1. Common Clinical Problems: Physiological
Chapter Seventeen
Common Clinical Problems:
Physiological

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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.

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

10. Answer
D. Equipment

11. 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

12. 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

13. 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

14. 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

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

16. Answer
C. Acute

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

18. Answer
D. Lengthening the time between voidings

19. 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.

20. 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

21. 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

22. 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

23. 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

24. 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.

25. 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

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

27. Answer
D. Nutritional deficiencies

28. 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

29. Answer
B. Every 2 hours

30. 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.

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

32. 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.

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

34. 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

35. Answer
C. Assessing for weight changes

36. 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

37. 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.

38. 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.

39. 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

40. Answer
D. Increasing daytime activities

41. 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.