CARE OF OLDER ADULT AREAS

o Skilled nursing facilities

COURSE DESCRIPTION ▪ Acute care facilities
This course deals with the ▪ Out patient
comprehensive theoretical and ▪ Medications, primary care,
practical concept, principles and manage illnesses
techniques of nursing care and o Retirement communities
management of the older persons. ▪ Compound of multiple house
Discussed are theories and concepts that cater elderly /
of aging the physiologic and couples
psychosocial changes and problems o Adult day care
associated with the process aging and ▪ Nurses organize programs
the ethical and legal aspects in the for a day to keep the
care of the older persons. The elderly active
learners are expected to recognize o Residential care facilities
physical and psychosocial changes in ▪ Nursing homes
the older personas and apply the ▪ Number one priority is
nursing process in assessing and safety
managing clients in the clinical ▪ Specialized: dementia care
setting. homes – created to make
patients safe
At the end of the third year, given
actual situations in selected ❖ Alarms
geriatric settings, the learners ❖ Anti-slip floor
demonstrate skills in safe and ❖ Handrails all over
appropriate nursing care and the place
management of the older persons. ❖ No back doors
➢ Symptoms of dementia:
GERONTOLOGY forgetfulness, loss of
is multidisciplinary and is concerned executive function
with physical, mental, and social o Transitional care units
aspects and implications of aging. ▪ Elderlies tend to regress
(more dependent, low
GERIATRICS physical function,
Geriatrics is a medical specialty cognitive function
focused on care and treatment of older impaired and decreased)
persons ▪ Transitional care units
help them to get back to
Although gerontology and geriatrics have their needs
differing emphases, they both have the o Rehabilitation hospitals
goal of understanding aging so that
▪ Therapies based in illness
people can maximize their functioning and
achieve a high quality of life. Ex: physical / cardiac
o Community based home care
▪ Collaboration of CHN and
TOPICS GN
PRINCIPLES OF GERONTOLOGY AND GERIATRICS ▪ Role of the nurse: home
NUTRITION IN AGING visits and do nursing
PHARMACOLOGY AND THE OLDER ADULT
process
SLEEP AND THE OLDER ADULT
PAIN MANAGEMENT
VIOLENCE AND MISTREATMENT OF OLDER ADULT GN is included in a family conference
CARE OF THE END-OF-LIFE or with a primary stakeholder to be
PHYSIOLOGICAL CHANGES IN AGING an advocate of the elderly, to know
the needs of the elderly and how these
needs are addressed
PRINCIPLE AND GOAL
Health promotion, Health protection,
Disease prevention, and Treatment of
disease with emphasis on evidence-
based best practices and current
clinical practice guidelines.
The goal for nurses who provide health
care to older people is not only to
improve the length of life, but also
to improve the quality of life.
SUBDIVISION
o Young Old (60-74)
o Middle Old (75-84)
o Old Old (85-99)
o Centenarian (100 up)
OTHERS
o Septuagenarian (70-79)
o Octogenarian (80-89)
*Aging starts at the moment of
conception and continues to the
remainder of life
*Old age-final stage of life (best and
worst experiences)
AGEISM
o Negative feedback towards old
age
FEMINIZATION OF LATER LIFE
o Male exposure to risk factors
may account for the differences
▪ Lifestyle
▪ Occupational hazards
▪ Disease developed later in
life
o Increases in female exposures to
risk factors will reduce
difference in life expectancy
DEMOGRAPHICS OF AGING
* ↑ Population = ↑ life expectancy
AGING IN THE PHILIPPINES
o The Philippines ranks 44 on the
Global Age Watch Index. While
older people still face
challenges in achieving income
security and health status, the
government is taking positive
action, such as the Expanded
Senior Citizens Act of 2010. A
targeted old age allowance is
still too limited to make any
difference
o There are also policies and
programs that recognize older
people's contribution, provide
entitlements to access social
services, promote their full
employment and maximize
opportunities for their LEGISLATIVE MILESTONES
participation in national
development. The government also Republic Act No. 344 or the
recognizes the need to address Accessibility Law of 1982 provides for
older people's specific needs in the minimum requirements and
terms of healthcare, housing and standards to make buildings.
income security. facilities, and utilities for public
use accessible to persons with
disability, including older persons
who are confined to wheelchairs and
those who have difficulty in walking
or climbing stairs. among others. 't

Republic Act No. 7876 entitled “An Act

Establishing a Senior Citizens Center
in all Cities and Municipalities of
the Philippines, and Appropriating
Funds Therefore" provides for the
establishment of Senior Citizens
Centers to cater to older persons”
socialisation and interaction needs
as well as to serve as a venue for the
conduct of other meaningful
activities. The DSWD in coordination
with other government agencies, NGOs
and people's organisations shall
provide the necessary technical
assistance in the form of social and
recreational services. health and
personal care services, spiritual
services. livelihood services and
volunteer resource services.

Republic Act No. 8425 provides for the

institutionalisation and enhancement
of the social reform agenda by
creating the National Anti-Poverty
Commission (NAPC). Through its multi-
dimensional and cross-sectoral
approach, NAPC provides a mechanism
for older persons to participate in
policy formulation and decision-
making on matters concerning poverty
alleviation.

Republic Act No. 10155, known as “The

General Appropriations Act of 2012".
under Section 28 mandates that a"
government agencies and
instrumentalities should allocate one
percent of their total agency budget
to programs and projects for older
persons and persons with The Plan of Action on Ageing 1999-2004
disabilities. Included health promotion and disease
prevention for adults, by providing
Republic Act No. 9994, known as free flu vaccinations, osteoporosis
“Expanded Seniors Citizen Act of screenings and eye tests. The National
2010", an act granting additional Action Plan on Senior Citizens focused
benefits and privileges to senior on aspects of quality of life such as
citizens, further amending Republic living independently.
Act No. 7432 and otherwise known as
“an act to maximise the contribution The Philippine Plan of Action for
of senior citizens to nation building. Senior Citizens (2011-2016) aims to
grant benefits and special privileges ensure giving priority to community-
and for other purposes". based approaches which are gender-
o The RA 9994 provides health care responsive. with effective leadership
services for poor older persons and meaningful participation of
such as free medical services on senior citizens in decision-making
government hospitals. processes, both in the context of
discounted services on private family and community. This plan of
hospitals and clinics, free action aims to ensure active aging for
vaccines, discounted medicines, senior citizens where preventive and
and mandatory PhilHealth promotive aspects of health are
coverage. emphasised in communities and where
health services are accessible,
Presidential Proclamation No. 470, affordable and available at all times.
Series of 1994, declaring the first Envisioning a population of senior
week of October of every year as citizens who are self-sufficient and
“Elderly Filipino Week." self-reliant. this plan aims to
promote financial security and
Presidential Proclamation No. 1048, financial independence of senior
Series of 1999, declaring a citizens by developing community-
“Nationwide Observance in the based local delivery systems to
Philippines of the International Year address their needs.
of Older Persons".
THEORIES ON AGING
Executive Order No. 105, Series of
2003, approved and directed the SCENESCENCE
implementation of the program o Used to define the ageing
providing for group homes and foster process
homes for neglected, abandoned, o Progressive deterioration of
abused. detached. and poor older body systems that can increase
persons and persons with the risk of mortality as the
disabilities. individual gets older

The Department of Social Welfare THEORIES OF AGING

Development (DSWD) has issued
Administrative Order No. 4 series of Biological
2010, “Guidelines on the Home Care o Aging affects body systems on
Support Services for Senior cellular level
Citizens”, establishing community- o Affects functioning and
based health care services for older longevity of organisms
persons. o Something inside the body
affects aging process
Psychological o Genes, DNA, cells (on/off) =
o Older person may have a positive problem in aging process
or negative perspective in aging o Telomere (end of chromosome) is
in terms of coping strategies responsible for protecting
o Positive or negative perspective chromosomes
in life o Telomere shortens → decreases
protection → cells will not
1. Retirement
reproduce/divide → cells die
2. Meaning of life o Telomere prematurely shorten =
3. Deal with declining health more cells will not reproduce
4. Dealing with death
Endocrine
Sociological o Biological clocks act through
o Roles and relationships that hormones to control the pace of
occur later in life aging
o Engagements o Certain hormone that prevent
aging
BIOLOGICAL AGEING THEORIES
Immunological
o A programmed decline in immune
PROGRAMMED
system functions leads to an
o Aging follows a biological increased vulnerability to
timetable and may represent a infectious disease, aging, and
continuation of the cycle that eventual death
regulates childhood growth and o Programmed decline in immune
development system = diseases/illnesses that
o Genetic codes will affect later in life
o Will tell the body when to increasing mortality
stop/go
o Cells stop their reproduction ERROR THEORIES
o Biological clock
o Apoptosis (cell death) Wear and Tear
o Cells and organs have vital
parts that wear out after years
ERROR of use
o Emphasize environmental o Body is like a machine and it
assaults to the human system will deteriorate like a machine
that gradually cause things to does over time
go wrong o There is a master clock that
o No predetermined age controls organs that slows down
o Will not deteriorate based on and become less efficient
biological clock o Function of the body will not be
o Cellular production/death is on its optimal functioning
caused by external factors that caused by environmental assault
are unpredictable and random
Cross-Link
o Accumulation of cross-linked
PROGRAMMED THEORIES proteins resulting from the
binding of glucose (simple
Programmed Longevity sugars) to protein (a process
o Aging is the result of the that occurs under the presence
sequential switching on and off of oxygen) causes various
of certain genes, with problems
senescence defined as the point o Impurities, cross-link proteins
in time when age-associated when combined with glucose =
functional deficits are abnormality =
manifested dementia/Alzheimer’s
Free Radical o Activities should be maintained
o Accumulated damage caused by o New activities should be planned
oxygen radicals causes cells, or taught
and eventually organs, to lose o Contradicts disengagement
function and organ reserve theory
o Byproducts of cell reproduction o Better chance of being happy or
(wastes) affect other organs, satisfied during old age
destroying it therefore slower
reproduction of cells then cell CONTINUITY
death = elderly o Successful aging involves
maintaining or continuing
Somatic DNA Damage previous values, habits,
o Genetic mutations occur and preferences, family ties, and
accumulate with increasing age, all other linkages that have
causing cells to deteriorate and formed the basic underlying
malfunction structure of adult life
o Continue activities when you
Emerging Biological were in the middle life
o Study and mapping of the human o Older adult also experiences
genome have led to the belief happiness and satisfaction
that many genes may be o Aging is an extension of your
responsible for human aging life
o Continue roles and
PSYCHOLOGICAL AGEING THEORIES responsibilities not only for
satisfaction and happiness, but
JUNG’S THEORY OF INDIVIDUALISM also teach younger generation to
o As a person ages, the shift of present them with their values
focus is away from the external and principles
world (extroversion) toward the
inner experience (introversion) VIOLENCE AND ELDER MISTREATMNENT
o Successful aging
LEARNING OBJECTIVES
ERIKSON’S DEVELOPMENTAL THEORY 1. Discuss current trends in elder
o Ego integrity versus despair, mistreatment, including
the older adult will become incidence in prevalence
preoccupied with acceptance of 2. Review key reasons why elder
eventual death without becoming mistreatment occurs
morbid or obsessed with these 3. Conduct clinical assessment for
thoughts screening and detection of elder
o Acceptance mistreatment
4. Create a nursing care plan for
SOCIOLOGICAL AGEING THEORIES the ongoing well-being of older
patients
DISENGAGEMENT 5. Summarize key resources for
o The appropriate pattern of elder mistreatment information
behavior in later life is for
the older person and society at INTRODUCTION
large to engage in a mutual and o The nurse has a role in
reciprocal withdrawal identifying and managing the
o Settle down; withdrawn from serious and potentially life-
society threatening syndrome of elder
o No longer needed in society maltreatment
o Elder mistreatment is a part of
ACTIVITY a larger societal problem,
o Older adults should stay active domestic violence
and engaged if they are to age o Elder mistreatment is the
successfully outcome of abuse, neglect,
 exploitation, or abandonment of DEFINITION OF ELDER MISTREATMENT
older adults and represents some o Physical abuse, sexual abuse,
of the most tragic behavior in neglect, abandonment,
the are of family violence financial/material
exploitation, and self-neglect
3 TYPES OF ELDER ABUSE are all subtypes of elder
PHYSICAL mistreatment.
EMOTIONAL
FINANCIAL CULTURAL PERCEPTIONS OF ELDER
MISTREATMENT
THEORIES OF ELDER MISTREATMENT o Elder mistreatment needs to be
o Psychopathology of the abuser understood in the context of
refers to caregivers who have individual cultures
preexisting conditions that o Elder mistreatment cannot be
impair their capacity to give tolerated, despite differing
appropriate care cultural perceptions
o Theories: o Cultural and linguistic
▪ Transgenerational Violence competences are important for
❖ There is a family successful intervention in cases
violence continuum of elder mistreatment
❖ Violence inside the
family LEGAL ISSUES
❖ Violence over a long o All states have some mechanism,
period of time whether mandatory or voluntary,
❖ Affects action of the for reporting elder
caregiver toward the mistreatment. State-by-state
elderly variations exist in terms of
❖ Learning theory: definitions, mechanisms for
observes violence and reporting, and appropriate
learns from it; governmental intake agencies
accepts violence as
true and normal CURRENT EVIDENCES
bringing it to adult o Low household income,
life unemployment, poor health self-
▪ Situational theory report, prior family violence,
and poor social support are
❖ Related to caregiver
consistent contextual factors
❖ Manifests anger/neglect
for the outcome of elder
❖ Caregiver cannot meet mistreatment
needs of the older adult
❖ Caregiver experiences RISK FACTORS OF ELDERLY MISTREATMENT
fatigue, emotional o Individual Risk Factor: poor
stress that is physical and mental health of
reflected towards older the elderly (alcohol/substance
adult abuse); abuser has a mental
▪ Isolation theory disorder/substance abuse;
❖ Happens when elderly female elderly
is isolated o Relationship Risk Factor: shared
❖ Keep elderly inside living situation; abuser is
the house for a long dependent from an older adult’s
period of time financial/pension increasing
❖ Basic needs will not be risk of abuse; poor family
given immediately relationship; chronic disease
o The identification of elder (dementia, bed ridden, stroke) =
mistreatment is most often done stress/ challenge to the family
by healthcare professionals to attend needs of the elderly
 o Community Risk Factor: social mistreatment, and the nurse’s
isolation of elders in a role is of utmost importance
community because of lack of
social support PHYSICAL EXAMINATION
o Sociocultural Risk Factors: o The physical symptoms of elder
neighbors who are ageists; mistreatment are often difficult
inheritance (affects
for clinicians to discern
distribution of power); couple
may move away, leaving elderly because older adults may suffer
at home alone; cannot pay for from chronic and acute illnesses
nursing homes; institutions that mask or mimic the presence
poorly trained of mistreatment
o Cognitively impaired older
adults provide an additional
challenge

Clinical Manifestation of Neglect

o Malnutrition
o Presence of contractures
(difficulty in moving
joints/muscles)
o Decrease in calf size

A caregiver’s refusal for interview or

leave the patient raises suspicion
Should also assess if caregiver is under
stress

NURSING DIAGNOSES
o Elder mistreatment may be
addressed by the following
nursing diagnoses from the North
American Nursing Diagnosis
Association:
▪ Caregiver Role Strain
▪ Coping, Ineffective Family
❖ Compromised
❖ Disabled
▪ Coping, Ineffective
Individual
▪ Protection, Ineffective
▪ Rape-trauma Syndrome
▪ Self-care deficit (poor
INSTITUTIONAL MISTREATMENT hygiene
▪ Self-esteem Situational
o There is death of information
low (unmotivated)
about mistreatment in nursing
▪ Social Isolation (alone)
homes and other residential care
facilities INTERVENTIONS
o Nurses working with older adults
ASSESSMENT must be aware of the elder
o Interdisciplinary comprehensive mistreatment reporting laws in
geriatric assessment of the their states
older adult’s cognitive and o Elder mistreatment requires an
psychosocial function is interdisciplinary team approach
essential in identifying elder
DOCUMENTATION
o Excellent documentation is
extremely important in elder
mistreatment case
FUTURE CONSIDERATIONS
o Accurate and uniform data must
be continuously collected at
state and national levels so
that elder mistreatment trends
can be monitored
o Future research focusing on
evidence-based interventions to
prevent elder mistreatment is
needed
QSEN RECOMMENDATIONS RELATED TO ELDER
MISTREATMENT
o The Quality and Safety Education
for Nurses (QSEN) project
addresses the challenge of
preparing future nurses with the
knowledge, skills, and attitudes
(KSAs) to continuously improve
the quality and safety of the
healthcare systems in which they
work
PHARMACOLOGY AND THE OLDER ADULTS
Learning Outcomes
1. Explain the interaction between
normal aging and responses to
drug therapy in older people
2. Identify principles of safe
medication management with older
persons in a variety of patient
care settings
3. Discuss measures to prevent and
reduce polypharmacy in older
patients
4. Describe assessments to monitor
older patients for adverse drug
effects and polypharmacy
5. Apply principles of teaching and
learning to promote compliance
and adherence to the medication
regimen
6. List nonpharmacological
therapies that may be useful as
alternatives to medications
7. Discuss issues related to
ensuring the safe use of drug
therapy by the older person
1. Explain the interaction between
normal aging and responses to drug
therapy in older people
AGE-RELATED CHANGES THAT INCREASE
RISK FOR ADVERSE DRUG AFFECTS
Older persons tend to have acute and
chronic conditions that may alter
pharmacokinetics (what the body does
to the drug) and pharmacodynamics
(what the drug does to the body)
Age-related Process
1. Decrease function
2. Slowed function
*Medication will be slowly absorbed,
metabolized, and excreted
*As nurses, we can recommend to the
doctor that the medication should be
lowered
Areas Greatly Affected with Aging
o Kidneys
o Liver
Decrease in body water (as much as
15%) and increase in body fat
❖ Increased concentration of
water-soluble drugs
❖ More prolonged effects of fat-
soluble drugs
Nursing Responsibilities:
o Identify if medication is water
or fat soluble
o Know side effects/adverse effect
and if manifested, the nurse
will discontinue medication and
refer
Hepatic blood flow may be decreased
by as much as 50% in individuals over
65 years
❖ Increased toxicity with normal
doses of “first-pass effect”
drugs
❖ Less drug would be detoxified
immediately by the liver
Decreased blood flow in the liver →
take liver time to metabolize and
detoxify the medication → medication
will be free flowing and circulating
the body → the medication will
increase its toxicity (not
metabolized yet)
*Slowness of metabolism of drugs in
the liver*

Nursing Responsibilities:
o Check for liver function tests NURSES’ NOTES
(enzymes in the liver: AST o If a patient is receiving two or
ALT/SGPT SGOT) more drugs that are highly
o Know drugs that are hepatotoxic: protein bound, the nurse should
antibiotics, NSAIDS, COX2 observe for drug interactions
inhibitors (Celecoxib, Arcoxia) and variations in responses to
each drug.
Decrease in serum albumin o Oral medications should be given
❖ Leads to altered binding with a nutritious liquid (e.g.,
capacity juice) rather than water if a
❖ May cause increased serum levels patient is anorexic or is likely
of the “free” or unbound to refuse to take adequate
proportion of protein-bound amounts of liquid. This
drugs maximizes the nutritional values
❖ May result in toxic levels of of liquids ingested. (Do not use
highly protein-bound drugs liquids that are contraindicated
because more unbound drug is due to drug–food interactions.)
available to produce its effects
Pharmacodynamic Alterations
Nursing Responsibilities: ✓ Decreased number of receptors
o Check serum (proteins) ✓ Decreased receptor binding
o Watch out for manic disorder ✓ Altered cellular response to the
medications (lithium/Zoloft) drug-
o Check creatinine (kidneys) ✓ receptor interaction

2. Identify principles of safe

medication management with older
persons in a variety of patient care
settings
Considerable individual variation in
the degree of decline of renal NURSES’ NOTES
function o The general rule for drug
prescription in the older person
Normal Changes in Ageing and Effects is “start low; go slow.”
on Drug Therapy o Drugs that should be used with
caution in older adults:
▪ Drugs that are new to the
market
▪ Drugs with CNS effects
▪ Drugs that are highly
protein bound
▪ Drugs that are eliminated
by the kidneys
▪ Drugs with a high first-
pass effect
 ▪ Drugs with a low 3. Discuss measures to prevent and
therapeutic-to-toxicity reduce polypharmacy in older
ratio patients.

DEFINITIONS OF ADVERSE DRUG REACTIONS Older Persons More Likely to Have

AND ADVERSE DRUG EVENTS Adverse Drug Reactions (ADRs) Related
to
Adverse Drug Reactions (ADRs): o Inappropriate drug or dosing
Response to a medicine that is noxious o Drug-drug interactions
and unintended, and that occurs at o Polypharmacy
normal doses during normal use (World o Non-adherence
Health Organization, 2008).

Adverse Drug Events (ADEs): Any

incident in which the use of a
medication (drug or biologic) at any
dose, a medical device, or a special
nutritional product (for example, a
dietary supplement, infant formula,
medical food) may have resulted in
injury or adverse outcome in a patient
(Joint Commission, 2007).

Adverse Drug Experience: Any adverse PIVOTAL ROLE OF NURSE

event associated with the use of a o Can prevent the need for some
drug in humans, whether or not medications
considered drug related. o Can reduce the dose or length of
drug therapy
Common Medications with ADE
o Cognitive effects INDICATION FOR REDUCE DOSAGE
o Gastroesophageal effects o Weight is less than average
o OTC medications o Decreased liver or renal
function
PIVOTAL ROLE OF NURSE o Experiencing exaggerated
o Ensure drug therapy is effective responses to drugs that may
for the person’s condition reflect toxic levels
o Prevent, detect, or intervene as
early as possible if the person POLYPHARMACY
develops adverse drug effects o Definition: The prescription,
administration, or use of more
NURSE’S ROLE IN PROMOTING SAFE AND medications than are clinically
EFFECTIVE MEDICATION MANAGEMENT indicated in a given patient
o Assure the correct storage, o Examples
preparation, and administration ▪ Medication that has no
(including the five rights) in apparent indication
the institutional setting ▪ Continuing use of a
o Educate the patient and family medication after a
concerning storage, condition has been
preparation, and administration resolved
o In the institutional setting, be o The nurse should obtain a
aware of the legal aspects of complete history of all drugs
medication delegation for the prescribed.
state in which he or she o Use of a medication to treat the
practices as well as the side
policies of the employing agency o effects of another medication
o Use of an inappropriate dose
 o Use of duplicate medications o Verification (collection of the
because the same drug has been medication history)
prescribed by more than one o Clarification (ensuring that the
prescriber medications and doses are
o Self-medicating with OTC appropriate)
medications or herbal remedies o Reconciliation (documentation
to treat the same condition of changes in the orders)

INCLUDE IN A COMPLETE DRUG HISTORY

o Vitamins
o OTC medications
o Dietary supplements
o Herbal remedies

INDICATION FOR DRUG THERAPY

o A specific diagnosis
o Clearly documented symptom or
condition to be treated
o Avoid use of a drug to treat the
side effects of another drug

4. Describe assessments to monitor

older patients for adverse drug MEDICATION REGIMEN REVIEW
effects and polypharmacy. o Interactions with other drugs
o Interactions with herbal
ASSESSMENT PARAMETERS medicines
o Physiological and psychosocial o Interactions with vitamins or
status foods
o Need for the drug o Patient allergies
o Risk of an adverse drug reaction o Duplicate therapy
▪ From more than one
o 2019 AGS Beers Criteria for prescriber or from use of
Potentially Inappropriate OTC medications containing
Medication Use in Older Adults the same or similar
The nurse can use the list as a basis of ingredients as prescribed
questioning the prescribing clinician medications
about the appropriateness of a drug being
used in a particular patient. There may 5. Apply principles of teaching and
be instances when the drug is used
appropriately in a specific patient. The
learning to promote compliance and
list also is useful in helping the nurse adherence to the medication regimen.
to be aware of the adverse effects that
should be monitored if an older patient ENHANCING MEDICATION COMPLIANCE
is receiving these drugs. o Reducing the impact of side
effects through
ADVERSE DRUG REACTION CLUES ▪ Adequate intake of fiber
o Cognitive impairment (e.g., and fluid intake can help
delirium, dementia, depression) to offset drug-induced
o Loss of appetite, nausea constipation
o Weight loss ▪ Scheduling diuretic so
o Falls that it does not interrupt
sleep or activities
MEDICATION MANAGEMENT AND important to the patient
RECONCILIATION ▪ Frequent intake of liquids
o Indicated whenever an individual or the use of lozenges to
moves from one care setting to help with dry mouth caused
another by medications
The following nursing diagnoses are 6. List nonpharmacological therapies
useful for describing situations that may be useful as alternatives to
requiring nursing intervention to promote medications.
the effective use of medications by
patients: Noncompliance (specify);
MEDICATION ALTERNATIVES
Therapeutic Regimen Management,
Ineffective; or Therapeutic Regimen “Heartburn”
Management, Family. o Eat small, frequent meals
o Stay in upright position for at
DRUGS: DRUG REGIMENT UNASSISTED SCALE least 30 minutes after taking
o Used to assess an elderly medications
person’s ability to take Pain
medications correctly o Use of distraction
o Employs four medication o Guided imagery
management tasks o Positioning
▪ Identification or showing o Ice or heat
the appropriate
medications 7. Discuss issues related to ensuring
▪ Access, or opening the the safe use of drug therapy by the
appropriate containers older person
▪ Dosage, or taking out the
DRUG THERAPY ISSUES
correct number per dose
o Healthcare fraud (is a crime.
▪ Timing, or demonstrating
It's committed when a dishonest
the timing of the doses
provider or consumer
If a medication is not demonstrating the
expected therapeutic effect in a patient, intentionally submits, or causes
the nurse should investigate carefully. someone else to submit, false or
The patient may not be taking the misleading information for use
medication at all or as prescribed in determining the amount of
because of cost and may be embarrassed to health care benefits payable.)
share this information. o Medication costs
o Internet pharmacies’ legitimacy
MEASURES TO MANAGE MEDICATIONS o Sharing others’ medications.
CORRECTLY Sometimes older persons share
o Simplifying the regimen if their medications with each
possible other. They should be cautioned
o Establishing a routine for that this practice is unwise and
taking medications that they should take only
o Scheduling medications at medications prescribed for them.
mealtime or in conjunction with o Use of imported medications. The
other specific daily activities use of medication imported from
o Developing a method with the or obtained in another country
patient for remembering if he or is controversial and is
she actually took the medication considered illegal. Some health
o Conducting a total assessment of professionals are concerned that
all medication, including OTC imported medications may not
and herbal preparations meet the quality standards of
o Telephone reminders, computer- drugs approved for use.
based reminders, or pill boxes o Use of outdated medications. The
o Obtain all of medications use of medications that are
(prescription and OTC) from the outdated is risky. The
same pharmacy; request no medications not only may be
childproof packaging or caps ineffective but also can
o Determine any financial actually cause injury to the
restraints; identify low-cost heart, liver, or kidneys. It is
alternatives unwise to use old medications in
an attempt to save money.
 CARE OF THE OLDER ADULT because of decreased elastin and
collagen; capillaries can be
MIDTERMS easily broken that causes
hemorrhages
CARE OF OLDER ADULTS WITH AGE RELATED o Discoloration (senile purpura)
CHANGES IN THE INTEGUMENT due to breakage of capillaries

LEARNING OUTCOMES FUNCTIONS

o Describe normal skin changes o Protection
associated with aging ▪ protects underlying organs
o Identify risks related to common through its layers; UV
skin illnesses of the elderly lights from its
o List nursing diagnosis related to keratinocytes and
common skin illnesses melanocytes
o Discuss appropriate nursing ▪ Wrinkles are due to
intervention for common illnesses protection mechanism of the
skin
STRUCTURE AND FUNCTION ▪ UV radiation destroys
elastin and collagen of the
Cutaneous membrane skin (photo aging)
o Epidermis ▪ Collagen: make skin compact;
▪ Keratin that toughens the provides integrity of the
skin/waterproofs the skin skin
▪ Melanin: produced by ▪ Elastin: serves as
melanocytes that protects scaffolding; framework
from ultraviolet radiation ▪ If decreased, Will have
o Dermis wrinkles and sagging
▪ Blood supplies and nerve
endings o Temperature maintenance
▪ Decrease in function, ▪ diminished because blood
sensation, and blood supply flow in the skin is
to that area. slowed/decreased; the
▪ Blood supply is responsible sebaceous glands are not
for thermoregulation producing sebum and sweat
▪ Decreases sensation and are glands which is responsible
prone to injuries for thermoregulation
o Accessory structures
▪ Hair o Synthesis and storage of
▪ Sebaceous glands: produce nutrients
sebum which nourishes hair. ▪ Synthesizes vitamin D that
Sebum out of the skin young assists calcium and
oil adults flaking in the phosphorus to go into the
forehead, scalp, face bones. With aging, it is
(seborrhae dermatitis) diminished/less efficient.
▪ Sweat glands: Decreasing amount of calcium
thermoregulator. E.g. Sweat and phosphorous into the
under the sun bones and risk for injury.
▪ Arrector pili muscle: when Older adult cannot go out.
contracted, causes the hair Provide both vitamin D and
to “stand up straight” calcium
Subcutaneous layer ▪ vitamin d synthesis and are
activated by sunlight.
AGEING: Decreases manufacturing as
o Cell production decreases by 30% aging and decreases vit d
= decreased wound healing synthesis
o Small blood vessels in the
epidermal area can rupture
 o Sensory reception Endocrine system
▪ nerve ending will decrease o Sex hormones stimulate sebaceous
sensation gland activity; male and female
o Excretion and secretion sex hormones influence hair
growth, distribution of
Effects of UV Radiation o subcutaneous fat, and apocrine
o Activates synthesis of Vitamin D sweat gland activity; adrenal
o Wrinkle, sunburn, premature aging hormones alter dermal blood flow
o Carcinoma and melanoma and help mobilize lipids from
adipocytes
o Synthesizes vitamin D3, precursor
of calcitriol
o Vitamin d3 – calcitriol; fat
emulsification
Cardiovascular system
o Provides oxygen and nutrients;
delivers hormones and cells of
immune system; carries away
carbon dioxide, waste products,
and toxins; provides heat to
maintain normal skin temperature
o Stimulation by mast cells
produces localized changes in
blood flow and capillary
permeability
Lymphatic system
Slowed, delayed function of the skin o Assists in defending the
and the client is exposed to risk for integument by providing
injuries additional macrophages and
mobilizing lymphocytes
Skeletal system o Provides physical barriers that
o Provides structural support prevent pathogen entry;
o Synthesizes vitamin D3, essential macrophages resist infection;
for calcium and phosphorus mast cells trigger inflammation
absorption (bone maintenance and and initiate the immune
growth) o response
Muscular system Respiratory system
o Contractions of skeletal muscle o Provides oxygen and eliminates
pull against skin of face, carbon dioxide
producing facial expressions o Hairs guard entrance to nasal
important in communication cavity
o Synthesizes vitamin D3, essential Digestive system
for normal calcium absorption o Provides nutrients for all cells
(calcium ions play an essential and lipids for storage by
role in muscle contraction) adipocytes
Nervous system o Synthesizes vitamin D3, needed
o Controls blood flow and sweat for absorption of calcium and
gland activity for phosphorus
thermoregulation; stimulates Urinary system
contraction of arrector pili o Excretes waste products,
muscles to elevate hairs maintains normal body fluid pH and
o Receptors in dermis and deep ion composition
epidermis provide sensations of o Assists in elimination of water
touch, pressure, vibration, and solutes; keratinized
temperature, and pain epidermis limits fluid loss
through skin
Reproductive system o Can be assessed through staging
o Sex hormones affect hair
distribution, adipose tissue
distribution in subcutaneous
layer, and mammary gland
development
o Covers external genitalia;
provides sensations that
stimulate sexual behaviors;
mammary gland secretions provide
nourishment for newborn infant
COMMON ILLNESSES IN THE ELDERLY

PRESSURE ULCERS

Extrinsic: tolerance to pressure

Pressure: amount of force that is
responsible in occluding blood flow
Shearing: sliding of parallel surface
against each other
Friction: movement on bed linens; no
wrinkling to avoid pressure ulcers
Moisture: incontinence
*By eliminating these risk factors, risk
factors would be avoided. *
Pressure Ulcers in the Older Person
Pressure Ulcer: injury where the
tissue/skin integrity is damaged
o Caused by unrelieved pressure
o Occurs in soft tissue over bony
prominences
▪ occipital area, scapular
area, sacral area, shoulder
blades, heel area
Suspected Deep Tissue Injury:
discoloration manifested by
ecchymosis, darkened color: cold to
touch, painful, mushy feeling beneath
(wound under an intact epidermal layer)
I: reddened area, non-blanching: like
a sunburn (blanche: pale discoloration
of the skin caused by an obstruction of
the blood vessel); there is pain
because the affected area is epidermal
layer
II: painful; shallow opening without a
slough (hanging skin); characterized as
blister/ruptured blister

III: full thickness loss of epidermal

and dermal layer, exposing subcutaneous
tissue; no more pain because nerve
ending in dermal layer are affected;
feeling of discomfort
IV: full thickness tissue lost, visible histamine: vasodilator. Blood vessel
bone or muscle; slough (hanging skin) dilates – increased blood supply
(fibrinogen, fibrin, leukocytes,
Unstageable: necrotic covered by slough macrophages, neutrophils) growth
factor beta: controls wound repair

Proliferation phase: epithelization-

epithelial tissue covers wound.
Granulation: during collagen
synthesis, re-epithelialization of
dermal area, new blood vessels are
being formed (angiogenesis)

Maturation phase: wound becomes thicker

and compact, injured portion is
healing, scab is being formed
(migration of fibroblast that creates
a meshwork, integration of skin)
Contraction: scab has been shed and
NURSING DIAGNOSIS epidermis is complete (peklat)
o Impaired skin integrity related
to skin lesions and inflammatory If a wound does not heal for six weeks:
response chronic wound
o Risk for impaired skin integrity
related to physical immobility NURSING MANAGEMENT OF SKIN TEARS
o Risk for impaired skin integrity Skin Tear: small cut/wound (abrasion,
related to decreased skin turgor incision, opening)
o Risk for impaired skin integrity o Use a lift sheet to prevent
related to effects of pressure, shearing injury.
friction o Do not use any pulling or sliding
o Risk for impaired tissue movements when assisting older
integrity related to decreased adults with a change in their
circulation position.
o Risk for infection related to o Protect the older adult by padding
pressure ulcer any surfaces that come in contact
o Pain related to destruction of with leg and arm movements such
tissue due to pressure and shear as side rails, wheelchair arm and
leg supports, and table corners.
SKIN INJURY AND REPAIR (trochanter pillow)
o Keep the environment free of
obstacles and well lit.
o Avoid harsh soaps. (causes dry
skin injuring epithelial cells)
o Keep skin moist with adequate
fluids.
o Keep fingernails and toenails cut
short and filed to remove rough
edges and prevent self-inflicted
skin tears. (Podiatrist)
o Apply skin-moisturizing creams to
arms and legs twice daily.
o Wear long sleeves and long pants
to add a layer of protection over
the skin.
Inflammatory phase: process of
inflammation; redness, heat, pein,
swelling, edema; proliferation of

Sharp debridement: scalpel to slough
tissue
Mechanical debridement: gauze and do
wet to dry dressing or flushing
Chemical debridement: use of antiseptic
and topical agent that will revitalize
tissue
Autolytic debridement: retentive
dressing that covers the skin,
meshwork, topical gel and dries up
Debridement is done by specialists
(wound care nurses)
Contamination: microorganism is
present
Colonization: present and proliferates
in the area but no symptoms of
infection
Infection: microorganism is present and
experience inflammation
Additional:
o Improve oxygenation
o Provide adequate supply to the
wound
o Provide vitamin c and e because
it stimulates protein, aids in
tissue repair
NURSING MANAGEMENT OF PRESSURE INJURY
o Reposition q2h. Use a pull sheet
to prevent shear and friction. If
redness occurs, consider a 11⁄2-
hour turning schedule. The older
adult should be turned in a 30°
angle position to the mattress
when on his or her side.
o Ensure proper positioning. Use
pillows or wedges to pre- vent the
skin from touching the bed on
trochanter, heels, and ankles. Do
not use rings or donuts.
o Avoid sitting. The sitting
position, either in bed or in the
chair, should be limited to 2
hours. Time in the chair should
be scheduled around mealtimes.
The person in bed should not be
left in the 90-degree position
except during meals.
o Increase activity. Encourage
older adults to change positions
by making small body shifts. This
will redistribute weight and
increase perfusion. Range-of-
motion exercises should be done
every 8 hours, and the techniques
should be taught to family and
patients.
o Keep the skin clean and dry.
o Lubricate the skin with a
moisturizer. Massage the area
around the reddened area or bony
prominence. (Do not massage any
reddened area.) Then apply a thin
layer of a petroleum-based
product, followed by a baby
powder– cornstarch product, to
reduce friction and moisture.
o Evaluate and manage incontinence.
A bowel and bladder management
program should be in place. If
soiling occurs, skin should be
cleansed per routine. Under pads
that absorb moisture and present
a quick-drying surface to the skin
should be used. Plastic-lined bed
pads should not contact the
person’s skin. Use minimal pads
and cover them with a sheet or
pillowcase.
o Monitor nutrition. Determine
factors that might cause
inadequate nutrition.
o Obtain laboratory data. Provide
additional canned supplements,
vitamin C, and zinc to promote
skin healing.
BRADEN SCALE: assessment for risk for AGE-RELATED CHANGES AFFECTING VISION
pressure injury AND HEARING

LEARNING OUTCOMES
o Discuss nursing interventions
that can be implemented to assist
the aging patient with vision and
hearing
o Describe importance of health
education and screening for eye
diseases to prevent unnecessary
vision loss in older adults

AGE-RELATED CHANGES IN VISION

o Visual impairment is defined as
visual acuity of 20/40 or worse
while wearing corrective lenses,
and legal blindness or severe
visual impairment is 20/200 or
The Hartford Institute for Geriatric more as measured by a Snellen wall
Nursing recommends this scale be used chart at 20 feet
for risk assessment in the following o Visual impairment and blindness
categories of older patients: in the older person are the result
o All bed- or chair-bound patients, of four main causes: cataracts,
or those whose ability to age-related macular degeneration,
reposition is impaired glaucoma and diabetic retinopathy
o All at-risk patients on admission o Visual impairment can lead to a
to healthcare facilities and loss of independence, social
regularly thereafter isolation, depression, and a
o All older patients with decreased decreased quality of life
mental status, incontinence, and o Visual impairment increases the
nutritional deficits risk of falls and fractures,
making it more likely that an
older person will be admitted to
a hospital or nursing home, be
disabled, or die prematurely
(Ham, Sloane, Warshaw et al.,
2007)
▪ Glaring due to slow
pupillary reaction
o The healthy older adult should
schedule a complete eye
examination every other year.
During this examination, visual
acuity should be evaluated,
pupils should be dilated with
examination of the retina, and
intraocular pressure should be
tested. Older adults with
diabetes should have this
complete visual evaluation yearly
(Reuben et al., 2011)
NURSING RESPONSIBILITIES
Assess appearance of eyes
o Assess behavior of the client
▪ check if there are stains in
his/her clothes
▪ check if make up is
symmetrical for female older
adults
o Check for bruises
o Snellen chart test should be
performed at low light. In a
bright clinic, they might suffer
from glare or sensitivity
o Check if eyeglasses are clean and
clear
ARMD
Thickening of lens (responsible for
focusing light inside the eyes) if lens
will thicken and harden, it will have
a harder time to focus and become
yellowish and opaque. Light scatters
and there will be color discrimination
problems and cause increased risk of
falling and vehicular accident
VISION: NURSING CARE
o Safety is a major concern with
vision changes in the older adult
o Because pupillary reaction slows
with age, an older adult requires
more time to become acclimated to
changes in light intensity.
Nurses should instruct patients
on the importance of walking
slowly when entering a room with
brighter or dimmer light.
o Provide adequate lighting in
high-traffic areas
o Recommend motion sensors to turn
on light when an older person
walks into a room
o Look for areas where lighting is
inconsistent. Dark or shadowy
areas can obscure objects
o Use proper lampshades to prevent
glare
o Use contrast when choosing paint
colors so that the older person
can easily discriminate between
walls, floors, and other
structural elements of the
environment
o Avoid reflective floors
o When designing signs, use bright
colors such as red, orange, and
yellow. Avoid soft blues, grays,
and light greens because the
contrast between colors will be
poor
o Use supplementary lamps near work
and reading areas
o Use red-colored tape or paint on
the edges of stairs and in
entryways to provide warning and
signal the need to step up or down
o Avoid complicated rug patterns
that may overwhelm the eye and
obscure steps and ledges
o Age-related macular degeneration
(ARMD) is the leading cause of
blindness in adults over the age
of 65
o ARMD is a degenerative disorder
of the macula that affects both
central vision (scotoma) and
visual acuity
o Patients with ARMD often require
more light for reading. They often
experience blurry vision, central
scotomas (blind spots within the
visual field), and
metamorphopsia, in which images
are distorted to look smaller
(micropsia) or larger (macropsia)
than they actually are
o Central vision is mainly affected
by this disorder, and peripheral
vision remains intact (NEI,
2009). A person with macular
degeneration will experience a
dark spot in the center of the
field of vision and must learn to
rely on and interpret peripheral
vision in order to function
o 25% reduction in the development
of age-related macular
degeneration by consuming high
doses of antioxidants (vitamins C
and E and beta-carotene) and zinc.
o Lutein and zeaxanthin are
antioxidant beta-carotenoid
 pigments that concentrate in the CATARACTS: NURSING CARE
eye, is associated with a lower o Post-surgical education includes
risk of ARMD reinforcement not to lift any
o These nutrients are found in eggs, heavy objects, strain at stool,
spinach, romaine lettuce, or bend at the waist. (cause
broccoli, corn, and brussels intraocular pressure and delay
sprouts. healing)
o As a nurse, position yourself on o Patients with cognitive
the area/side where there is no impairments such as Alzheimer’s
ARMD disease must be carefully
supervised for at least 24 hours
RISK FACTORS after surgery to ensure that they
o Age do not remove the protective eye
o Smoking patch and do not rub their eye.
o Family history of ARMD o When surgery is needed in both
o Exposure to UV light eyes, one eye is done first and
o Comorbidities the second procedure is scheduled
a month or so later to allow
CATARACTS healing and recovery.
o Cataracts cloud the lens,
decrease the amount of light able GLAUCOMA
to reach the retina, and inhibit o Glaucoma is associated with optic
vision. nerve damage due to an increase
o Development is slow and painless, in IOP (intraocular pressure),
and may be unilateral or which can ultimately lead to
bilateral. vision loss.
o Cataracts are the leading cause o Problem with the optic nerve
of blindness in the world. o Aqueous humor (produced in
o Patients with cataracts may anterior chamber of eye). The one
experience blurry vision, glare, maintaining intraocular pressure
halos around objects, double (10-20; average 15)
vision, difficulty sensing o If outflow of AH is obstructed,
contrasting colors because colors it will accumulate and increase
appear faded or discolored, and pressure in the eyes damaging the
poor night vision. optic nerve and gradual visual
o Patients with cataracts should be loss
recommended for surgery o Greater than 21 the optic nerve
(treatment of choice) will atrophy and will experience
▪ outpatient basis blindness
▪ 15-30-minute procedure o Manifestation: pain
▪ local anesthesia (topical)
▪ lens will be removed and RISK FACTORS
replaced with an artificial o Age
lens (phacoemulsification) o Increased ICP
▪ 1-3 weeks of rest o Diabetes
▪ 20k for procedure; lens 60k o Hypertension
but depends on where it’s
made GLAUCOMA: NURSING CARE
o When administering eyedrops
RISKFACTORS (lowers ICP), it is important for
oAge the nurse to first wash his or her
oSmoking and alcohol hands, ask the patient to tip the
oObesity head backward and look upward,
oComorbidities like diabetes, then pull the lower lid down
hyperlipidemia slightly to make a small pouch.
o UV rays o The nurse should try not to drop
the medication directly onto the
 eye but rather into the eyelid o The nurse should educate patients
pouch to prevent a violent blink on how to check serum glucose
reflex and excessive tearing. levels, when and how to administer
medications (insulin or oral
DIABETIC RETINOPATHY hypoglycemic medications), and
o Diabetic retinopathy is a signs and symptoms of
microvascular disease of the eye hypoglycemia and hyperglycemia.
occurring in both type 1 and type
2 diabetes. AGE-RELATED CHANGES IN HEARING
o Damage to the ocular o Hearing loss can interfere with
microvascular system impairs the communication, enjoyment of
transportation of oxygen and certain forms of entertainment
nutrients to the eye (Huether & such as music and television,
McCance, 2012). safety, and ultimately,
o Develop micro aneurysms and independence.
create new blood vessels o Hearing impairments make
(neovascularization) that can communication difficult and are
cause drainage of the aqueous often frustrating for both the
humor may be impaired and cause patient and family.
another glaucoma (neovascular o In the older adult, cerumen tends
glaucoma) to be drier and harder, and tends
o Prevention of diabetic to accumulate in the ear canal due
retinopathy is dependent on tight to decreased activity of the
glycemic control in addition to apocrine glands. Hearing may
managing hypertension and become impaired if cerumen
hyperlipidemia. accumulates to impact the canal.
o Goals of treatment for patients o Cerumen impaction is one of the
with diabetes include maintaining most common and reversible causes
an average pre-prandial blood of conductive hearing loss in
glucose of 80 to 120 mg/dL, an older adults.
average bedtime capillary blood o Auto toxic medications, exposure
glucose of 100 to 140 mg/dL, and to excessive noise, smoking and
a hemoglobin (HbA1c) of less than head injury are also factors
7.
o Gradual vision loss with HEARING: NURSING CARE
generalized blurring and areas of o Recommended aural hygiene
focal vision loss. involves gentle cleansing of the
auricles (out-side of the ears)
DIABETIC RETINOPATHY: NURSING CARE while bathing or showering. The
o Nurses educate patients about use of cotton-tipped applicators
diabetes mellitus and the to cleanse the ear canal is not
importance of glycemic control to recommended because the
prevent retinopathy. applicator may push the cerumen
o Proper nutrition, including a deeper into the canal and thus
low-carbohydrate and low- increase the risk of impaction,
cholesterol diet, is imperative as well as traumatize the canal
to keep blood glucose levels down wall and tympanic membrane
and decrease the risk not only of (McPhee & Papadakis, 2011).
cardiovascular disease and o Curette. A small instrument with
hypertension but also to decrease a scoop on the end is inserted
the risk of microvascular damage into the ear canal while the helix
to the eyes. is lifted posteriorly and
o Exercise helps to lower glucose laterally.
levels, burns extra calories for ▪ Increased risk of injury to
weight management, and reduces the tympanic membrane/ear
insulin resistance in people with canal
type 2 diabetes.
o Lavage or irrigation. Irrigation o Pause at the end of each phrase
is the simpler and more or sentence.
straightforward approach to o If the patient has a hearing aid,
cerumen removal. provide assistance with the
▪ Saline solution/warm water device, plus glasses if needed.
▪ Risk for infection o Assess the illumination in the
room and make sure that the
o Contraindications patient can see you. Face the
▪ Perforated tympanic patient at all times during the
membrane conversation.
▪ Ear traumas o The patient may read lips, so it
▪ Tumor is important not to cover your
▪ Diabetic patient because of mouth or chew gum. Do not speak
high risk for infection into the chart or converse with
someone over your shoulder. The
o Examination of the ear may reveal patient will misinterpret your
an external infection or message.
impaction that can be treated o Speak slowly and clearly in a
appropriately to resolve the normal tone of voice—do not shout.
hearing loss. If the problem is o If the patient does not understand
not that obvious, a few basic your message, rephrase it rather
screening tests can be performed: than repeating the same words.
the whisper, Weber, and Rinne o Gestures, if appropriate, may
tests. help.
o The working condition of the o Use written communication if the
hearing aid is then assessed. patient is able to see and read.
Assessment parameters include: o Ask the patient for an oral or
▪ Integrity of the ear mold. written response to determine if
the communication was successful.
▪ Battery.
▪ Dials.
▪ Switches.
▪ Tubing for behind the ear
aids.

Hearing Aids
▪ Check batteries
▪ Checked by audiologist for
tuning in 2-3 months
▪ Clean with water or saline
with a cotton pad. Don’t use
alcohol because it would
degrade the plastic
▪ Batteries should be removed
in a dry place

o Eliminate extraneous noise in the

room. For example, with the
patient’s permission turn the
television or radio down or off.
o Stand 2 to 3 feet from the
patient.
o Gain the patient’s attention
before speaking. Touch lightly on
the arm or shoulder if needed.
o Try to lower the pitch of your
voice.
 CARE OF OLDER ADULTS ▪ These changes are especially
FINALS pronounced in
neurodegenerative diseases
such as Alzheimer’s disease
AGE-RELATED NEUROLOGICAL CHANGES
(a progressive and
irreversible disease,
Learning Outcomes
causing dementia) or
1. Describe the age-related changes
Parkinson’s disease (a
in the neurologic system
progressive disease,
2. Differentiate delirium,
causing rigidity, tremor,
depression, and dementia
and slowness of movement).
3. Discuss the different types of
o Neuroendocrine changes also occur
dementia, its stages, and nursing
with aging. There is a mean
management
increase in glucocorticoids with
4. Discuss clinical manifestation of
aging, which in effect puts the
Parkinson’s disease and its
body in a chronic stress
nursing management
condition.
MYTH: aging adult - cognitive decline ▪ This increase in
glucocorticoids may
Memory, attention, and executive influence the development of
function do experience changes with depression and the
development of type 2
aging, but the ability to learn new
material and meet the cognitive demands diabetes mellitus, a common
of independent living remains intact disease of older adults.
without the presence of neurologic ▪ Hypothalamic pituitary
disease axis: responsible in
increasing blood sugar –
Lobes of the Brain increase cortisol causing
Frontal Lobe hunger
o executive function o The neurologic conditions of the
o abstract thinking and planning central nervous system fall into
o also responsible for language the categories of memory,
o Broca’s area: speaking movement, seizure disorders, and
o short term memory storage stroke.
o The conditions of the peripheral
Temporal Lobe nervous system fall into the
o language (Wernicke area ability categories of motor, sensory, and
to comprehend or understand) autonomic disorders.
o hearing, perception, vision
o long term memory storage 3D IN GERIATRIC PSYCHIATRY
(hippocampus, located under Lola Pearl, 83-year-old female in a
amygdala responsible for long-term care setting. Appears
emotions) confused. Has been crying and trying to
o if damaged, it results to aphasia leave the facility. She has been
or the inability to understand or needing more help to manage personal
recognize language care but sometimes refuses it.
o Delirium
Occipital Lobe o Depression
o visual o Dementia

Parietal Lobe DELIRIUM

o tasting o Altered consciousness has been
regarded as a core feature of
o With aging there is neural death delirium.
and changes in the synapse between o DSM-5 now operationalizes
neurons ‘consciousness’ as ‘changes in
attention’. It should be
 recognized that attention relates MISCPAGE
to content of consciousness, but 1. Depressed mood most of the day,
arousal corresponds to level of nearly every day.
consciousness. 2. Markedly diminished interest or
pleasure in all, or almost all,
CCF activities most of the day, nearly
o Disturbance of consciousness every day.
(i.e., reduced clarity of 3. Recurrent thoughts of death,
awareness of the environment) recurrent suicidal ideation
occurs, with reduced ability to without a specific plan, or a
focus, sustain, or shift suicide attempt or a specific plan
attention. for committing suicide.
o Change in cognition (e.g.: memory 4. Diminished ability to think or
deficit, disorientation, language concentrate or indecisiveness,
disturbance, perceptual nearly every day.
disturbance) occurs that is not 5. A slowing down of thought and a
better accounted for by a reduction of physical movement
preexisting, established, or (observable by others, not merely
evolving dementia. subjective feelings of
o The disturbance develops over a restlessness or being slowed
short period (usually hours to down). Psychomotor agitation or
days) and tends to fluctuate retardation
during the course of the day. 6. Significant weight loss when not
dieting or weight gain, or
o Evidence from the history, decrease or increase in appetite
physical examination, or nearly every day.
laboratory findings is present 7. Feelings of worthlessness or
that indicates the disturbance is excessive or inappropriate guilt
caused by a direct physiologic nearly every day.
consequence of a general medical 8. Fatigue or loss of energy nearly
condition, an intoxicating every day.
substance, medication use, or
more than one cause. DEMENTIA
o “A COMMON DISORDER, occurring in o DSM-5: Neurocognitive Disorder.
50% of older persons admitted to An umbrella term for a number of
acute care settings. neurological conditions, of which
o UNrecognized and UNdiagnosed, the major symptom is the decline
MISdiagnosed as depression in brain function due to physical
o It is a MEDICAL EMERGENCY changes in the brain. It is
o “PRIORITY: SAFETY AND distinct from mental illness.
COMMUNICATION o Alzheimer’s Disease is the most
▪ Orient, reorient and make common type of dementia in the
the clients recognize older persons (60%)

DEPRESSION DSM-4: Memory loss and one:

o UNDERREPORTED (masked by o Aphasia - Expressive/Receptive
dementia, by comorbidities, or ▪ A-PH(F)ADING language or
stigma of aging) comprehension of speech. “A”
o DSM-5: The individual must be (absence or stop) “‘phasia”
experiencing five or more (speech).
symptoms during the same 2-week o Apraxia - inability to carry out
period and at least one of the motor activities
symptoms should be either (1) ▪ A-PRENO of action despite
depressed mood or (2) loss of physical ability and
interest or pleasure willingness. “A” (absence or
stop) “praxia/praxis”
(action).
 o Agnosia - inability to recognize addresses just given or reporting
or identify objects despite what was just said)
intact sensory function.
▪ AG-NO!-SIA, (like I don’t 3. Executive ability
know siya!) “A” (absence or o Involves planning, decision
stop) “gnosis” (knowledge). making, working memory,
o Executive dysfunction - higher responding to feedback, error
order decision making and correction, overriding habits and
planning mental flexibility
▪ S-O-A-P - sequencing, o Warning signs: patient is unable
ordering, abstract thinking to do both familiar and complex
and planning tasks and projects (at work and
at home). Needs to rely on others
to plan instrumental activities
of daily living or make decisions.
Has problems with abstract
thinking, displays loss of
initiative as well as
poor/decreased judgement

4. Learning and memory

o Involves immediate memory, recent
memory (free recall, cued recall
and recognition memory) and long-
term memory
o Warning signs: patient repeats
self in conversation, often with
PCELLS the same conversation. Cannot
DSM-5: Difference between Minor and keep track of short list of items
Major Neurocognitive Disorder is based when shopping or of plans for the
on the six cognitive domains: day. Requires frequent reminders
to orient task at hand, confusion
1. Perceptual-motor-visual perception about time and place, and
(praxis) repetitive behavior
o Involves picking up the
telephone, handwriting, using a 5. Language
fork/spoon o Involves expressive language
o Warning signs: patient has (naming, fluency, grammar and
difficulties with previously syntax) and receptive language
familiar activities (using tools o Warning signs: patient has
or, driving a motor vehicle) and significant difficulties with
navigating in familiar expressive or receptive language.
environments Often uses general terms such as
‘that thing’ and ‘you know what I
2. Complex attention mean’. With severe impairment may
o Involves sustained attention, not recall names of closer friends
divided attention, selective and family
attention and information
processing speed 6. Social cognition
o Warning signs: patient has o Involves recognition of emotions
increased difficulty in and behavioral regulation,
environments with multiple social appropriateness in terms
stimuli (TV, radio, of dress, grooming and topics of
conversation). Has difficulty conversation
holding new information in mind o Warning signs: patient may have
(recalling phone numbers or changes in behavior (shows
insensitivity to social
 standards, or make decisions performance in the range of two
without regard to safety). or more standard deviations below
Patient usually has little appropriate norms (i.e., below
insight into these changes. the third percentile) on formal
Becomes socially withdrawn or testing or equivalent clinical
isolated evaluation.
o The cognitive deficits are
DSM-5: MINOR NEUROCOGNITIVE DISORDER: sufficient to interfere with
also medically referred to as Prodromal independence (i.e., requiring
Disease or Mild Cognitive Disorder minimal assistance with
(MCI) and is defined by the following instrumental activities of daily
criteria: living).
o There is evidence of modest o The cognitive deficits do not
cognitive decline from a previous occur exclusively in the context
level of performance in one or of a delirium
more of the domains, based on the o The cognitive deficits are not
concerns of the individual, a primarily attributable to another
knowledgeable informant or the mental disorder (for example
clinician; and a decline in major depressive disorder and
neurocognitive performance, schizophrenia).
typically involving test
performance in the range of one DSM-5: MINOR VS. MAJOR NEUROCOGNITIVE
and two standard deviations below DISORDER
appropriate norms (i.e., between o Report by patient, informant,
the third and sixteenth clinician -and
percentiles) on formal testing or o NCD: Minor 1-2 vs Major >2
equivalent clinical evaluation. o Interference with independence in
o The cognitive deficits are IADLs, Minor intact IADLs vs.
insufficient to interfere with Major impaired IADLs
independence (for example o Not exclusively due to delirium
instrumental activities of daily
living such as complex tasks such o Alzheimer’s type of dementia has
as paying bills or managing insidious onset and gradual
medications, are preserved), but progression
greater effort, compensatory
strategies, or accommodation may TYPES OF DEMENTIA
be required to maintain o Alzheimer’s Disease (MOST COMMON)
independence Vascular Dementia
o The cognitive deficits do not o Lewy Body Disease
occur exclusively in the context o Fronto-Temporal Dementia
of a delirium.
o The cognitive deficits are not
primarily attributable to another
mental disorder (for example
major depressive disorder and
schizophrenia)

DSM-5: MAJOR NEUROCOGNITIVE DISORDER:

o There is evidence of substantial
cognitive decline from a previous
level of performance in one or
more of the domains, based on the
concerns of the individual, a
knowledgeable informant, or the
clinician; and a decline in
neurocognitive performance,
typically involving test
PERCENTAGES OF EACH TYPE OF DEMENTIA Amygdala
o Memory, decision-making, and
Fronto-temporal dementia (5%) emotional responses
o Damage to the frontal lobe and/or
temporal parts of the brain. DEMENTIA IN THE LIMBIC SYSTEM OF THE
Behavior, emotional responses, BRAIN
and language skills are affected o Has different affected areas or
lobes in the brain
Dementia with lewy bodies (DLB) (15%) ▪ But it generally affects the
o Is a type of dementia that shares hippocampus and amygdala
characteristics with both ▪ Cerebral cortex and limbic
Alzheimer’s and Parkinson’s system
diseases—protein deposits in the ▪ Limbic system- hippocampus
nerve cells and amygdala
▪ Hippocampus- encoding and
Alzheimer’s disease (60%) retrieval of information,
o Is the most common cause of damage causes global
dementia- parts of the brain retrograde amnesia that is
become damaged irreversible
▪ Amygdala- controls ability
Vascular dementia (20%) to feel certain emotions and
o Problems in the supply off blood to perceive them in other
to the brain people
o At an early stage, difficulty
PARTS AND FUNCTIONS OF THE LIMBIC remembering names of loved ones
SYSTEM and recent events
▪ Demonstrate impaired
judgement, disorientation,
behavior, trouble in
speaking, swallowing, and
walking
o Once it damages the hippocampus,
global retrograde amnesia occurs-
cannot retain newly acquired
information

Hypothalamus
o Controls body temperature,
hunger, fatigue, and sleep

Basal ganglia
o Control of movements, hearing,
habit, cognition, and sensation

Thalamus
o Regulation of sleep,
consciousness, and alertness

Hippocampus
o Motivation, emotion, learning,
and memory
 ▪ APP (amyloid precursor
protein) if this breaks down
becomes beta amyloid
- This bridges impulses
(chemical and electrical)
from one neuron to the
other
- If this metabolizes
becomes beta amyloid
- Half of Beta broken down
and metabolized and
eventually thrown away
- Half remains and forms
plaques in the
hippocampus
o Tau protein
▪ A normal protein existing in
every cell body (neurons)
but for some reasons these
proteins undergo a process
where phosphate molecules
target tau proteins > loses
its shape and then becomes
tangled > connects to the
microtubules of the neuron
and then it blocks the
signal of the chemical and
electrical signals from one
neuron to the other, thus,
o Two problems: formation of degrading neurons leading to
amyloid plaques and death
neurofibrillary proteins or tau o No cure for Alzheimer’s currently
proteins ▪ But can be prevented by
▪ Amyloid plaques combine then balanced diet (fasting
stops transmission of diets) and exercising
neurotransmitters > neuron ▪ Memory exercising
dies > (x) transmission of o Increasing sulcus spaces and
impulses > (x) memory, brain increasing ventricles is evident
control, function in Alzheimer’s
▪ Tau protein combine > cause
tangles > also hinder STAGES
impulse transmission > death
of neuron
▪ Increase and accumulation >
damage cortical area which
controls motor, memory, and
executive
▪ Number of synapses decreases
> neuron deprived on
nutrients > death
o As people age amyloid and tau
proteins increase in number
o Function of beta amyloid and tau o Not easily diagnosed because the
proteins only manifestation is memory loss
▪ There is already a lot of
beta amyloid in the synapse
MILD o Prompt treatment of all
o Begins with forgetfulness reversible and irreversible
o Progresses to disorientation and conditions
confusion o Coordination between care
o Personality changes providers and family members
o Symptoms of depression/manic
behaviors Goal
o Preserve self-esteem
MODERATE o Retain self-care abilities
o Need assistance with ADLs o Prevent complications
o Unable to remember names
o Loss of short-term recall Additional notes
o May display anxious, agitated, o Parkinson’s is considered as
delusional, or obsessive behavior dementia because it also causes
o May be physically or verbally shrinkage of the brain
aggressive o Travels from the hippocampus to
o Poor personal hygiene the right area where it reaches
o Disturbed sleep the thalamic area and the basal
o Inability to carry on a ganglia where dopamine is created
conversation and stored
o May use “word salad” (sentence o Dopamine is responsible for
fragments) accuracy of movement
o Posture may be altered
o Disoriented to time and place
o May ask questions repeatedly

SEVERE
o Loss of verbal articulation
o Loss of ambulation
o Bowel and bladder incontinence
o Extended sleep patterns
o Unresponsive to stimuli

MANAGEMENT
o Cure is NOT POSSIBLE
o Pharmacologic – START LOW, GO SLOW
to decrease cognitive decline
o Non-Pharmacologic
▪ CBT: Cognitive Behavior
Therapy ASSESSMENT TOOLS
▪ Communication, Consistency o CAM: Confusion Assessment Method
▪ SAFETY AND COMMUNICATION (Delirium)
o MMSE: Mini Mental Status
Pharmacologic Examination or Mini-Cog
Cholinesterase Inhibitors (Dementia)
o Block the breakdown of ACH o CDT: Clock Drawing Test
o Acetylcholine, a neurotransmitter (Dementia) supplement to MMSE
for thinking and memory o GDS: Geriatric Depression Scale
o Side effects: nausea and diarrhea (Depression)
o Donepezil, Rivastigmine,
Galantamine (mild to moderate)
o Memantine (moderate)

Nurse’s Role
o Appropriate use of available
pharmacologic and
nonpharmacologic interventions
PARKINSON’S DISEASE (PD)
o A chronic, progressive neurologic
disorder
o Symptoms are caused by the loss
of nerve cells in the pigmented
substantia nigra pars compacta
and the locus coeruleus in the
midbrain
▪ Substantia nigra pars
compacta- has dopamine
o Lewy bodies are present in the
basal ganglia, brain stem, spinal
cord, and sympathetic ganglia
▪ Lewy body will be tangled in
the synapse of a neuron
▪ This will result to the
motor deficits
o Considered an extrapyramidal
syndrome - chorea (involuntary
twitching of the limbs or facial
muscles), and dystonia
(involuntary muscle contractions
forcing unusual or painful
positions)
▪ EPS- because of its
anatomical structure
- Tremors
▪ Chorea and dystonia- both
are involuntary due to the
imbalance of acetylcholine
(excitatory
neurotransmitter) and
dopamine (inhibitory
neurotransmitter)
▪ In Parkinson’s there is
decrease of the dopamine
resulting to involuntary
movements
o Increases with AGE; more common
in men than women
▪ Parkinson’s disease is
prevalent in 1-2 persons/
1,000 people increases 2%
above 65 years old
o Unknown cause
▪ Idiopathic symptoms will
appear even without other
symptoms
o Loss of the dopaminergic cells
situated deep in the midbrain in
the substantia nigra (the black
substance so named because of the
melanin seen in those neurons).
With the depletion of dopamine,
which inhibits neurotransmitters,
an abnormal movement syndrome
 characterized by rigidity and o Message passed to end of axon >
tremor can occur sacs containing dopamine is
o Aside from the dopaminergic stimulated to be released in the
activity, exposure to synapse > crosses to bind to
environmental toxins that results dopamine receptors > opening >
to genetic predisposition can transmitting the message to the
lead to this disease receptor cells > dopamine goes
▪ Toxins > becomes neurotoxins back to the synapse > reabsorbed
> inflammation of the brain in the axon
> especially in the blood o There are enzymes that destroys
vessels > decrease in dopamine if it is not reabsorbed,
nutrients especially in the MAO-B (Monoamine Oxidase Type B)
substantia nigra > enzymes, cleans the synapse so it
decreasing dopamine release is ready for the next message
or production o Destruction of the dopamine
o Will worsen without treatment neuronal cell in the substantia
o Also, a neurodegenerative nigra of the basal ganglia >
disorder decrease/ depletion of dopamine
o Patients with this disease may stores > imbalance of the
also present cognitive impairment excitatory and inhibitory
o May happen to first degree neurotransmitters
relatives of older people who had o Excitation occurs (because
Parkinson’s acetylcholine is higher) > no
o Currently, no exact diagnostic restriction in the movement >
test, but is assessed and tested occurs in the corpus striatum,
through PET scans, MRIs, dopamine where EPS tract is located
tests controlling the complex body
o For confirmatory test, autopsy is movements
done o With severity of PD depletion of
dopamine leads to other changes >
PATHOLOGY OF PARKINSON’S DISEASE affect other neurotransmitters
like glutamate, GABA, and
serotonin
o GABA and glutamate are excitatory
neurotransmitters
o Serotonin – mood stabilizer
o That is why you see PD a mask-like
expression

FOUR CARDINAL MANIFESTATIONS

o Loss or decline in dopamine cells

> depletion > abnormal movement
syndrome > rigidity, tremor occur
d/t the decline of dopamine in the
synapse needed for transmission
at the nerve terminals which is
necessary to create movement
o Therapy to correct dopamine
deficiency > pharmacological o Two of the four of the cardinal
administration (levodopa, a manifestations may help you
synthetic dopamine) is done diagnose that a patient has PD
o Metabolic precursor of dopamine,
this also presents bradykinesia
 o May manifest cognitive Postural
impairments during the course of o Stoop posture
the disease o Shuffling gait- prone to falls
because patient does not lift feet
Tremor when walking
o Begins in the hands o They shuffle because they have
o Often occurring in one side and lost their balance
then as it progresses it will also
occur in the other side Priority
o Resting tremor o Safety of client
o When a client is at rest the hands
are shaking Will I die of PD?
o Disappear with purposeful You die with Parkinson’s disease, not
movement form it
o Rhythmic, slow turning motion, o You will not die because of PD but
pronation, supination of the you will die with it and its
hands, or the forearm symptoms
o Pill-rolling tremor o Later diagnosis, earlier death
▪ Early diagnosis will lead to
Rigidity better prognosis
o Stiff movements o Parkinson’s disease is not
o Resistance to passive limb considered fatal, however people
movement with PD have a shorter life
o Involuntary stiffness to passive expectancy
movement of extremities o In advanced cases, difficulty
o Early in the disease, a patient swallowing can cause PD patients
may complain of shoulder rigidity to aspirate food into the lungs,
(1st sign) leading to pneumonia or other
o Jerky movements- lead pipe or pulmonary conditions
cogwheel movement ▪ Parkinson’s with dementia
o Stiffness of the arm but on one with dysphagia has a high
side of the body rate of mortality
o Bells’ palsy and trigeminal o Loss of balance can cause falls
neuralgia- twitching which is that result in serious injuries
different from stiffness or death
o No difference in male and female
PD manifestations

Akinesia
o No movement
o Sudden arrest of movement

Bradykinesia
o Slowness of active movements
o Peristalsis will still be normal
because this is involuntary, but
the problem will be in the
chewing, eating, swallowing
because this are voluntary > high
risk for aspiration, may present
dysphagia (inability to swallow)
in progressive stages

Mid stage
o Urinary and bladder problems are
presented here
 ▪ Do not give food high in
vitamin B or pyridoxine or
Advanced vitamin B complex because
o Can no longer walk or stand vitamin B facilitates
without assistance breakdown of levodopa,
o Not able to do activities of daily increases action of dopa
living decarboxylase
o There are present cognitive ▪ Older person may develop
manifestations already drug induced tolerance
▪ Drug becomes ineffective at
PHARMACOLOGICAL TREATMENT FOR PD this time hyperactive
movements will show, take
note of the time when
levodopa is administered
o Amantadine
▪ Combined with levodopa and
carbidopa or cholinergic
▪ Potentiated release of
dopamine (remaining
dopamine in the substantia
nigra)
▪ This is transitory, does not
happen all the time this is
why It is combined
o In the synaptic junction there is ▪ Also, a prophylaxis in viral
dopa decarboxylase > destroys infections
dopamine o Dopamine agonists
o There are two factors that
▪ Directly stimulates
complicate the mechanism of
dopamine receptors >
action of levodopa
increase dopamine in the
▪ Med must past through BBB substantia nigra > restores
dopa decarboxylase is also the balance between
in the intestinal mucosa inhibitory and excitatory
▪ Only 30-40% of the neurotransmitters
medication crosses the BBB ▪ Initiated in the early
▪ Most of it is lost before it stages of PD before starting
enters the gen circulation with levodopa
and BBB ▪ Used in combination with
o New drug- levodopa + DDC inhibitor levodopa throughout the
> destroys dopa decarboxulase progression of PD
▪ Carbidopa + levodopa ▪ Bromocriptine
(sinemet) can be divided
▪ Pramipexole
into 4
▪ Ropinorole (requip)
▪ Added to maximize absorption
▪ Patients should be monitored
and facilitate crossing of
for sleepiness and
the BBB
drowsiness
▪ Should be taken in an empty
o MAO-B inhibitors
stomach
▪ Normally we have this in the
▪ At least 1 hour before meals
synapses, it destroys
or 2 hours after meals
dopamine that is not
▪ Potential side effect nausea reabsorb signal
and vomiting, postural transmission
hypotension
▪ Inhibits breakdown of
▪ Teach strategies to avoid dopamine
falling o COMT inhibitors (peripheral)
▪ How to sit and how to stand,
hold on unto something
 ▪ Catechol-O- NURSING CARE
methyltransferase The goal of treatment is to control the
▪ Reduces motor fluctuations symptoms and maintain functional
in PD and increases duration independence
of levodopa and carbidopa by o Do you have leg or arm stiffness?
decreasing its o Have you experienced any
biotransformation in the irregular jerking of your arms and
peripheral tissues legs?
▪ Synergistic drugs o Do you noticed yourself grimacing
▪ May cause dizziness and turn or making faces or chewing
urine orange or brown in movements?
color o Does your mouth water
▪ Make sure avoids alcohol, excessively?
this will potentiate risk of
liver failure o Improve functional mobility
o COMT inhibitor (central) o Maintain independence in
▪ Anticholinergic activities of daily living
▪ Used for symptomatic o Achieve adequate bowel movement
treatment o Attain and maintain acceptable
nutritional status
▪ Relieves tremors and
o Achieve effective communication
rigidity
o Develop positive coping
▪ Blocks action of
mechanisms
Acetylcholine and corrects
imbalance
FUBCTIONAL MOBILITY
▪ WOF: dry mouth, o Encourage exercises for joint
constipation, blurred mobility and joint flexibility
vision (not given to client (e.g., stationary bike, walking,
w glaucoma) urinary and range-of-motion exercises)
retention o Teach patient to walk erect, watch
▪ Do not give if the client the horizon, use a wide-based
has urinary retention gait, swing arms with walking,
because it could complicate walk heel-toe, and practice
an enlarged prostate marching to music
o Encourage breathing exercises
NURSING DIAGNOSIS while walking and frequent rest
o Impaired physical mobility periods to prevent fatigue or
related to muscle rigidity and frustration
motor weakness
o Self-care deficit related to FALL
tremor and motor disturbances o Falls are a significant public
o Constipation related to health problem. Worldwide, falls
medication and reduced activity are the second leading cause of
o Imbalanced nutrition: less than accidental or unintentional
body requirements related to injury deaths
tremors, slowness in eating, o The presence of dementia
difficulty in eating and increases risk for falls,
swallowing twofold, and individuals with
o Impaired verbal communication dementia are also at increased
related to decreased speech risk of major injuries (fracture)
volume, slowness of speech and related to falls
inability to move facial muscles
o Ineffective coping related to
depression and dysfunction due to
disease progression
o Risk for falls/risk for injury
related to rigidity and motor
weakness
 assistance in pulling up without
help
o Enlist assistance of an
occupational therapist as
indicated

BOWEL ELIMINATION
o Increase oral fluid intake and
encourage to eat food with
moderate fiber content
o Establish a regular bowel routine
o A raised toilet seat is useful,
because the patient has
difficulty in moving from a
standing to a sitting position

SWALLOWING AND NUTRITION

o Promote swallowing and prevent
aspiration by having patients
sit in upright position during
meals
o Provide semisolid diet with
thick liquids that are easier to
swallow
o Teach patient to place the food
on the tongue, close the lips and
teeth, lift the tongue up and
then back, and swallow;
encourage patient to chew first
on one side of the mouth and then
on the other

Question
Question The nursing diagnosis for a patient is
A patient with Parkinson’s disease has imbalanced nutrition less than body
a diagnosis of impaired physical requirements related to the progress of
mobility related to bradykinesia. Which Parkinson’s disease and adverse effects
action will the nurse include in the of pharmacotherapy. What is the best
plan of care? nursing intervention to include in the
a. Instruct the patient in plan of care?
activities that can be done while a. Cheese-and-cracker snacks
lying or sitting b. Whole grains and vegetables
b. Suggest that the patient rock form c. Cereals fortified with vitamin B6
side to side to initiate led
movement COMMUNICATION
c. Have the patient take small steps o Remind patient to face the
in a straight line directly in listener, speak slowly and
front of the feet deliberately, and exaggerate
pronunciation of words; a small
SELF-CARE electronic amplifier is helpful
o Environmental modifications are if the patient has difficulty
necessary to compensate for being heard
functional disabilities o Instruct patient to speak in short
o A hospital bed at home with sentences and take a few breaths
bedside rails, an overbed frame before speaking
with a trapeze, or a rope tied to o Enlist speech therapist to assist
the foot of the bed can provide patient