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GERONTOLOGICAL NURSING

Geriatrics – The study of old age, includes the physiology, pathology, diagnosis and management of the diseases of the older adults Gerontology- The broader field of geriatrics which is the study of the aging process including the biologic, psychological and sociologic aspects. Gerontologic nursing - the field of nursing that specializes in care of the elderly. this can be provided in the acute, chronic or community settings. Emphasis of care: a. promotes and maintain functional status- independence b. maintain dignity and maximum autonomy Ageism – Prejudice or discrimination against older people.

Theories of aging;

1. 2. 3. 4. 5. 6. 7.

Genetic or Mutation Theory – Changes in the replication of DNA-RNA are the causes of aging. Autoimmune or Immunologic Theory – Aging is caused by a change in the immune system. Wear and Tear Theory – Believes that the body is like a machine where parts wear out and the machine eventually breaking down. Rate of Living Theory – States that the body has a fixed rate of potential for living. Waste Theory – States that chemical wastes collect in the body and produce deterioration by interfering with cellular functioning. Collagen Theory – Collagen stiffens with age, producing loss of elasticity in organs, skin, tendons, blood vessels and etc. Endocrine Theory – Events occurring in the hypothalamus and pituitary are responsible for the changes in the hormone production and response that result in the organism’s decline.

Cognitive aspects of aging:
Misconceptions with regards to the decline in the mental functioning of the elderly are caused by the failure of early researchers to consider a multitude of factors that could alter the intelligence of the old adult population. Hospitalization, institutionalization, sudden change in the environment, medical therapy and altered role performance may cause temporary alterations in cognition. Intelligence: It has been demonstrated that when subjected to a test, older adults has a steady decline in their test results. However, health and the environment has been attributed to cause a profound influence on this and certain types of intelligence decline (spatial perceptions, nonintellectual information) while others do not (problem solving ability, verbal comprehension, mathematical ability). Learning and Memory The ability to acquire new skills and information decreases in the older adult but with adequate motivation they still continue to learn. Memory has 3 components that includes short term (5-30seconds), recent memory (1hr.-several days), long-term memory (lifetime). In the absence of pathology age related loss occurs more frequently with shortterm and recent memory acquisition, recording, storing and recall(benign senescent forgetfulness). To facilitate learning: 1. Use of mnemonics 2. links new information with familiar information 3. use visual, auditory and other sensory cues 4. encourage wearing of prescribed sunglasses and hearing aids 5. provide a quiet, nondistracting environment 6. keep teaching periods short 7. pace learning task according to the endurance of the learner 8. encourage verbal participation 9. positive reinforcements PHYSIOLOGIC CHANGES OF AGING The well being of an individual depends on the physical, mental, social and environmental factors. Therefore, we need to determine these factors and the effects it has on our clients in order to appropriately effect our nursing interventions. Cardiovascular System Heart Disease- the leading cause of death among the aged Changes: Cardiac output decreases (1% annually after the age of 20) Less reserve and responds less effectively to stress Heart valves becomes thicker and stiffer Heart muscles and arteries lose their elasticity Calcium and fat deposits accumulate in the arterial walls Veins become tortuous Manifests as

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itching.Cardiac dysrrhythmias CHF CVA Intermittent claudication CAD PVD Hypertension MI Orthostatic hypotension Health promotion Regular exercise stress management Proper diet smoking cessation Weight control precautionary measures (sit-stand slowly) Regular BP monitoring Respiratory System Changes Increased AP chest diameter Kyphosis Calcification of the costal cartilages and reduced mobility of the ribs Diminished efficiency of the respiratory muscles Increased rigidity and loss of elastic recoil (increased RLV. decreased VC) Diminished gas exchange and diffusing capacity Decreased cough efficiency and reduced ciliary activity (prone to RTI) Manifests as: Altered lung capacity and function Respiratory tract infections Health promotion Regular exercise Influenza immunizations Appropriate fluid intake Smoking cassation Regular pneumococcal vaccination Integumentary System Changes: Thinning of the epidermis and dermis Diminished subcutaneous fats. painful sexual intercourse Erectile dysfunction Health promotion: Local estrogen replacements Vacuum penile pumps Vasostimulating medications Oral medication (viagra) Genitourinary System: Changes: Decreased kidney mass secondary to loss of nephrons Decreased filtration rate Diminished tubular function and less efficiency in resorbing and concentrating urine Slower restoration of acid-base balance in response to stress Stress/ urge incontinence BPH (men) Manifests as: Urinary incontinence Retention of urine secondary to enlargement of the prostate Bladder infections Health promotion Adequate hydration 2 . decreased acidity) Uterine and ovarian involution Decreased pubococcygeral muscle tone (relaxed vagina and perineum) Changes: Men Penis and testes decreased in size Diminished levels of androgens Manifests as: Decreased sexual desire and activity secondary to: Decreased vaginal lubrication. narrowed size. vaginal bleeding. especially of the extremities Collagen fibers become stiffer Reduced elastic fibers Diminished blood supply due to the decrease in the capillaries of the skin Decreased hair pigmentation Decreased sweat And sebaceous glands activities Manifests as Dry skin and increased susceptibility to infection Intolerance to extremes in temperature and sun exposure Graying of the hair Health promotion Avoid exposure to the sun Use lubricating skin cream Avoid excessive soaks in the tub Adequate intake of water Reproductive System Changes: Women Diminished ovarian and estrogen production Thinning of the vaginal wall. loss of elasticity Decreased vaginal secretions (dryness.

20-25% fat Fluids: 8-10 eight ounce glasses/ day Musculoskeletal System Changes: Loss of bone mass (>40. inadequate calcium intake. whole grains. potato. loss of estrogens) Kyphosis (convexity of the spine) Flexion of the hips and the knees (affects balance. internal organ function) Decreased activity Back pain Health promotion: Calcium. 10 second rest interval. F>M) Increased incidence of fracture (vertebra. estrogen. strength. femur. humerus.500 mg/day : Sources -dairy products -dark green vegetables -broths from soup bone with vinegar 3 . 30-80 repetitions per day High fiber diet Increase mobility Gastrointestinal System: Changes: Tooth decay and loss Decrease salivary flow Dry mouth Decreased gastric motility Diminished absorption of nutrients and vitamins in the small intestines Deficiencies in the absorption and tolerance to fat Manifest as: Periodontal diseases Delayed emptying of the stomach contents Constipation Abdominal discomfort and flatulence Fecal impaction Fecal incontinence and obstruction Predisposing factors Lack of dietary bulk Inactivity Prolonged laxative use Insufficient fluid intake Ignoring the urge to defecate Excessive dietary fat Medication side effects Health promotion: Regular dental care Adequate amount of fluids Eating small. vitamin D.bearing exercises (swimming and brisk walking): Done in moderation with short and frequent rests Effects Increases the efficiency of heart contraction Improves oxygen uptake by the cardiac and skeletal muscles Reduces fatigue Increased energy Increases muscle endurance.calcium intake: 1. radius. flexibility and endurance Manifest as: Osteoporosis (associated with inactivity. frequent meals Regular bowel habits Avoiding heavy activity after eating Avoid using laxatives and antacids Eating a high fiber. low fat diet Nutritional Health Changes: Decreased physical activity reduces the number of calories needed to maintain Slower metabolic rate ideal weight of the older adult Manifest as: Sub optimal nutrient intake Predisposing factors: Apathy Loneliness Lack of oral health Immobility Poverty Lack of taste discrimination Depression Inadequate knowledge Health promotion Low sodium and low fat diet Increased fruit and vegetable diet Fish . brown rice Diet: 55-60% carbohydrates. tibia) Diminished muscle size. and fluoride supplements Regular Weight. mobility. buttocks or inner thigh then let go (tighten then relax) 5 second contraction.Ready access to toilets Voiding every 3-4 hours while awake Practicing pelvic floor exercises (Kegel’s) -Identify the pubococcygeus muscle -Attempt to hold back flatus or stop the flow of urine without contracting the abdomen. strength and flexibility Reduces cardiovascular risk factors Hi.

yellowing cloudy lens of the eye causing the light to scatter Color blindness -the ability to discriminate between blue And green declines.SSx : feelings of sadness feelings of guilt and worthlessness fatigue sleep and appetite disturbances restlessness diminished memory and concentration suicidal ideation impaired attention span . senile macular degeneration. and dehydration Sensory System: Sensory deprivation. often called Acute Confusional State -SSx: Altered LOC (stupor-hyperactivity) delusions Disorganized thinking fear Short attention span anxiety Hallucinations paranoia 4 . b. Wax builds up Taste and Smell Dulling of the sweet taste – may lead to preference of salty and highly seasoned foods Health Promotion Substitute salt in giving flavor to foods with herbs. ch. Visual changes: Presbyopia – difficulty in reading at the usual distance. onions. p). smell and taste. May be mistaken for confusion Difficulty in discriminating between high frequency tones of consonants (f. Diminished accommodation – takes longer to adjust when going to and from light and dark environment as the pupil dilates slowly and less completely because of increased stiffness of the muscles of the iris Health Promotion: Reading glasses Dark glasses Allow for longer periods to adjust Auditory Changes: Presbycusis. th. this may lead to boredom. s. Desipramine. may cause older people to respond inappropriately to conversation. irritability. Prozac) TCA (Nortriptyline.The most common affective/ mood disorder of old age and is often responsive to treatment .deafness. pneumonia.A medical emergency. garlic and lemons MENTAL HEALTH DISORDERS DEPRESSION .the absence of stimuli in the environment or the inability to interpret stimuli secondary to sensory loss.Treatment: SSRI (Paxil. textures. pictures.It can be an early sign of illness or a result of physical illness . Increased incidence of eye disease : cataracts. sounds. diabetic retinopathy. Doxepine) Psychosocial approach ECT may take 4-6 wks for symptoms to recede DELIRIUM . confusion. usually begins at the fifth decade of life Sensitivity to glare. t. medication interaction.Low phosphorous diet: Avoid red meats cola drinks processed foods Nervous System: Changes: Loss Of nerve cells leading progressive loss of brain mass Reduction in the synthesis and metabolism of major neurotransmitters Reduced speed of nerve impulse conduction Less efficient function of the ANS Cerebral ischemia More difficulty in maintaining homeostasis Manifest as: Slower reaction and response increases the risk for falls and injuries Postural hypotension Health Promotion Allow a longer time to respond to a stimulus Move more deliberately Beware of sudden onset of confusion it may indicate UTI. disorientation and anxiety this can be corrected by meaningful stimulation or substitution of one sense for another in interpreting the stimuli and enhancing sensory stimulation in the environment with colors.

Supervised nutritional and fluid intake c. Infection .Risk factors: early onset AD late onset AD a.Age of onset between 50. Provide familiar environmental cues-(S. losses in memory. Alzheimer’s disease (AD) c. Malnutrition b. family members and friends touching and talking to the patient.Other non.Symptoms are usually subtle in onset progressing slowly and eventually becoming obvious and devastating . . Pick’s disease MULTI. Fecal impaction h.Progressive. the prevalence increases with age. Mixed . decreased mental and physical vigor Sudden confusion Gradual and spotty memory loss May hallucinate and become delirious AD. neurologic disease that begins insidiously and is characterized by gradual losses in cognitive function and disturbances in behavior and affect.1-10% of the cases is found among middle aged individuals . Family history a. Medication or alcohol toxicity g. Sensory deprivation or overload e. abstract reasoning ability. Down syndrome b. psychiatric disorders d. functional c.INFARCT DEMENTIA .3 General categories: a. degenerative. Multi –infarct dementia b. Environmental factors b.like manifestations in later stages ALZHEIMER’S DISEASE (AD) .A progressive deterioration in the intellectual abilities in such a severity that it interferes with the persons social and occupational performance. downward decline in mental functioning .MAKES UP around 15% of the cases. behavioral .characterized by: 1.) ALZHEIMER’S DISEASE AND OTHER DISORDERS Dementia.70 years old. headaches. Genes c. irreversible.Characterized by unpredictable. Lack of environmental cues d.Permanent irreversible brain damage or death may follow if unrecognized and underlying cause is not treated. Head trauma c. Life experiences Pathology: 5 . judgment and language 2. Calm and quite environment d. next to AD . polypharmacy c.May occur secondary to: a.Every small infarct is followed by some recovery followed by the next infarction Pathology: Disruption of the blood supply to the brain(multiple small strokes) Rapid infarction (death of the brain tissue) Cerebral damage Dizziness. uneven..Risk factors: Cardiovascular and cerebrovascular diseases . Dehydration i.3 most common nonreversible dementias: a.Reversible causes: a. alcohol abuse b. deterioration of the ability to perform ADLs over time . M>F . . Physical illness f.Alzheimer’s dementia a.Therapeutic interventions: Varies depending on the reason for the symptoms a.A. cognitive b. AIDS related dementia c. Personality changes 3. . PD b. normal pressure hydrocephalus . Withdrawal of non-essential medications b.

Allow smoking only with supervision e. Avoid applying restraints since it increases agitation g. Thyroid hormone levels d. Quite and pleasant manner of speaking. Remove potential hazards b. objects.hepatotoxic thus clients must be closely monitored Nursing management: Supporting cognitive function . places b. Advocate active participation to keep client maintain abilities for a longer period Promoting physical safety – a hazard free environment promotes maximum independence and a sense of autonomy a. Use of memory aids and cues to minimize confusion and disorientation d. Limit environmental stimuli and follow a regular routine b. CBC b. Supervise all outdoor activities 6 . Provide nightlights c. paranoid e. Secure doors leading from the house h. toileting) Dysphagia Incontinence terminal stages: lasts for months Immobile and requires total care Death: resulting from a. handling money b. Dehydration Assessment and diagnostic findings: Health history Diagnostic tests a. gets lost in a familiar environment c. Prominently displayed clocks and calendars may enhance orientation to time e. hostile c. HIV testing c. combative With progression of the disease intensification of the symptoms occurs: Speaking skills deteriorates to nonsense syllables Agitation and physical activities increase: patient may wander at night Total dependence on ADLs (eating. Malnutrition c. suspicious d. CSF g. concealed with adequate cognitive function) Depression Marked/ obvious forgetfulness manifested in daily actions a. repeating the same stories they forget that they have already told Conversation becomes difficult and there are word finding difficulties The ability to formulate concepts and think abstractly disappears (concrete interpretation) Impulsive behavior Difficulties with everyday activities a. EEG Depression scale and Cognitive function test e. MRI f.a calm and predictable environment helps the person interpret the surroundings and his activities a. Distraction and persuasion may reducer wandering behavior f. clear and simple explanations c. Color coding the doorway to facilitate geographic orientation f. depressed b. operating simple appliances Personality changes a. Pneumonia b. CT scan Medical management: Tacrine HCL – enhances acetylcholine and manages symptoms of AD .Neuropathologic changes (neuronal death) Biochemical changes (loss of acetylcholine) Neurofibrillary tangles Senile/ neuritic plaques cerebral cortex Decreased brain size Clinical Manifestations: Subtle memory loss (early stages. lose the ability to recognize familiar faces. Monitor food and drug intake d.

Simplify daily activities into short achievable steps to give as sense of accomplishment.Not associated with normal aging and thus can be prevented with early interventions to help maximize the quality of life. Provide adaptive means for incoordination that interferes with feeding h. stimulation and contentment with its non-judgmental friendliness f. Set realistic goals that provide satisfaction d. check the temperature of foods to prevent burns g. Discourage long periods of daytime sleeping. Serve hot foods and beverages warm. exercise. inability to perform ADL and IADLs independently c. when combined with decreased host resistance will lead to illness or injury . Mealtime should be kept simple and calm.i. Convert liquids to gelatin to facilitate swallowing f.Used to describe those elders at higher risk for adverse health outcomes or geriatric syndromes . visits should be brief and non-stressful. Encourage to verbalize about sexual concerns and provide sexual counseling g. Encourage meaningful expression of love such as touching and holding. letters.Frequently seen in the elderly. With progression it would be necessary to feed the patient. Using an object / nonverbal language to communicate e. Promote hobbies and activities to improve the quality of life (walking. a.managed by: listening to music. GERIATRIC SYNDROMES: MULTIPLE PROBLEMS WITH MULTIPLE ETIOLOGIC FACTORS Geriatric syndromes . Unhurried and reduction of noises and distractions b.combative. Clear. Environment should be kept simple and familiar and noise free Catastrophic reaction. limit visitors to 1-2 at a time to avoid over stimulation b. rocking or stroking. As caregivers we need to discern the need of the patient exhibiting this type of behaviors to prevent further decline in their health with the problem remaining uncorrected.overreaction to excessive stimulation . a. Cut food into small pieces to prevent choking e. extreme old age (85 and above) b. wandering and other inappropriate behaviors that may arise when some physical or psychological needs are unmet. agitated state characterized by: screaming. Encourage to make choices when appropriate and to participate in self care activities as much as possible Providing for socialization and intimacy needs – a. easy to understand sentences c. Pet – may provide comfort. Goals are adjusted to fit the client’s declining abilities b. Promoting balanced activity and rest – Some clients may exhibit sleep disturbances. and phone calls are encouraged. Tactile stimuli to reinforce affectation Promoting independence in self care activities – AD makes it difficult for the person to maintain functional independence. Structuring activities c. c. Promoting adequate nutrition a. Offer familiar foods that look appetizing and taste good c. socializing). music or a back rub b. Promote a regular pattern of activity and rest c. to avoid client playing with the food d. Frailty . Visits. crying and physical or verbal assault . b.Applies to elderly people who are most vulnerable to significant problems as a result of any of the following: a. Wear ID bracelet Reducing anxiety and agitation – patient may become aware of their diminishing abilities thus emotional support is needed to reinforce a positive self image a. Offer one dish at a time. Direct supervision may sometimes be necessary. Improving communication a. e. Lists and simple written instructions d. efforts are directed towards helping them remain functionally independent for as long as possible. distraction. Encourage recreation and simple activities c. without confrontations b. To protect clothing use apron or smock rather than a bib i. To promote sleep: milk. presence of multiple chronic diseases Impaired Mobility Multifactoral causes includes: PD OA Diabetic neuropathy Osteoporosis Cardiovascular compromise Sensory deficits Elderly clients should be encouraged to stay active as possible 7 .

this is further aggravated by their inability to determine between: dizziness – a sensation of disorientation in relation to position vertigo – spinning sensation .May lead to falls and injuries Falls and falling . waist and jacket restraints Chemicals: medications -May lead to injury or death: strangulation skin tears vascular and neurologic damage fractures pressure ulcers increased confusion significant emotional trauma -The time spent to supervise client on restraint is better used in addressing the unmet need that provoked the behavior that resulted in the use of the restraint. perform AROM in unaffected aside and PROM in the affected part Change the position frequently Dizziness -Older people frequently seek help for dizziness.Bed rest should be kept to a minimum when ill to avoid deconditioning and other complications When in bed rest.Causes maybe cerumen build up dysfunction in the: cerebellum proprioceptive receptors cerebral cortex vestibular system brainstem . vest.physical: lap belts. 8 .Common and preventable source of mortality and morbidity related to greater decline in ability to perform ADL and social activities and increased incidence of institutionalization . geriatric chairs.Women > men hip fx – most common Restraints.