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P. 1 Care of the Chronically Ill and the Older Person

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Care of the Chronically Ill and the Older Person Ratings: (0)|Views: 617|Likes: 2 Published by Gleanne Condes

More info: Published by: Gleanne Condes on Dec 04, 2011 Copyright:Attribution Non-commercial

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CARE OF THE CHRONICALLY ILL AND THE OLDERPERSON

It deals with concepts, principles andtechniques of nursing care managementof those with chronic illness and

olderpersonsPRI NCIPLES OF GERONTOLOGY Health promotion, health protection,diseas e prevention and treatment of disease with

emphasis on evidencebasedbest practices and current clinicalpractice guidelines. Aging is an inevitable and

steadilyprogressi ve process begins at the moment of conception andcontinues throughout the remainder of life. The final stage

of life consisting of oldage, can be the best or worst time of life requires work and planning throughout allof the previous stages to be a

successfuland enjoyable period.DEMOGR APHICS AND AGING Countries all over the world are facingdemograph ic aging.

All nations are soon will be faced withimportant issues regarding the provisionof healthcare to older persons. In 1997 -10%

(561 million) of the worldspopulation was age 60 and older projected to increase to 15% by 2025.LONGEVIT

Y AND THE SEX DIFFERENTIAL The gender differences in life expectancymay be explained by the complexinteractio ns between

biological, social,and behavioral factors. Greater male exposure to risk factors( tobacco, alcohol, and

occupationalhaza rds) might negatively affect male lifeexpectancy.LI FE AFTER 65 Women 65 + 19 years Men 65 can

expect to live another 16. life expectancyattributed to improved healthcareincreased use of preventive services-

healthier lifestylesSENES CENCE refers to the progressive deterioration of body systems that can increase the riskof

mortality as an individual gets older.GERIATRI CS Often used as generic term related to theaged, but specificically

refers to medicalcare of the agedSOCIAL GERONTOLOGY Concerned with the social aspects of aging versus biological or psychological

Geropsychology branch of psychologyconce rned with helping older persons andtheir families maintain wellbeing,overco me problems &

achieve maximumpotentia l during later life Geropharmacolo gy is the study of pharmacology as it relates to older adultsGERONTO

LOGICAL NURSING It involves advocating for the health of older persona at al levels of preventionROLE S OF THE

GERONTOLOIC AL NURSE Provider of care Teacher Manager Advocate Research consumer THEO

RIES OF AGING Theories of aging fall into several groups,including biological, psychological,and sociological theories.

BIOLOGICAL AGING THEORIES PROGRAMMED THEORIES hypothesize that the bodysgenetic codes contain instructionsfor the

regulation of cellularreproducti on and death. Programmed Longevity aging is theresult of the sequential switching on and

off of certain genes- with aging, associated functionaldeficits are manifested. PROGRAMMED THEORIES Endocrine

Theory Biologicalclocks act through hormones tocontrol the pace of aging. Proponents of this theory

ascribe tothe use of various natural andsynthetic hormones, such ashuman growth hormone, to slowthe aging process Immunological

Theory Aprogrammed decline in immunesystem functions leads to anincreased vulnerability to infectiousdisease

, aging and eventual death.ERROR THEORIES environmental assaults and the bodysconstant need to manufacture

energy andto fuel metabolic activities cause toxicbyproducts may eventually impair normal body function and cellular repair.

Wear and Tear Theory Cells andorgans have vital parts that wear out after years of

use. master clock controls all organs

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cellular function

slows down withtime less efficient at repairing bodymalfunctions that are caused byenvironmental assaults.

Cross Link Theory an accumulation of crosslinkedproteins resulting from the binding of glucose (simple sugars)

to proteincauses various problems. Once the binding occurs, the CHONcannot perform normally and mayresult in visual problems like cataractsor

wrinkling and skin aging.

Free Radical Theory accumulated damage caused byoxygen

radicals causes cells andeventually organs, to lose function andorgan reserve. The use of antioxidants and

vitaminsis believed to slow this damage.

Somatic DNA Damage Theory Genetic mutations occur

andaccumulate with increasing age - cells deteriorate and malfunction.PSY CHOLOGICAL AGING THEORIES

JUNGS THEORY OF INDIVIDUALI SM the shift of focus is away from theexternal world (extroversion)

towardthe inner experience (introversion). search for answers to many of lifesriddles and try to find the essence of the true self.

To age successfully, the older personwill accept past accomplishments andfailures.

ERICKSONS DEVELOPMEN TALTHEORY

According to Erickson, there are 8stages of life with developmental tasksto be accomplished at each stage. ego integrity

versus despair the older adult will becomepreoccupi ed with acceptance of eventual death without becomingmorbid

or obsessed with thesethoughts. Older persons who have not achievedego integrity may look back in theirlives with dissatisfaction

and feelunhappy, depressed, or angry overwhat they have done or failed to do.SOCIOLOGIC AL AGING THEORIES

DISENGAGEM

ENT THEORY Introduced by Cummings and Henry the appropriate pattern of behavior inlater life is for the older

person toengage in a mutual and reciprocalwithdra wal. Thus, when death occurs,neither the older individual nor thesociety is

disadvantaged and socialequilibrium is maintained

ACTIVITY THEORY contradicts the disengagement

theory;older adults should stay active and engaged if they are to agesuccessfully. When retirement occurs,replaceme nt activities must

be found.

CONTINUITY THEORY successful aging involves maintainingor continuing previous values,

habits,preference s, family ties, and all otherlinkages that have formed the basicunderlying structure of adult life. Older age is not

viewed as a time thatshould trigger major life readjustment,but rather just a time to continuebeing the same person.

AGE STRATIFICAT ION THEORY Physical impairment is associated withfewer social contacts, less socialsupport,

depression and lower lifesatisfaction Changing status of older adults due todifferences in cohort groups

PERSON-

ENVIRONMEN T-FIT THEORY Functional competence is affected bymultiple intrapersonal conditions

suchas ego, strength, motor skills, biologichealth, cognitive capacity, sensoriperceptual capacity as well as

externalcondition s posed by the environmentNUR SING THEORIES OF AGING

Functional consequence s theory


o

Environment & biopsychosocialc onsequences impactfunctioning


o

Nursing role is risk reduction tominimize ageassociateddisabili ty in order to

enhancesafety & quality of living

Theory of thriving
o

Failure to thrive results fromdiscord between the

individualand his or her environment orrelationships


o

Nurses identify and modifyfactors that contribute todisharmony among

theseelemnts. TH E AGING POPULATION


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About 1/8 Americans is aged 65 andolder

in 2005. In the Philippines 14.1% is aged 65and older Changes in life expectancy weremainly due to improved sanitation

andadvances in medical care Older population today are challengedin dealing with chronic diseasesEFFECT S OF ETHNICITY

Aging population comprises 22% of the minority Losses (spouse, friends,independ ence, levels of function,status in society) coupled with

socioeconomic status & racialdiscriminati on put these group atincreased risk for poor healthoutcomes. MORTALITY &

MORBIDITY In 2001 the leading cause of deathwas


o

Diseases of the heart


o

Malignant neoplasms

CVA
o

Chronic Lower Respiratorydisea ses


o

Influenza
o

Pneumonia
o

DiabetesAGING

CHANGES THAT AFFECT COMUNICATION The ability to communicate dependson


o

Physiological Process

Listening, Speaking,Gestur es, Reading,Writing, Touching,Moving.


o

Psychological Process Cognitive

process(attention , memory, selfawareness, oranization &reasoning)SEN SORY MODALITIES INVOLVED INCOMMUNICAT

ION Vision
o

70% of all sensory informationcomes from the eyes


o

Gestures and non

verbalbehavior (blink, tears smile) Hearing


o

Reception of communication
o

Physical properties (Pitch

& Timber) Other


o

Touch may be used assubstitute for sight


o

Chemical senses of smell(ofaction)


o

Movement/Gestu resSPEECH Primary form of communication Requires both visual & auditory Involves pronunciation &

articulationfor form a languageDISABI LITY Results in modifying their style incommunication to othersROLE

OF THE BRAIN IN COMMUNICATI ON ORGANIZE INFORMATION RESPOND TO CHANGE

RECOGNIZES COMPLETE ORAMBIGUOUS INFORMATIONA GE RELATED CHANGES IN THE EYE LENS


o

Changes in color with age(amber or opaque)


o

Becomes flattened and lessflexible


o

Inability to focus and seecertain

colorsAGE RELATED CHANGES IN THE EYE IRIS & PUPILS


o

At 50 pupillary reflex respondmove

slowly
o

Senile miosis (size of the pupildeclines)


o

Difficult to see illuminationAREA S OF THE BRAIN

IMPORTANT FORCOMMUNIC ATION Cortex


o

Large sheet of neurons thatcovers the brain


o

Contains sensory ,motorinformation & thoughts Thalamus


o

Relays sensation to the brain Forebrain


o

Interprets &

integrates sensoryinformatio n based on pastexperiences NORMAL & PATHOLOGICAL CHANGES & THEIRIMPACT IN

COMMUNICATI ON
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What is Chronic Illness An illness that persists for a long period of time (3

months or more) The term "chronic" comes from the Greekchronos. In ancient Greece, the "father of medicine" Hippocrates

distinguisheddise ases that were acute (abrupt, sharpand brief) from those that were chronic. In medicine, a chronic disease is adisease that

is long-lasting or recurrent. The term chronic describes the course of the disease, or its rate of onset and
MODALITY NormalChangesPat hologicalChangesI

mpact onCommunication VISION Changes in lenspupil & iris.Results in poorvisual acuity,presbyopiaincrea sesensitivity tolight and glareMaculardegenerati onDiabeticretinopathyGl aucomaSenile cataractsRetinaldetach mentsIsolation,Insecurit

y,Depression,Embarras smentDecrease inexchange of communication MODALITY NormalChangesPat hologicalChangesI mpact onCommunication HEARING ConductiveproblemsSe nsorineuralproblems(Pr

esbycusis)results in lossin sensitivityto pitch withhighfrequencyconso nants,poor wordrecognitionHearing lossdue toexposure tonoise,ototoxicsubstan ces,medications,poison s,acute trauma& certainmedicalcondition sInatention,repetitivequ estions,isolation,insecuri ty,decrease

insocialfunctioning,depr ession ,loneliness,difficulties infollowinginstructions MODALITY Normal ChangesPathologic alChangesImpact onCommunication SPEECH&LANGUAGE DecreaserespirationOve rproductionof mucus/red ucedsaliva Loss of teeth

Decreaseelasticity of muscle toneResults inshaky &breathy voice,tremulous &frequentattempts of throat clearingDysarthia (CVA)Verbal apraxia(paraysis of speechmuscles)Aphasia COPDMechanicalventila tionLaryngectomyDifficu lties

inproducingLanguage,c oherentmeaningful &verbalcommunicationD ifficulty inunderstandingverbalc ommunication MODALITY Normal ChangesPathologic alChangesImpact onCommunicationC OGNITIVEDecline ininformationproce

ssingspeed, dividedattention,s ustainedattention abilityto performvisuospati altask and shortterm memoryDeliriumD ementiaAlzheimer sDiseaseDependin g oncognitiveimpair

ment,Disorientatio n &inappropriateres ponse,difficulties infinding words,depression, loss of insight, isolation,inability to earnnew information MODALITY

NormalChangesPat hological ChangesImpact onCommunication MOVEMENT Due to declinein manysensoryorgan s,cognitivefunction ing &bodilystrengthres ults inreducedvelocity

andaccuracy &greatervariability acrossindividualsP arkinsonsdiseaseD isabilityReduced ability tocommunicatenon verbalinformation,i nsecurity & lossof independenceMOD ALITY NormalChan gesPathologicalCh

angesImpact onCommunicationT OUCH Reduction inthe no of receptorsReduct ion of bloodflowResult s in areduction intactile &vibrationsensatio ns,decreasedsensit ivity towarm &

coldstimuliDement ia,Parkinsons orDiabetes canimpactsomatos ensoryfunctioning Use of mouth toexplore thequality of theobjects safetymight becompromisedMO DALITY

NormalChangesPat hological ChangesImpact onCommunicationP SYCHOLOGICALIn general,older adultsreports levelsof satisfactio nthat aresimilar toyoungeradultsDe pression Slowed responselack of

motivationdecreas e in socialactivity
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