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Geriatric nursing – Role of nurse in geriatrics

Cardiovascular system

Intolerance to activity r/t blood vessel changes in heart secondary to increased cholesterol level.

Nursing care:

  • Undertake activities at the appropriate pace and allow enough time between position changes to prevent dizziness.
  • Encourage exercise as tolerated.
  • Lifestyle changes if needed, i.e. smoking cessation or alcohol.
  • Modified diet with decreased salt and fat.

Respiratory system

Impaired gas exchange r/t decreased capacity of lungs.

Risk of infections r/t decreased lung capacity.

Nursing care

  • Encourage smoking cessation and deep breathing.
  • Reduce the pace of activities with more rest periods.
  • Make sure individuals have proper nutrition and drinking plenty of fluids.
  • Immunizations in the fall for influenza, pneumonia and watch for signs of infection, i.e. coughing, shortness of breath, sputum color etc.
  • Teach breathing and diaphragmatic exercises.

Gastrointestinal system

Indigestion r/t decrease in secretion of gastric juices

Increased risk for gum disease r/t decreased production of saliva.

Prone to constipation r/t decreased fluid and fiber intake.

Nursing care:

  • A balanced diet, include high fiber foods.
  • Regular toileting schedule.
  • Periodic dental exams and good oral hygiene.
  • Evaluation of dentures for good fit.
  • Refer individuals with incontinence and swallowing problems.

Urinary system

Urinary incontinence r/t enlargement of the prostate gland or decrease in muscle tone and bladder capacity.

Nursing care:

  • Quick access to toileting facilities.
  • Reminders to use the toilet.
  • Encourage adequate fluid intake.
  • Refer for evaluation when incontinence develops.
  • Screen for prostate cancer and diabetes.

Behavioural approaches for incontinence

  • —Reduce caffeine, liquids
  • Timed voiding – go often enough to avoid accidents
  • —Bladder training – lengthen time between voids gradually
  • Prompted voiding – caregiver positively reinforces dryness, neutral response to wetness

Endocrine system

Diabetes r/t decrease in the production of hormones, i.e. insulin by pancreas

Reproductive changes r/t decrease in estrogen in females & decrease in testosterone in males.

Nursing Care

  • Blood sugar monitoring.
  • Teach sign and symptoms of hypo and hyperglycemia.
  • Feet care & nail care.
  • Wound care.
  • Provide gynecological exams for women.
  • Provide prostate exam for men.
  • Educate the client about the changes.

Sleeping pattern

Disturbed sleep pattern r/t decrease in sound sleep, excessive day time sleeping or development of sleep apnea.

Nursing Care:

  • Encourage regular sleep routine
  • Reduce use of caffeine and fluids before bedtime.
  • Watch for signs of sleep apnea such as excessive daytime sleeping, behavior snoring.
  • Encourage exercise, activities and walking.

Pharmacological changes

Risk for overdosing r/t decreased absorption, distribution and elimination of medications secondary to changes in liver, kidney and GI systems.

Nursing Care:

  • Make sure that every treating physician knows all the medications that the individual is taking, prescription as well as over the counter.
  • Know what each medication’s purpose and its side affects.
  • Encourage starting with a low dosage of a new medication and increase slowly.
  • Watch for signs and symptoms of a drug reaction.

Behavioral and cognitive changes

Decrease in cognitive and adaptive skills r/t ageing changes in brain.

Depression and isolation r/t empty nest syndrome.

Nursing care:

  • Establish routines in activities of daily living.
  • Use memory aids.
  • Speak slowly, clearly and give short simple instructions.
  • Supplies mnemonics to enhance recall of related data
  • Encourage ongoing learning
  • Links new information with familiar information
  • Use visual, auditory, and other sensory cues
  • Encourage learners to wear prescribed glasses and hearing aids
  • Provide glare-free lighting
  • Provide a quiet, non distracting environment.
  • Involve in various activities.
  • Maintain self worth and dignity.

Psychological aspects of ageing

Fear of aging r/t retirement and perceived non-productivity.

Stress r/t impaired physical activities and appearance; disabilities from chronic illness.

Social isolation r/t death of significant others.

Nursing care:  Stress and Coping in the Older Adult

  • Coping patterns and the ability to adapt to stress are developed over the course of a lifetime and remain consistent later in life.
  • Teach about meditation, yoga and relaxation techniques.
  • Involve in group works.
  • Maintain self identity and give respect.
  • Inform them about senior citizens schemes, old age pension, traveling facility by government etc.