Geriatric Nursing

Introduction

This paper will try to show different ways for geriatric care that are useful to a LPN

who encounters aging people in daily life. Because they are complex, older people

always deserve personal attention. Nurses address physical, psycho social, cultural and

family concerns as well as promoting health and emphasizing successful aging.

Life expectancy is rising at rates which call for the proper preparation of nurses to take

good care of the rapidly increasing number of the aged.

It is important to distinguish changes involved with normal aging from changes

attributable to pathophysiology. Alterations in the structure and function of multiple

body system may affect an older person appearance, mobility and ability to fight off

infections. Geriatric medications need to be managed so as to avoid too much use of

medicine since this group receives a lot of medication if poor care is taken. Multiple

medications can cause a variety of drug interaction in older people. Primary drug reaction

occurs when one drug causes one side effect, secondary drug reaction occurs when one

medication reacts with another. This is brought about by polypharmacy. Old people

should be treated in ways that are of benefit and do no harm or as little harm as possible

Principle of assessment: data regarding biomedical, functional, psychological and social

issues are obtained to help in planning and implementation of individual health care.

A pressure ulcer is a lesion caused by unrelieved external pressure resulting from

occlusion of the blood flow, tissue ischemia and cell death. Pressure ulcers are often

viewed as a complication of an acute or chronic illness. The presence of ulcers may also

be evidence of poor nursing care. Although pressure ulceration can be prevented, it may

also occur despite optimal nursing care and advanced technologies. In order to provide

effective nursing care for the older adult with pressure ulcers, the nurse must approach

patient care within a holistic frame work. This framework should include an integration

of good assessment, use of research-based intervention and methodical intervention of

patience outcomes. Some specific issues of prevention, assessment and treatment of adult

with pressure ulcers are, aging skin: The older people have an aged skin and due to

exposure to the sun the skin wrinkles, epidermis thins, blood vessels recede, dermal-

epidermal ridges flatten and the skin appears thin and fragile. The age related changes

may lead to ulceration. The skin which is our largest organ can help in viewing the

overall functioning of the entire body. All clinicians working with older people at risk for

or suffering from pressure ulcers must be mindful of these varying relationship in using

the cutaneous “window” of person to plan and implement individualized, comprehensive

care.

Summary

Ulcers have different stages. Stage one ulcers are characterized by non-blancherble

erythema of intact skin. It is important to note that stage one pressure ulcers are difficult

to identify in darkly pigmented people and are usually indicated by discoloration,

warmth, endyma, indurations and hardness. Stage two ulcers are partial lesions

extending into the epidermis and the dermis. Stage three ulcers are defined as the full

thickness skin loss. Stage four is characterized by extensive tissue damage which extends

to the muscle, bone or the underlying structures.

Through a holistic assessment and evaluation a nurse can build a plan of care for those

patients who suffer from pressure injury. When treating an ulcer wound treatment should

focus on wound healing. For a chronic, non healing ulcer, comfort should be a top

priority. For pressure injury careful positioning padding to reduce the risk of pressure

ulceration is important. Wound healing occurs only if the patience is physiologically able

to provide needed substrate; wound cleanliness, moist and infection free and the cause of

injury is removed. For older people it takes longer to heal and so extra care should be

taken. When normal interventions fail to heal a pressure ulcer, surgical intervention

may be the best option. If the paitent is not mobile you have to frequently turn the paitent

to prevent the sore/ulcer getting any worse .

Cardiovascular disease affects the heart and the blood vessels. The disease is caused

by disruption in the blood circulation secondary to decreased vessel. Cardiovascular

disease is common in 50% of the population over the age of 65, and accounts for 40% of

deaths in this group. Because of the changes associated with normal aging and some of

the unique aspects of reporting and presenting in old adults, underestimation of the

seriousness, cardiac disease often occurs. This can lead to misdiagnosis, under treatment,

and even death. There are different kind of heart disease: Atherosclerosis and

arteriosclerosis. Arteriosclerosis is a disease of the arteries, characterized by abnormal

thickening and hardening of vessel walls, it also leads to atherosclerosis. Due to advance

in age the disease easily finds its way to old people and so it should be carefully

diagnosed and proper treatment given. When diagnosing look out for cases of fainting,

continuous chest pain, nausea, shortness of breath, rapid heart rate, rapid weight gain,

pain in the abdomen, swelling of legs among others. Then address the issue of

hypertension, high blood cholesterol, diabetes, obesity and overweight, smoking, and

hereditary issues. Treatment includes medication and physical exercises.

The following age related changes may occur in the respiratory system of an old

person: diminished muscle strength in the diaphragm and thorax, stiffer chest wall,

decreased elastic recoil, decreased elasticity in the alveoli reduced surface area, with

diminished capacity for gas exchange, decreased vital capacity, and drier mucous

membrane leading to more difficulty in mucous excretion. Tests should be carried out by

doing x-ray coupled with physical examination. The following are possible diseases in

old people; bronchitis, asthma, pneumonia, tuberculosis, and chronic obstructive

pulmonary disease. Some of this disease leads to cardiovascular disease due to effect on

the lungs by air pollution. Nurse should draw a plan for treatment which includes

working with other specialties like heart experts.

Diabetes melitus is a metabolic disorder with two major types, type one and type two.

Their end result is hyperglycemia. Type one is caused by lack of insulin production by

beta cells. Type two is the most common and is caused by deficiency or inadequacy of

insulin receptors in cells. Treatment goals are to symptoms and maintain as normal blood

glucose as possible without inducing hypoglycemia to decrease the risk of long term

complications. Nurse should emphasize nutrition and exercise which are vital for victims.

For older people monitoring for complications which can lead to lower extremity

amputation, hypertension, myocardial infarction, stroke, vision loss, or nephropathy

should be carried out especially in type 2 diabetic patient.

Conclusion

Changes in structure and function of the nervous system occur with normal aging and

can result in changes in mobility, balance, coordination, sensation, comprehension,

cognitive performance or behaviour. These changes reflect a slowing of neurological

response as fewer neurons are available to provide sensory and motor messages to and

from the central nervous system. The common terms for dizziness include vertigo, pre-

syncope and disequilibrium.

Stroke is also known as brain attack It is created by interruption of blood supply to

some areas of the brain. This interruption can occur as a result of an occlusion or

hemorrhage. Occlusion leads to ischemic stroke, categorized as thrombic and embolic.

Thrombic stroke occurs in vesicles when oxygenated blood fails to flow to the occlusion

site. Embolic stroke occurs when clots form everywhere