Best Nursing Care for the Elderly
Domlur, Bengaluru Feb 11, 2017
A nursing care plan is the final product of the entire planning phase of the nursing process. Such care plans offer a mode of communication among nurses, the patients and other healthcare providers to achieve the desired outcome. Without the care plan, the services being rendered would lose their consistency and quality.
These nursing care plans can either be formal (written down or computerized) or informal (not written down anywhere).
A formal plan of care is again subdivided into individualized (customized) and a standardized care plan.
What is the purpose of a formal care plan?
• It offers the healthcare providers a definite direction to care for the patient.
• A care plan ensures continuity in the care provided. It is almost like a flow chart that guides the nurses on what to do, while detailing the flow of activities from one level to the other.
• It offers updated knowledge of the patient’s condition.
• It helps in documenting whatever progress the patient is making.
• It also helps to assign staff to patients with specific needs. Staff members with a specific skill set might be required to handle certain patients with specific needs and requirements.
Listed below are the nursing plans for three chronic illnesses that could affect the elderly:
A degenerative and an irreversible condition, Alzheimer’s disease is probably the commonest cause of dementia among the elderly. This particular condition usually affects after one has reached the age of sixty and goes on to adversely impact one’s cognitive functions and abilities. Since this condition cannot be reversed, nursing care assumes paramount importance that helps in bettering the patient’s quality of life.
• Assessing the ability of the patient to process thoughts and observing any instance of cognitive dysfunction, slurring/disoriented speech, decline in memory, change in thought patterns and difficulty in communicating.
• Assessing disorientation and confusion
• Assessing the ability of the patient to cope with events and changes in surroundings, motivation and his/her general interest in things going on around him.
• Getting the patient in tune with his environment again through the use of newspapers, radio, television or other media.
• Assessing patient for sense deprivation, lack of proper nutrition, infection and dehydration
• Maintaining regularity in sleep, eating habits and exercises
• Assisting the patient by labeling different drawers, keeping written reminder notes and using color coding and pictures
• Allowing and helping the patient to walk around in a controlled/confined environment
• Providing positive feedback and reinforcement for positive behavior
• Limiting the number of decisions that the patient can make and conveying warmth and support while communicating with the patient
• Maintaining a quiet and comfortable ambience and providing opportunities for social interaction
• Advising the patient’s family on how to deal with the patient
• Informing the immediate family or other relatives on how to identify dangerous and hazardous situations
• Eliminating or minimizing sources of danger and hazards in the environment
• Suggesting distraction techniques to the patient as well as the family such as soothing music, a quiet walk or looking at older picture albums
• Monitoring for cues of non-verbal communication such as smiling, grimacing, etc.
• Trying to detect presence of psychosis, aphasia (language disorder), aphonia (damage to the mouth or the larynx resulting in an inability to speak)
• Providing certain assistive devices whenever required
• Assisting the patient with grooming and dressing
• Helping the patient with toileting routine
• Teaching the patient and instructing the family on ROM (range of motion) exercises to help with the patient’s mobility.
• Assessing sleeping patterns of the patient, the number of naps the patient takes and their frequency, quantum of activity the patient does in a day and checking for lethargy, fatigue and apathy.
• Monitor medications for the patient and keeping a check on his consumption of alcohol or intake of caffeine, if any.
• Assessing for confusion, drop in cognitive faculties and behavioral changes
• Checking for clarity in vision and detecting glaucoma or cataract, if any
• Assessing olfactory, gustatory and auditory clarity
• Assessing numbness, if any, in the patient’s extremities, pain or loss of sensation
Parkinson’s disease is a progressive degenerative disorder that affects one’s motor functions, ultimately resulting in immobility and disability. Commonly affecting people post the age of fifty, this disorder is connected with a dip in the levels of dopamine and it occurs more in the darker sex.
• Assessing the patient’s endurance and energy levels and their connection with respiration
• Administering oxygen whenever necessary
• Checking for any lung congestion
• Checking for coughing and noticing the color of the sputum
• Turning the patient every 3 hours
• Administering bronchodilators whenever required
• Regulating and monitoring the patient’s fluid intake
• Encouraging coughing and deep breathing
• Carrying out suction if needed
• Helping the patient to come out of depression and orienting him/her with reality
• Sorting out the patient’s current set of medications
• Checking for the patient’s cognitive/sensory impairment, slurring of speech, psychosis, aphonia, aphasia, etc.
• Reinforcing the practice of speaking slowly and clearly and listening to the speaker while listening
• Monitor the patient’s non-verbal communication cues
• Inducing a calm ambience for the patient
• Instructing on how to perform certain facial muscle exercises such as frowning, smiling, etc.
• Helping the patient with techniques that aid movement
• Assisting the patient to walk with an erect posture and a straight gait
• Charting out daily exercises for the patient that will help with mobility, such as walking, riding a cycle and swimming
• Charting out a proper diet for the patient and helping with how to stay hydrated
• Providing massages and warm baths
• Referring a physiotherapist to the patient
• Weighing the patient every day, preferably on the same scale and at the same time
• Monitoring the patient’s weight every week
• Evaluating the ability of the patient to swallow
• Examining the extent of paralysis
• Not allowing dry mouth syndrome to set in, as a result of the various medications for Parkinson’s Disease
• Allowing for taste and sensory stimulation by feeding the patient through the unaffected side of the mouth
• Providing foods that need little chewing so as to avoid choking
• Feeding through tube if normal oral intake isn’t happening
• Massaging the neck and facial muscles right before feeding
• Assessing mobility and ambulation (a process wherein the patient gets out of then hospital bed and engages in light and routine activities such as walking or standing)
• Reducing risks of injury by instructing the patient to turn maintaining wide arcs
• Teaching a number of exercises and stretches in order to improve mobility
• Constantly helping the patient with his gait and posture
• Maintaining continuity in care by allocating other personnel whenever possible
• Encouraging the patient to express his feelings without any concern or inhibition
• Reinforcing positive behavior
• Helping the patient maintain coping skills
• Instructing the patient’s family and the patient on how to reach out for counseling or other support groups
• Finally, advising the patient to strictly adhere to the dosage of the medications
Also known as cardiac dysrhythmias, cardiac arrhythmias are aberrant electrical conductions that lead to irregular heart rhythm and rate. These vary in severity; from mild and asymptomatic ones that do not need medical intervention to the violent ones which require prompt resuscitation. This could result from an underlying heart disorder, a systemic condition, drug toxicity or an imbalance in the electrolyte level in the body. This condition also varies in terms of its effects on one’s heart functions; whether ventricular (beginning in the ventricles) and supraventricular (beginning right above the two chambers of the heart).
• Noting regularity and rate of pulse, whether thready or steady
• Checking for heart rate, regularity of heart beat, drop in heartbeats or extra heartbeats
• Monitoring the patient’s vital signs; examining noticeable variations in pulse, blood pressure, changes in skin color, respiration, consciousness level, body temperature and urinary output during an episode of dysrhythmia
• Determining the arrhythmia type; sinus tachycardia (abnormally high resting heart rate, more than 100bpm), sinus bradycardia (abnormally less resting heart rate, less than 60 bpm), premature atrial contractions (caused due to the premature release of an electric impulse originating in the atrium), atrial flutter (dysrhythmia in the heart’s atrial chambers) or heart blocks
• Instructing on relaxation techniques such as deep breathing
• Look into chest pain reports and going into the causes of it
• Taking a note of all aggravating factors of chest pain
• Conducting CPR if required and monitoring electrolyte balance in the body, and providing supplemental oxygen whenever required
• Checking for potassium imbalance and giving necessary medications
• Administering medications as per doctor instructions
• Monitoring pacemaker function
• Charting out the recommended diet plan for the patient
• Keeping a tab on the sodium levels in the body and taking corrective steps
• Advising immediate medical intervention in circumstances of irregular heartbeat, dizziness, chest pain or bouts of fainting.
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