elder care, safety, and fall prevention
Terms
undefined, object
copy deck
- baseline vulnerability
-
-age
-physical health
-frailty
-sensory loss
-cognition (chronic dementia, acute mental status) - predictive model of delirium
-
acute confusion=delirium
-looking at "insults" that health system does which increase problem(s)
-also predisposing factors: Vulnerability
-Precipitating Factors: Insults - consequences of restrive devices
-
-immobility: we want to improve not decrease this.
-psychological
-injuries - physical consequences of immobility
-
-pressure ulcers
-incontinence
-muscle atrophy
-bone loss - psychological consequences of restraints
-
-agitation
-confusion
-loss of dignity - Injuries ass. with restraints
-
-asphyxiation
-entrapment
-falls - specific approaches to fall/injury prevention
-
-assess behavioral and functional changes
-evaluate fall risk
-orient and inform
-facilitate observation: increase time OOB
-distract: glove over IV
-offer activities
-promote mobility
-exercise
-improve ability to get out of bed safely (lighting)
-maintain continence
-promote comfort
-provide reminders (alarms, signs)
-Reduce injury/entrapment risk (hip pads, low ht bed, impact mat) - definition of siderails as restraints
- "restricts the pt's movement and the pt cannot remove it"
- hartford institute mission
-
-to set a national agenda and shape the quality of health care for elderly
-promote geriatric nursing excellence
-promote competence in geriatric practice for all nurses
-influence both individual nurses and the systems they work in. - falls in old people
-
-common
-high morbidity, mortality
-many causes and risk factors
-potentially preventable - causes of falls
-
-multiple causes usually involved
-frequently not observed
-poor recall of event
-different ways to categorize cause:
1. primary or precipitating cuase
2. all contributing causes
3. other risk factors - clinical approach to the faller
-
-assess and treat any injury
-determine cause (history, physical, lab)
-prevent recurrence: trt cause/illness, reduce risk factors, adaptive behaviors (slow rise, cane) - basic falls risk assessment
-
-falls history
-med review
-focused physical exam
-functional & cog status
-environ survey - falls history
-
-circumstances
-major medical problems
-drugs: esp. cardiac, diuretic, psychoactive - physical exam: key aspects
-
VS: postural pulse/BP, temp
HEENT: vision, hearing, nystagmus
Neck: ROM, motion-induced vertigo, bruit
Card/Pulm: CHF, arrhythmia, murmur
Ectrems: arthritis, ROM, deformities, feet
Neuro: altered MS, gait/balance, weakness, focal finding, tremor, rigidity, peripheral neuropathy - reduce fall risk
-
-reduce use of psychoactive drugs
--treatment of pain
-improve sleep
-bed height
-lighting
-skid-proof floor/socks
-provide "transfer enabler" or safe "short" rail
-promote continence (siderail=barrier for confused elder)
-impact mat
-increase surveillance: bed alarms - Diarrhea assessment
-
History: onset, frequency, character, consistency, medication hisotry, dietary history
Physical: VS, ht, wt, skin turgor, abdomen, rectum - Causes of diarrhea
-
-motility disturbances
-decreased fluid absorption
-increased fluid secretion - Motility disturbances
-
-irritable bowel syndrome
-gastrectomy
-diabetic enteropathy - decreased fluid absorption
-
-oral intake of laxatives
-malabsorption syndrome
-mucosal damage - increased fluid secretion: most common
-
-infections: clostridium difficile
-drugs
-foods - Clostridium difficile (C.Diff)
-
-a common cause of diarrhea in frail elders.
-elders on antibiotics especially susceptible
-highly infectious - nursing interventions for diarrhea
-
-treat and identify the cause BEFORE treating the symptoms
-handwashing
-contact isolation
-antibiotics
-fluid repletion - antidiarrheal agents
-
-anticholinergics (imodium, lomotil)
-Demulcents (pepto)
-Narcotics - Constipation: definition
-
-frequency <3 bowel movements a week
-individualized
-NOT associated with aging - clinical manifestations of constipation
-
-abd bloating, distention, pain
-hard dry stool
-headache
-nausea
-hemorrhois
-valsalva maneuver
-diverticulosis
-fecal impaction - causes of constipation
-
-dietary related
-colonic disorders
-medication related
-neurologic disorders - Nursing interventions: constipation
-
-treatment depends on symptoms and assessemnt
-dietary teaching
-exercise
-position during bowel movement - Laxative choices
-
-bulk (metamucil, fibercon)
-osmotic/saline (mag citrate, lactulose, MOM)
-emollient (colace, mineral oil)
-stimulant/irritant (ex-lax, senacot)
-suppositories
-enemas - nursing assessement: UTI
-
-atypical presentation in elderly: non-specific S&S such as change in functional status, fatigue, anorexia, nausea, vomiting, MENTAL STATUS CHANGES, hypothermia, afebrile
-Typical presentation: frequency, urgency, suprapubic or low back pain, burning, fever and malaise - risk factors in elderly women for UTI
-
-use of pessary
-atrophic vaginitis
-short urethra
-cystocele
-catheterized
-immobility, incontinence
-bladder stones - risk factors in elderly men for UTI
-
-prostate enlargement
-lack of circumcision
-catheterized
-immobility, incontinence
-bladder stones - Interventions: UTI
-
-monitor adverse effects of antibiotics
-fluids
-avoid catheterization
-handwashing
-I/O - Pt teaching: UTI
-
-teaching perineal hygiene
-avoid caffeine, chocolate, alcohol
-pain managment
-antibiotic teaching
-avoid bubble baths - Urinary Incontinence
-
-15-30% community dwelling older adults
-women>men
-at least 50% of NH residents
-defined as the involuntary loss of urine
-adverse effects: social isolation, skin breakdown, depression, falls, high economic costs - types of urinary incontinence (UI)
-
-acute reversible
-persistent - Acute/transient incontinence: UI
-
D-delirium/confusion
I-infection
A-atrophic vaginitis
P-pharamaceuticals
P-polyuria
R-restricted mobility
S-stool impaction - Chronic UI
-
U-urge
F-functional
O-overflow
S-stress - urge incontinence
-
involuntary loss of urine ass with sensation to void (urgency)
Symptom: i go before i can get to the bathroom
mechanism: bladder involuntary contracts, sphincter involuntary relaxes
causes: CNS or Local - Functional incontinence
-
definition: chronic physical or cognitive impairments
symptom: i can't get to the bathroom
Mech: inability to toilet self
Causes: severe dementia, arthritis, hip fracture - Overflow incontinence
-
Def: involuntary loss of urine ass with over-distention of the bladder
symp: I just go a little bit. I am always leaking
Mech: bladder fails to contract & spincter fails to relax until overcome by pressure
causes: outlet obstruction, hypotonic bladder - stress incontinence
-
Def: sphincter failure ass with increased abdominal pressure
symp: i lose it when i cough or sneeze
mech: involuntary relaxation of sphicter due to sphincter damage
causes: pelvic surgery - Behavioral treatment for UI
-
-biofeedback
-kegels
-toileting program - drug therapy treatment & other: UI
-
-look at current drug regimen
-drugs for urge UI, for stress UI, overflow UI
-Glycemic control
other:
-surgery
-absorptive products
-PESSARY-inserted into vagina or rectum, used to treat stress UI