Reasons to study the Older Adult

in nursing practice

DUE TO THE FOLLOWING REASONS IT IS IMPARITVE TO HAVE THE COMPETENCE TO DELIVER CARE IN THE OLDER ADULT POPULATION

~The increase in the OA population. People aged 65 & older expected to represent 20% of the population.

~>than 83% cardiovascular disease deaths occure in people aged 63 & older

~25% of people aged 60 & older have diabetes

~56% of of all cancer diagnosis & 70% of cancer deaths were in people aged 65 & older

~Injury death rates in the OA are more than twice that of younger adults.

~Increasing # of OA reported in emergency hopital visits.

Physiological Cardiovascular changes that

happen in aging

-arterial wall thickening & stiffening-leads to decreased compliance

-left ventricular & atrial hypertrophy

-sclerosis of atrial & mitral valves-leads to Decreased Cardiac Reserve (no change in heart rate)

-isolated systolic hypertension

-risk of arrythmias

-postural & diuretic induced hypertension

-syncope (dizziness)

Nursing assesments & implications for

cardiovascular changes in the older adult

~Assesments~

-check heart rates, rythms, murmurs, & heart sounds

-Check BP (lying, sitting & standing) & pulse pressure

-palpate the carotid arteries &

peripheral pulses for symmetry

~Implications~

-safety to prevent falls

-Encourage & support healthy aging lifestyles

Physiological changes in the Pulmonary

Sytem specific to the older adult

~Decreased respiratory muscle strength

~diminished ciliary & macrophage activity-leading to a drier, decreased cough reflex

~decreased response to hypoxia (deprivation of O2) leading to Hypercapnia (too much CO2 in the blood)

~Reduced pulmonary reserves- leading to dyspnea, & decreased exercise tolerance

Key Pulmonary assesments

for the older adult

~Risperation rate, rythm, regularity, volume, depth, & exercise capacity

~Auscultate lung sounds in all fields

~inspect chest -obtain smoking history (include marijuana smoking history as well)

~Moniter secretions, positioning, blood gasses,

& pulse oximetry

~Assess cough

Nursing Implications for the

older adult with pulmonary issues

~Keep airways open: positioning, oxygen, bronchiodilaters (as ordered)

~Incentive spirometry

~Maintain hydration & mobility

~educate on coughing techniques & smoking cessation

Physiological changes in the Renal &

Genitourinary changes in the older adult

~decrease in kidney mass, GFR, decreased drug clearance

~Reduced bladder capacity, elasticity, & muscle tone

~Increased post void residuals, & nocturnal urine production

~MALES: prostate enlargement with risk of BPH

Implications related to renal & genitourinary

changes in the older adult

~reduced reserves, & risk of complication in illness

~Nephrotoxic injury & adverse effects form drugs

~Risk of volume overload, reduced excretion of acid load, dehydration leading to:

-hypotremia (thiazide diuretics) hypernatremia (with fever), hyperkalemia (with potassium sparin diuretics)

~increased risk of urinary urgency, incontinence, UTI, nocturnal polyuria, & falls risk

Nursing Care of older adults with renal

or gentitourinary changes

~Maintain drug levels: reveiw lab values, & asses for drug toxicities

~Asses for fluid electrolyte imbalnces, maintain minimums

~(for nocturnal polyuria)-Decrease fluids in evening, avoid caffeinated beverages, use prompted voiding schedules

~fall prevention -essential at night

Physiological changes in Oropharyngeal &

Gastrointestinal systems specific

to the older adult

~decrease in strength of mastication, taste & thirst perceptions

~decreased gastric motility with delayed emptying

~malabsorption of carbohydrates, B12, D, folic acid, & calcium

~impaired sensation to defecate

~reduced hepatic reserve -leading to a decreased metabolism of drugs

Implications of GI changes in

the older adult

~constipation is not "normal" no matter the age

~risk of chewing impairment, fluid/electrolyte imbalances, poor nutriotion

~Gastric changes -(GERD, NSAIDS induced ulcers)

~Stable liver function tests, risk of adverse drug effects

Nursing assesment & care of the older adult

with changes in the GI system

~assess abdomen & bowel sounds

~assess oral cavity, chewing & swallwing, dysphagia -if aspiration assess lungs for infection & other symptoms

~moniter weight, BMI, determination of dietary intake

~assess for GERD, constipation, impaction

Nursing care for older adults

with GI changes

~moniter drug levels & liver function tests, assess nutritional indicators in labs

~educate on lifestyle changes & medications for GERD

~educate on normal bowel frequency, exercise, diet, laxatives recommended

~encourage community based nutritional programs

Physiological changes in the Musculoskeletal

changes in the older adult

~Sarcopenia -decline in muscle strength & mass associated with aging

-increased muscle weakness & poor exercise tolerance

-lean body mass replaced by fat

-bone loss in women & men

-decreased ligament & tendon strength,

cartilage erosion, changes in stature

Implications related to changes in the

musculoskeletal system in older adults

~Sarcopenia -increased risk of disability, falls,

& unstable gait

~Risk of osteipenia, ostoporosis

~limited ROM, risk of osteoarthritis

Key concepts for caring for

the older adult

~Clinical assessment is essential

-look for patterns & changes from baseline for the individual older adult

~Educate & demystify the myths of aging

(often a barrier to older adults themselves)

~Exercise, diet, medication management, pain management, & falls prevention

-key concepts to assisting

older adults in "aging well"

What is "person centered care"

mean when caring for an older adult?

~Focusing on the needs of the older adult, incorperating their personal beliefs, values, & thoughts -critical in delivering quality care

~Culture, environment,situation, or ethical considerations for care -developes a quality individualized plan of care for the older adult

What is the SPICES assessment

used in older adult care

S is for sleep disorders -sleep affects quality of life

P is for problems with eating or feeding -could effect medications in the body, chokeing (if swallowing is an issue), nutritional state, fluid/electrolyte balances

I is for incontinenece

C is for confusion

E is for evidence of falls -fractures is the #1 killer in the older

S is for skin breakdown -may cause an infection, lenghthen stay in hospitaln spicificaly dangerous with the "antibiotic resistant" infections

 causes & effects of

Sleep disorders in the older adult

~sleep effects cognative thinking -causing risk for falls

~medical conditions that effect sleep

~medications that effect sleep

~sleep is needed on a daily basis

Tips on helping the older adult

with meeting thier nutritional needs

~Assess nutritional status -use diet intakes, lab values, weight, oral hygiene/dentures, chewing abilities

~Assess environment -can adult afford food? can they get to store? do they not like eating alone?

~Create visually appealing meals

~encourage eating together

~Use herbs & spices to add flavor, -older adults have fewer taste buds, they wont eat unless it taste good

~Educate OD on good food preperation techniques

*INCONTINENCE IS NOT A NORMAL AGING PROCESS*

~Different types of incontinence

-Urge -do not feel need to go then can't wait

-Stress -going when they cough or sneeze

-Bowels -is there an urge sensation

~plan to toilet regulary, use least restrictive products (briefs V.S. catheter)

~Change beverages, reduce caffeine, provide cammode or urinal

What puts the Older Adult at risk for

skin breakdown & pressure ulcers?

*Assesment of the skin is key to monitering skin breakdown. RN should not deligate this job*

~Decreased mobility

~decreased nutritional status

~decreased healing abilities due to medication

~skin integrity issues

Medication management in the

older adult

~Know the medication~

-side effects

-potential impact on the individual older adult -drug/drug interactions

~Act~

-educate the older adult, & family caregivers about medications

-develope systems to better assist an older adult in managing their medications (reminder calls, assisted living, etc.)

~Review~

-review all medications with older adults

-report any changes in understanding or cognition to primary care provider

What are the legal & ethical

roles of an RN

~mandatory reporter

What types of drug orders are given by the

doctors for the patients

~Stat orders

~single dose orders

~standing orders

~PRN orders

~5 RIGHTS

~3CHECKS

What are the 5 rights & 3 Checks

for safe medication administration?

~RIGHT DRUG

~RIGHT DOSE

~RIGHT TIME

~RIGHT ROUTE

~RIGHT CLIENT

~Check the 5 rights 3 times~

what are the other rights for

for safe medication administration?

~ proper drug storage

~ accurate dose calculation

~ Accurtae med. dose preperation

~ Prevention & reporting of med. administration errors

~ patient teaching

~ correct transcription

What are the drug routes used

to administer medication?

~Enteral -Oral, or tube

          -swallow

          -sublingual

          -buccal

~Parenteral

          -intradermal

          -SQ

          -Im

          -IV

~Topical -skin/mucous membranes

          -rectal or vaginal

          -optic

          -ophthalmic

          -intranasal

          -inhalants

What are the 11 patterns in

GORDANS FUNCTIONAL HEALTH PATTERNS?

1) Health perception & health management

2) Nutritional Metabolic pattern

3) Elimination pattern

4) Activity & exercise pattern

5) Cognative-Perceptual pattern

6) Sleep rest pattern

7) Self-perception-Self-concept pattern

8) Role-relationship pattern

9) Sexuality & Reproduction pattern

10) Coping-stress pattern

11) Value Belief pattern

What is malpractice

What is Negligence

-An error that causes a consenquence, acting incorrectly

-Do something wrong to make a mistake

(RN is equally responsible for error made by DR.)

-The failure to act

What is informed consent and who

is responsible for getting informed

consent from patient?

-Gives the patient the information needed to make a decision regarding their health care

-It is the providers responsibility to expalin medical proceedures to the patient

-RN CAN witness the signiture of a client, but CAN NOT witness the proceedure

What is assult

what is battery

-Any kind of threat

Physical injury

-restraint of any kind

-the action of the threat (including any restraints)

What are the 3 types of

nursing diagnosis?

1) ONE PART

- wellness diagnosis or syndrom diagnosis

2) TWO PART (problem R/T cause)

-Risk diagnosis or possible nursing diagnosis

3) THREE PART (problem R/T cause AEB S&S

-actual diagnosis

Expected Outcomes

A PROMPT

*Goals made by RN & PT*

A adress the nursing diagnosis

P patient centered involve PT in the process of goals & achievment

R realistic & obtainable create goals that are realistic to the individual & his/her diagnosis

O one behavior only ask PT to acomplish 1 activity at a time so the acomplishments can be identified

M measurable use sources of measurment (distance, weight, temp.)

T time frame implement a time frame the goal is to be obtained

1) Stat-now, immediatly

2) single dose

3) standing-most common order

4) PRN-pain management

-better if reason why is indicated

-can only administer for indicated use

-assess pain prior to administering and again after (time frame to assess after adminstration depends on the route)

What are the 7 parts to a

medication order?

1) Name of PT

2) Date & time

3)name of drug

4) dose of drug

5) Route of administration

6) Time/frequency (what type of order is it)

7) Signiture of Dr

Whats important in documentation

of med. administration?

-Document immediatly after med. administration to PT (at the bedside if possible)

- It is a legal document

- Document if PT refuses to take med.

What is the role of the RN if a PT

refuses a particular med?

-Educate PT on the importance of the medication and the possible results if med. is not taken

- If PT insists on refusal, DOCUMENT

- When many meds are scheduled. put meds in sequential order

~NEVER administer meds you havnt prepared yourself

~Do not take verbal orders, only written orders

~Never leave med with a PT to take later

~If Pt qustions med., double check the order

~ WHEN IN DOUBT, hold the med

~label all syringes

What are the 3 drug routes for

medication administration?

1) Enteral -swallow, sublingual, buccal

2) Parenteral -intradermal, sub-Q, intramuscular, intravenus

3) Topical -skin, mucous membrane (rectal, vaginal, otic, opthalmic, internasal, inhalants)

Things to remeber with administering

meds. the Enteral route

~ give PT plenty of water (unless otherwise contraindicated)

~ GI complications will effect drug absorption

~ If PT vomits-check vomit for intact pill. Just because med maybe disolved does not mean it has necessarily been absorbed

Things to remember when administering

meds. subligual

~ have Pt sip small amout of water prior to administering

~SL is a quick acting route

~ Smoking causes vasoconstriction and severly affects the absorption of SL meds

~ DO NOT give to uncounciess PT's

Things to remeber when administering

meds topically

~ Topical route can give a systemic effect or local effect

~ Asses PT to be sure other topical patches are off

~Asses are med is being applied first

Things to remember when administering

meds Rectally (enemas, suppository, ointments)

~ DO NOT use in cardiac PT's

~Administer w Pt lying on left side (if possible)

~give enemas with PT lying down (not on comode)

~do not deligate enemas-requires assessment prior to, very invasive, & its a medication

~place recatl meds on the side of the rectal wall

things to remember when administering

inhalants

~ASSESSMENT is key to all inhalants

~ Osculate lung sounds prior to administering med

~ lung sounds typically sound worst after med has been administered

~ direct the PT to take a deep breath prior to using puffers

Things to remember when administering

meds Intramuscular

*never use dorsogluteal site for IM route*

~ drugs absorb rapidly in skeletal muscle do to its high vascular state

~3 IM sites used

1)deltoid-primarily for vaccines

2)ventrogluteal-first choice, good for large volume of med

3)vastus lateralis-used with pediatrics, good location for self administration