Nursing Care for Older Adults in Chronic Illness PDF

# Nursing Care for Older Adults in Chronic Illness By: Marie Niña P. Dumaguing, RN ## Acute Illness * Diseases that have a rapid onset and short duration * **Characteristics:** * Usually self-limiting * Responds readily to treatment * Complications infrequent * After illness retur...

# Nursing Care for Older Adults in Chronic Illness By: Marie Niña P. Dumaguing, RN ## Acute Illness * Diseases that have a rapid onset and short duration * **Characteristics:** * Usually self-limiting * Responds readily to treatment * Complications infrequent * After illness return to previous level of functioning ## Chronic Illness * Diseases that are prolonged, do not resolve spontaneously, and are ready cured completely * **Characteristics:** * Permanent impairments or deviation from normal * Irreversible pathologic changes * Residual Disability * Special rehabilitation required * Need for long-term medical and nursing management ## Trajectory of Chronic Illness * Chronic illness may have acute exacerbations in which an individual moves from a level of optimum functioning, with the illness well controlled, to a period of instability during which the individual may need assistance ## 7 Tasks of People with Chronic Illness * Prevent & manage a crisis * Carry out prescribed treatment regimen * Control Symptoms * Adjust to changes in course of disease * Prevent social isolation * Attempt to normalize interactions with stress ## Geriatric Syndrome * Is a term used to describe unique health conditions in elderly patients that are multifunctional in cause and do not fit into discrete organ-based categories ## Frailty * Is an impairment in mobility, balance, endurance, physical activity, muscle strengths, nutrition, and cognition ## Polypharmacy * Is the concurrent use of multiple medications, sometimes defined as four or five or more by a single person ### Implications of Polypharmacy 1. **Non-Adherence** * Is defined as the extent to which patients are not willing to follow the instructions they are given for prescribed treatments 2. **Adverse Drug Reactions** * Is a detrimental response to a given medication that is undesired, unintended or unexpected in recommended dose ## Clinical Manifestations of Adverse Drug Reaction * Nausea * Dizziness * Constipation * Orthostatic hypotension * Gastrointestinal Bleeding * Falls * Urinary Incontinence * Muscle Aches * Sexual Dysfunction * Insomnia * Confusion ### Implications of Polypharmacy 1. **Drug-Drug Interaction** * May occur when two or more drugs are taken concurrently 2. **Medication Errors** * Defined as taking the wrong medication or the wrong dose at the wrong time or for wrong purpose ## Pharmacokinetics * Refers to the absorption, distribution, metabolism and excretion of a given drug or what the body does to the drug ## Pharmacodynamics * Refers to the biochemical or physiological interaction of drugs or what the drugs does to the body ## Intervention/Nursing Considerations 1. The nurses should be knowledgeable about drug therapy & the medications the individual is taking 2. The nurse should be vigilant about monitoring for adverse effects as well as evaluating the therapeutic effect 3. Monitor the patients' serum blood urea nitrogen & creatinine 4. Monitor Renal function & liver function test 5. Always consider non-pharmacologic approaches 6. Instruct the patients to obtain all medications at a pharmacy ## Falls * Is an event which results in a person unintentionally coming to rest on the ground or another level ### Risk Factors for Falls **Intrinsic Factors:** * Cognitive Impairments * Medication alcohol * Impaired Mobility * Fall History * Acute & Chronic Illness * Elimination Problems * Sensory Defects * Frailty * Postural Hypotension **Extrinsic Factors:** * Poor Lighting * Poor Color distinction * Cluttered Environment * Unfamiliar Environment * Stairs * Throw Rugs * Unsuitable Footwear * Restraints * Side Rails ## Morse Fall Scale | Item | Scale | Scoring | | :----------------------------------------------- | :---- | :------ | | 1. History of falling; immediate or within 3 months | No | 0 | | | Yes | 25 | | 2. Secondary diagnosis | No | 0 | | | Yes | 15 | | 3. Ambulatory aid | | | | Bed rest/nurse assist | | 0 | | Crutches/cane/walker | | 15 | | Furniture | | 30 | | 4. IV/Heparin Lock | No | 0 | | | Yes | 20 | | 5. Gait/Transferring | | | | Normal/bedrest/immobile | | 0 | | Weak | | 10 | | Impaired | | 20 | | 6. Mental status | | | | Oriented to own ability | | 0 | | Forgets limitations | | 15 | ## Strategies for Fall Prevention 1. Modify the Environment 2. Evaluate Gait & Balance 3. Review Medication 4. Develop a Fall Prevention Plan 5. Restrain Use ## Delirium * Disturbance of consciousness with reduced ability to focus, sustain or shift attention * A change in cognition or development of a perceptual disturbance ## Anxiety * Is a normal adaptive reaction to new situations or perceived threats & can manifest as tachycardia & palpitations, insomnia & tachypnea ## Generalized anxiety * Is characterized by persistent excessive worry with fluctuating severity of symptoms that include restlessness, irritability, sleep disturbance & impaired concentration ## Panic Attacks * Are characterized by an autonomic arousal that includes tachycardia, difficulty breathing, diaphoresis, light-headedness & severe weakness ## Strategies for Care 1. Instruct patients prior to painful procedures and self-management pain 2. Medication to treat anxiety include benzodiazepines, selective serotonin reuptake inhibitors (SSRI) ## Depression * Is linked to a decreased quality of life, through loss of interest, motivation * Is a significant risk for suicide ## Strategies for Care 1. Aimed toward remission & prevention of recurrence 2. Pharmacological therapies include TCA 3. Cognitive Behavioral Therapy 4. Exercise, Light therapy, Alternative medicine, and counselling ## Urinary Incontinence * Involuntary leakage of urine ## Nocturia * The awakening from sleep to urinate ## Sleep Disorders * **Insomnia:** Difficulty falling and staying asleep * **Sleep Aprea:** The narrowing or loss of tone in pharyngeal airway * **Restless Leg Syndrome:** Neurological disorder characterized by an uncontrollable urge to move to relieve paresthesia or dyesthesias ## Strategies for Care 1. Environmental Restructing 2. Relaxation 3. Sleep Hygiene 4. Aroma Therapy 5. Herbal Therapy 6. Medications ## Dysphagia * An underrecognized, poorly diagnosed, and poorly managed health problem that negatively impacts the quality & potentially quantity of life ## Deglutition * The act of swallowing in which a food or liquid bolus is transported from the mouth through the pharynx & esophagus into the stomach ## Oropharangeal Dysphagia * Is usually related to neuromuscular impairments affecting the tongue, pharynx, & upper esophageal sphincter ## Strategies for Care 1. **Compensatory Eating Techniques:** Upright position with the arms & feet supported should be maintained for at least 30-60 minutes after eating 2. A quiet room is preferable to decrease distractions & allow greater concentration on eating 3. Diet Modifications 4. Oral Hygiene 5. Non-Oral Feedings ## Pressure Ulcers * Is a lesion caused by unrelieved pressure with damage to the underlying tissue ### Risk Factors for Pressure Ulcers * Advanced Age * Immobility * Malnutrition * Diminished Level of Consciousness * Impaired Sensation ## Braden Scale - For Predicting Pressure Sore Risk **Severe Risk: Total score ≤ 9** **High Risk: Total score 10-12** **Moderate Risk: Total Score 13-14** **Mild Risk: Total score 15-18** | Risk Factor | Score / Description | Date of Assess | 1 | 2 | 3 | 4 | | :------------------- | :------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | :------------- | :-- | :-- | :-- | :-- | | **Sensory Perception** | **1. Completely Limited** - Unresponsive (does not moan, flinch, or grasp) to painful stimuli, due to diminished level of consciousness or sedation, or limited ability to feel pain over most of body surface. | | | | | | | | **2. Very Limited**- Responds only to painful stimuli. Cannot communicate discomfort except by moaning or restlessness, or has a sensory impairment which limits the ability to feel pain or discomfort over ½ of body. | | | | | | | | **3. Slightly Limited** - Responds to verbal commands but cannot always communicate discomfort or need to be turned, or has some sensory impairment which limits ability to feel pain or discomfort in 1 or 2 extremities. | | | | | | | | **4. No Impairment** - Responds to verbal commands. Has no sensory deficit which would limit ability to feel or voice pain or discomfort. | | | | | | | **Moisture** | **1. Constantly Moist** - Skin is kept moist almost constantly by perspiration, urine, etc. Dampness is detected every time patient is moved or turned. | | | | | | | | **2. Often Moist** - Skin is often but not always moist. Linen must be changed at least once a shift. | | | | | | | | **3. Occasionally Moist** - Skin is occasionally moist, requiring an extra linen change approximately once a day. | | | | | | | | **4. Rarely Moist**- Skin is usually dry; linen only requires changing at routine intervals. | | | | | | ## Friction and Shear | | | | :---------------- | :------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | | **1. Problem** | Requires moderate to maximum assistance in moving. Complete lifting without sliding against sheets is impossible. Frequently slides down in bed or chair, requiring frequent repositioning with maximum assistance. Spasticity, contractures, or agitation leads to almost constant friction. | | **2. Potential Problem** | Moves feebly or requires minimum assistance. During a move, skin probably slides to some extent against sheets, chair, restraints, or other devices. Maintains relatively good position in chair or bed most of the time but occasionally slides down. | | **3. No Apparent Problem** | Moves in bed and in chair independently and has sufficient muscle strength to lift up completely during move. Maintains good position in bed or chair at all times. | Total score of 12 or less represents HIGH RISK | Assess | Date | Evaluator Signature/Title | Assess | Date | Evaluator Signature/Title | | :----- | :--- | :-------------------- | :----- | :--- | :-------------------- | | 1 | | | 3 | | | | 2 | | | 4 | | | Name: Last, First Middle Attending Physician Record No Room/Bed ## Nutrition * Is important for the client at risk with pressure ulcers ## Pressure Ulcer Scale for Healing **PUSH Tool 3.0** | | Length X Width (in cm2) | 0 | 1 | 2 | 3 | 4 | 5 | Sub-score | | :-- | :---------------------- | :-- | :-- | :--- | :--- | :--- | :--- | :-------- | | | | | | | | | | | | | | 0 | <0.3 | 0.3-0.6 | 0.7-1.0 | 1.1-2.0 | 2.1-3.0 | | | | | | | | | | | | | | | 6 | 3.1-4.0 | 4.1-8.0 | 8.1-12.0 | 12.1-24.0 | > 24.0 | | | | Exudate Amount | None | Light | Moderate | Heavy | | | Sub-score | | | | 0 | 1 | 2 | 3 | | | | | | Tissue Type | Closed | Epithelial Tissue | Granulation Tissue | Slough | Necrotic Tissue | | Sub-score | | | | | | | | | | | **Total Score:** **Tissue type definitions:** * 0 - Closed, if wound completely covered with epithelium (new skin). * 1 - Epithelial tissue: for superficial ulcers, new pink or shiny tissue growing from edges or as islands on ulcer surface. * 2 - Granulation tissue: pink or beefy red tissue with a shiny, moist granular appearance * 3 - Slough: yellow or white tissue that adheres to ulcer in strings or think clumps or is mucinous * 4 - Necrotic tissue (eschar): black, brown or tan tissue that adheres firmly to wound bed or under edges and may be firer or softer than surrounding skin Adapted from www.npuap.org, National Pressure Ulcer Advisory Panel ## Thank You for Listening