Matthew 6:33 Phillipians 4:6 Be anxious for nothing, but in everything by prayer and supplication, with thanksgiving, let

your requests be made known to God.

NURSING FACTS IN BRIEF

Care of the Elderly and Hospice Care/Care in Death and Dying

BULLETS ON CARE OF THE ELDERLY/ GERONTOLOGICAL NURSING The young adult extends from 20 to 40 years old, middle adult from 40 to 60 years old, and late adult above 60 years old. The young adult (20-40): o Majority consider this as their reproductive years and peak of their functioning. o Has the capacity to develop intimate, lasting and committed relationship with another person, or a cause, institution or creative effort. o The young adult is capable of principled reasoning. Their choice of action is based on principles. o Develops a sense of responsibility, the maintenance of appropriate impulse control, the ability to plan and implement realistic goals, and the development of a career. In middle and late adulthood (40-60; 60 above): o Various physical changes take place like decreased in skeletal muscle function, thinning of hair, decreased visual acuity, diminished taste sensation, wrinkles occur due to poor skin turgor, decreased moisture and loss of subcutaneous fats etc. o Menopause occurs in women between ages 40 and 50, average of 47 years old. o Climacterium (Andropause) occurs in men due to decrease of androgen levels between ages 70 and 90 years old. o This stage is considered the years of stability and consolidation. o A person becomes more altruistic, and concepts of service to others and love and compassion gain prominence. o The person may experience midlife crisis between ages 35 to 45, the deadline decade. This occurs when the individual recognizes that he has reached the halfway mark of life. Gerontology is the science and study of the aging process. Gerontologic Nursing is the care and attention to individuals undergoing the aging process with the emphasis on the developmental stages of aging. Geriatrics is the science and study of the physiologic and pathologic problems of individuals in their later maturity. Senility is the aging process characterized by severe mental deterioration. Theories of Aging : Biological o Genetic/ Mutation Theory affirms that changes in replication of DNA-RNA are the causes of aging. o Autoimmune/ Immunologic Theory states that aging is caused by factors that change the immune system. o Wear and Tear Theory compares the body to a machine. Parts wear out and the machine breaks down. o Rate of Living Theory avers that the body has a fixed rate of potential for living. The faster one lives, the sooner one ages and dies. Waste Theory describes aging as the accumulation of chemical wastes in the body that produce deterioration. o Endocrine Theory states that events occurring in the hypothalamus and pituitary gland are responsible for changes in the hormone production that result in the organisms decline. Theories of Aging : Psychosocial o Disengagement Theory arises from the fact that human beings are mortal and must eventually leave their place and role in the society. o Activity Theory assumes that the same norms exist for all mature individuals. The degree to which the individual acts like or looks like is the determinant of the aging process. o Continuity Theory accounts for the continuous flow of phases in the life cycle and does not limit itself to change. Elderly usually feel cold even in warm climate because they have a poor temperature regulation. Loss of calcium from bones especially in vertebral bodies may increase the elderly to increased propensity to fracture. They usually decrease in height of about 1 inch due to thinning of intervertebral disks; common among postmenopausal women. The elderly are at high risk for fluid electrolyte imbalance; dehydration and dizziness occur even within short time of food and fluid deprivation. Developmental Tasks of the Older Adult: Adjusting to decreasing physical strength and health. Adjusting to retirement and reduced income. Adjusting to the death of ones spouse. Establishing an explicit affiliation with ones age group. Meeting social and civil obligations. Establishing satisfactory living arrangements. Establishing satisfactory relationships with adult children. Finding meaning in life. Communication considerations: o Demonstrate respect by remembering names and calling the person by the name. o Face the person when speaking. o Speak distinctly and clearly. o Do not shout, increased frequency of voice pitch makes hearing difficult. o Provide written instruction/ repetition of instruction; memory and attention span have diminished. Promoting Independence and Self-Esteem o Place equipment conveniently and encourage the use of self-help devices. o Encourage them to do as much as possible for themselves, provided that safety is maintained. o Assist with personal care as necessary. o Acknowledge the elderly clients ability to think, reason, and make decisions. Hygienic Practices and Skin Care o Daily bath is not necessary (dry skin). o Use mild, superfatted soap. o

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

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Use bath oils, lanolin or body lotion (no alcohol). Use pressure mattresses, flotation pads/ mattresses alternately. o Change position frequently. o Massage bony prominences and weight-bearing areas every 2 hours. o Assist in ambulation as much as possible. o Foot care- soak feet in warm water before cutting nails. Visual Aids and Dental Care o o
o o o o Keep eyeglasses clean and always available Keep night lights on to prevent accidents Clean dentures following each meal Prevent loss of dentures Regular exercises of feet and legs to prevent peripheral vascular disorders (PVDs). Encourage correct posture and deep breathing. Promote proper body alignment. Use supportive pillows and firm mattress. Footboard keeps cover off the toes. Active ROM, gradual change of position. Provide leather-soled, well fitting shoes to prevent accidents/ falls.

Exercise and Body Alignment

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Sleep Patterns and Mental Status o Elderly sleep lightly, intermittently with frequent waking; provide low bed/ night light and adequate supervision when getting up. Nutritional Needs o Increase in fiber and fluid to prevent constipation. o Encourage vitamins and mineral supplements. o Provide foods that are high in CHON. Urinary Elimination
o Frequency of voiding is common (decreased muscle tone of the bladder with impairment of bladder emptying capacity; increased residual, urine infection). Increase fluid intake to dilute urine and decrease its irritating properties (limit fluids during the night to prevent nocturia). Reduced sensation, decreased awareness of the need to empty bladder. Relaxation of perineal muscles in elderly women interferes with complete emptying of the bladder (UTI).

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Many elderly men have BPH. Involutional changes in the lining of the vagina lead to decreased resistance to organism (infection with discharge). Emotional Needs o Needs someone to talk to (plan time to visit; allow visits with a clergyman). o Comforted by touch (conveys feeling of concern, interest and acceptance). o Maintain family contact. o Provide diversional activities (books/ magazines with large prints, radio, TV). o Allow to verbalize about feelings on death (do not avoid the topic). Physiologic changes associated with aging that influence medication administration and effectiveness: o o
o o Altered memory and less acute vision. Decrease in renal function, resulting in slower elimination of drugs and higher drug concentration in blood-stream for longer periods. Less complete and slower absorption from the GI tract. Increased proportion of fat to lean body mass, which facilitates retention of fat soluble drugs and increases potential for toxicity. Decreased liver function which hinders biotransformation of drugs. Decreased organ sensitivity which means that the response to the same drug concentration in the vicinity of the target organ is less in older people than in the young. Altered quality of organ responsiveness resulting in adverse effects becoming pronounced before the therapeutic effects are achieved.

Common Problems among the Elderly: o Confusion/Dementia Nursing Interventions: Spend time with the patient. Use touch to convey concern. Provide frequent reiteration of orienting data (time and place). Have clocks or calendars in the environment. Explain all actions, procedures and routines to the patient. Address the patient by his name. Keep a routine of activities. o Osteoporosis Nursing Interventions: Have adequate calcium in the diet- milk, dairy products, dish, beans, cereals, calcium supplements. Get regular exercise, if not contraindicated. Avoid alcohol, quit smoking. They reduce bone mass. Make the home safe to avoid accidents. Use good body mechanics when lifting objects (bend the knees instead of the back). Wear rubber-soled, low-heeled shoes that grip well. Put items frequently used within easy reach. Use handrails when going up and down stairs. o Postural Hypotension Nursing Interventions: Get out of bed slowly and in stages. Sleep with head of bed elevated several inches. Have a daily fluid intake of 2-3 liters. Avoid hot showers or baths, may cause vasodilation, thereby, venous pooling. Avoid straining at stool. This may cause fall of BP. Avoid bending down and suddenly standing up again. Use thigh-length elastic stockings to reduce venous pooling. o Hypertension Nursing Interventions: Encourage stress reduction and relaxation. Encourage healthy diet (fresh fruit, rice, vegetable). Reduce salt intake to 1 to 6 grams per day. Take prescribed medications at regular basis. Elderly abuse:
o o o o Psychologic abuse is instilling fear, threat or making the eldery perform demanding tasks. Physical abuse includes hitting, slapping or burning. Financial abuse is taking their money or forcing them to sign over their assets. Infringement of personal rights such as restraining for long periods of time against their will or isolating them from normal social interactions. The perpetrator of the abuse is usually the spouse or the child of the victim. Caregivers who abuse their family members are often middle-aged or older or have emotional problems such as alcoholism or substance abuse.

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According to Kubler Ross, there are five stages of Death and Dying (DABDA):1. Denial, 2. Anger, 3. Bargaining, 4. Depression, 5. Acceptance The FOCUS of Hospice Care is to give support and care of the dying person and family, with the goal of facilitating a peaceful and dignified death, more so, to improve the QUALITY of life, rather than CURE.

According to legend, one day a man was wandering in the desert when he met Fear and Plague. They said they were on their way to a large city where they were going to kill 10,000 people. The man asked Plague if he was going to do all the work. Plague smiled and said, "No, I'll only take care of a few hundred. I'll let my friend Fear do the rest.

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

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