GERONTOLOGY

UNIT V
NURSING MANAGEMENT OF
PHYSIOLOGICAL / PSYCHOLOGICAL
DISORDERS
 OBJECTIVES
By the end of this session, students will be able
to:
•review age related changes by systems
•Capture the atypical clinical presentations of
older persons, experiencing various diseases.
•Apply the nursing process in caring for older
persons
•State the significance of polypharmacy in care
of the older persons.
 Nervous System
AGE RELATED CHANGES
• Decline in brain weight
• Reduced speed in nerve conduction
• Increased confusion with physical illness, loss of
environmental cues
• Reduced cerebral circulation (becomes faint, loses
balance)
• Slower response to changes in balance - predisposes to
falls
• Hypothalamus regulates temperature less effectively
• Alteration in sleep-wake cycle
 UNIQUE CLINICAL
MANIFESTATIONS- CNS
DISORDER TYPICAL ATYPICAL
PRESENTATION PRESENTATION
Depression Sad mood, Confusion,
increased sleep apathy,
time, fluctuations absence of
in weight. subjective
feelings of
depression.
 GERONTOLOGY – UNIT V
NEUROLOGICAL – Nursing Diagnoses
• Anxiety
• Pain
• Fear
• Anticipatory grieving
• Risk for injury
• Chronic low self esteem
• Disturbed sensory perception
• Social isolation
 GERONTOLOGY – UNIT V
NEUROLOGICAL / Common Medical Diagnoses
• Parkinson’s disease
• Transient ischemic attacks
• Cerebrovascular accidents
• Dementia – Alzheimer’s Disease
• Delirium
• Depression
• Sleep disorders
 GERONTOLOGY – UNIT V
NEUROLOGICAL – General Nursing Interventions
• Early recognition of symptoms
• Prevention of complications
• Promoting independence
• Preventing injury
• Using complementary therapies (check for drug
interactions and evidenced based guides)
 Cardiovascular Changes
AGE RELATED CHANGES
• More prominent arteries in head, neck, and extremities.
• Less elasticity of the blood vessels
• Decreased cardiac output
• Less efficient oxygen utilisation
• Diminished ability to respond to stress
• Heart rate, stroke volume do not increase with maximum
demand
• Slower heart recovery rate
• Increased blood pressure
 UNIQUE CLINICAL
MANIFESTATIONS- CVS
DISORDER TYPICAL ATYPICAL
PRESENTATION PRESENTATION
Myocardial Severe, substernal Mild or no
Infarction chest pain, SOB, chest pain,
nausea confusion,
weakness,
dizziness.
 GERONTOLOGY – UNIT V

CARDIOVASCULAR – Nursing Diagnoses

• Ineffective tissue perfusion
• Activity intolerance
• Impaired gas exchange
 GERONTOLOGY – UNIT V

CARDIOVASCULAR / Common Medical

Diagnoses
• Hypertension
• Hypotension
• Congested cardiac failure
• Pulmonary emboli
• Coronary artery disease
• Peripheral vascular disease
 GERONTOLOGY – UNIT V

CARDIOVASCULAR – General Nursing

Interventions
• Promotion of heart healthy practices
• Early recognition of symptoms
• Prevention of complications
• Promoting circulation
• Promoting foot care
• Using complementary therapies (check for drug
interactions and evidenced based guides)
 Respiratory System
AGE RELATED CHANGES
• Decreased ciliary action
• Increase in residual lung volume
• Thoracic muscles more rigid
• Blunting of cough and laryngeal reflexes
• Decrease in muscle strength, endurance, vital
capacity
• Decreased gas exchange, diffusing capacity
 GERONTOLOGY – UNIT V
RESPIRATORY – Nursing Diagnoses
• Impaired gas exchange
• Ineffective breathing pattern
• Risk for infection
• Ineffective airway clearance
• Impaired gas exchange
• Activity intolerance
 UNIQUE CLINICAL
MANIFESTATIONS- RS
DISORDER TYPICAL ATYPICAL
PRESENTATION PRESENTATION
Pneumonia Cough, SOB, Absence of the
production of usual symptoms,
sputum confusion,
malaise, anoxeia.
 GERONTOLOGY – UNIT V

RESPIRATORY –Medical Diagnoses

• Influenza
• Asthma
• Chronic Bronchitis
• Emphysema
• Pneumonia
• Lung Cancer
• Lung Abscess
 GERONTOLOGY – UNIT V

RESPIRATORY – General Nursing Interventions

• Promotion of healthy respiratory practices
• Early recognition of symptoms
• Prevention of complications
• Ensure safe oxygen administration
• Performing postural drainage
• Promoting productive cough
• Using complementary therapies (check for drug
interactions and evidenced based guides)
 Gastrointestinal System
AGE RELATED CHANGES
• Decreased sense of thirst, smell, taste
• Decreased salivation
• Esophagus more dilated
• Difficulty swallowing food
• Less production of hydrochloric acid, pepsin, lipase, and
pancreatic enzymes
• Delayed esophageal, gastric emptying
• Reduced intestinal blood flow
• Reduced gastrointestinal motility
• Liver smaller in size
 UNIQUE CLINICAL
MANIFESTATIONS- GI
DISORDER TYPICAL ATYPICAL
PRESENTATION PRESENTATION
Acute Right lower Diffuse abdominal
appendicitis quadrant pain, confusion,
abdominal pain, urinary urgency,
fever, absence of fever
tachycardia. or tachycardia.
 GERONTOLOGY – UNIT V

GASTRO INTESTINAL – Nursing Diagnoses

• Acute pain
• Deficient fluid volume
• Constipation
• Diarrhea
• Risk for infection
• Activity intolerance
• Imbalanced nutrition: Less / more than body requirements
• Impaired oral mucous membrane
 GERONTOLOGY – UNIT V

GASTRO INTESTINAL – Common Medical

Diagnoses
• Stomatitis
• Dental problems
• Dysphagia
• GERD, Ulcers, Hiatal hernia
• Cancers of Esophagus, stomach, colon,
pancreas
 GERONTOLOGY – UNIT V
GASTRO INTESTINAL– Common Medical
Diagnoses
• Diverticular disease
• Chronic constipation
• Flatulence
• Intestinal obstruction
• Fecal impaction
• Bowel incontinence
• Acute appendicitis
• Biliary tract disease
 GERONTOLOGY – UNIT V

GASTRO-INTESTINAL – General Nursing

Interventions
• Promotion of healthy eating practices
• Early recognition of symptoms
• Prevention of complications
• Using complementary therapies (check for drug
interactions and evidenced based guides)
 Genitourinary System
AGE RELATED CHANGES
• Decreased size of renal mass
• Decreased tubular function (between ages 20-90,
renal blood flow decreases 53% and GFR decreases 50%)
• Decreased bladder capacity
• Weakened bladder muscles
• Male: Benign prostatic hyperplasia
• Female: Relaxed perineal muscles, detrusor
instability (urge incontinence), urethral
dysfunction (stress urinary incontinence)
 UNIQUE CLINICAL
MANIFESTATIONS- GU
DISORDER TYPICAL ATYPICAL
PRESENTATION PRESENTATION
Urinary Dysuria, Absence of
Tract frequency, dysuria,
Infection hematuria. confusion,
incontinence,
anorexia.
 UNIQUE CLINICAL
MANIFESTATIONS- Immune
DISORDER TYPICAL ATYPICAL
PRESENTATION PRESENTATION
Infection Fever, tachycardia, Temperature
elevated white normal or
blood cell count. below normal,
absence of
tachycardia,
slightly
elevated white
blood cell
 GERONTOLOGY – UNIT V

GENITO URINARY – Nursing Diagnoses

• Acute pain
• Ineffective health maintenance
• Impaired urinary elimination
• Risk for infection
• Risk for injury
• Toileting self care deficit
• Body image disturbance
• Impaired skin integrity
• Impaired social interaction
• Sleep pattern disturbance
 GERONTOLOGY – UNIT V

GENITO URINARY – Common Medical Diagnoses

• Urinary incontinence
– Stress
– Urge
– Overflow
– Functional
– Total
• Bladder cancer
• Renal calculi
• Glomerulonephritis
• Renal Failure
 GERONTOLOGY – UNIT V

GENITO URINARY – General Nursing

Interventions
• Caring health team
• Sensitivity / maintaining client dignity
• Privacy eg during catherisation
• Promote positive self concept
• Minimise embarrasment
 GERONTOLOGY – UNIT V

REPRODUCTIVE SYSTEM – Nursing Diagnoses

• Acute pain
• Anxiety
• Risk for infection
• Sexual dysfunction
• Body image disturbance
• Impaired skin integrity
• Impaired urinary elimination
 GERONTOLOGY – UNIT V
REPRODUCTIVE SYSTEM – Common Medical
Diagnoses _ Female
• Urinary Tract Infections
• Atrophic vaginitis
• Cancer of vulva, vagina, cervix, endometrium,
ovaries,
• Perineal herniation
• Dyspareunia
• HIV and AIDS
 GERONTOLOGY – UNIT V

REPRODUCTIVE SYSTEM – Common Medical

Diagnoses _ Male
• Benign prostatic hyperplasia
• Cancer of prostate
• Tumors of penis, testes and scrotum
• HIV and AIDS
 GERONTOLOGY – UNIT V

REPRODUCTIVE SYSTEM – General Nursing

Interventions
• Promotion of safe sex practices
• Early recognition of symptoms
• Prevention of complications
• Using complementary therapies (check for drug
interactions and evidenced based guides)
 Musculoskeletal System
AGE RELATED CHANGES
• Loss of bone density / bone more brittle
• Shortening of vertebrae – decrease in height
• Loss of muscle strength, size
• Degenerated joint cartilage
• Slight hip, wrist, knee flexion
• Slight kyphosis
• Impaired flexion and extension movement
 GERONTOLOGY – UNIT V

MUSCULO SKELETAL SYSTEM – Nursing

Diagnoses
• Acute pain
• Activity intolerance
• Risk for infection and injury
• Disturbance in self concept
• Body image disturbance
• Impaired physical mobility
• Impaired social interaction
 GERONTOLOGY – UNIT V

MUSCULO SKELETAL SYSTEM – Common Medical Diagnoses

• Fractures
• Osteoarthritis
• Rheumatoid arthritis
• Osteoporosis
• Gout
• Podiatric conditions
 GERONTOLOGY – UNIT V

MUSCULO SKELETAL SYSTEM – General Nursing

Interventions
• Client / family education
• Prevention of injury
• Management of pain
• Promoting independence
• Use of assistive devices
 GERONTOLOGY – UNIT V
AGE RELATED CHANGES
ENDOCRINE
•Slowing of metabolism
•Alteration in pancreatic activity
•Decreased blood levels of growth hormone,
estrogen, and testosterone
 UNIQUE CLINICAL
MANIFESTATIONS- Endocrine
DISORDER TYPICAL ATYPICAL PRESENTATION
PRESENTATION

Diabetes 5 p’s Orthostatic hypotension,

periodontal disease, gastric
hypotony, impotence,
neuropathy, confusion,
glaucoma, infection.
 GERONTOLOGY – UNIT V

ENDOCRINE SYSTEM – Nursing Diagnoses

• Anxiety
• Fear
• Risk for infection / injury
• Deficient knowledge
• Noncompliance
• Imbalanced nutrition: Less than body requirements
• Sexual dysfunction
• Ineffective tissue perfusion
• Impaired skin integrity
 GERONTOLOGY – UNIT V

ENDOCRINE SYSTEM – Common Medical Diagnoses

• Diabetes
• Hypothyroidism
• Hyperthyroidism
• Hyperlipidemia
 GERONTOLOGY – UNIT V

ENDOCRINE SYSTEM – General Nursing

Interventions
• Client / family education
• Dietary education
• Management of pain
 Special Senses
AGE RELATED CHANGES
• Vision
– diminished ability to focus on close objects
– inability to tolerate glare
– difficulty adjusting to changes of light intensity
– decreased ability to distinguish colors
• Hearing
– decreased ability to hear high-frequency sounds
– tympanic membrane thinning
– loss of resiliency
• Taste and smell
– decreased ability to taste, smell
 GERONTOLOGY – UNIT V

SPECIAL SENSES – Nursing Diagnoses

• Anxiety
• Fear
• Risk for infection / injury
• Impaired verbal communication
• Powerlessness
• Self care deficits
• Disturbed body image
• Disturbed sleep pattern
• Impaired social interaction
 GERONTOLOGY – UNIT V

SPECIAL SENSES – Common Medical Diagnoses

• Cataracts
• Glaucoma
• Macular degeneration
• Detached retina
• Corneal ulcers
 GERONTOLOGY – UNIT V

SPECIAL SENSES – General Nursing

Interventions
• Client / family education
• Stimulation of all senses
• Effective communication
• Strategies to prevent injury
• Dietary education / considerations
 Integumentary System
AGE RELATED CHANGES

• Decreased subcutaneous fat, interstitial fluid,

muscle tone, glandular activity, sensory
receptors resulting in decreased protection
against trauma, sun exposure, temperature
extremes
• Diminished secretion of natural oils,
perspiration
• Capillary fragility
 GERONTOLOGY – UNIT V

INTEGUMENTARY – Nursing Diagnoses

• Anxiety
• Pain
• Risk for infection / injury / Hyperthermia / Hypothermia
• Disturbed body image
• Sexual dysfunction
• Impaired social interaction
• Impaired skin integrity
 GERONTOLOGY – UNIT V

INTEGUMENTARY – Common Medical

Diagnoses
• Pruritis
• Keratosis
• Seborrheic keratosis
• Skin cancer
• Vascular lesions
• Pressure ulcers
 GERONTOLOGY – UNIT V

INTEGUMENTARY – General Nursing

Interventions
• Promoting normalcy
• Prevention of pressure ulcers
• Using alternative therapies
• Protect from extremes in temperature
 Geriatric Syndromes
• Impaired mobility
• Dizziness
• Falls, falling
• Urinary incontinence
• Susceptibility to infection
• Altered pain, febrile responses
• Altered emotional impact
• Altered systemic response
 Pharmacologic Aspects
• Polypharmacy: administration of multiple
medications at same time; common in older
persons with several chronic illnesses
• Aging changes alter drug in terms of:
– Absorption
– Metabolism
– Distribution
– Excretion
 GERONTOLOGY – UNIT V

PHARMACOLOGICAL – Nursing Diagnoses

• Anxiety
• Pain
• Risk for adverse drug reactions
• Risk for medication errors
 GERONTOLOGY – UNIT V
Pharmacology alert
•NSAID use / abuse
•Use of PPI as the gold standard for
management of gastric ulcers
 GERONTOLOGY – UNIT V
Nursing Implications
•Need adjustment of dosage due to age; “start low,
go slow”
•Assess medication knowledge, use
•Need for medication review, coordination of
prescriber
•Problem of noncompliance:
– Factors that affect compliance
– Keep medication regimen as simple as possible
– Develop strategies to improve compliance
 SUMMARY
• There are several atypical disease presentations in
the older person, nurses need to be aware of these
to improve the care of older adults.
• Multiple physical and physiological and psychological
changes can impact the ability to function and
perform activities of daily living.
• Safety is a primary concern when caring for older
clients, thorough assessment and client / family
teaching are critical.
• Polypharmacy impacts the morbidity and mortality
of older persons.
 REFERENCE
• Eliopoulos, C. (2010). Gerontological Nursing.
Philadelphia: Lippincott Williams & Wilkins.
• Luekenotte, A.G., (2006) Gerontological
Nursing. St. Louis: Missouri: Mosby Inc.