Elderly Nursing Care Plan with Impaired Physical Mobility and Activity Intolerance

Elderly Nursing Care Plan with Impaired Physical Mobility and Activity Intolerance

Nursing Care Plan   October 03, 2013

Mobility is the movement that gave freedom and independence for someone. Although the type of activity changed throughout human life, mobility is central to participate in and enjoy life. Maintaining mobility is critical for optimal mental and physical health of all elderly.

Immobility is broadly defined as the level of activity that is less than optimal mobility. Immobility, activity intolerance, and sindromdissue often occurs in the elderly. Barriers to physical mobility nursing diagnosis, potential disuse syndrome, and activity intolerance gives a broader definition of immobility.

Onset of immobility or intolerance activity for most people does not occur suddenly, moving from full mobility to physical dependence or total inactivity, but rather develop slowly and unnoticed. Interventions directed toward the prevention of the consequences of immobility and inactivity may decrease the speed of the decline.


Impaired Physical Mobility

Definitions:

A state of the limited ability of independent physical movement experienced by a person. (Carroll-johnson. 1988)

Immobilization is the inability of a person to move his own body. Immobilization said to be the main risk factor in the emergence of decubitus wound either in the hospital or in the community. This condition can increase the time an emphasis on skin tissue, and subsequently lead to lower circulation decubitus sores. Immobilization in addition to directly affecting the skin, also affects several organs. For example, the cardiovascular system, peripheral blood circulation disorders, respiratory system, reduce lung movement to take oxygen from the air (lung expansion) and result in decreased oxygen intake to the body. (Lindgren et al. 2004)

Defining characteristics

1. Inability to move with purpose in the environment, including mobility in bed, move and ambulate
2. Reluctance to move
3. Limitation of range of motion
4. Decrease the power, control, or muscle mass
5. Experienced restrictions on movement, including protocols and medical mechanical
6. Impaired coordination

Related factors

1. Activity intolerance
2. Decreased strength and endurance
3. Pain and discomfort
4. Perceptual or cognitive disorders
5. Neuromuscular disorders
6. Depression
7. Severe anxiety

Activity Intolerance

Definitions:

A state of energy insufficiency in physiological or psychological on a person to survive or complete daily activities necessary or desirable. (Carroll-johnson. 1988)

Defining characteristics

1. Verbal report of fatigue or weakness
2. Heart rate or blood pressure is not normal to the activity
3. Discomfort: Dyspnea after activity
4. Electrocardiographic changes indicating the presence of dysrhythmias or ischemia

Related factors

1. Bed rest and immobility
2. General weakness
3. Sedentary lifestyle
4. Imbalance between oxygen supply and requirement

 Internal Factors

Internal factors that cause or contribute to immobility .
1 . Decrease in musculoskeletal function :
Muscles ( atrophy , dystrophy , or injury ) , bone ( infection , fracture , tumors , osteoporosis , or osteomastia ) , joints ( arthritis and tumors ) , or a combination of the structure ( and cancer drugs ) .

2 . Changes in neurologic function :
Infection (eg, encephalitis ) , tumor , trauma , drugs , vascular disease ( eg, stroke ) , degenerative diseases ( eg, Parkinson's disease ) , demyelinating disease ( eg, multiple sclerosis ) , exposure to toxic products ( eg, carbon monoxide ) , metabolic disorders ( eg, hypoglycemia ) , or nutritional deficiencies .

3 . Pain :
Multiple and varied as the causes of chronic diseases and trauma .

4 . Perceptual deficits :
Excess or shortage of input sensory perception

5 . Reduced cognitive abilities : Disruption

6 . Fall :
Physical effects : injury or invoice
Psychological effects : syndrome after fall

7 . Changes in social relations
Actual factors ; ( eg, loss of a spouse , moving away from family or friends )
Perceptual factors ( eg, change of mindset as depression )

8 . Psychological aspects : helplessness in learning , depression .


External Factors

External factors that contribute to immobility:
1. Therapeutic program
2. Characteristics institutional residents
3. Characteristics of staff
4. Nursing care delivery systems
5. Barriers
6. Institutional policies


Management

1. Primary Prevention
Primary prevention is a process that lasts throughout life and episodic. As an ongoing process throughout life, moblilitas and activity depends on the function of the musculoskeletal system, cardiovascular, pulmonary. As an episodic process of primary prevention aimed at preventing the problems that can arise due to imoblitas or inactivity.

2. Secondary prevention

Downward spiral, which occurs due to an acute exacerbation of immobility can be reduced or prevented by nursing interventions. The success of the intervention comes from an understanding of the various factors that cause or contribute to immobility and aging. Secondary prevention focuses on maintenance of function and prevention of complications. Nursing diagnosis related to secondary prevention is impaired physical mobility.

Nursing Care Plan for Elderly with (Acute / Chronic) Gastritis

Nursing Care Plan for Elderly with (Acute / Chronic) Gastritis

Nursing Care Plan   September 21, 2013

Gastritis is a common disease in the community, but once the disease is often underestimated and overlooked by the sufferer. In fact, gastritis disease can not be underestimated. Gastritis is a digestive disease of the stomach are caused by excessive stomach acid production. This resulted imflamasi or inflammation of the gastric mucosa. Sufferers feel will feel sore stomach and heartburn in the area around the solar plexus. If this is allowed and ignored protracted it will lead to erosion of the gastric mucosa. In some cases, gastritis can lead to ulcers in the stomach and an increase in stomach cancer.

Gastritis (dyspepsia / heartburn) is a disease caused by excess stomach acid or stomach acid resulting in increased inflammation of the gastric mucosa such as cut, or pain in the gut. Symptoms occurred, ie, the stomach was sore and heartburn. Mechanisms of gastric damage caused by an imbalance of digestive factors such as gastric acid and pepsin to the production of mucus bicarbonate blood flow.

There are two types of gastritis are:

Acute Gastritis

Acute Gatritis (inflammation of the gastric mucosa) is most often caused by faulty diet, eg. eating too much, too fast, eating too much food seasoning, or infected food. Other causes include alcohol, aspirin, bile reflux or radiation therapy. Gastritis can also be the first sign of acute systemic infection. Form a more severe acute gastritis caused by strong acid or alkali which can lead to gangrene or perforation of the mucosa.

Chronic Gastritis

Prolonged gastric inflammation caused by benign and malignant gastric ulcers or bacteria Helicobacter pylori. These bacteria colonize the place with the concentrated gastric acid. Chronic gastritis is classified as type A or type B. Type A disease associated with autoimunmis, pernicious anemia. Type A occurs in gastric fundus or corpus. Type B (H. pylori) on the antrum and pylorus. Associated with H. pylori. dietary factors like-iminum heat, seasoning, use of drugs, alcohol, smoking, or refluksisi intestine into the stomach.


Etiology

• Gastritis is an inflammation of the gastric mucosa.
• Acute erosive gastritis: irritants that can heal itself caused by irritants (eg, NSAIDs, alcohol), severe physiological stress (eg, major surgery, burns, ventilator), or local trauma (eg NG tube).
• A type of chronic gastritis: inflammation of the proximal stomach as a result of pernicious anemia, atrophic gastritis, aclorhidria, autoimmune disorders, or radiation.
• Type B chronic gastritis: inflammation of the distal stomach or antrum as a result of Helicobacter pylori infection.
• Reflux gastritis: inflammation as a result of the bile and pancreatic lymph in the secondary hull as a result there is no pyloric or pyloric are nonfunctional (eg after partial gastrectomy).
• Hemorrhagic gastritis: gastritis with significant inflammation as a reaction to severe stress (eg ICU patients, hypoxia, ischemia, uremia).

Clinical Manifestations

• Epigastric pain or burning in bad taste that gain weight by eating.
• Dyspepsia
• Anorexia
• Nausea / vomiting
• Bleeding can occur resulting in hematemesis, melena.

Acute Gastritis

• Superficial ulceration may occur and lead to hemorrhage.
• Discomfort in the abdomen with headache, lethargy, nausea, and anorexia. Possible vomiting and hiccups.
• Some patients showed asymptomatic.
• Colic and diarrhea can occur if foods that irritate not vomited but instead reaches the intestine.
• Patients usually recover about a day, although the appetite may be lost for 2 to 3 days.

Chronic Gastritis

• Gastritis type A: essentially asymptomatic except for the symptoms of vitamin B12 deficiency.
• Gastritis type B: patients complain of anorexia, heartburn after eating, belching, a sour taste in the mouth or nausea and vomiting.

Treatment

Treatment of gastritis in general is to eliminate the main factor etiology, gastric diet with small portions and often, as well as drugs. However, the specifics can be distinguished as follows:

Acute Gastritis

1. Reduce drinking alcohol and eating regular and healthy until the symptoms disappear; transformed into a diet that does not irritate.
2. If symptoms persist, IV fluids may be required.
3. If gastritis caused by ingesting strong acidic or alkaline, dilute and neutralize the acid with common antacids, such as aluminum hydroxide, H2 receptor antagonists, proton pump inhibitors, anticholinergics and sucralfate.
4. If gastritis caused by ingesting a strong base, use citrus juice or vinegar diluted in dilute.
5. If severe corrosion, avoid emetic and rinse the stomach because of the danger of perforation.
6. Antacids: Antacids are drugs that can be liquid or tablet form and is a common drug used to treat mild gastritis. Antacids neutralize stomach acid and can relieve pain caused by stomach acid quickly.
7. Acid inhibitors: When antacids are no longer able to cope with the pain, the doctor may recommend medications.

Chronic Gastritis

1. Diet modification, stress reduction, and pharmacotherapy.
2. Cytoprotective agents: Drugs of this class helps to protect the tissues that line the stomach and small intestine.
3. Proton pump inhibitors: A more effective way to reduce stomach acid is to close the "pumps" within acid-producing cells of the stomach acid. Proton pump inhibitors reduce acid by covering the work of the "pumps" it.
4. H. pylori may be treated with antibiotics. There are several regimens in overcoming the infection of H. pylori. The most commonly used is a combination of antibiotics and proton pump inhibitors. Sometimes also added bismuth subsalycilate. Antibiotics used to kill bacteria, proton pump inhibitor works to relieve pain, nausea, heals inflammation and improve the effectiveness of antibiotics. Treatment of infection of H. pylori is not always successful, the speed to kill H. pylori is extremely diverse, depending on the regimen used. However, a combination of three drugs seem more effective than a combination of two drugs. Therapy in the long term (for 2 weeks of therapy compared with 10 days) also seem to increase effectiveness. To ensure H. pylori is gone, it can be re-examined after the treatment carried out. Respiratory examination and stool examination were two types of checks are often used to ensure the absence of H. pylori. Blood tests will show positive results for several months or even more despite the fact that the bacteria is gone.

Geriatric Nursing - Alzheimer's Disease Assessment

Geriatric Nursing - Alzheimer's Disease Assessment

Nursing Assessment   September 17, 2013

Assessment in Alzheimer's disease

1 . Activity / rest
Symptoms : Feeling tired
Signs : Day / night restless , helpless , disruption of sleep patterns
lethargy : decreased interest or concern in usual activities , hobbies , inability restates what is read / follow event television programs .
Motor skills disorder , inability to do normal things that have been done , the movement is very useful .

2 . Circulation
Symptoms: History of cerebral vascular disease / systemic . hypertension , embolic episodes ( a predisposing factor ) .

3 . Ego integrity
Symptoms : Suspicious or fear of the situation / person fantasies , misperceptions about the environment , identification of objects and faults of people , hoarding objects : objects that one believes that placement has been stolen , lost multiple , changes in body image and self-esteem perceived .
Signs : Hiding disability ( many reasons are unable to perform an obligation , it may also open the hand without reading the book yet ) , sit and watch the others , the first activity may accumulate objects are not moving and emotionally stable , repetitive movements ( folded unfolded folded cloth ) , hide stuff , or take a walk .

4 . Elimination
Symptoms : Encouragement urination
Signs : Incontinence of urine / feaces , tend to constipation .

5 . Food / fluid
Symptoms : History of hypoglycemia episodes ( a predisposing factor ) changes in taste , appetite , weight loss , denying the hunger / need to eat .
Symptoms: Loss of ability to chew , avoiding / refusing to eat ( probably trying to hide skill ) . and looking increasingly thin ( advanced stage ) .

6. Hiygene
Symptoms: Need help / dependent people
Signs: not able to maintain the appearance, personal habits are lacking, poor cleaning habits, forgetting to go to the bathroom, forget the steps for waste water, unable to find a bathroom, and less interested in or have forgotten at meal time: dependent on others for over the kitchen to cook and prepare food, eat, use cutlery.

7. Neuro-sensory
Symptoms: The denial of the presenting symptoms, especially cognitive changes, and blurred or picture, hypochondria complaints about fatigue, dizziness or headache sometimes. Complaints in cognitive abilities, decision-making, given the pass, drop behavior (observed by nearby). Loss of sensation of proprioception (body position or a certain part of the body in space), and a history of cerebral vascular disease / systemic embolism or hypoxia that lasted periodically (as a predisposing factor) as well as seizure activity (secondary to the brain damage).
Symptoms: Damage communication: aphasia and dysphasia; difficulty in finding the right words (especially nouns); asked repeatedly or conversations with the substance of the word that has no meaning; fragmented, or speech not audible. Lose the ability to read and write stages (loss of fine motor skills).

8. Comfort
Symptoms: A history of serious head trauma (may be a predisposing factor or acceleration factor), traumatic accidents (falls, burns, and so on).
Sign: ecchymoses, lacerations and hostile / attack others.

9. Social interaction
Symptoms: Feeling lost power. psychosocial factors previously; influence of personal and individual that appears to change patterns of behavior that emerge.
Symptoms: Loss of social control, the behavior was not appropriate.

Mental Health Nursing Care for the Elderly

Mental Health Nursing Care for the Elderly

Nursing   April 29, 2013

Every year the definition of elderly changes, but maybe its fair to talk about the age of 65 as being the start of elderly. While this definition is somewhat arbitrary, it is many times associated with the age at which one can begin to receive pension benefits. At the moment, there is no United Nations standard numerical criterion, but the UN agreed cutoff is 60+ years to refer to the older population.

Elderly mental health care is an important issue that affects almost one in every five American adults who are in fact known to be affected by some form of mental illness or the other. These mental illnesses include suffering from dementia and psychosis, delirium as well as depression and schizophrenia.

Elderly mental health care today suffers from many lacunae and among these lacunae is the fact the majority of elders suffering from mental ailments shirk from getting them treated. It is commonly found that such elders will suffer their condition in silence and are ready to put up with many discomforts rather than face the stigma of being known as being mentally disturbed.

In today's day and age a worrying aspect to dealing with elderly health care needs is the fact that the cause of death in the twentieth century is radically different than what was common in the previous century. In the nineteenth century deaths were caused by acute as well as infectious ailments, though in these modern times the main killers are chronic as well as degenerative ailments of old age.

In most cases, mental health problems in elders that require treatment are quite conveniently ignored. Improper treatment of mental illnesses in elders seems to the most prominent reason contributing to high suicidal rate in these people. Many of these people require specialized mental health services.

There are several reasons that contribute to improper mental health services to the elderly :

1. In most cases, elders are reluctant to undergo treatment for their mental health disorder. They continue to harbor their minds with discomfort and stigmas, thereby showing resistance to leaving their homes and going to a rehabilitation center or a clinic.

2. Our society has never shown respect or dignity for individuals suffering from mental health problems. Even a mental health professional is apprehensive about an elderly person with such condition. Beliefs and attitudes of these professionals do have a significant influence on the quality of medical care provided to the patients.

3. Medical negligence is another big hurdle. In many situations, symptoms of mental health diseases are just written off as indicators of ageing.