NCM 214 Care Of Older Adult PDF

NCM 214 CARE OF OLDER ADULT Objectives: At the end of 2 hour lecture- discussion, the students will be able to: Describe common disorders of older adults affecting the cardiovascular and respiratory system according to their definition, risk factors, assessment and management  Common CARDIOVASC...

NCM 214 CARE OF OLDER ADULT Objectives: At the end of 2 hour lecture- discussion, the students will be able to: Describe common disorders of older adults affecting the cardiovascular and respiratory system according to their definition, risk factors, assessment and management  Common CARDIOVASCULAR Problems among the Elderly  HYPERTENSION “silent killer” Systolic BP increases to a greater extent than the diastolic BP Isolated systolic hypertension (ISH) : commonest form of hypertension in older people  Risk Factors Lipid abnormalities Diabetes mellitus Body mass index Smoking Atrial Fibrillation Left ventricular hypertrophy Alcohol and diet Exercise  Assessment Asymptomatic – majority Early indicators – Fatigue – Headache – Epistaxis – Dizziness Severe HPN – Throbbing occipital headache prevalent in the morning  Nursing Diagnosis 1. Knowledge deficit: Hypertension and self-care management related to new diagnosis and interventions 2. Ineffective individual coping related to perceived limitations to diagnosis 3. Ineffective management of therapeutic regimen 4. Altered nutrition: more than body requirement related to high fat, caloric and sodium intake  Management Nonpharmacologic Weight loss Salt restriction Increasing potassium intake Reducing alcohol intake Exercise Vitamin C PHARMACOLOGIC MANAGEMENT  HYPOTENSION (postural) Decline in systolic pressure of 20mm Hg or more after rising and standing for 1 min Causes: ✔ increase intake of vasoactive meds ✔ age-related changes such as blunting of baro reflex- mediated heart response to hypotensive and hypertensive Can be a serious consequences for older person such as falls, stroke, syncope and coronary complication  Management: 1. Get out of bed slowly and in stages 2. Sleep with head of bed elevated several inches 3. Have a daily fluid intake 2 to 3 liters 4. Avoid hoy showers or baths. 5. Avoid straining at stool. 6. Exercise regimen must be recommended by the physician 7. Avoid prolonged standing 8. Pharmacotherapy: Fludrocortisone, as prescribed  CORONARY ARTERY DISEASE insight (Leuckenotte, 2000) CAD is the leading cause of death and disability in women over 40 years old. Approximately 1 of every 2 women will die of CAD Women experience more epigastric pain and shortness of breath than chest pain  CORONARY ARTERY DISEASE MANAGEMENT Angioplasty Coronary Artery Bypass Graft Oxygen Therapy Pharmacologic Beta-blocker ACE inhibitors Antihypertensives Cardiac Rehabilitation Program  Angina first symptom of CAD in the older adult often occurs related to exercise or stress and is relieved by rest and/or nitroglycerin. Chest pain is generally shorter (less than 5 minutes) than MI classic presentation - squeezing pain or pressure in the sternal area (LEVINE’S SIGN)  Angina ASSESSMENT: Dyspnea Dizziness Confusion Most times older adult does not have typical chest pain  Angina MANAGEMENT – Unstable angina: may require hospitalization – stable angina: medication and lifestyle modifications ✔ weight management ✔ stress management ✔ limiting caffeine ✔ Smoking cessation ✔ exercise regimen based on myocardial capacity ✔ Control of hypertension  Myocardial Infarction Risk increases with age  Myocardial infarction Steps to follow while awaiting emergency treatment: 1. Have the patient rest. 2. Provide supplemental oxygen. 3. Give nitroglycerin sublingually every 5 minutes times three and monitor vitals signs. 4. Give aspirin if not contraindicated  Management  Nursing Diagnosis 1. Pain related to imbalance between oxygen need and supply 2. Risk for decreased cardiac output related to decreased pumping ability of the heart 3. Knowledge deficit: CAD related to new diagnosis and treatment plan 4. Anxiety: Death  CONGESTIVE HEART FAILURE 10 per 1,000 people over the age of 65 Risks: Hypertension doubles for blood pressures >160/90 Diabetes Mellitus CAD Renal Disease Myocardial infarction CHF often occurs within 6 years after a heart attack  Symptoms Shortness of breath Edema Coughing or wheezing Fatigue Lack of appetite or nausea Confusion Increased heart rate Atypical signs – decreased appetite – weight gain of a few pounds – insomnia  Common RESPIRATORY Problems among the Elderly  PNEUMONIA an infection in the lungs that can be caused by factors including bacteria, viruses, and aspiration. a leading cause of death among the elderly Incidence of CAP among age 71–85 is 50/1000 per year  PNEUMONIA FACTORS THAT CONTRIBUTE TO HIGHER INCIDENCE: ⮚ poor chest expansion and shallow breathing ⮚ lowered resistance to infections ⮚ reduced mobility and debilitation ⮚ reduced sensitivity of pharyngeal reflexes  Diagnostics chest x-ray complete blood count sputum culture History taking  Assessment crackles may be heard in the lungs through auscultation chest pain with shortness of breath VIRAL Symptoms: ✔ Fever ✔ nonproductive hacking cough ✔ muscle pain ✔ Weakness ✔ Shortness of breath  Assessment BACTERIAL symptoms ✔ Chills ✔ chest pain ✔ sweating ✔ productive cough ✔ dyspnea ✔ Confusion  Nursing Diagnosis 1. Ineffective airway clearance related to decreased energy and tracheobranchial inflammation/ obstruction/ secretion 2. Impaired gas exchange related to altered oxygen supply and alveolar-capillary membrane changes 3. Ineffective breathing pattern related to respiratory muscle fatigue  Management Rest Increase oral fluid intake MEDICATIONS: Antipyretics, Antibiotics, Antitussive, Brochodilators Chest Physiotherapy Report signs of respiratory complications Pneumonia and Flu vaccine for >65  Management CHEST PHYSIOTHERAPY  EMPHYSEMA vs. CHRONIC Symptom BRONCHITIS Emphysema Chronic bronchitis shortness of breath ✓ ✓ fatigue ✓ ✓ difficulty performing tasks ✓ feeling less alert ✓ blue or gray fingernails ✓ fever ✓ cough ✓ excess mucus production ✓ symptoms that come and go ✓