Common Clinical Problems: Physiological Chapter Seventeen Common Clinical Problems: Physiological

Alteration in Mobility Immobility major medical disability for older adults and yet it is overlooked by many nurses Important to maintain and improve an individual’s ability to be mobile Can help the patient by assisting to bathroom before and after meals and bedtime Musculoskeletal system Bones less dense, brittle, possible fractures Muscle weakness Osteoarthritis, joint stiffness

Alteration in Mobility (cont’d) Cardiovascular system Oxygen consumption Decreased cardiac output but with exercise can increase cardiac output Respiratory system Rigidity of rib cage Osteoporosis Diminished vital capacity of lungs Less efficient gas exchange

Alteration in Mobility (cont’d) Response to illness Chronic health problems can restrict mobility. Poor eyesight, stiff joints, shortness of breath, acute illnesses Complications from immobility Contractures, pneumonia, incontinence, constipation, pressure ulcers, dehydration, thrombophlebitis, loss of appetite, psychological problems from sensory deprivation

Alteration in Mobility (cont’d) Nursing implications Physical activity prevents complications and slows rate of aging process. Limit bedrest. Assist with ambulation.

Potential for Injury From Falls Aging of musculoskeletal system increases risk for falls and this is the top reason for a person to develop immobility Presence of chronic illness increases risk for falls. Intrinsic: factors inherent to the individual Normal aging changes Deficiencies in health status Changes in mental status Changes in functional ability

Potential for Injury From Falls (cont’d) Intrinsic (cont’d) Posture and balance Affected by musculoskeletal, neurological, and visual systems such as seen with Parkinson’s Gait Decreased speed and step height, hesitant steps, stooped posture Vision Decreased acuity, peripheral vision, depth perception, night vision, tolerance for glare

Potential for Injury From Falls (cont’d) Extrinsic: environmental conditions Poor lighting Slippery floors and small cramped spaces Objects in pathway Inadequate footwear Nursing implications Assess individual’s ability to maneuver safely in immediate environment. Identify needs. Develop interventions to prevent falls.

Which would be an extrinsic factor that could increase the risk for falls? Gait Posture Balance Equipment

Answer D. Equipment

Alterations in Elimination Urinary incontinence Not a normal aspect of aging Major reason why older adults are placed in nursing homes Associated with skin breakdown, behavioral disturbances, urinary tract infections

Alterations in Elimination (cont’d) Urinary incontinence (cont’d) Types of incontinence Acute or transient: presence of another medical problem such as with Dementia, Delirium, Infection, Renal stones, Pharmaceutical/Psychological (DRIP) Chronic: gradual onset, worsens over time Four types of chronic incontinence Urge Stress Overflow Functional

Alterations in Elimination (cont’d) Incontinence (cont’d) Urge incontinence Feel urge but unable to get to toilet in time Stress incontinence Sudden increase in intra-abdominal pressure from coughing, sneezing, laughing, lifting Overflow incontinence Outlet obstruction, bladder does not empty sufficiently such as possible with fecal impaction or taking diuretics because of increase in volume

Alterations in Elimination (cont’d) Incontinence (cont’d) Functional incontinence Unable or unwilling to attend to toileting needs such as when siderails are left up; or unable to reach bathroom due to something in the way Nursing implications Identify and treat causes of transient incontinence. Medicinal, surgical, or behavioral treatment for chronic incontinence Assist with initiating a toileting program-starting with every 2 hrs-goal would be to increase the period of time between voiding

What type of incontinence occurs when an acute, curable condition is present? Urge Stress Acute Overflow Functional

Answer C. Acute

What is the goal of bladder retraining? Eliminating the urge Treating the cause Decreasing the pressure Lengthening the time between voidings

Answer D. Lengthening the time between voidings

Alterations in Elimination (cont’d) Constipation Avoidance is important for older adults. Age-related changes Slower peristalsis, lack of mobility, decreased exercise, lack of fiber and water in diet, medications-such as diuretics, sedatives, aluminum containing antacids Nursing interventions Establish regular bowel pattern. Increase exercise, water intake, and fiber intake.

Alterations in Skin Integrity Pressure ulcers Any lesion caused by unrelieved pressure that results in damage to underlying tissue Extremely serious health problem Prevention of pressure ulcers should be focus of nursing care Risk factors Mechanical Physiological

Alterations in Skin Integrity (cont’d) Mechanical risk factors Pressure over bony prominences Shearing of skin over sacrum, heals, anterior tibial region Friction and moisture to skin

Alterations in Skin Integrity (cont’d) Physiological risk factors Aging skin less resistant to mechanical forces Immobility and lack of spontaneous body movements Should implement ROM exercises to maintain joint flexibility and prevent skin breakdown Malnutrition and deficiencies in zinc, iron, vitamin C, and protein

Alterations in Skin Integrity (cont’d) Staging of pressure ulcers Stage I Nonblanchable erythema of intact skin Stage II Partial-thickness skin loss Stage III Full-thickness skin loss

Alterations in Skin Integrity (cont’d) Staging of pressure ulcers (cont’d) Stage IV Full-thickness skin loss with extensive destruction Prevention Assess for risk. Reduce risk on bony prominences by using gel filled mattresses Prevent shearing and friction.

Alterations in Skin Integrity (cont’d) Prevention (cont’d) Keep skin clean and dry Frequent change of position Provide adequate nutrition and hydration-remember protein provide different nutrition from carbohydrates and fats Treatment Highly individualized-if patient does not sit provide finger foods that are nutritious such as sandwiches, fruit, cheeses Prevention of irritation Adequate nutrition

Which is a physiological risk factor related to pressure ulcers? Shear Friction Pressure Nutritional deficiencies

Answer D. Nutritional deficiencies

How often should a patient be repositioned to help reduce the risk of pressure ulcers? Every hour Every 2 hours Every 4 hours When requested by patient

Answer B. Every 2 hours

Altered Nutritional Status Adequate nutrition is important for health maintenance, disease prevention, treatment of chronic illness, and recovery from acute illness. Body must have sufficient intake of carbohydrates, fat, protein, vitamins, minerals, and water.

Altered Nutritional Status (cont’d) Risk factors Anorexia Poor dentition Poor-fitting dentures, lack of dentures Decreased appetite Polypharmacy Social isolation Depression

Altered Nutritional Status (cont’d) Risk factors (cont’d) Changes in metabolism Cognitive impairment Assessment Monitor recommended daily allowances. Monitor weight over period of time. Measure serum albumin.

Altered Nutritional Status (cont’d) Nursing interventions Maintain oral feedings with appropriate modifications. Provide meals in a pleasant, relaxed environment. Provide supplements as needed.

What is the most appropriate method to assess nutritional status over time? Assessing meal intake Assessing for hunger Assessing for weight changes Assessing albumin level

Answer C. Assessing for weight changes

Sleep Pattern Disturbances Sleep disturbances increase with age. More frequent and prolonged awakenings Stage IV and REM sleep diminish. Urinary frequency Symptoms of sleep deprivation Fatigue, tiredness, eye problems, muscle weakness, diminished coordination, apathy, depression

Sleep Pattern Disturbances (cont’d) Sleep disorders Sleep apnea Sundown syndrome Increase in symptoms of confusion during late afternoon and early evenings Nursing interventions Avoid sleeping medications, tranquilizers, and sedatives.

Sleep Pattern Disturbances (cont’d) Nursing interventions (cont’d) Promote sleep with use of back rubs, snacks, assistance with toileting, repositioning, and relief of pain. Increase daytime activities.

Which nursing intervention can help to improve sleep quality in the older adult? Administering sedatives Using incontinent pads Elevating the head of the bed Increasing daytime activities

Answer D. Increasing daytime activities

Iatrogenesis Disorders acquired as a result of receiving treatments which can include pressure ulcers because of the lack of frequent turning Numerous chronic conditions require complex treatments.