system is composed of the
kidneys, ureters, bladder and urethra. Any part of your urinary system can become infected, but most infections
involve the lower urinary tract — the bladder and the urethra.
Clinical manifestations:
• Vomiting
• Pelvic pressure
• Lower abdomen discomfort
Bladder (cystitis) • Frequent, painful urination
• Blood in urine
2. colony counts
3. cellular studies
4. urine cultures
Medical management:
Nursing Intervention:
1. Relieving pain
H. Endocrine System
1. Hypothyroidism
2. Hyperthyroidism
I.Immune System
1. Pernicious Anemia
J. Sensory Problems