ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
INTRODUCTION
Care of Older Person
•
•
•
•
•
•
•
•
•
Gerontology – is the study of the aging
process
Geriatrics – is the care of aging people.
Senescence – the normal aging process.
Aging is normal. Normal changes in the
body both in structure and function.
Psychological and social changes also
occur-we review these today.
Geriatric Nursing – care of the elderly
individual regardless of whether they are
diseased or not.
Senility – aging process characterized by
severe mental deterioration.
Life Span – maximum potential for
survival (115y/0).
Life Expectancy – from birth to death
(76.3 y/o).
Frail Old – above 76 y/o, functional
impairment to self-care.
Centenarians – 100 y/o and above.
Classifications of Aging
•
•
•
•
•
Middle Age – 40-60 y/o
Young Old – 61-70
Middle Old
Very Old
Old and above
Purpose of Nursing Care
-
Increase health-promoting behaviors in
the aged.
-
-
-
Minimize and compensate for healthrelated losses and impairments related
to aging.
Provide comfort and sustenance through
the distressing and debilitating events of
aging, including dying and death.
Facilitate the diagnosis, palliation and
treatment of disease in the aged.
Factors that Affect Gerontological Nursing
-
Characteristics of the recipients.
The environment
Knowledge and competencies of the
nurses.
Roles and standards for care.
Application of the nursing process to
care for the older adult.
Aging is not merely the passage of time.
It is the manifestation of biological
events that occur over a span of time.
It is important to recognize that people
age differently.
The aging body does change.
The Older Person
-
People live longer than ever before.
Retirement is the reward for a life time
of working.
Chronic illness is common in older
persons.
Disability often results.
Many have at least one disability.
_______________________________________________________________________________________
RDGRacho | NCM 3157
1
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Normal Aging has four Aspects
1. Biological aspect of aging
Changes are observed in:
- Skin
- Cardiovascular system
- Respiratory system
- Musculoskeletal system
- Gastrointestinal system
- Endocrine system
- Genitourinary system
- Immune system
- Nervous system
- Sensory system
2. Psychological Aspect of Aging
Memory functioning
-
-
-
Short-term memory seems to
deteriorate with age, but longterm memory does not show
similar changes.
Time required for memory
scanning is longer for both recent
and remote recall among older
people.
Mentally active people show less
memory decline than those who
are not mentally active.
Intellectual Functioning
-
-
-
Intellectual abilities of older
people do not decline but do
become obsolete.
The age of their formal
educational
experiences
is
reflected in their intelligence
scoring.
Learning ability.
-
Ability to learn continues
throughout
life,
although
strongly influenced by interests,
activity, motivation, health, and
experience. Adjustments do need
to be made in teaching
methodology and time allowed
for learning.
3. Sociocultural Aspect of Aging
- Changes in Social Roles
- Social Responses to Aging
- Negative Stereotype
- Negative Attitudes
- Positive Attitudes
- Negative Discrimination
- Positive Discrimination
4. Sexual Aspect of Aging
- Cultural stereotypes play a large
part in the misperception that
many people hold regarding
sexuality of older adults.
- Physical Changes Associated with
Sexuality.
- Changes in women:
• Decline in ovarian function.
• Reduced
production
of
estrogen.
• Vaginal dryness -Menopausal
symptoms (hot flashes, night
sweats,
sleeplessness,
irritability, mood swings,
migraine headaches, urinary
incontinence, weight gain).
_______________________________________________________________________________________
RDGRacho | NCM 3157
2
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
•
Some women choose to take
hormone
replacement
therapy
- Physical Changes Associated with
Sexuality.
- Changes in men:
•
•
•
•
•
•
Decline
in
testosterone
production.
Erectile dysfunction.
Decrease in testicular size.
Decrease in amount of
ejaculate.
Viable sperm are prod
uced well into old age.
_______________________________________________________________________________________
RDGRacho | NCM 3157
3
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
ASPECTS OF NORMAL AGING
Physical Changes
-
-
Physical changes occur with aging.
These happens to everyone.
The rate and degree of change vary with
each person. They depend on diet,
health, exercise, stress, environment,
heredity, and other factors.
Quality of life does not have to decline.
1. Integumentary System
- The skin loses its elasticity, strength, and
fatty tissue layer.
- Secretions from oil and sweat glands
decrease – don’t need baths as often.
- Blood vessels are fragile – bruise easily.
- Brown spots appear on sun-exposed
areas.
- Loss of the skin’s fatty tissue layers
affects the body.
- Dry skin causes itching and skin is easily
damaged – use mild soap and apply
lotion.
- Another changes that take place are that
the skin heals worse and are more
susceptible to the development of
diseases like cancer most leather, itching
and ulcers.
Rationale: The nurse has to watch and to
control the skin of the old patient.
Realizing the necessary valuations.
- The sebaceous glands diminish their size:
greater incidence of insulations in old.
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-
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Rationale: To get a suitable hydration. To
maintain a suitable temperature.
The reduction of collagen production. It
produces that the skin is less flexible
implying greater susceptibility to the tear
injuries.
Rationale: Valuation of the skin.
The reduction of the function of the
gland sudorípara, contributes to the
dryness of a skin, that is broken.
Rationale: To hydrate skin. These injuries
can become vestibules of entrance of
bacteria and cause to cutaneous injuries
majors.
Fragile blood vessels increase the risk
for:
• Skin breakdown
• Skin tears
• Pressure ulcers
• Bruising
• Delayed healing
You need to protect the person from
drafts and cold.
A shower or a bath twice a week is
enough.
Partial baths are taken at other times.
Lotions and creams prevent drying and
itching.
Nails become thick and tough.
Feet usually have poor circulation.
The skin has fewer nerve endings-less
able to feel pain.
White or gray is common.
Hair loss occurs in men.
_______________________________________________________________________________________
RDGRacho | NCM 3157
4
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
-
Hair thins on men and women.
Facial hair may occur in women.
creases with age.
Integumentary Changes Associated with Aging
PHYSIOLOGYC CHANGE
Decreased vascularity of dermis
Decreased amount of melanin
Decreased sebaceous and sweat gland function
Decreased subcutaneous fat
Decreased thickness of epidermis
Increased localized pigmentation
Increased capillary fragility
Decreased density of hair growth
Decreased rate of nail growth
decreased peripheral circulation
Increased androgen/estrogen ratio
-
Hair is drier from decreases in scalp oils.
Skin disorders in
RESULTS
Increased pallor in white skin
Decreased hair color (graying)
Increased dry skin; decreased perspiration
Increased wrinkling
Increased susceptibility to trauma
Increased incidence of brown spots (senile
lentigo)
Increased purple patches (senile purpura)
Decreased amount and thickness of hair on head
and body
Increased brittleness of nails
increased longitudinal ridges of nails; increased
thickening and yellowing of nails
Increased facial hair in women
Nursing Assessments and Care Strategies related to Integumentary Changes
NURSING ASSESSMENTS
NURSING ASSESSMENTS
Monitor skin temperature.
Monitor skin temperature.
Assess skin turgor over sternum or forehead, not Assess skin turgor over sternum or forehead, not
forearm. Check tongue for furrow.
forearm. Check tongue for furrow.
Assess for skin breakdown or changes in color or Assess for skin breakdown or changes in color or
pigmentation.
pigmentation.
Assess areas where skin surfaces touch and trap Assess areas where skin surfaces touch and trap
moisture (under breasts, adipose rolls, etc.). for moisture (under breasts, adipose rolls, etc.). for
signs of maceration or yeast infection.
signs of maceration or yeast infection.
Determine adequacy of hygiene and need for Determine adequacy of hygiene and need for
toenail trimming.
toenail trimming.
Musculoskeletal System
-
Muscle cells decrease in number.
Muscles atrophy (shrink) and decrease in strength.
• Bones lose minerals, especially calcium.
_______________________________________________________________________________________
RDGRacho | NCM 3157
5
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
-
Bones lose strength, become brittle, and break easily.
Vertebrae shorten.
Joints become stiff and painful.
Mobility decreases.
Activity, exercise, and diet help prevent bone loss and loss of muscle strength.
Musculoskeletal Changes Associated with Aging
PHYSIOLOGYC CHANGE
Decreased bone calcium
RESULTS
Increased osteoporosis; increased curvature of
the spine (kyphosis)
Decreased fluid in intervertebral disks
Decreased height
Decreased blood supply to muscles
Decreased muscle strength
Decreased blood supply to muscles
Decreased muscle strength
Decreased tissue elasticity
Decreased mobility and flexibility of ligaments
and tendons
Decreased muscle mass
Decreased mobility and flexibility; increased risk
for falls
Nursing Assessments and Care Strategies related to Musculoskeletal Changes
NURSING ASSESSMENTS
CARE STRATEGIES
Assess strength and functional mobility.
Provide assistance as needed, modify physical
environment, initiate safety precautions to
decrease risk for falls, encourage range of motion
(ROM) exercise, refer to physical or occupational
therapy.
Assess nutritional intake.
Educate regarding importance of calcium intake,
administer supplements as ordered.
Determine activity patterns.
Encourage regular low-impact exercise.
CHANGES WITH AGEING
CLINICAL CONSEQUENCES
- Reduces lung elasticity and alveolar
- Reduced vital capacity.
support.
- Increased residual volume.
- Increased chest wall rigidity.
- Reduced inspiratory reserve volume.
- Reduced cough and ciliary action.
- Increased risk of infection.
-
Atrophy of muscles
Tendons shrink and harden
Reduction in bone mineral and mass
_______________________________________________________________________________________
RDGRacho | NCM 3157
6
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
-
Loss of height
Joint activity and motion
Increased risk fractures
Respiratory System
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Respiratory muscles weaken. Lung tissue becomes less elastic.
The person may lack strength to cough and clear the airway of secretions.
_______________________________________________________________________________________
RDGRacho | NCM 3157
7
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Respiratory Changes Associated with Aging
PHYSIOLOGYC CHANGE
Decreased body fluids
RESULTS
Decreased ability to humidify air resulting in drier
mucous membranes
Decreased number of cilia
Decreased ability to trap debris
Decreased number of macrophages
Increased risk for respiratory infection
Decreased tissue elasticity in the alveoli and lower Decreased gas exchange; increased pooling of
lung lobes
secretions
Decreased muscle strength and endurance
Decreased ability to breathe deeply; diminished
strength of cough
Decreased number of capillaries
Increased rigidity of rib cage; decreased lung
capacity
Increased calcification of cartilage
Increased rigidity of rib cage; decreased lung
capacity
Nursing Assessments and Care Strategies related to Respiratory Changes
NURSING ASSESSMENTS
NURSING ASSESSMENTS
Assess breathing depth and effort.
Assess breathing depth and effort.
Assess cough and sputum production.
Assess cough and sputum production.
Assess for signs and symptoms of respiratory Assess for signs and symptoms of respiratory
infection.
infection.
-
Reduction of respiratory activity.
Increased rigidity of thoracic cage.
Kyphosis
Increased anterior-posterior diameter of chest.
Blurted cough reflex, reduced cilia.
Less lung expansion.
Circulatory System
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The heart muscle weakens. Arteries narrow and are less elastic.
Sometimes circulatory changes are severe.
• Rest is needed during the day.
• Overexertion is avoided.
_______________________________________________________________________________________
RDGRacho | NCM 3157
8
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Nursing Assessments and Care Strategies related to Cardiovascular Changes
PHYSIOLOGYC CHANGE
RESULTS
Decreased cardiac muscle tone.
Decreased tissue oxygenation related to
decreased cardiac output and reserve.
Increased heart size, left ventricular enlargement. Compensation for decreased muscle tone.
Decreased cardiac output.
Increased chance of heart failure; decreased
peripheral circulation.
Decreased elasticity of heart muscle and blood Decreased venous return; increased dependent
vessels.
edema; increased incidence of orthostatic
hypotension;
increased
varicosities
and
hemorrhoids.
Decreased pacemaker cells.
Heart rate 40 to 100 bpm; increased incidence of
ectopic or premature beats; increased risk for
conduction abnormalities.
Decreased baroreceptor sensitivity.
Decreased adaptation to changes in blood
pressure.
Increased incidence of valvular sclerosis.
Increased risk for heart murmurs.
Increased atherosclerosis.
Increased blood pressure, weaker peripheral
pulses.
CHANGES WITH AGEING
CLINICAL CONSEQUENCES
- Reduced maximum heart rate.
- Reduced exercise tolerance.
- Dilation of aorta.
- Widened aortic arch on X-ray.
- Reduced elasticity of conduit/capacitance
- Widened pulse pressures.
vessels.
- Increased risk of postural hypotension.
- Reduced number of pacing monocytes in
- Increased risk of atrial fibrillation.
SA node.
Nursing Assessments and Care Strategies related to Cardiovascular Changes
NURSING ASSESSMENTS
NURSING ASSESSMENTS
Assess apical and peripheral pulses.
Assess apical and peripheral pulses.
Assess blood pressure lying, sitting, and standing. Assess blood pressure lying, sitting, and standing.
Assess ability to tolerate activity.
Assess ability to tolerate activity.
The Hematopoietic and Lymphatic Systems
-
-
Body
fluids
distribute
essential
protective factors, nutrients, oxygen,
and electrolytes throughout the body.
The two major fluids of the body are:
• 1. Blood
• 2. Lymph
1. Blood
• Blood flows within the heart and
vessels of the cardiovascular
system.
• The general functions of blood:
_______________________________________________________________________________________
RDGRacho | NCM 3157
9
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
•
•
•
o transportation
of
nutrients
o waste products
o blood gases
o and hormones
o regulation
of
fluidelectrolyte balance
o acid-base balance
o and body temperature
o and protection against
pathogenic attack by the
WBCs
and
against
excessive blood loss
through
clotting
mechanisms.
Albumin, the most abundant
plasma protein, is important in
the maintenance of osmotic
pressure needed to regulate
blood pressure and volume.
Globulins function as transport
agents for lipids and fat -soluble
vitamins; the γ -globulin fraction
is composed of antibodies that
provide
immunity
from
pathogens.
portion of the blood is composed
of three types of blood cells:
o A. red blood cells (RBCs)
or Erythrocytes, live for
approximately 120 days.
They are formed in the
red bone marrow by stem
cells, which undergo
mitosis.
o B. WBCs or Leukocytes
have protective functions:
they destroy dead or
damaged tissue, detoxify
foreign proteins, protect
from infectious disease,
and function in the
immune response.
o C.
Platelets
or
thrombocytes, are not
whole cells but pieces of
cells.
§ They
are
produced when
large cells called
megakaryocytes
fragment
and
enter
the
circulation.
§ Platelets, which
remain
in
circulation
for
approximately 10
days, play an
important role in
the
blood’s
clotting
mechanism.
Lymphatic System
-
-
The lymph and circulatory systems are
parallel and interdependent.
The major components of the immune
system.
• lymphocytes Antibodies
• Are formed by the lymph system
to protect the body from
pathogenic
microorganisms,
malignant cells, and foreign
proteins.
The lymph system consists of the:
_______________________________________________________________________________________
RDGRacho | NCM 3157
10
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
•
•
•
•
•
•
Lymph vessels
Fluid
Nodes
Nodules
Spleen
Thymus gland
-
Functions of the Lymphatic System
-
-
Fluid balance. The lymphatic vessels
transport back to the blood fluids that
have escaped from the blood vascular
system. About 30 liters (L) of fluid pass
from the blood capillaries into the
interstitial spaces each day, whereas
only 27 L pass from the interstitial spaces
back into the blood capillaries. If the
ntial roles in body defense and resistance to disease.
extra 3 L of interstitial fluid remained in
the interstitial spaces, edema would
result, causing tissue damage and
eventually death. The remaining fluid
enters the lymphatic capillaries, where
the fluid is called lymph.
Fat absorption. The lymphatic system
absorbs fats and other substances from
the digestive tract. Lacteals are special
lymphatic vessels located in the lining of
the small intestine. Fats enter the
lacteals and pass through the lymphatic
vessels to the venous circulation.
House of the body’s defenses. The
lymphoid tissues and organs house
phagocytic cells and lymphocytes, which
play esse
Hematopoietic and Lymphatic Changes Associated with Aging
PHYSIOLOGYC CHANGE
RESULTS
Increased plasma viscosity.
Increased risk for vascular occlusion.
Decreased red blood cell production.
Increased incidence of anemia.
Decreased mobilization of neutrophils.
Less effective phagocytosis.
Increased immature T-cells response
Decreased immune response.
Lower serum albumin levels.
Edema; increased levels of medications that are
highly protein bound.
Nursing Assessments and Care Strategies related to Cardiovascular Changes
NURSING ASSESSMENTS
NURSING ASSESSMENTS
Monitor laboratory tests, including Hgb, Hct, Monitor laboratory tests, including Hgb, Hct,
WBC, and differential.
WBC, and differential.
_______________________________________________________________________________________
RDGRacho | NCM 3157
11
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Gastrointestinal System
Gastrointestinal Changes Associated with Aging
PHYSIOLOGYC CHANGE
Increased dental caries and tooth loss
RESULTS
Decreased ability to chew normally; decreased
nutritional status
Decreased thirst perception
Increased risk for dehydration and constipation
Decreased gag reflex
Increased incidence of choking and aspiration
Decreased muscle tone at sphincters
Increased incidence of heartburn (esophageal
reflux)
Decreased saliva and gastric secretions; increased Decreased digestion and absorption of nutrients;
gastric pH
altered absorption of some medications that are
pH-dependent
Decreased gastric mobility and peristalsis
Increased flatulence, constipation, and bowel
impaction
Decreased liver size and enzyme production
Decreased ability to metabolize drugs, leading to
increased risk for toxicity
Nursing Assessments and Care Strategies related to Respiratory Changes
NURSING ASSESSMENTS
NURSING ASSESSMENTS
Assess oral cavity for dentition, condition of Educate regarding importance of good oral
mucous membranes and hygiene.
hygiene; stress need for adequate fluid intake.
Dental referral as necessary.
Assess swallow and gag reflex.
Encourage posture that facilitates swallowing.
Consult with speech therapy for swallow studies
and safe dietary regimen.
Monitor weight changes.
Measure and record weight at least one time per
month, more often if fluid balance issues present.
Assess intake of nutrients and fluid.
Educate regarding recommended dietary intake.
Establish calorie count and intake and output if
problems are suspected.
Assess bowel sounds and bowel elimination Establish bowel routines. Teach importance of
patterns.
adequate fluid, fiber, and activity. Administer
laxatives, stool softeners, suppositories, or
enemas as needed to prevent constipation and
impaction.
Assess effectiveness of medications.
Observe for therapeutic effects (or lack thereof)
observe for signs of toxicity.
_______________________________________________________________________________________
RDGRacho | NCM 3157
12
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Digestive System
-
Salivary glands produce less saliva. Dysphagia (difficulty swallowing) is a risk.
Taste and smell dull.
Secretion of digestive juices decreases.
Loss of teeth and ill-fitting dentures cause chewing problems.
Peristalsis decreases.
Fewer calories are needed.
Central Nervous System
-
Nerve conduction and reflexes slow.
Blood flow to the brain is reduced.
Changes occur in brain cells.
Sleep patterns change.
Touch and sensitivity to pain and pressure are reduced.
Taste and smell dull.
Neurologic Changes Associated with Aging
Nursing Assessments and care strategies
related to neurologic changes
Nursing Assessments
Care Strategies
Assess alertness level, Report
abnormal
cognition,
and findings to primary
functional abilities.
care provider. Refer
for
neurologic
evaluation.
Assess balance and Educate
regarding
reflexes.
safety precautions and
use
of
assistive
devices.
Structure
tasks
to
reduce
confusion;
allow
adequate time to
perform tasks.
_______________________________________________________________________________________
RDGRacho | NCM 3157
13
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Promoting Vis
ual Wellness in Older Adults
§
§
Nursing:
o Age related changes
o Negative factional consequences
o Risk factors
§ Nursing intervention
• Wellness
outcomes
Age-related changes risk factors
o Elasticity in eyelids
o Tear production
o Corneal opacity
o Degenerative changes in all
structures involved in visual
function.
Guidelines for Assessing Vision
Questions to Assess Awareness and Presence of
Vision Impairment:
1. Have you noticed any changes in your
vision during the past few years?
2. Do you experience any uncomfortable
symptoms, such as dry eyes?
Do you have difficulty managing any of your
usual activities because you have trouble
seeing?
1. Have you ever tripped or fallen because
you had trouble seeing?
2. Have you stopped doing any activities
because of vision problems?
3. Are there things you would do if you
could see better?
Questions to Ask if Vision Loss Is
Acknowledged:
§ When did you first notice a loss of vision
or a change in your ability to see?
Have the changes been gradual, or did
you notice sudden changes at any
particular time?
§ How would you describe the changes in
your ability to see?
§ Have you noticed pain, blurred vision,
burning or itching, halos around lights,
intolerance to bright light, a difference
between day and night vision, or spots or
flashing lights in front of your eyes?
§ When was the last time you had your
eyes checked?
§ Where do you go for eye care?
§ Have you ever had your eyes checked for
cataracts, glaucoma, and other eye
conditions?
§ What do you think about going for
regular check-ups for glaucoma and
other eye problems?
Questions to Identify Risk Factors for Vision Los
§ When you spend time outdoors in the
sun, do you use sunglasses or a hat to
protect your eyes from bright light?
§ Do you smoke cigarettes?
§ Do you have a history of diabetes or
hypertension?
§ Do you have a family history of glaucoma
or macular degeneration?
§ What medications do you take? (Refer to
Table 17-2 to identify medications that
may increase the risk for vision loss.)
§
Promoting Visual Wellness in Older Adults
§ Nursing Assessment
o Risk Factor:
o Environmental conditions (Glare,
lighting)
o Effects on daily activities.
_______________________________________________________________________________________
RDGRacho | NCM 3157
14
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
§
§
o Health behaviours (eye exams,
protective measures)
o Glare, poor lighting.
o Exposure to ultraviolet rays.
o Smoking.
o Nutrient deficiencies.
o Adverse medication effects.
o Diseases
(Diabetes,
hypertension.)
Eye Changes Blue and green colours are
hard to see:
o Eyelids thin and wrinkle.
o Tear secretion is less.
o The pupil becomes smaller and
responds less to light.
o Clear vision is reduced.
o The lens of the eye yellows.
o Older persons become more
farsighted-unable to see close
items.
Negative Functional Consequences:
o ↓ ability to focus on near objects
o ↑ sensitivity to glare
o Need for ↑ illumination
o Dry eyes
o Difficulty driving at night
Ear changes
§ Changes occur in the acoustic nerve.
§ Eardrums atrophy high pitched sounds
are hard to hear.
§ Wax secretion decreases.
§ Wax becomes harder and thicker.
Physiologic change
Results
Decreased
tissue Decreased ability to
elasticity
distinguish
highfrequency sounds
Decreased
joint Decreased hearing
mobility
ability
Decreased
Increased risk for
ceruminous cells in cerumen impaction
external ear canal
causing conductive
hearing loss
Atrophy of vestibular Increased problems
structures and in the with
balance;
inner ear
decreased number of
hair cells.
Auditory Changes associated with Aging
Nursing Assessments and care strategies related to auditory changes
Nursing Assessments
Care strategies
Assess hearing and balance
Refer for audiometric testing as needed. `
Inspect ear canal for cerumen impaction.
Administration of prophylactic drops may
reduce likelihood of impaction formation.
Irrigation may be needed if impaction is present.
Assess functioning of hearing aid if used.
Check that batteries are working and that device
is not plugged with cerumen.
Keep an
amplifying device on each patient care unit to
use with hard of hearing individuals who do not
have a functional hearing aid.
_______________________________________________________________________________________
RDGRacho | NCM 3157
15
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Assess for social isolation or behavioural
Encourage socialization
excessive changes.
in
areas
without
Olfactory Changes Associated with Aging
Physiologic change
Decreased number of papillae on tongue
Decreased number of nasal sensory
Results
Decreased ability to taste
Decreased ability to receptors and to detect
smells
Nursing assessment and care strategies related to olfactory changes
Nursing assessments
Care strategies
Assess ability to smell and taste
Teach importance of storing food properly and
checking expiration dates. Keep drugs and
chemicals separated from foods.
Endocrine Changes Associated with Aging
Physiologic Change
Decreased pituitary secretions (growth
hormone)
Decreased production of thyroid-stimulating
hormone
Decreased insulin production or increased
insulin resistance.
Decreased production of parathyroid hormone
Results
Decreased muscle mass
Decreased metabolic rate.
Increased risk for type 2 diabetes mellitus.
Increased blood calcium levels (seen with
osteoporosis)
Nursing assessments and care strategies related to endocrine changes.
Nursing assessments
Care strategies
Monitor laboratory values, paying special Educate patients regarding dietary needs and
attention to minerals, such as calcium and self-testing of blood glucose.
sodium levels and blood glucose.
Assess for body temperature, weight, hair Notify primary care provider of assessment
distribution or behavioural changes, which may findings.
indicate endocrine imbalance.
_______________________________________________________________________________________
RDGRacho | NCM 3157
16
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Renal System
Changes with ageing
§ Loss of nephrons
§ Reduced glomerular filtration rate
§ Reduced tubular function
Clinical consequences
§ Impaired fluid balance
§ Increased risk of dehydration/overload.
§ Impaired drug metabolism and excretion.
Urinary System
§ Kidney function decreases.
§ The kidneys atrophy. Blood flow to the kidneys is reduced.
§ The ureters, bladder, and urethra lose tone and elasticity.
§ Bladder muscles weaken- incontinence occurs
§ Bladder size decreases.
§ In men, the prostate gland enlarges
§ Urinary tract infections are risks.
Urinary changes associated with aging
Physiologic change
Decreased number of functional nephrons.
Results
Decreased filtration rate with decrease in drug
clearance
Decreased blood supply
Decreased removal of body wastes; increased
concentration of urine
Decreased muscle tone
Increased volume of residual urine
Decreased tissue elasticity
Decreased bladder capacity
Delayed or decreased perception of need to Increase incidence of incontinence
void
Increased nocturnal urine production
Increase need to awaken to void or episodes of
nocturnal incontinence
Increased size of prostate (male)
Increased risk for infection; decreased stream
of urine; increased hesitance and frequency of
urination
Nursing assessments and care strategies related to urinary changes
Nursing assessments
Care strategies
_______________________________________________________________________________________
RDGRacho | NCM 3157
17
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Monitor for signs of drug toxicity
Promptly notify primary care provider of
relevant observations
Assess for urinary frequency
Palpate bladder after voiding or use doppler to
determine whether bladder is emptying
completely
Assess for signs and symptoms of urinary tract Obtain a urine specimen for analysis
infection
Assess frequency and timing of episodes of Establish a toileting schedule based on
incontinence
assessment data
Reproductive changes associated with aging
Nursing assessments and care strategies related to reproductive charges
Nursing assessments
Care strategies
Assess for signs and symptoms of infection or Report unusual vaginal discharge to primary
inflammation
care provider. Administer treatment as
prescribed.
Assess factors that may interfere with sexual Discuss normal physiologic changes and the
activity
possible effect’s function. Educate females
regarding use of artificial lubrication. Possible
referral of males to primary care provider for
pharmacologic
treatment
of
erectile
dysfunction.
Changes in the body reproductive system
• Male
o Reduction sperm count
o Prostatic enlargement
• Female
o Atrophy
o Estrogen depletion
Male reproductive system
§ The hormone testosterone decreases slightly.
§ It affects strength, sperm production, and reproductive tissues.
§ An erection takes longer.
§ The phase between erection and orgasm is longer.
§ Orgasm is less forceful than when younger.
§ Erections are lost quickly.
§ The time between erections is longer
§ Older men may need the penis stimulated for arousal.
_______________________________________________________________________________________
RDGRacho | NCM 3157
18
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Women Reproduction
§ Menopause occurs in women. Menstruation stops.
§ The woman can no longer have children.
§ Female hormones (estrogen and progesterone) decrease.
§ The uterus, vagina, and genitalia atrophy.
§ Vaginal walls thin and there is vaginal dryness.
§ Arousal takes longer.
§ Orgasm is less intense.
§ The pre-excitement state returns more quickly.
_______________________________________________________________________________________
RDGRacho | NCM 3157
19
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
THEORIES OF AGING
Theories of Aging
Definition:
§ Aging can be defined as the time-related
deterioration of the physiological
functions necessary for survival and
fertility.
§ Aging process is the process of growing
old or developing the appearance and
characteristics of old age.
Classification of aging:
§ Objectively – ageing is a universal
process that begins at birth and is
specified by the chronological age
criterion.
§ Subjectively – aging is marked by
changes in behaviour and selfperception and reaction to biologic
changes.
§ Functionally – aging refers to the
capabilities of the individual to function
in society.
Young Old (60-74 yrs.), middle old (75-84
years), and old-old (above 85 years) The life
expectancy of Indians are 65-67 years.
Biological Theories
§ Programmed Theories
o Aging has a biological timetable.
§ Error Theories
o Aging is a result of internal and
external assaults that damage
the cells/organs so they can no
longer function properly.
Programmed vs Error Theories
Programmed
Error Theories
Theories
§
§
§
Programmed
senescence
Theory
Endocrine
Theory
Immunology
Theory
§
§
§
§
§
§
Wear and
Tear Theory
Rate of living
Theory
Cross-linking
Theory
Free Radical
Theory
Error
Catastrophe
Theory
Somatic
Mutation
Theory
Programmed Theories
1. Programmed Senescence Theory:
a. There is sequential switching
“off” and “on” of specific genes.
2. Endocrine Theory:
a. Hormones control the speed of
aging.
3. Immunologic Theory:
a. Immune system is programmed
to decline overtime.
4. Error Theories:
a. Wear and Tear Theory - It states
that years of damage to cells,
tissues and organs wears them
out.
b. Rate-of-Living Theory - The
greater basal metabolic rate of
the organism, the shorter the
lifespan.
c. Cross-linking Theory – The
accumulation of cross-linked
_______________________________________________________________________________________
RDGRacho | NCM 3157
20
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
proteins damage cells and
tissues.
d. Free Radical Theory - Free
radicals can cause damage to
cells and organs.
e. Catastrophe Theory - Aging is the
result of the accumulation of
errors in cellular molecules that
are essential for cellular function
and reproduction.
f. Somatic Mutation Theory Genetic mutation occur and
accumulate with age in the
somatic cell causing the cell to
deteriorate and malfunction.
Psychological Theories
§ Full-Life Development Theory
§ Mature-Life Theories:
o Robert Peck’s Theory
o The Activity Theory
o Disengagement Theory
Full Development Theory
§ The ego is a positive driving force for
development:
o The ego’s job is to establish and
maintain identity.
o A lack of identity leads to lack of
direction and non-productivity.
§ Adulthood – “Generativity” vs
“Stagnation”
§ Old Age – “Ego Integrity” vs “Despair”
§ Adulthood:
o “Generality”
§ Giving back to society by
raising children.
§ Being productive at work
§ Being involved in the
community.
Guiding, parenting, and
monitoring the next
generation.
o Stagnation
§ Being unproductive
§ Feeling anger, hurt and
self-absorption.
Old Age:
o “Ego Integrity”
§ Exploring life as a retired
person who is not
identified with an
occupation.
§ Contemplating
accomplishment.
§ Feeling life is successful.
o “Despair”
§ Feeling guilt about the
past
§ Not accomplishing life
goals
§ The final pathway:
Dissatisfied – Despair –
depression –
hopelessness
§
§
Mature Life Theory
1. Robert Peck – The elderly goes through
three development stages to reach full
psychological development:
§ Stage 1 – Ego Differentiation vs
World Role Preoccupation.
§ Stage 2 – Transcendence vs.
Body Preoccupation
§ Stage 3 – Ego Transcendence vs
Ego Preoccupation.
2. The Activity Theory – Bernice Neugarten
describes tasks that must be
accomplished for successful aging. Some
of these tasks include:
_______________________________________________________________________________________
RDGRacho | NCM 3157
21
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Accepting reality and the
imminence of death.
§ Coping with physical illness
§ Accepting the necessity of being
dependent on outside support
while still making independent
choices that can give
satisfaction.
3. Disengagement Theory
§ Both older people and society
mutually withdraw from each
other.
and strength – Betty Friedan
§
§
§
A person gradually disconnects
from other people in anticipation
of death.
Intrinsic changes in personality
occur which allow a person to
psychologically withdraw from
society’s expectations.
Aging is not lost youth but a new stage of
opportunity
_______________________________________________________________________________________
RDGRacho | NCM 3157
22
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
CHRONIC ILLNESS
Chronic Illnesses:
§ CAD
§ Hypertension
§ Chronic Obstructive Pulmonary Disease
§ Diabetes Mellitus
§ Cancer
§ Dementia
§ Stroke
_______________________________________________________________________________________
RDGRacho | NCM 3157
23
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
CORONARY ARTERY DISEASE
§
§
It is the narrowing or blockage of the coronary arteries.
It is the leading cause of mortality and morbidity in the older adults.
Coronary Artery Disease
Modifiable Risks
Non-Modifiable Risks
↑ Na, ↑Fat Intake
>50 y.o
Smoking, Alcohol
Men
Obesity with DM/HPN Family History
Sedentary Lifestyle
African-American
Stress
↓ Estrogen
Types:
Atherosclerosis
-
Fat Deposition
Fibrous Formation
Hardening of vessel wall
1.
2.
3.
4.
Injury to endothelial arterial wall.
Endothelial smooth muscle cell growth
Release of collagen and fibrous proteins
Lipid, Platelets accumulation (plaque
development, clot formation)
5. Blockage of arteries
6. Decrease in blood flow
Angina Pectoris
-
Myocardial Ischemia
1. Stable
- Atherosclerosis
- Chest Pain = increase physical activity
- Relieved with rest
2. Unstable
- New onset, unpredictable and worsening
chest pain.
- Can’t be relieved by rest/meds
3. Silent
- Asymptomatic
_______________________________________________________________________________________
RDGRacho | NCM 3157
Myocardial Infarction
-
Myocardial Damage
Pathophysiology
§ Decreased Oxygen
o Cell Starvation
§ Anaerobic Metabolism
o Release of lactic acid
§ Inadequate compensation
§ Myocardial Ischemia
§ SNS Stimulation
o Increased HR
o Increase O2 demand
24
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
4. Intractable
- Severe chest pain
- Does not respond to Medications
5. Variant
- Pain at rest
- Early morning or at night
Pathophysiology
§ Lipid profile:
o Fat Deposits in arteries
o Narrowing of the Lumen
o Decrease blood supply
§
NSG. Dx: Altered Tissue Perfusion
o Decrease Oxygenation
o Anaerobic Metabolism
§
LDH
o Lactic Acid Formation
§
Levine’s Sign
o Chest Pain
Clinical Manifestation
- Chest Pain
- Numbness
- Shortness of Breath
- Pallor
_______________________________________________________________________________________
RDGRacho | NCM 3157
§
§
§
Myocardial Infarction
Decreased Contractility
Heart Attack
Triggers
- Exercise
- Emotions
- Exertion
- Eating
- Environment
Clinical Manifestations
- Chest
- Pain/Tightness
- Anxiety
- Nausea/Vomiting
- Elevated Body Temp.
- Pallor
- Abnormal Heart Rhythm
- Dyspnea
- Diaphoresis
Diagnostics
- ECG
- Chest Xray
- Thalium Scan
- 2D – Echo
- Coronary Angiogram
25
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Diagnostic Test
- ECG: ST Depression
- Stress Test
- Cardiac Enzymes
- 2D – Echo
CK/CPK
- 5-35
- Rise: 4-8 hrs
- Peak: 12-36 hours
- Normalize: 3-4days
Nursing Management
- Oxygen Supplementation
- MHBR
- CBR without BRP
- Nitro-glycerine Patch
Troponin
- 0
- Rise: instantly
- Peak: 4-12 hrs
- Normalize: 1-3 weeks
LDH
-
100-190 iu/l
Rise: 12-24hrs
Peak: 2-6 days
Morphine So4
- Relaxes Cardiac muscles
- Decreases O2 demand
- Improved Perfusion
Beta Blockers
- Blocks beta cells activation
- Decreases HR
- Decrease cardiac workload
- Blocks beta cells activation
- Decreases HR
- Decrease cardiac workload
_______________________________________________________________________________________
RDGRacho | NCM 3157
26
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Calcium Channel Blockers
- Decreases calcium response
- Vasodilation
- Decreased BP
- Decreased HR
Potassium Channel Blocker
- Blocks potassium response
- Decreased contraction
- Decrease HR
Sodium Channel Blockers
- Blocks sodium stimulation
- Enables sinus rhythm
Nursing Responsibilities:
- Strategies to prevent the development of
cardiovascular disease and to promote
healthy lifestyle.
- Help maximize functional abilities,
thereby increase mobility and
independence in carrying out ADLs.
- Referrals to social service agencies that
can facilitate to determine informal and
formal support system.
- Determine whether medications are
managed correctly.
_______________________________________________________________________________________
RDGRacho | NCM 3157
27
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Arteriosclerosis
Hypertension
-
Hardening of vessel wall
-
1.
2.
3.
4.
Increased Blood Pressure in Arterioles
Weakening of intimal Arteriole lining
Loss of arteriole wall elasticity
Narrowing of passage of blood
-
It is a condition when the force of blood
in the walls of the artery is too high.
The ‘silent killer’
Systolic pressure >120mmHg; Diastolic
pressure is >80mmHg
Risk Factors:
o Dyslipidemia
o Obesity
o diabetes mellitus
o metabolic syndrome
o sedentary lifestyle
Signs & Symptoms:
- Headache
- Hyspnea
- Retinopathy
- Chest pain
- Sensory or motor problem
Diagnostic Evaluation:
- Health History and Physical Examination
- Lab Test: Urinalysis, Blood Chemistry,
ECG
Medical Management:
- Diuretics (thiazides, loop, K-sparring)
- Aldosterone Receptor Blockers
_______________________________________________________________________________________
RDGRacho | NCM 3157
28
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
-
(spironolactone)
Beta blockers (atenolol, propranolol)
Alpha1-blockers (doxazosin)
ACE inhibitors (captopril)
Angio II rec blockers (irbesartan)
Ca Channel blockers (diltiazem,
verapamil)
Nursing Intervention:
- Promote healthy lifestyle.
- Increasing knowledge
- Promoting home and community-based
care
- Monitoring and managing potential
complications
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
§
It is a disease that is characterized by airflow limitation that is not fully reversible.
Risk Factors
- Exposure - tobacco smoking, biomass fuel, and air pollution.
- Host factors – genetic abnormalities, abnormal lung development, and accelerated aging.
Diagnostics:
- History taking
- Physical Examination
- Spirometry
_______________________________________________________________________________________
RDGRacho | NCM 3157
29
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Management:
- Smoking cessation
- Pharmacological – bronchodilators, corticosteroids, influenza, and pneumococcal vaccinations.
- Surgical – bullectomy, lung transplantation.
- Pulmonary rehabilitation.
Nursing Responsibilities:
1. Patient Education
Breathing exercise
Inspiratory muscle training
Activity pacing
Self-care activities
Physical conditioning
Oxygen therapy
Nutritional therapy
2.
Coping Measures
Anxiety, depression, and changes in behavior.
Types:
-
Chronic Bronchitis
Emphysema
It is the inflammation of the bronchial tubes caused by long term
exposure to irritants.
The presence of cough with sputum for at least 3 months and in 2
consecutive years.
It is 4-10x common to smokers
It is the abnormal and permanent dilation of the terminal air spaces of the lungs,
combined with the destruction of the alveolar wall.
Signs and Symptoms:
- Dyspnea
- Minimal cough
_______________________________________________________________________________________
RDGRacho | NCM 3157
30
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Signs and Symptoms:
- Chronic, productive cough
- Purulent sputum
- Hemoptysis
- Mild dyspnea
- Cyanosis 9due to hypoxia)
- Peripheral edema 9due to cor pulmonale)
- Ceackles, wheezes
- Prolonged expiration
- Obese
-
Increased minute ventilation
Pink skin, pursed-lip breathing
Accessory muscle use
Cachexia
Hyperinflation, barrel chest
Decreased breath sounds
Tachypnea
ASTHMA
§
It is chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema and mucus production.
Risk Factors
- Cigarette
- Food
- Infection
- Genetic
- Pollution
- Cold weather
- Pet
- Dust
Signs and Symptoms:
- Breathlessness
- A tight feeling in the chest
- Wheezing
- Cough
_______________________________________________________________________________________
RDGRacho | NCM 3157
31
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Diagnostics:
- Family, environmental and occupational history
- Blood Test: increased eosinophil
- Increased IgE
- ABG
Management:
• Pharmacological Therapy
- Long-acting control medications
- *Corticosteroids (prednisolone)
- * Beta-agonist (salmeterol, formoterol)
- * Leukotriene modifiers (montelukast)
Nursing Responsibilities:
- Approach the patient and family in a calm manner.
- Obtain a history of allergic reactions to medication.
- Identify present medications the patient is taking.
- Administer prescribed drug and monitor patient’s response.
- Identify present medications the patient is taking.
- Administer prescribed drug and monitor patient’s response.
- Apply fluids if patient is dehydrated.
- Assist in intubation procedure.
- Teaching Patient Self-Care:
- * Nature of asthma
- * Purpose ang action of medication
- * Triggers to avoid and how to do so
- * Proper inhalation technique
- * When to seek assistance and how to do so
_______________________________________________________________________________________
RDGRacho | NCM 3157
32
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
DIABETES MELLITUS
§
§
§
It is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period.
Type 1 DM results from the pancreas’s failure to produce enough insulin. This form was previously referred to as “insulin-dependent diabetes mellitus”
(IDDM) or “juvenile diabetes”.
Type 2 Dm begins with insulin resistance, a condition in which cells fail to respond to insulin properly. This form was previously referred to as “non-insulin
dependent DM” (NIDDM) or “adult-onset diabetes”.
Risk Factors
- Family history
- Genetics: the presence of certain genes indicates an increased risk of developing type 1 DM.
- Geography: the incidence of type 1 diabetes tends to increase as you travel away from the equator.
- Age; although type 1 diabetes can appear at any age, the first peak occurs in children between 4 to 7 years old, and the 2nd is in children
between 10 to 14 years old.
- Exposure to certain viruses, such as the Epstein-Barr virus, Coxsackie virus, mumps virus, and cytomegalovirus.
Signs and Symptoms:
- Always thirsty
- Blurry vision
- Wounds that do not heal
- Vaginal infections
- Always hungry
- Always tired
- Sexual problems
- Numbness or tingling in hands or feet
- Frequent urination
- Systemic weight loss
Diagnostics:
_______________________________________________________________________________________
RDGRacho | NCM 3157
33
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
- Fasting plasma glucose
-
HbA1c
Oral glucose tolerance test (OGTT)
Management:
- Nutrition Therapy
- Exercise
- Monitoring
- Pharmacologic Therapy
- Insulin Therapy
- Surgical: Pancreatic Transplantation (Type1)
Nursing Responsibilities:
- Monitor serum glucose levels
- Teach patient signs and symptoms of hyper/hypoglycaemia
- Altered liver, renal function will affect medication action
- Avoid OTC meds without MD approval
- Assess for GI distress and sensitivity
- Know appropriate time to administer meds
_______________________________________________________________________________________
RDGRacho | NCM 3157
34
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
ALTERNATIVE AND COMPLEMENTARY MEDICINE
Alternative and Complementary Medicine
- Complementary and alternative medicine
(CAM) is the term for medical products and
practices that are not part of standard
medical care.
What is the difference?
1. Complementary
- complementary practices are those that work in
conjunction with standard western Medicine.
This could be anything from massage therapy to
traditional Chinese medicine, but it is always good
practice to inform your doctor of your
complementary treatment.
2. Alternative
- alternative practices are those that take place of
standard western medicine.
When choosing to utilize alternative practices, you
should always make sure you find the discipline and
practitioner that is right for you.
Check reviews, background and certifications prior
to use.
Purposes:
- To achieve the healing effects of medicine
- To feel better
- To improve your quality of life
Basic Concepts
1. HOLISM: the idea that the whole of the sick
person including their body, mind and way of life,
should be considered when treating them, and not
the just the symptom of the diseases.
HUMANISM: a system of thought that considers the
solving of human problems with the help of
religious beliefs, it emphasizes the fact that basic
nature of human is good.
BALANCE: a situation in which different things exist
in equal, correct or good amount.
ENERGY: the ability to put effort and enthusiasm
into an activity, work, etc.
HEALING: the process of returning to normal
function after a period of disease or injury.
Types:
1. Mind-Body Medicine
2. Biologically Based
3. Body-Based Therapy
4. Energy-Based Techniques
Mind Body Medicine
-
-
Focus on the interactions o f mind body,
and behavior, with the intent to use the
mind to affect physical functioning and
promote health (NATIONAL CENTER FOR
COMPLEMENTARY AND ALTERNATIVE
MEDICINE).
MBM is the understanding of the
complete interpenetration of mind and
body and the possibility that all their
aspects can speak with one another and
can promote healing – Dr. James Gordon.
_______________________________________________________________________________________
RDGRacho | NCM 3157
35
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
Biologically Based
-
It involves supplementing a person’s normal
diet with additional extracts, nutrients,
herbs and/or certain foods.
Dietary
therapies,
herbs,
vitamins,
aromatherapy.
It involves practices that manipulates or
move specific body parts or the whole body.
Naturopathy is a field of medicine which
borrows basic principles from several
ancient tradition of schools of medicine.
In treatment, physical pressure is applied to
acupuncture points or ashi trigger points
with the aim of clearing blockages in these
meridians.
Reflexology, also known as zone therapy, is
an alternative medical practice involving the
-
application of pressure to specific points on
the feet and hands.
It a pseudoscientific alternative medicine
that is concerned with the diagnosis and
treatment of mechanical disorders of the
musculoskeletal system, especially the
spine.
Energy Based
-
It involves practices involving belief in
energy fields around and inside the human
body that are altered by providers for health
benefit.
- It is a pseudoscientific alternative-medicine
practice that uses semiprecious stones and
crystals such as quartz, agate, amethyst or
opals.
_______________________________________________________________________________________ 36
RDGRacho | NCM 3157
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
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- In treatment, physical pressure is applied to
Defamation
acupuncture points or ashi trigger points
- Written or spoken communication that
with the aim of clearing blockages in these
holds a person up to ridicule or scorn and
meridians.
tends to harm his or her reputation.
- It is a Japanese form of alternative medicine
- Libel: written defamation.
through which a "universal energy" is said to
- Slander: spoken defamation.
be transferred through the palms of the
practitioner to the patient in order to
Invasion of Privacy
encourage emotional or physical healing.
- It is a group of physical, mental, and spiritual
- Violence of a person’s right to be left
practices or disciplines that originated in
alone or to enjoy reasonable
ancient India, aimed at controlling and
noninterference with his/her life.
stilling the mind, and recognizing the
Elder Abuse and Neglect
detached
'witness-consciousness'
as
untouched by the activities of the mind and
- Elder abuse can be defined as “a single,
mundane suffering.
Risk of CAM:
-
It is not guaranteed safe.
Lack of standardization of either the practice
or the dispensing of the therapies and
techniques.
No standard format exists to ensure that
practitioners are adequately trained in the
techniques used.
Can delay medical and surgical treatment
causing the disease to aggravate.
ETHICAL
Intentional Torts
-
Acts by a nurse performed with the
intent to bring about specific result.
Assault: is an attempt to threat to injure
another person.
Battery: is unwanted or unconsented
physical contact.
or repeated act, lack of appropriate
action, occurring within any relationship
where there is an expectation of trust
which causes harm or distress to an older
person.
Types:
Physical abuse: any action that causes
physical pain or injury.
Psychological/emotional abuse: the
infliction of mental anguish. E.g.
ignoring, isolating, shouti8ng.
Financial/material abuse: the illegal or
improper exploitation and or use of
funds or resources.
Sexual abuse: non-consensual contact of
any kind with an older person.
Neglect: the refusal or failure to fulfill a
care-taking
obligation
including/excluding a conscious and
intentional attempt to inflict physical or
emotional distress on the older person.
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RDGRacho | NCM 3157
37
ATENEO DE DAVAO UNIVERSITY
SCHOOL OF NURSING BATCH 2023
NCM 3157: MEDICAL SURGICAL NURSING LECTURE
ADAPTED FROM: POWERPOINT/LECTURE
_______________________________________________________________________________________
is perceived with caution and only when
for the clear benefit of the patient.
Prevention of Abuse
-
-
To increase public awareness and
knowledge of the issue.
To promote education and training of
professionals and paraprofessionals in
identification,
treatment
and
prevention.
To further advocacy on behalf of abused
and neglected elders.
To study into the causes, consequences,
prevalence, treatment and prevention of
elder abuse and neglect.
Advance Directives
-
-
Do not Resuscitate Orders
-
Abandonment
-
It occurs when dependent person or
person responsible for care leaves the
older person physically, emotionally, and
financially defenseless.
-
Restraints
Physical Restraints and Chemical Restraints
-
-
-
-
Presumed benefit of restraint should be
carefully weighed against the risk of
complications and the insult it brings to
the patients’ dignity.
Physical restraint should be used only
when the patient is a danger for himself
or others and when all other behavior
management have been exhausted.
It creates an obligation for the
professional to attend carefully to the
negative consequences of restraint and
preventing them.
Chemical restraints are by giving
psychoactive pharmacological agents. It
Advance
directives
are
written
statements of a person’s wishes
regarding medical care.
It is a formal, legally endorsed document
that provide instructions for care (living
will) or names a proxy decision maker
(durable power of attorney).
DNR are legal and binding but must be
justified as client request or be medically
indicated.
When DNR order is made, the supporting
documentation must include client’s
current condition, prognosis, summary
of decision making and who was
involved.
Assisted Suicide and Euthanasia
-
-
-
Grave decision and certainly do not
provide medication to hasten death in a
patient.
Ensure that the elderly person has
complete information when asked to
make a decision regardi9ng health care.
It is illegal in most countries.
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RDGRacho | NCM 3157
38