Nursing Medical Surgical Topic

1. NURSING CARE OF
ELDERLY

2. INTRODUCTION
•Gerontologic nursing is the care of older adults based on the
specialty body of knowledge of gerontology and nursing.
•Care of older adults is complex and presents challenges that require
skilled assessment and creative nursing interventions specially for
this population.
•The goal for gerontologic nursing include:-
1- Promoting and maintaining functional status
2- Helping older adults to identify and use their strengths to achieve
optimal independence.
•The nurse helps the older person to maintain dignity and maximum
autonomy despite physical, social, and psychological losses.

3. CARE OF OLDER ADULTS INCLUDE
A. Nursing assessment
B. Planning
C. Nursing implementation
D. Evaluation

4. A- NURSING ASSESSMENT
Pre Assessment-
Before beginning the assessment process, first attend to
primary needs.
For example, make certain that the patient is comfortable and
does not need to urinate.
Place all assistive devices, such as glasses and hearing aids,
within reach.
Evaluate your patient’s level of fatigue and stop the interview if
necessary.
Allow adequate time to offer information to the patient and
time for the patient to respond to questions. Interview both the
older adult and his or her family or caregivers.

5. The focus of a comprehensive geriatric assessment is to
determine appropriate interventions to maintain and enhance
the functional abilities of older adults.
Comprehensive geriatric assessment is interdisciplinary and, at
a minimum, includes
a) The medical history,
b) Physical examination,
c) Functional assessment,
d) Medication review,
e) Cognitive and mood evaluation (Mental Status examination),
f) Social resources,
g) Assessment of ADLs and IADLs (Activities of daily living;
instrumental activities of daily living)

6. B- NURSING PLANNING
When setting goals with older adults, it is helpful to
identify their strengths and abilities.
Include caregivers in planning.
Priority goals for older adults might include
1. Gaining a sense of control,
2. Feeling safe,
3. And reducing stress.

7. C- NURSING IMPLEMENTATION
Nursing implementation focuses on-
1. Rehabilitation
2. Assistive Devices
3. Medication Use
4. Depression management
5. Sleep
6. Safety
7. Community Support Services
8. Hospice Services

8. 1- REHABILITATION
•Rehabilitation aims to enhance and restore functional ability and
quality of life to those with physical impairments or disabilities.
•The goal of rehabilitation is to help older adults adapt to or recover
from disability.
•Rehabilitation may occur in acute inpatient rehabilitation or long-
term care settings.
•Older adults with chronic conditions, such as stroke, arthritis, and
heart disease, have increased risk of becoming functionally limited.
•Reducing disability through geriatric rehabilitation is important to
the quality of life of older adults.

9. 2- ASSISTIVE DEVICES
•Consider the use of assistive devices as interventions for
older adults.
•Using appropriate assistive devices such as dentures,
glasses, hearing aids, walkers, wheelchairs, adult briefs or
protectors, adaptive utensils, elevated toilet seats, and skin
protective devices can decrease disability.
•Include these tools and devices in the older adult’s care
plan when appropriate, and provide instruction in the
proper use of the devices.

10. 3- SAFETY
Safety is crucial in the health maintenance of older adults.
When compared to younger adults, older adults are at higher risk for
accidents because of normal sensory changes, slowed reaction time,
decreased thermal and pain sensitivity, changes in gait and balance,
and medication effects.
The Nurse can provide valuable counsel regarding environmental
changes, which may improve safety for older adults.
Measures such as colored step strips, tub and toilet grab bars, and
stairway handrails can be effective in “safety-proofing” the living
spaces of older adults. The Nurse can also advocate for home fire and
security alarms.
Uncluttered floor space, railings, and increased lighting and night-
lights are some of the easiest and most practical adaptations

11. 4- MEDICATION USE
Medication use in older adults requires thorough and regular assessment,
care planning, and evaluation.
Nonadherence to medication regimens by older adults is common.
Four of ten older adults are unable to read prescription drug labels, and two
thirds are unable to understand the health information that is provided to
them.
To accurately assess medication use and knowledge, ask older adults to
bring all medications that they take regularly or occasionally to their health
care appointment. The Nurse will then be able to accurately assess all
medications the patient is taking.
Other interventions are:
•Evaluate cognitive function and ensure ability to self-administer medication.
•Encourage the use of written or electronic medication-reminder systems.

12. 5- DEPRESSION
•Depression is not a normal part of aging and it is often an under recognized
problem in older adults.
•Depression is associated with female gender, divorced or separated marital
status, low socioeconomic status, poor social support, and a recent adverse
and unexpected event.
•Encourage older adults who exhibit depressive symptoms to seek treatment.
•Because older adults with depression may feel unworthy, withdrawn, and
isolated, the support of the family or others in encouraging older adults to
seek treatment is important.
•Assist older adult caregivers who exhibit depressive symptoms to seek
medical attention.

13. 6- SLEEP
•Sleep disturbances frequently occur in older people, affecting
more than 50% of adults 65 years of age or older.
•Laboratory screening can help to rule out disease processes
that might be affecting an older person’s ability to sleep at
night.
•If a spouse notes excessive snoring, a sleep study is indicated
to rule out sleep apnea.
•The nurse can recommend prudent sleep hygiene behaviors
such as avoiding daytime napping, eating a light snack before
bedtime, and decreasing the overall time in bed to adjust for
the fewer hours of sleep need.

14. 7-COMMUNITY SUPPORT SERVICES
Many community supports exist that help the older person maintain
independence.
Informal sources of help, such as family, friends, the mail carrier,
church members, and neighbors, can all keep an informal watch.
Area Agencies on Aging perform many community services, including
telephone reassurance, friendly visitors, home repair services, and
home-delivered meals.

15. 8- HOSPICE SERVICES
•Hospice care is a type of care that focuses on the palliation of
a chronically ill, terminally ill or seriously ill patient's symptoms.
•Hospice services are a dignified alternative to the chaos of the acute
care setting when a patient with an end-stage disease is not
expected to live long.
•Hospice is a program of supportive and palliative services for dying
patients and their families that includes physical, psychological,
social, and spiritual dimensions of care.
•Home care and hospice nurses are in a unique position to facilitate
early discussions about a patient’s wishes and goals at the end of
life.

16. D- EVALUATION
The evaluation phase of the nursing process is similar for all patients.
The results of evaluation direct the Nurse to continue the plan of care or
revise as indicated.
Use the following questions to evaluate the effectiveness of care for
older adults.
• Is there an identifiable change in ADLs, IADLs, mental status, or
disease signs and symptoms?
• Does the patient consider his or her health state to be improved?
• Does the patient think the treatment is helpful?
• Do the patient and caregiver think the care is worth the time and cost?
• Can you document positive changes that support the interventions?