Geriatric Lecture Assignment

Chronic diseases of older person

NAME: Frances Dianne G. Mercado

SEC: BSN 4
DATE: November 11 2020

1.Explain the pathophysiology and rationale for nursing diagnoses related to:
1. Physiologic functioning RT to respiration.
- In physiology, respiration is the movement of oxygen from the outside environment to
the cells within tissues, and the transport of carbon dioxide in the opposite direction.
- Nursing Diagnosis: Ineffective Airway Clearance, Impaired Gas Exchange,
Ineffective Breathing Pattern

2. Cardiac output and circulation

- Cardiac output (CO) is the amount of blood pumped by the heart minute and is the
mechanism whereby blood flows around the body, especially providing blood flow to
the brain and other vital organs. The body’s demand for oxygen changes, such as
during exercise, and the cardiac output is altered by modulating both heart rate (HR)
and stroke volume (SV)
- Nursing Diagnosis: Decreased Cardiac Output, Activity Intolerance, Excess Fluid
Volume,,Ineffective Tissue Perfusion

3. Peripheral tissue perfusion

- Tissue perfusion is crucial for organ functions such as the formation of urine, muscle
contraction, and exchange of oxygen and carbon dioxide. Blood is a connective
tissue comprised of a liquid extracellular matrix termed as blood plasma which
dissolves and suspends multiple cells and cell fragments. It carries oxygen from
the lungs and nutrients from the gastrointestinal tract. The oxygen and nutrients
 subsequently diffuse from the blood into the interstitial fluid and then into the body
cells. Insufficient arterial blood flow causes decreased nutrition and oxygenation at
the cellular level. Decreased tissue perfusion can be temporary, with few or minimal
consequences to the health of the patient, or it can be more acute or protracted, with
potentially destructive effects on the patient. When diminished tissue perfusion
becomes chronic, it can result in tissue or organ damage or death.
- Nursing diagnosis: Ineffective Tissue perfusion

4. Fluid and electrolyte imbalance

- Electrolytes are minerals in your body that have an electric charge. They are in your
blood, urine, tissues, and other body fluids. Electrolytes are important because they
help, balance the amount of water in your body, balance your body's acid/base (pH)
level, move nutrients into your cells, ,ove wastes out of your cells, make sure that
your nerves, muscles, the heart, and the brain work the way they should.
- Nursing Diagnosis: Excess Fluid Volume (Hypervolemia), Deficient Fluid Volume
(Hypovolemia)

5. Neurologic functioning
- Functional neurological disorder (FND) is a medical condition in which there is a
problem with the functioning of the nervous system and how the brain and body
sends and/or receives signals, rather than a structural disease process such as
multiple sclerosis or stroke.
- Nursing Diagnosis: Impaired physical mobility related to hemiparesis, loss of balance
and coordination, spasticity, and brain injury, Acute pain (painful shoulder) related to
hemiplegia and disuse, Self-care deficits (bathing, hygiene, toileting, dressing,
grooming, and feeding) related to stroke sequelae, Disturbed sensory perception
related to altered sensory reception, transmission, and/or integration

6. Movement elimination
- Defecation is the term given for the act of expelling feces from the digestive tract via
the anus. It is a complex function that requires coordinated involvement from
the gastrointestinal system, the nervous system, as well as the musculoskeletal
system.
- Nursing Diagnosis: Altered Bowel Elimination

7. Protective mechanism of skin

- The skin acts as an external barrier to bacteria, preventing infection
and protecting the internal organs. The skin also protects the body from ultraviolet
radiation using the pigment barrier formed from melanocyte cells found in the top of
the papillary dermis and a protein layer found in the epidermis.
- Nursing Diagnosis: Impaired Tissue Integrity

8. Chronic illness i.e heart disease

- . In heart failure, the heart may not provide tissues with adequate blood for metabolic
needs, and cardiac-related elevation of pulmonary or systemic venous pressures may
result in organ congestion
- Nursing Diagnosis: Decreased Cardiac Output ,Activity Intolerance, Excess Fluid
Volume, Risk for Impaired Gas Exchange, Risk for Impaired Skin Integrity, Deficient
Knowledge, Acute Pain, Ineffective Tissue Perfusion

9. Hypertension
- Increased systemic vascular resistance, increased vascular stiffness, and increased
vascular responsiveness to stimuli are central to the pathophysiology of hypertension.
- Nursing Diagnosis: Risk for Decreased Cardiac Output, Activity Intolerance, Acute
Pain, Ineffective Coping

10. diabetes
- Diabetes mellitus (DM) is a chronic disease characterized by insufficient production
of insulin in the pancreas or when the body cannot efficiently use the insulin it produces.
This leads to an increased concentration of glucose in the bloodstream (hyperglycemia).
It is characterized by disturbances in carbohydrate, protein, and fat metabolism.
Sustained hyperglycemia has been shown to affect almost all tissues in the body and is
associated with significant complications of multiple organ systems, including the
eyes, nerves, kidneys, and blood vessels.
- Nursing Diagnosis: Risk for Unstable Blood Glucose, Deficient Knowledge, Risk for
Infection, Risk for Disturbed Sensory Perception, Powerlessness, Risk for Ineffective
Therapeutic Regimen Management, Risk for Injury Imbalanced Nutrition: Less Than
Body Requirements

11. chronic obstructive pulmonary disease

- Chronic Obstructive Pulmonary Disease (COPD) is a condition of chronic dyspnea
with expiratory airflow limitation that does not significantly fluctuate. For people
with COPD, this starts with damage to the airways and tiny air sacs in the lungs.
Symptoms progress from a cough with mucus to difficulty breathing. The damage done
by COPD can't be undone.
- Nursing Diagnosis: Impaired gas exchange, Ineffective airway clearance, Ineffective
breathing pattern

12. Cancer
- Cancer is a disease caused when cells divide uncontrollably and spread into
surrounding tissues. Cancer is caused by changes to DNA. Most cancer-causing DNA
changes occur in sections of DNA called genes. These changes are also called genetic
changes.
- Nursing Diagnosis: Anticipatory Grieving, Situational Low Self-Esteem, Acute Pain,
Altered Nutrition: Less Than Body Requirements, Risk for Fluid Volume Deficit, Fatigue,
Risk for Infection, Risk for Altered Oral Mucous Membranes, Risk for Impaired Skin
Integrity
 13. Arthritis
- In rheumatoid arthritis, the body's immune system attacks the lining of the joint
capsule, a tough membrane that encloses all the joint parts. This lining (synovial
membrane) becomes inflamed and swollen. The disease process can eventually
destroy cartilage and bone within the joint.
- Nursing Diagnosis: Acute Pain, Impaired Physical Mobility, Disturbed Body Image Self-
Care, Deficit Risk for Impaired Home Maintenance, Deficient Knowledge

14. Dementia
- Dementia is a symptom of a variety of specific structural brain diseases as well as
several system degenerations. Alzheimer's disease presently is the commonest cause
in the developed world, causing a cortical-subcortical degeneration of ascending
cholinergic neurons and large pyramidal cells in the cerebral cortex.
- Nursing Diagnosis: Disturbed Thought Process, Chronic Confusion, Impaired Verbal
Communication, Self-Care Deficit: Bathing/Hygiene, Self-Care Deficit: Dressing and
Grooming, Physical Mobility, Disturbed Sleep Pattern

15. Stroke
- A stroke happens when there is a loss of blood flow to part of the brain. Your brain
cells cannot get the oxygen and nutrients they need from blood, and they start to die
within a few minutes. This can cause lasting brain damage, long-term disability, or even
death. The primary pathophysiology of stoke is an underlying heart or blood vessel
disease. The secondary manifestations in the brain are the result of one or more of
these underlying diseases or risk factors. The primary pathologies include hypertension,
atherosclerosis leading to coronary artery disease, dyslipidemia, heart disease, and
hyperlipidemia. The two types of stroke that result from these disease states are
ischemic and hemorrhagic strokes.
- Nursing Diagnosis: Ineffective Cerebral Tissue Perfusion, Impaired Physical Mobility,
Impaired Verbal Communication, Disturbed Sensory Perception, Ineffective Coping,
Self-Care Deficit, Risk for Impaired Swallowing

16. Behavioral: powerlessness, grieving and bereavement, spirituality, preparation

for death and dying.
- Grief and loss is something that all people will experience in their lifetime. The loss
may be actual or perceived and is the absence of something that was valued. An actual
loss is recognized and verified by others while others cannot verify a perceived loss.
Both are real to the individual who has experienced the loss. Grief is the internal part of
the loss; it is the emotional feelings related to the loss. Nurses may experience this
personally, or they may be the support system for patients and their families going
through grief and loss. There are normal stages of grief that people experience;
however, every person’s experience is individual. The feelings of loss are commonly
associated with the death of a loved one, but they can be experienced for a number of
reasons. People may experience grief and feelings of loss about a significant change
such as the loss of a job, loss of function, loss of a limb, loss of a pet, the feeling of loss
of control, and loss of loved ones. It is the nurse’s role to provide compassionate care to
the patient and loved ones, and this care will be different from person-to-person. It is
also important for the nurse to maintain emotional resiliency, so they are able to provide
the best care for those experiencing grief.

17. Safety needs: physical, environment

- Safety and Infection Control – protecting clients and health care personnel from health
and environmental hazards. Related content includes, but is not limited to: Accident/
Error/Injury Prevention, Emergency Response Plan, Safe Use of Equipment Security,
Plan Ergonomic Principles, Standard Precautions/Transmission-Based Precautions/
Surgical Asepsis Handling Hazardous, and Infectious Materials Home Safety, Reporting
of Incident/Event/Irregular Occurrence/Variance, Use of Restraints/Safety Devices
Discusses the appropriate nursing intervention for

A.Wellness
1. Nutrition support
- For nutrition support, the client must visit the physician to determine his/her health
status. If a diagnosis has been identified then the nurse will conduct health teaching
with collaboration with the nutritionist on emphasizing what diet should the client
comply. The nurse can discuss alternatives with the physician’s order on how to get
enough nourishment for the required daily intake.

2. Activity and exercise ( e.g. tai chi, walking)

- The nurse should collaborate one activity and exercises that the client can perform
within her limity\s (if there are any) Ideally, an individual should do 30minutes of
exercise daily and there are many exercises that a person can do, the most basic and
easiest would be walking 1-3 kilometers a day. If a person is a a younger client, he or
she may increase workout intensity by running or doing sports. If a client complains that
he or she finds cardio exercise is boring, you may suggest and refer them to Zumba
sessions since these exercise seem fun and distracts the idea that the client is actually
exercising. The nurse must also emphasize that consistency is key when it comes to
exercising.

3. Stress management and relaxation (therapeutic massage)

- Therapeutic massage incorporates a variety of advanced modalities that enhance the
body's natural restorative functioning. Light to firm touch is used to release tension,
relax muscles, increase blood and lymph circulation, and impart a sense of calm. In this
concept, the nurse may conduct health teaching
B. PHYSIOLOGIC FUNCTIONING:
1. Respiratory management (pneumonia, COPD)
- Once the infection gets into the lungs, inflammation causes air sacs, called alveoli, to
fill up with fluid or pus. This can lead to trouble breathing, coughing, and coughing up
yellow or brown mucus. Breathing may feel more difficult or shallow. You may
experience chest pain when you take a deeper breath.

2. Cardiac output / tissue perfusion

- The cardiac output is also one of the determinants of the amount of oxygen delivered
from the lungs to the body’s tissues. Doubling the cardiac output doubles the oxygen
delivered to the tissues. If cardiac output falls the oxygen delivered to organs like the
brain may be inadequate and cause low levels of cellular oxygenation (hypoxia) which
can cause tissue and organ failure.
3. Fluid and electrolytes management (diarrhea, dehydration)
- Drinking plenty of water and other electrolyte balanced fluids Make sure to hydrate
throughout day. Your body loses water each time you have diarrhea. If the client is
unable to drink, he or she must have an intravenous therapy as ordered by the
doctor. The patient is losing minerals so he or she must also consume mineral rich
foods such as sodium and potassium.

4. Neurologic management (stroke, dementia)

- Different neurologic disorders require different management thus it is very important
for the nurse to take note of the diagnosis according to the physician. In general,
neurologic management emphasize on keeping the patient away from potential dangers
that could worsen the situation. Medications that are prescribed should administered
precisely and observe for the side effects to report the physician when necessary.
Lifestyle changes should also be initiated by the nurse through health teaching such as
eating food low in saturated fat, exercise and quitting smoke.
 5. Movement ( arthritis immobility)
- When arthritis becomes a disability causing immobility the nurse must support the
client by providing relief such self-managing osteoarthritis through physical activity,
weight loss and activity modification, you may need to consider seeing a specialist if
pain continues. Also, food intake plays a huge role for certain arthritis thus the nurse
must impart health teachings on diet to avoid high sodium foods and increase fluid
intake.

6. Elimination management (incontinence)

- some manangement include for incontinence are lifestyle changes – such as reducing
caffeine intake (including green tea), stopping smoking and losing weight. pelvic floor
muscle training – this technique strengthens the pelvic floor muscles and is an effective
treatment for stress incontinence, especially if the muscle has been damaged. bladder
training – bladder training involves learning techniques to increase the length of time
between feeling the need to urinate and passing urine. The course usually lasts for at
least six weeks and can be combined with the Kegel exercises. Some individuals may
find that timed toileting is helpful, particularly people with a learning disability or
cognitive impairment.

7. Skin and wound management

- Skin and wound management is very important to prevent infection that can worsen
the cut. The nurse must always ensure that the wound is free from microorganism by
keeping the site clean and dry with the use of antiseptic solution and gauze to protect it.
The nurse must apply the 5 principles of wound management such as Haemostasis,
Cleaning the wound, Analgesia if neccessary as ordered, skin closure, dressing and
follow-up advice.

C. BIOBEHAVIORAL management
1.Coping intervention for helplessness, powerlessness, hopelessness, sensory
deprivation, sleeplessness, bereavement
- In situations like this the nurse should be an advocate because health doesn't only
entail physical health but the whole being for a person. The nurse must encourage the
client to be independent with assistance if necessary. Behavior therapy teaches patients
how to reduce, control, or eliminate their maladaptive behaviors. Behavior therapy,
similar to cognitive therapy, differs from other forms of psychotherapy because the
methods have been experimentally tested and found to be effective. It teaches methods
and techniques on how to change rather than relying on pure awareness of underlying
problems. The nurse can impart health teachings on deep breathing, distract the client
by refocusing on other things and just provide support.

2. Spiritual care
- It is very important to identify the spiritual belief of the client and respect it regardless
of what it is. Spiritual care attends to a person's spiritual or religious needs as he or
she copes with illness, loss, grief or pain and can help him or her heal emotionally as
well as physically, rebuild relationships and regain a sense of spiritual wellbeing.
Spiritual care has positive effects on individuals' stress responses, spiritual well-
being.

3. Physical comfort promotion (hygiene, grooming)

- Physical comfort is the feeling of well being brought about by internal and
environmental conditions that are experienced as agreeable and associated with
contentment and satisfaction. The nurse should facilitiate physical comfort measures
such as taking a bath, cutting nails, combing hair, toothbrushing and changing
clothes as this will alleviate the patient’s condition to feeling better towards him or
herself despite the illness. This will also enhance the image of the client as an
individual.
 D. Safety, privacy and integrity
1.Physical safety
- The nurse must ensure the physical safety of the client especially in the
hospital making sure that the environment is free from hazards of falling, tripping and
sliding because these can only induce further medical problems. The presence of
healthy and well-rested nurses is critical to providing vigilant monitoring,
empathic patient care, and vigorous advocacy. Patient safety is an essential and vital
component of quality nursing care.

2. Managing the environment

- After identifying the hazards, the nurse can avoid these by simply raising side
rails to prevent falls. Ensuring that the floor is dry and informing the watcher to assist
the client is mobilizing especially when the nurse is not around. The nurse can also
encourage the significant other to secure a clean and quiet environment that is
conducive for rest to provide comfort for the client. Keeping the windows is also
important because having direct sunlight will bring good mood to the client most
especially if the client has been confined in the room.

E. Bioethical components of care

- The bioethical components of care are as follows: Autonomy: In medicine, autonomy
refers to the right of the patient to retain control over his or her body. A health care
professional can suggest or advise, but any actions that attempt to persuade or coerce
the patient into making a choice are violations of this principle. In the end, the patient
must be allowed to make his or her own decisions – whether or not the medical provider
believes these choices are in that patient’s best interests – independently and according
to his or her personal values and beliefs. Beneficence: This principle states that health
care providers must do all they can to benefit the patient in each situation. All
procedures and treatments recommended must be with the intention to do the most
good for the patient. To ensure beneficence, medical practitioners must develop and
maintain a high level of skill and knowledge, make sure that they are trained in the most
current and best medical practices, and must consider their patients’ individual
circumstances; what is good for one patient will not necessary benefit another. Non-
Maleficence: Non-maleficence is probably the best known of the four principles. In short,
it means, “to do no harm.” This principle is intended to be the end goal for all of a
practitioner’s decisions, and means that medical providers must consider whether other
people or society could be harmed by a decision made, even if it is made for the benefit
of an individual patient. Justice: The principle of justice states that there should be an
element of fairness in all medical decisions: fairness in decisions that burden and
benefit, as well as equal distribution of scarce resources and new treatments, and for
medical practitioners to uphold applicable laws and legislation when making choices.