Geriatric nursing
Encyclopedia
Geriatric nursing is the specialty that concerns itself with the provision of nursing
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....

 services to geriatric or aged individuals.

Geriatric nursing

This page tries to outline the state of art guidelines for geriatric care that are useful to a nurse practitioner
Nurse practitioner
A Nurse Practitioner is an Advanced practice registered nurse who has completed graduate-level education . Additional APRN roles include the Certified Registered Nurse Anesthetist s, CNMs, and CNSs...

 and clinical nurse specialist
Clinical nurse specialist
A clinical nurse specialist is an advanced practice registered nurse, with graduate preparation from a program that prepares CNSs. According to the APRN Consensus Model for Regulation "The CNS serves a unique APRN role in integrating care across the continuum and through three spheres of...

 who encounters aging person in practice. Due to their complexity, aged people always deserve personal attention. Nurses address physical, psycho social, cultural and family concerns as well as promoting health and emphasizing successful aging.

Life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...

 is rising at rates which call for the proper preparation of nurses to take good care of the rapidly increasing number of the aged.

It is important to distinguish changes involved with normal aging from changes attributable to pathophysiology
Pathophysiology
Pathophysiology is the study of the changes of normal mechanical, physical, and biochemical functions, either caused by a disease, or resulting from an abnormal syndrome...

. Alterations in the structure and function of multiple body system may affect an older person appearance, mobility and ability to fight off infections. Geriatric medications need to be managed so as to avoid too much use of medicine since this group receives a lot of medication if poor care is taken. Multiple medications can cause a variety of drug interaction
Drug interaction
A drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own. Typically, interaction between drugs come to mind...

 in older people. Primary drug reaction occurs when one drug causes one side effect, secondary drug reaction occurs when one medication reacts with another. This is brought about by polypharmacy
Polypharmacy
Polypharmacy is the use of multiple medications by a patient, especially when too many forms of medication are used by a patient, when more drugs are prescribed than is clinically warranted, or even when all prescribed medications are clinically indicated but there are too many pills to take ....

. Old people should be treated in ways that are of benefit and do no harm or as little harm as possible. Principle of assessment: data regarding biomedical, functional, psychological and social issues are obtained to help in planning and implementation of individual health care.

Pressure injuries

A pressure ulcer is a lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...

 caused by unrelieved external pressure resulting from occlusion
Vascular occlusion
Vascular occlusion is a sudden blockage of a blood vessel, usually with a clot. It differs from thrombosis in that it can be used to describe any form of blockage, not just one formed by a clot. When it occurs in a major vein, it can, in some cases, cause deep vein thrombosis. The condition is...

 of the blood flow, tissue ischemia and cell death. Pressure ulcers are often viewed as a complication of an acute
Acute (medicine)
In medicine, an acute disease is a disease with either or both of:# a rapid onset, as in acute infection# a short course ....

 or chronic illness. The presence of ulcers may also be evidence of poor nursing care. Although pressure ulceration can be prevented, it may also occur despite optimal nursing care and advanced technologies. In order to provide effective nursing care for the older adult with pressure ulcers, the nurse must approach patient care within a holistic frame work. This framework should include an integration of good assessment, use of research-based intervention and methodical intervention of patience outcomes. Some specific issues of prevention, assessment and treatment of adult with pressure ulcers are aging skin: The older people have an aged skin and due to exposure to the sun the skin wrinkles, epidermis thins, blood vessels recede, dermal-epidermal ridges flatten and the skin appears thin and fragile. The age related changes may lead to ulceration. The skin which is the largest organ can help in viewing the overall functioning of the entire body. All clinicians working with older people at risk for, or suffering from pressure ulcers must be mindful of these varying relationships in using the cutaneous "window" of person to plan and implement individualized, comprehensive care.

Ulcers have different stages. Stage one ulcers are characterized by non-blancherble erythema
Erythema
Erythema is redness of the skin, caused by hyperemia of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation...

 of intact skin. It is important to note that stage one pressure ulcers are difficult to identify in darkly pigmented people and are usually indicated by discoloration, warmth, endyma, indurations and hardness. Stage two ulcers are partial lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...

s extending into the epidermis and the dermis. Stage three ulcers are defined as the full thickness skin loss. Stage four is characterized by extensive tissue damage which extends to the muscle, bone or the underlying structures.

Through a holistic assessment and evaluation a nurse can build a plan of care for those patients who suffer from pressure injury. When treating an ulcer wound treatment should focus on wound healing. For a chronic
Chronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...

, non healing ulcer, comfort should be a top priority. For pressure injury careful positioning padding to reduce the risk of pressure ulceration is critical. Wound healing occurs only if the patience is physiologically able to provide needed substrate; wound cleanliness, moist and infection free and the cause of injury is removed. For older people it takes longer to heal and so extra care should be taken. When customary interventions fail to heal a pressure ulcer, surgical intervention may be the best option.

Cardiovascular disease

This is a disease that affects the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...

 and the blood vessels. The disease is caused by disruption in the blood circulation secondary to decreased vessel, patently (constriction, spasm and occlusion
Vascular occlusion
Vascular occlusion is a sudden blockage of a blood vessel, usually with a clot. It differs from thrombosis in that it can be used to describe any form of blockage, not just one formed by a clot. When it occurs in a major vein, it can, in some cases, cause deep vein thrombosis. The condition is...

). Cardiovascular disease is common in 50% of the population over the age of 65, and accounts for 40% of deaths in this group. Because of the changes associated with normal aging and some of the unique aspects of reporting and presenting
Presenting
In medicine, the term presenting means not only present, but seen. For example, at birth most babies present head first and their presenting part is their head....

 in old adults, underestimation of the seriousness, cardiac disease often occurs. This can lead to misdiagnosis, under treatment, and even death. There are different kind of heart disease: Atherosclerosis
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...

 and arteriosclerosis
Arteriosclerosis
Arteriosclerosis refers to a stiffening of arteries.Arteriosclerosis is a general term describing any hardening of medium or large arteries It should not be confused with "arteriolosclerosis" or "atherosclerosis".Also known by the name "myoconditis" which is...

. Arteriosclerosis is a disease of the arteries, characterized by abnormal thickening and hardening of vessel walls, it also leads to atherosclerosis. Due to advance in age the disease easily finds its way to old people and so it should be carefully diagnosed and proper treatment given. When diagnosing look out for cases of fainting, continuous chest pain, nausea, shortness of breath, rapid heart rate, rapid weight gain, pain in the abdomen, swelling of legs among others. Then address the issue of hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...

, high blood cholesterol, diabetes, obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...

 and overweight, smoking
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...

, hereditary issues. Treatment includes medication and physical exercises.

Respiratory issues

The following age related changes may occur in the respiratory system of an old person: diminished muscle strength in the diaphragm
Thoracic diaphragm
In the anatomy of mammals, the thoracic diaphragm, or simply the diaphragm , is a sheet of internal skeletal muscle that extends across the bottom of the rib cage. The diaphragm separates the thoracic cavity from the abdominal cavity and performs an important function in respiration...

 and thorax
Thorax
The thorax is a division of an animal's body that lies between the head and the abdomen.-In tetrapods:...

, stiffer chest wall, decreased elastic recoil
Elastic recoil
Elastic recoil is the rebound of the lungs after having been stretched by inhalation, or rather, the ease with which the lung rebounds. With inhalation, the interpleural pressure of the lungs decreases. Relaxing the diaphragm during expiration allows the lungs to recoil and regain the interpleural...

, decreased elasticity in the alveoli reduced surface area, with diminished capacity for gas exchange
Gas exchange
Gas exchange is a process in biology where gases contained in an organism and atmosphere transfer or exchange. In human gas-exchange, gases contained in the blood of human bodies exchange with gases contained in the atmosphere. Human gas-exchange occurs in the lungs...

, decreased vital capacity, and drier mucous membrane
Mucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...

 leading to more difficulty in mucous
Mucus
In vertebrates, mucus is a slippery secretion produced by, and covering, mucous membranes. Mucous fluid is typically produced from mucous cells found in mucous glands. Mucous cells secrete products that are rich in glycoproteins and water. Mucous fluid may also originate from mixed glands, which...

 excretion
Excretion
Excretion is the process by which waste products of metabolism and other non-useful materials are eliminated from an organism. This is primarily carried out by the lungs, kidneys and skin. This is in contrast with secretion, where the substance may have specific tasks after leaving the cell...

. Tests should be carried out by doing x-ray coupled with physical examination. The following are possible diseases in old people; bronchitis
Bronchitis
Acute bronchitis is an inflammation of the large bronchi in the lungs that is usually caused by viruses or bacteria and may last several days or weeks. Characteristic symptoms include cough, sputum production, and shortness of breath and wheezing related to the obstruction of the inflamed airways...

, asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...

, pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...

, tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

, and chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease , also known as chronic obstructive lung disease , chronic obstructive airway disease , chronic airflow limitation and chronic obstructive respiratory disease , is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly co-existing diseases...

. Some of this disease leads to cardiovascular disease due to effect on the lungs by air pollution
Air pollution
Air pollution is the introduction of chemicals, particulate matter, or biological materials that cause harm or discomfort to humans or other living organisms, or cause damage to the natural environment or built environment, into the atmosphere....

. Nurse should draw a plan for treatment which includes working with other specialties like heart experts.

Genitourinary issues

They include urinary incontinence
Urinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...

 (transient, established or combination), urinary tract infection
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...

 (asymptomatic bacteriuria, uncomplicated UTI and complicated UTI) and prostate disease (benign prostatic hyperplasia
Benign prostatic hyperplasia
Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....

) and prostate cancer
Prostate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...

. Nurses should be careful with the language while carrying diagnosis so they can obtain as much information as possible.

Diabetes melitus

Diabetes melitus is a metabolic disorder with two major types, type one and type two. Their end result is hyperglycemia
Hyperglycemia
Hyperglycemia or Hyperglycæmia, or high blood sugar, is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a glucose level higher than 13.5mmol/l , but symptoms may not start to become noticeable until even higher values such as 15-20 mmol/l...

. Type one is caused by lack of insulin production by beta cells. Type two is the most common and is caused by deficiency or inadequacy of insulin receptors in cells. Treatment goals are to symptoms and maintain as normal blood glucose as possible without inducing hypoglycemia
Hypoglycemia
Hypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose. The term literally means "under-sweet blood"...

 to decrease the risk of long term complications. Nurse should emphasize nutrition
Nutrition
Nutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....

 and exercise which are vital for victims. For older people monitoring for complications which can lead to lower extremity amputation
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...

, hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...

, myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

, stroke, vision loss
Vision loss
Vision loss or visual loss is the absence of vision where it existed before, which can happen either acutely or chronically .-Ranges of vision loss:...

, or nephropathy
Nephropathy
Nephropathy refers to damage to or disease of the kidney. An older term for this is nephrosis.-Causes:Causes of nephropathy include administration of analgesics, xanthine oxidase deficiency, and long-term exposure to lead or its salts...

 should be carried out especially in type 2 diabetic patient.

Thyroid

The most encountered disorders are hyperthyroidism
Hyperthyroidism
Hyperthyroidism is the term for overactive tissue within the thyroid gland causing an overproduction of thyroid hormones . Hyperthyroidism is thus a cause of thyrotoxicosis, the clinical condition of increased thyroid hormones in the blood. Hyperthyroidism and thyrotoxicosis are not synonymous...

, hypothyroidism
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...

 and nodular thyroid disease. Hyperthyroidism is characterized by an excess of amount of thyroid hormone. In hypothyroidism the thyroid glands fails to produce thyroid hormone. Nurse practitioners have a responsibility to evaluate and manage thyroid disorders by applying strategies specific to older adults.

Delirium

Also known as acute confusion, it is a prevalent and serious health problem for acutely ill adults. Delirium can be defined as transient and etiological non-specific organic mental syndrome
Syndrome
In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others...

 characterized by reduced ability to focus, sustain or shift attention.

Dizziness

Changes in structure and function of the nervous system occur with normal aging and can result in changes in mobility, balance
Balance (ability)
In biomechanics, balance is an ability to maintain the center of gravity of a body within the base of support with minimal postural sway. When exercising the ability to balance, one is said to be balancing....

, coordination
Motor coordination
thumb|right|Motor coordination is shown in this animated sequence by [[Eadweard Muybridge]] of himself throwing a diskMotor coordination is the combination of body movements created with the kinematic and kinetic parameters that result in intended actions. Such movements usually smoothly and...

, sensation, comprehension
Understanding
Understanding is a psychological process related to an abstract or physical object, such as a person, situation, or message whereby one is able to think about it and use concepts to deal adequately with that object....

, cognitive performance or behaviour. These changes reflect a slowing of neurological response as fewer neurons are available to provide sensory and motor messages to and from the central nervous system. The common terms for dizziness include vertigo, pre-syncope and disequilibrium.

Stroke

Also known as brain attack, created by interruption of blood supply to some areas of the brain, this interruption can occur as a result of an occlusion
Vascular occlusion
Vascular occlusion is a sudden blockage of a blood vessel, usually with a clot. It differs from thrombosis in that it can be used to describe any form of blockage, not just one formed by a clot. When it occurs in a major vein, it can, in some cases, cause deep vein thrombosis. The condition is...

 or hemorrhage. Occlusion leads to ischemic stroke, categorized as thrombic and embolic. Thrombic stroke occurs in vesicle
Vesicle (biology)
A vesicle is a bubble of liquid within another liquid, a supramolecular assembly made up of many different molecules. More technically, a vesicle is a small membrane-enclosed sack that can store or transport substances. Vesicles can form naturally because of the properties of lipid membranes , or...

s when oxygenated blood fails to flow to the occlusion site. Embolic stroke occurs when clots form everywhere.

External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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