care for the older person

7/29/2019 Care for the Older Person

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Care of the OlderPerson

Maria Thresa Jader

Princes Joy LabanzaAnjelika Eurelle Mapili

Bryan Sadol


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Developmental Aspects of

AgingRisk for Activity Intolerance related to DeconditionedStatus (Aging)

Note presence of medical diagnosis and/or therapeuticregimens

Determine current activity level and physical conditionwith observation, exercise tolerance testing, or use offunctional level classification system (e.g. Gordons)

Discuss with client the relationship of illness ordebilitating condition and ability to perform desiredactivities.

Provide information regarding potential interferingfactors with activity

Instruct client in unfamiliar activities and in alternateways of doing familiar activities


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Acute Confusion related to Over 60 years of age

Note presence of agitation, fear, and anxiety

Evaluate sleep and rest status, noting insomnia,sleep deprivation, and over sleeping.

Evaluate mental status, noting extent ofimpairment in orientation, attention span, ability tofollow directions, ability to send and receivecommunication, appropriateness of response.

Monitor/adjust medication regimen and noteresponse. Determine medication that can bechanged or eliminated.

Orient client to surroundings, staff, necessaryactivities, as needed. Avoid challenging illogicalthinking.


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Death Anxiety

Determine how client sees self in usual lifestyle role functioningand perception and meaning of anticipated loss to the client.

Ascertain current knowledge of situation

Observe behavior indicative of the level f anxiety present

Identify coping skills currently used and how effective they are.Be aware of defense mechanisms being used by the client.

Note clients religious and spiritual orientation, involvement inreligious activities, presence of conflicts regarding spiritualbeliefs.

Listen for expression of inability to find meaning in life or suicidalideation

Provide open and trusting relationship

Direct clients thoughts beyond present state to enjoyment ofeach day and the future when appropriate.

Encourage expression of feelings. Acknowledge anxiety/fear. Donot deny or reassure client that everything will be alright. Behonest on answering questions/providing information.


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Impaired memory related to Age

Note clients age and potential for depression

Perform or review results of cognitive testing

Orient/reorient client as needed Implement appropriate memory-retraining

techniques

Provide for and emphasize importance of pacing

learning activities and getting sufficient rest. Assist client to establish compensation strategies


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Risk for Situational Low Self-Esteem related to

Functional Impairment

Determine individual factors that could contribute

to diminish self-esteem Note clients perception of threat to self in current

situation.

Verify clients concept of self in relation to cultural

or religious ideals.

Assess negative attitudes and/or self-talk.


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Biophysical & Physiological

AgingDecreased Cardiac Output related to Altered HeartRate/Rhythm

Evaluate clients reports and evidence of extreme

fatigue, intolerance for activity, sudden or progressive

weight gain, swelling of extremities, and progressiveshortness of breath

Determine vital signs/hemodynamic parameters

including cognitive status.

Provide for adequate rest, positioning client for

maximum comfort.

Monitor cardiac rhythm continuously

Asses potential for/type of developing shock states


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Activity Intolerance

Note clients report of weakness, fatigue, pain,

difficulty accomplishing tasks, and/or insomnia.

Assess emotional and psychological factorsaffecting the current situation

Adjust activities

Provide and monitor response to supplemental

oxygen, medications, and changes in treatment

regimen

Promote comfort measures


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Imbalanced Nutrition: less than body requirementrelated to Inability to ingest or digest food

Determine clients inability to chew, swallow, and tastefood. Evaluate teeth and gums for poor oral health, and

note if denture fits, as indicated. Determine psychological factors, perform psychological

assessment

Assess weight

Encourage client to choose foods or have family

member bring foods that seem appealing Assist with or provide oral care before and after meals

and at bedtime.


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Constipation

Review medical, surgical, and social history for

conditions often associated with constipation

Note general oral/dental issues Note energy and activity levels and exercise

pattern

Instruct in and encourage a diet of balanced fiber

and bulk and fiber supplements

Encourage and activity and exercise within limits

of individual ability.


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Risk for Impaired Skin Integrity related of

extremes of age

Assess skin routinely, noting moisture, color, and

elasticity Note presence of conditions or situations

Change position in bed or chair on a regular

schedule.

Keep bedclothes dry

Provide safety measures during ambulation and

other therapies that might cause dermal injury

Provide preventive skin care to incontinent client


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Psychological Aspects of

AgingImpaired Memory implement appropriate memory retraining

techniques

encourage ventilation of feelings of frustration

monitor clients behavior and assist in use of

stress management techniques

assist client t establish compensation strategies

to improve functional lifestyle and safety


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Disturbed Thought Process

evaluate mental status

note behavior such as untidy personal habit;

slowing and slurring of speech assess clients anxiety level in relation to situation

assist with treatment with underlying problems


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Impaired Verbal Communication

review history for neurological conditions that

could affect speech such as CVA, tumor, hearing

loss and so forth

evaluate mental status

note level of anxiety level present


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Chronic Sorrow related to Experiences chronicillness or disability

Look for cues of sadness

Determine level of functioning

Encourage verbalization about situation

Encourage expression of anger, fear, and anxiety

Acknowledge reality of feelings of guilt/blame

Discuss healthy ways of dealing with difficulties

situation Encourage involvement in usual activities,

exercise, and socialization within limits of physicaland psychological state.


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Disturbed Sensory Perception

Identify client with condition that can affectsensing, interpreting, and communicating stimuli

Assess ability to speak, hear, interpret, and

respond to simple commands

Observe for behavioral responses

Determine response to stimuli

Interpret stimuli and offer feedback

Reorient to person, place, time, and events, asnecessary

Promote meaningful socialization

Provide safety measures


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Successful Aging

Death Anxiety

Determine how client sees self in usual lifestyle

functioning

Note physical/ mental condition

Determine ability to manage own self-care

Identify coping skills currently used and howeffective they are


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Risk for Loneliness

Differentiate ordinary loneliness and a state of

consent sense of disphoria

Determine how individual perceives/ deals withsolitude

Assess sleep/appetite disturbances

Establish nurse/client relationship in which client

feels free to talk about feelings

Discuss importance of emotional bonding

Encourage involvement in special interest groups


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Ineffective Role Performance

Maintain positive attitude toward client

Make information available for client to learn

about expectations that may occur Refer to support groups as indicated by individual

needs

Use techniques of role rehearsal to help the client

develop new skills to cope with changes


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Readiness for Enhanced Spiritual Well-Being

Determine spiritual motivation for growth

Explore meaning and relationship of spirituality

life/ death and illness to lifesjourney Determine influence of cultural beliefs

Encourage client to take time to be introspective

in the search of peace and harmony

Discuss use of relaxation/ meditative activities


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Effective Therapeutic Regimen Management

Identify individuals perception of adaptation to

treatment changes

Discuss present resources used by client Identify steps necessary to reach self goals

Promote client/ care giver choices and

involvement in planning and implementing added

responsibilities

Provide for follow up home visit as appropriate

Mobilize support system


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Geriatric Nutrition

Impaired Nutrition: less than body requirement

Determine ability to chew, swallow and taste

-discuss eating habits

-assess drug interactions

-assess weight, age, body build, strength

-note total daily intake

-small feedings with snacks

- use flavoring agents to enhance food satisfaction andfood appetite

- encourage clients to choose food that are appealingto improve appetite


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Impaired Swallowing related to decrease gag

reflex

Encourage a rest period before meals to minimize

fatigue Determine food preferences of client to

incorporate as possible enhancing intake.

Ensure temperature of food/fluid which will

stimulate sensory receptors

Provide a consistency of food/fluid that is most

easily swallowed


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Impaired Oral Mucus Membrane

Determine nutrition/ fluid intake and reported

changes

Encourage adequate fluid to prevent dehydration Recommend avoiding alcohol, smoking/ chewing

tobacco which may further irritate mucosa

Encourage use of chewing gum, hard candy and

so forth to stimulate saliva


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Risk for Imbalanced Fluid Volume

Measure and record intake and output

- monitor Blood pressure responses

- assess for clinical signs of dehydration - maintain fluid/ sodium restrictions when needed


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Deficient Fluid Volume

determine effects of age

- assess vital signs

- note strength of peripheral pulses - monitor blood pressure

- observe urinary output; color, and measure

amount and specific gravity


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Impaired Memory r/t neurological disturbances

Observe patients thought process every after shift.

Changes indicate progressive improvement or a decline in patients underlyingcondition.

Implement appropriate safety measures to protect patient from injury. He orshe may be unable to provide his/her needs.

Call the patient by name and introduced your name. Provide backgroundinformation (place, time and date) frequently throughout the day to providereality orientation.

Spend sufficient time with the patient to allow him/her to become comfortablediscussing memory loss and establish a trusting relationship.

Be clear. Be concise and direct in establishing goals to promote maximal useof patients remaining cognitive skills. Offer short, simple explanations topatient each time you carry out a medical and nursing procedure to avoidconfusion.


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Self care deficit r/t frustration over loss of independence

Assist patient in accepting necessary amount of dependence. Ifdisease, injury, or illness resulting in self-care deficit is recent, patientmay need to grieve before accepting that dependence is possible.

Encourage independence, but intervene when patient cannotperform. To decrease frustration.

Provide positive reinforcement for all activities attempted; notepartial achievements. This provides the patient with an externalsource of positive reinforcement.

Set short-range goals with patient. To facilitate learning anddecrease frustration.

Use consistent routines and allow adequate time for patient tocomplete tasks. This helps patient organize and carry out self-careskills.


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Self care deficit r/t frustration over loss of independence

Assist patient in accepting necessary amount of dependence. If

disease, injury, or illness resulting in self-care deficit is recent,

patient may need to grieve before accepting that dependence is

possible.

Encourage independence, but intervene when patient cannot

perform. To decrease frustration.

Provide positive reinforcement for all activities attempted; notepartial achievements. This provides the patient with an external

source of positive reinforcement.

Set short-range goals with patient. To facilitate learning and

decrease frustration.

Use consistent routines and allow adequate time for patient tocomplete tasks. This helps patient organize and carry out self-

care skills.


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care for the older person

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