Nursing of the Geriatric Patient Dr. Michael Kidd B.V.Sc, Cert IV Workplace Assessment

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1 Nursing of the Geriatric Patient Dr. Michael Kidd B.V.Sc, Cert IV Workplace Assessment General Considerations: Never in a cage before or frequently hospitalised Multiple concurrent diseases Care with drug interactions/ toxicity Client is aware of what is happening, including the need to hospitalise What to expect in Geriatric Patients Think of your experience with elderly or incapacitated human patients Must be patient, allow time etc OHS very significant why? Bites / scratches always be aware of their teeth, position of your face etc Lifting awkward positions, overweight dogs REMEMBER IF YOU HURT YOUR BACK SIGNIFICANT LIFE AND CAREER PROBLEMS! Musculoskeletal Disease Stiffness - Clin signs and how we can help Pain Clin signs and how we can help Discomfort Clin signs and how we can help Discomfort Do we underestimate this? Resultant Anxiety Consider elderly humans with discomfort This mammal is in pain and discomfort so we give analgesia what about the DISCOMFORT. This mammal is now ANXIOUS is that now too hard to deal with? Anxiety/ Discomfort in Geriatrics Decreased sensory ability-vision, hearing, smell Change of routine Perception of fear strange humans Perception of fear noise and pheromones of other inmates Cramped environment RESULT DISORIENTATION AND THEREFORE MORE ANXIETY Yes, we can help

2 Position/Position/Position in real estate becomes Environment/Environment/Environment for our geriatric patient ENVIRONMENT A is SCHEDULING Minimum hospital stay e.g. dental come in when procedure due to start rather than 4 hours in a cage Home a.s.a.p. Possibly avoid the busiest days for these oldies ENVIRONMENT B is MACRO Must think - who is this elderly, confused patient s neighbour? Do we just use whatever cage is free If I was an aged cardiac CKCS would I want to be next to a young,mad staffy If you were an aged renal failure DSH cat do you want to look at and smell an aggressive Rottie? ENVIRONMENT C is MICRO Blankets/air con Heating pads ( care if can t escape from them) Client s stuff Space not enough vs too much Ease of getting up and into and out of cage Elimination Comforting words, pats, cuddles etc. Elimination Why more frequent? Disorientation Decrease bladder tone Decrease anal sphincter tone Specific disease entities kidney disease, diabetes, cushings etc. Need frequent walking/changing Must control our frustrations re soiling Observe patient s signals as often not much warning Client s very concerned re this aspect ( as bad as calling he a she Surgical Recovery More disorientation Longer recovery time Possibly need more analgesia Must be careful with positioning for surgery e.g. are you pulling on arthritic joints Post anae monitoring more crucial? Nutrition Fluid Decreased ability to deal with water deprivation Worse complications if IVF stops Confused older patient could chew IVF line out etc.

3 Nutrition Why a decreased appetite? Disorientation and so anxiety Out of routine Mouth problems Olfactory and taste bud ability compromised Different diet Maybe waits for client to feed them? Nutrition What can we do? Mad staffy away Hand feed High palatability of food Heat up food High quality food is important since not eating much Gentle approach and comforting words Increase frequency / wait until analgesic has had effect? Give time and TLC to patient Appetite stimulants Obesity Must be aware how important this is to DJD etc. How common ( I think 80% of my patients are overweight and < 1 % are underweight) Remember OHS plan your lift, get help, don twist use your legs not your back etc. Obesity Tact with owner compliance Owner may be obese tricky if you are on the phone to them Education elderly patients need 20% less energy Dog is always with owners kids, parents etc. Are their treats or snacks. My dog only likes my food My dog prefers cat food I can t resist those eyes My partner has a life-threatening disease and the only pleasure is feeding the dog Obesity Direct approach needed Decreased longevity- Your dog may DIE earlier if you continue this way Your dog will be in more pain and discomfort due to the excess food you are giving him Your dog will be so much unhappier since it is not as mobile. Next step may be EUTHENASIA If there is weight loss may need less medication which is better for your dog and your pocket Show the clients the charts of normal dogs then make them look at theirs.

4 Obesity Treatment WHAT SHOULD A VET NURSE SAY This works for my dog and I don t deviate It will SO MUCH be worth it in the end Your pet will be so much happier/grateful to you in the end You must only feed this amount of this type of food at this time every day. No treats or anything else to get into your pet s mouth Regular weigh-ins at no charge I BET your pet will want to go on more walks etc. Anorexic Animals Difficult for us, owners and animals esp. cats Occurs in many complex diseases Hyper T, Renal Disease, GIT problems, Liver Disease, neoplasia etc. Always examine mouth fully teeth, gums, tongue, palate etc. Assess stages anorexic or emaciated or moribund Managing Anorexia Maintain fluids/feeding tubes Takes time for underlying disease to improve be careful not to promise a false cure Proactive with trying many types of food / syringe feeding/tube feeding/force feeding Proactive with pain relief, comforting the patient and looking after Environments A,B,C Honesty with client re progress and long term prognosis Euthanasia Tips/ Thoughts Is the client s distress impacting on the animal s comfort Get your own head space ready give necessary time What do you say Best possible environment Sedation as a first step How and when to ask re options of disposal or payment Should you be yourself or only clinical One eye on client collapse, faint, anger, guilt etc. Euthanasia HOW DO YOU MINIMISE YOUR STRESS OR IMPACT ON YOU HOW DO YOU HELP THIS WITH YOUR VET AND VICE-VERSA UNLOCKING HOW TO SWITCH OFF

5 Specific Conditions Cardiac SOME EXAMPLES Regular rechecks Multiple drugs Doses can change Anae care oxygen %, respiration, body temperature Specific Conditions Neoplasia SOME EXAMPLES Drug side-effects Protective clothing Care for waste products Multiple organs involved? Specific Conditions Dental As a nurse you may make the difference of client agreeing or not What do you say Why don t even good clients realise the animal s mouth is painful and smelly? Compliance of dental products and rechecks Specific Conditions Renal Must monitor urine output lots or suddenly less Diet advice to clients Confusion with clients lower UTI is not renal Effect on rest of body incl mouth Attention to IVF Specific Conditions Behavioral Changes Must monitor urine output lots or suddenly less Diet advice to clients Confusion with clients lower UTI is not renal Effect on rest of body including mouth Attention to IVF