This article is an outline of guidelines for geriatric care that may be useful to nurse practitioners and clinical nurse specialists who encounter older people in practice. Due to their complexity, aged people always deserve personal attention. Nurses address physical, psycho social, cultural and family concerns as well as promoting health and emphasizing successful aging.
Rising Life expectancy creates a need for the preparation of nurses to care for the rapidly increasing number of the aged.
It is important to distinguish changes involved with normal aging from changes attributable to pathophysiology. Alterations in the structure and function of multiple body system may affect an older person's appearance, mobility and ability to fight off infections. Geriatric medications require careful management to avoid overmedication as this group receives a lot of medication (see polypharmacy. Multiple medications can cause a variety of drug interaction in older people. Primary drug reaction occurs when one drug causes one side effect, secondary drug reaction occurs when one medication reacts with another. Older people should be treated in ways that are of benefit and do no harm or as little harm as possible. Principle of assessment: data regarding biomedical, functional, psychological and social issues are obtained to help in planning and implementation of individual health care.
A pressure ulcer is a lesion caused by unrelieved external pressure resulting from occlusion of the blood flow, tissue ischemia and cell death. Pressure ulcers are often viewed as a complication of an acute or chronic illness. The high prevalence of pressure ulcers, especially facility-acquired pressure ulcers, is a concern in patient care today. While rates have decreased in some care settings, 1 in 10 patients in acute care still experience a pressure ulcer and almost 1 in 20 patients develop a facility-acquired pressure ulcer. The presence of ulcers may also be evidence of poor nursing care. Although pressure ulcers can be prevented, they may also occur despite optimal nursing care and advanced technologies. To provide effective nursing care for the older adult with pressure ulcers, the nurse must approach patient care within a holistic frame work. This framework should include an integration of good assessment, use of research-based intervention and methodical intervention of patience outcomes. Some specific issues of prevention, assessment and treatment of adult with pressure ulcers are aging skin: The older people have an aged skin and due to exposure to the sun the skin wrinkles, epidermis thins, blood vessels recede, dermal-epidermal ridges flatten and the skin appears thin and fragile. The age related changes may lead to ulceration. The skin which is the largest organ can help in viewing the overall functioning of the entire body. All clinicians working with older people at risk for, or suffering from pressure ulcers must be mindful of these varying relationships in using the cutaneous "window" of person to plan and implement individualized, comprehensive care.
Pressure ulcers are catogorized by a staging scheme. Stage one ulcers are characterized by non-blancherble erythema of intact skin. Stage one pressure ulcers are difficult to identify in darkly pigmented people and are usually indicated by discoloration, warmth, endyma, indurations and hardness. Stage two ulcers are partial lesions extending into the epidermis and the dermis. Stage three ulcers are defined as the full thickness skin loss. Stage four is characterized by extensive tissue damage which extends to the muscle, bone or the underlying structures.
Through a holistic assessment and evaluation a nurse can build a plan of care for those patients who suffer from pressure injury. When treating an ulcer treatment should focus on wound healing. For a chronic, non healing ulcer, comfort should be a top priority. Positioning and padding can reduce the risk of pressure ulcers. Wound healing occurs only if; the patient is physiologically able to provide needed substrate; wound cleanliness is maintained, moisture and infection are controlled and the cause of injury is removed. Older people take longer to heal so extra care is needed. When customary interventions fail to heal a pressure ulcer, surgical intervention may be an option.
Cardiovascular disease affects the heart and the blood vessels. It is caused by disruption in the blood circulation secondary to decreased vessel patency (constriction, spasm and occlusion). Cardiovascular disease is occurs in 50% of the population over the age of 65, and accounts for 40% of deaths in this group. Because of the changes associated with normal aging and some of the unique aspects of reporting and presenting in older adults, underestimation of the seriousness of cardiac disease occurs. This can lead to misdiagnosis, under treatment, and even death. There are different kinds of heart disease: Atherosclerosis and arteriosclerosis. Arteriosclerosis is a disease of the arteries, characterized by abnormal thickening and hardening of vessel walls, it leads to atherosclerosis. When diagnosing look for cases of fainting, continuous chest pain, nausea, shortness of breath, rapid heart rate, rapid weight gain, pain in the abdomen, swelling of legs and other symptoms. Issues of hypertension, high blood cholesterol, diabetes, obesity and overweight, smoking, hereditary should be addressed. Treatment includes medication and physical exercises.
The following age related changes may occur in the respiratory system of an older person: diminished muscle strength in the diaphragm and thorax, stiffer chest wall, decreased elastic recoil, decreased elasticity in the alveoli reduced surface area, with diminished capacity for gas exchange, decreased vital capacity, and drier mucous membrane leading to more difficulty in mucous excretion. X-ray studies and physical examination aid in evaluating pulmonary function. Respiratory diseases in older people include; bronchitis, asthma, pneumonia, tuberculosis, and chronic obstructive pulmonary disease. Some of these lead to cardiovascular disease related to air pollution. Nurses should draw a plan for treatment which includes working with other specialties like heart experts.
They include urinary incontinence (transient, established or combination), urinary tract infection (asymptomatic bacteriuria, uncomplicated UTI and complicated UTI) and prostate disease (benign prostatic hyperplasia) and prostate cancer. Nurses should be careful with the language while carrying diagnosis so they can obtain as much information as possible.
Diabetes mellitus is a metabolic disorder with two major types, type one and type two. Their end result is hyperglycemia. Type one is caused by lack of insulin production by beta cells. Type two is the most common and is caused by deficiency or inadequacy of insulin receptors in cells. Treatment goals are to symptoms and maintain as normal blood glucose as possible without inducing hypoglycemia to decrease the risk of long term complications. Nurse should emphasize nutrition and exercise which are vital for victims. For older people monitoring for complications which can lead to lower extremity amputation, hypertension, myocardial infarction, stroke, vision loss, or nephropathy should be carried out especially in type 2 diabetic patient.
The most encountered disorders are hyperthyroidism, hypothyroidism and nodular thyroid disease. Hyperthyroidism is characterized by an excess of amount of thyroid hormone. In hypothyroidism the thyroid glands fails to produce thyroid hormone. Nurse practitioners have a responsibility to evaluate and manage thyroid disorders by applying strategies specific to older adults.
Also known as acute confusion, it is a prevalent and serious health problem for acutely ill adults. Delirium can be defined as transient and etiological non-specific organic mental syndrome characterized by reduced ability to focus, sustain or shift attention.
Changes in the structure and function of the nervous system occur with normal aging and can result in changes in mobility, balance, coordination, sensation, comprehension, cognitive performance or behaviour. These changes reflect a slowing of neurological response as fewer neurons are available to provide sensory and motor messages to and from the central nervous system. Common terms for dizziness include vertigo, pre-syncope and disequilibrium.
Also known as brain attack, created by interruption of blood supply to some areas of the brain, this interruption can occur as a result of an occlusion or hemorrhage. Occlusion leads to ischemic stroke, categorized as thrombic and embolic. Thrombic stroke occurs in vesicles when oxygenated blood fails to flow to the occlusion site. Embolic stroke occurs when clots form everywhere.
- Cotter, Valerie T.; Strumpf, Neville E. (2001). Advanced Practice Nursing with Older Adults: Clinical Guidelines. McGraw-Hill Medical. ISBN 0071341579.