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NURSING SKILLS RELATED TO PHYSIOLOGICAL CHANGES IN THE ELDERLY

NURSING SKILLS RELATED TO PHYSIOLOGICAL CHANGES IN THE ELDERLY. Susan Hench, RN, MSN Assistant Professor of Nursing N102. Pharmacokinetics. Absorption Age-related changes

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NURSING SKILLS RELATED TO PHYSIOLOGICAL CHANGES IN THE ELDERLY

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  1. NURSING SKILLS RELATED TO PHYSIOLOGICAL CHANGES IN THE ELDERLY Susan Hench, RN, MSN Assistant Professor of Nursing N102

  2. Pharmacokinetics • Absorption • Age-related changes • Decreased intracellular fluid, increased gastric ph, decreased cardiac function and circulation, slower metabolism, slower drug absorption • Route of administration • Concentration and solubility of drug • Diseases and symptoms • Diabetes and hypokalemia cause faster absorption while edema and pain slow absorption

  3. Pharmacokinetics • IM, SQ, PO and PR (less moisture in the rectum and the vagina prolong the melting time of suppositories) not absorbed as well as inhaled, topical or IV (monitor for fluid/ circulatory overload when giving IV meds and fluid) • Drugs that are highly soluble are absorbed quickly

  4. Pharmacokinetics • Distribution • Changes in circulation, body temperature, tissue structure and cell membrane permeability affect distribution • Adipose tissue increases as compared to lean body mass • If several drugs are taken together that compete for binding sites, distribution will be slowed

  5. Pharmacokinetics • Reduced serum albumin levels affect drug effectiveness • Decreased cardiac output reduces circulation time of medications • Be sure to monitor blood levels of medication frequently-toxicity happens quickly in dehydration and hypoalbuminemia

  6. Pharmacokinetics • Metabolism, Detoxification, And Excretion • Renal system primarily responsible • Nephron units are decreased in number and may not function well • Decrease in blood flow to the kidneys

  7. Pharmacokinetics • Liver also has detoxification and excretion functions • Liver decreases in size and function with age, hepatic blood flow decreases • Liver removes less poisonous nitrogen • Forms less bile, secretes less enzymes that are responsible for detoxification of meds

  8. WHAT NURSES CAN DO • Encourage exercise to stimulate circulation • Prevent hypothermia and fluid volume deficit • Monitor drug-drug (Rx, OTC and herbal) and drug-food interactions • Consider the most effective route for the drug

  9. Pharmacodynamics In Older Persons • Biologic and therapeutic effects of drugs at the site of action or on the target organ • High risk of adverse reactions in the elderly • Nurses should make sure that drug-induced cognitive and behavioral changes are not treated with additional drugs • Any symptom in an older adult should be suspected as being related to a drug interaction or adverse reaction until proven otherwise

  10. The elderly person sometimes forgets to tell the doctor about other medications he or she is taking • Really need a good history-ask questions about medication they take for constipation, GI upset, coughing, if they get a cold, do they take any vitamins, etc.

  11. Polypharmacy and drug misuse among the elderly can be a significant medical problem that can go unrecognized

  12. Measures To Improve Safety • Pill boxes • Pre-pour meds • Charts • Check off lists • Maintain accurate drug history

  13. Measures To Improve Safety • Teach in terms the older person can understand • Have them write out questions for pharmacist or doctor • Make list with all meds-Rx and OTC • Include adverse reactions or allergies on list • Emphasize no sharing of meds

  14. Measures To Improve Safety • Make sure it is clear to you and to the patient why the drug was ordered or why they are taking it, is there any other nondrug therapy that would work? • Are they taking the smallest possible dose?

  15. Measures To Improve Safety • Are they following any special instructions that may come with the drug, eg-on an empty stomach, at a certain time of day, not with other meds, etc. • Is the most effective route being used? • Is the best form being used? Are pills being crushed that should not be?

  16. Discontinuing Medications • The older adult is extremely sensitive to drugs • Drugs should always be withdrawn slowly or weaned • Stopping or decreasing a medication suddenly may cause rebound symptoms

  17. Factors That Affect The Discontinuation Of Drugs • Type of drug • Reason given • Dosage • Length of time person has been taking the drug

  18. Nursing Implications • Certain drugs can cause serious rebound symptoms when withdrawn or stopped abruptly • All patients and caregivers should understand their medication regimen • Stress to never increase or decrease a medication dose or stop taking a medication without consulting their physician

  19. Integumentary System • The external and visible sign of aging – lines, wrinkles, gray hair • The system most of us use to “guess” someone’s age • Heredity and genetics play a role in skin aging • Exposure to sunlight is the single most important factor in age-related skin changes

  20. Integumentary System • Lines, wrinkles • Thicker nails • Graying hair • Solar elastosis or photoaging-loss of elasticity and wrinkling of the skin from sun exposure-fair skinned persons more prone

  21. Integumentary System • Nurses need to regularly assess patients’ skin status • Astute attention to skin status is critical to prevent serious problems • Skin is the first line of defense against infection

  22. SKIN CHANGES Wrinkles A result of the redistribution of subcutaneous fat and collagen changes Collagen is responsible for giving strength and elasticity to the skin Cartilage keeps growing in the nose and ears causing lengthening and broadening Integumentary System

  23. Integumentary System • SKIN CHANGES • Dryness • Sebaceous glands decrease in their secretion of sebum • Dryness leads to pruritis, open areas • Leads to increased risk of breakdown, slower healing, and infection

  24. Integumentary System • SKIN CHANGES • Pigmentation • Melanocytes cluster causing “age spots” • Less melanocytes (or melanin) which leads to a pale skin appearance • Skin appears thin and translucent

  25. Integumentary System • Subcutaneous fat is lost • Cold intolerance increases • Skin sags • Benign growths such as skin tags or nevi • Heat intolerance due to fewer sweat glands and decreased perspiration • Increased heat stroke susceptibility

  26. Integumentary System • SKIN CHANGES • Pruritis - itching • Keratosis – rough, raised, yellowish patches • Seborrheic Keratosis • Actinic Keratosis • Malignant Melanoma - cancer • A,B,C,D’s - asymmetry, border, color, diameter

  27. SCABS FROM PRURITIS – Severe itching Ear w/ ACTINIC KERATOSIS SEBORRHEIC KERATOSIS-SINGLE AND MULTIPLE

  28. AGE SPOT ON CHEEK MALIGNANT MELANOMA SEBORRHEIC KERATOSIS VS SQUAMOUS CELL CARCINOMA LENTIGOMELANOMA ON HEAD

  29. Integumentary System • NAIL CHANGES • Related to decreased vascular supply and nutritional changes • Grow more slowly • Thick, hard and brittle • Become yellow and have ridges

  30. Integumentary System • HAIR CHANGES • Graying from loss of melanin in the hair • Thins on scalp, legs, axilla, and pubic region • Nose and ear hair gets thicker • Women may get facial hair

  31. Integumentary System • NURSING IMPLICATIONS IN SKIN CARE • Promote activity to increase circulation • May need humidified air along with adequate hydration • Maintain good nutrition • Avoid over use of soap • Add emollients to bath water • Avoid skin irritants and rough clothing • Use lotions, creams, and oils

  32. Integumentary System • NURSING IMPLICATIONS IN SKIN CARE • Daily baths are not always necessary • Every 3 to 4 days for average older person • Excessive bathing may be hazardous to the skin • Pay early attention to skin irritations and abnormalities • Employ good nursing techniques to prevent pressure ulcers

  33. Integumentary System • NURSING IMPLICATIONS FOR HAIR CARE • Shampoo hair less frequently • Combing the hair distributes the oils and stimulates the scalp • NURSING IMPLICATIONS FOR NAIL CARE • Soak feet and hands • Cut nail straight across • Filing nails is best

  34. NOTE!!!! • Do not cut diabetics’ nails-should be seen by a podiatrist • Persons on Coumadin and other blood thinners should file nails

  35. Integumentary System • NURSING DIAGNOSES • Impaired skin integrity or risk for impaired skin integrity • Deficient knowledge • Bathing/hygiene self-care deficit • Others related to incontinence, mobility, nutrition

  36. Respiratory System

  37. Respiratory System • Respiratory health is vital to the elderly person’s ability to maintain a physically, mentally, and socially active lifestyle

  38. Respiratory System • MAIN PROBLEM IS DIMINISHED OXYGENATION • Lifetime of insult • Insult from smoking, pollution, and infection takes its toll in old age • Respiratory disease is leading cause of disability

  39. Respiratory System • AGING FACTORS • Rib cage becomes more rigid, costal cartilage calcifies and is not as flexible so breaths are more shallow • More use of the diaphragm and abdominal breathing • Osteoporosis and kyphosis create a stooped posture which leads to a decreased ability to expand chest

  40. Respiratory System • Abdominal muscles lose tone and weaken • Reduction in body fluid and reduced fluid intake can cause drier mucus membranes making the removal of mucus more difficult and may lead to the development of mucus plugs and infection

  41. Respiratory System • AGING CHANGES • Lung tissue loses elasticity • Decrease in the total number of aveoli = decrease in lung capacity • Development of a barrel chest

  42. Respiratory System • Decreases in residual volume, vital capacity and total lung capacity • Leads to faster SOA with increasing activity • The alveoli also enlarge (more so with COPD) thus creating less alveolar surface for gas exchange • Arteriosclerotic changes lead to decreases in circulation through the lungs as well

  43. Respiratory System • AGING CHANGES • Diminished cough R/T rigidity of thoracic wall and decreased strength of the expiratory muscles • Decreased ciliary action of the bronchial lining • Clearing of the bronchi decreases (happens in younger persons during sleep) • Secretions are retained

  44. Respiratory System • Elderly more predisposed to pneumonia and emphysema • The most important risk factor for pneumonia is aspiration • Pneumonia also can be due to retained secretions • Emphysema due to the lung and alveoli changes characterized by over distended alveolar sacs

  45. Respiratory System

  46. Respiratory System • NURSING IMPLICATIONS • Encourage coughing and deep breathing • Encourage and promote exercise to increase lung expansion • Encourage adequate hydration

  47. Respiratory System • Remember respiration will normally increase with activity but an increase in respirations not related to activity or too large for the amount of exercise may indicate an infection • Exercise can be ambulation, getting in and out of bed, sitting up, dangling, changing position in bed • Hydration will help thin secretions and will make them easier to cough up

  48. Respiratory System • NURSING IMPLICATIONS • May need to administer oxygen • Be diligent after surgery because the elderly can develop atelectasis and pneumonia rapidly

  49. Respiratory System • NURSING DIAGNOSES • Ineffective airway clearance • Risk for aspiration • Ineffective breathing pattern • Impaired gas exchange • Activity intolerance

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