Chapter 32 Caring for the Elderly Client

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Chapter 32 Caring for the Elderly Client Physiological Changes and Adaptations Terms: ego integrity vs despair, gerontology, health conditions Activity and exercise Blood and lymphatic system Slight thickening of plasma Decreased RBC and WBC production with more immature T cells (and slower immune response) Anemia Leukemia Cardiovascular systems Slight increase in size, thickening of walls, Reduced cardiac output and stroke volume Arteries less elastic Baroreceptors less sensitive, so BP increases; possible orthostatic hypotension Cardiovascular disease accounts for 75% of deaths after 65 Angina pectoris Myodardial infarction Coronary valve disease Congestive heart failure Term: cardiomegaly, hypertrophies Thrombophlebitis Peripheral vascular disease Term: intermittent claudication Venous stasis Varicose veins Aneurysms Hypertensive disease Endocrine system Pituitary produces less growth hormone. Possible increase in thyroid-stimulating hormone, change in metabolic rate and sensitivity to cold Pancreatic function decreases with age. Diabetes mellitus Hypothyroidism Gastrointestinal system Decreased digestive enzymes Slower absorption

Reduction in gastric ph Altered swallowing reflex Decreased peristalsis Teeth may loosen. Gastroesophageal reflux disease (GERD) with hiatal hernia Ulcers Diverticula Colon cancer Hemorrhoids Rectal prolapse Reproductive system In female Menopause, hot flashes Decreased elasticity of organs and tissue Vaginal secretions decrease Cervix, uterus, ovaries, fallopian, breasts atrophy In male Decreased testosterone Penis may take longer to become erect. Benign prostatic hypertrophy (prostate gland enlargement) with frequent urination, hesitancy, decreased force, loss or urinary control, increased UTIs, decreased ejaculatory force In female Uterine prolapse Yeast infection Breast cancer In male Prostate cancer Erectile dysfunction Integumentary system Drier skin, paler (if light-skinned), more susceptible to hypothermia Wrinkles, tenting Age spots (lentigo senilis) Hair pigment changes and thinning hair Nail ridges; slower nail growth Basal cell carcinoma Dermatitis Rosacea Pressure ulcers Musculoskeletal system

Loss of calcium starting in 3 rd to 4 th decade, bones thinner and weaker Intervertebral disks shrink (can lead to kyphosis) Loss of height Decreased mobility and flexibility Reduced glycogen supply, buildup of cellular waste products Muscle spasms and fatigue Unsteady gait Osteoporosis Osteoarthritis Rheumatoid arthritis Bursitis Gout Neurologic system Decrease in efficiency of temperature-regulating mechanism Decrease in body temperature and adaptability to environmental changes Possible reduction in pain and touch sensation Size and weight of brain decrease Decreased motor response Decreased sleep efficiency Terms: restless leg syndrome, nocturnal myoclonus Parkinson s disease Dementia Alzheimer s disease Transient ischemic attacks (TIAs) Cerebrovascular attacks (CVAs) Respiratory system Reduced ability to humidify air Change in pitch and quality of voice Diminished shape and size of chest cavity, calcification of cartilage Decreased lung capacity and increased respiratory effort COPD Sensory alterations Eyes Arcus senilis grayish haze at outermost part of cornea Decreased tear production Presbyopia Astigmatism Night blindness

Clouding of lens Floaters Ears Presbycusis Nose and mouth Altered smell or taste (see also Table 27-9) Eyes Diplopia Cataracts Glaucoma Macular degeneration Diabetic retinopathy Retinal detachment Ears Otosclerosis Tinnitus Meniere s disease Renal system Decreased number of working nephrons Reduced filtering ability of kidneys Ineffective bladder emptying Nocturnal frequency Continence training [corresponds to Box 32-1] Bladder training [corresponds to Box 32-2] UTIs Chronic renal failure Polypharmacy condition that occurs when medications (including possibly herbal supplements) interact and create side effects o Elderly most susceptible due to decreased body system functioning o Manifestations: Nausea or malaise Confusion or irritability Fainting Jaundice Sluggishness Changes in elimination Psychosocial changes and adaptations o Coping with loss (emotional and economic) o Financial changes (unemployed, retired) o Home care and independence Assisted living facilities o Facing death Priorities in nursing care:

o Meet physical and psychosocial needs. o Observe normal and abnormal changes. o Assist as needed with ADLs. o Create a safe environment. o Adapt personal care to needs of client. o Give perineal care often with incontinence. o Preserve client s dignity. o Check for skin dehydration. o Ask about expected physical changes. o Allow time for clients to think and respond. o Show respect for client s cultural or religious views. [corresponds to Box 32-3] o Reorient confused client as needed. Nursing Process Care Plan: Client With Chronic Obstructive Pulmonary Disease Critical Thinking Care Map: Caring for a Client after Coronary Artery Stent Placement

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