Test 1- PHC and gerontology Flashcards
(144 cards)
1
Q
Define Health
A
A state of complete physical, mental and social well-being, not merely the absence of disease or infirmity
2
Q
What are the dimensions of health
A
Physical- body shape, size and function
Mental -ability to think clearly and coherently, the ability to make rational judgements
Emotional- the ability to recognise emotions, adapt to and cope with stress and anxiety
Social-the ability to make and sustain relationships with people
Spiritual- religious practices and beliefs
Societal- environmental, working and living conditions, employment, income, social norms and standards
3
Q
What is community Healthcare
A
Refers to all the health services that a community can use
Includes personal:(clinics; hospitals)
Non-personal: (water supply, sanitation)
4
Q
What is community Health
A
The discipline concerned with the study and improvement of the health characteristics of biological communities
5
Q
What is community Health Nursing (FBPN)
A
The field of nursing that is a blend of primary health care and nursing practice
The philosophy of care is based on the believe that care is directed to the individual, family and groups contributes to the healthcare of the population.
The goal to assist the individual, family and community in attaining their highest level (optimum) of holistic health
Contribute to health promotion, education, health talks
Education regarding disease prevention and cure, maintain healthy lifestyle
6
Q
What is primary healthcare
A
Essential healthcare that improves health and Makes universal health available to all, especially the poor, through economic and social justice and equity
7
Q
what is a health system
A
is a set of components that combine to, support and improve health of a population
8
Q
Describe a health system of a country
(BAP)
A
● Broader in scope than a health care system
● All aspects of a nation’s health, including the institutional, material, cultural and human elements of the system
● Primary purpose is to improve health
9
Q
describe a healthcare system
A
● The way in which health care is given to the people.
● People and resources involved in the delivering healthcare to individuals.
10
Q
what are the subdivisions of the healthcare system
A
- Sector
- Level
- Unit
11
Q
gives examples of sector as a subdivision of the healthcare system
A
Public
Private (for profit)
private(not for profit)
12
Q
gives examples of level as a subdivision of the healthcare system
A
ward
district
region
province
national
international
13
Q
gives examples of unit as a subdivision of the healthcare system
A
Carer
Clinic
Hospital
Contact
Patient
Individual
Community
14
Q
explain the national healthcare system (sector explained)
A
The public health care system is funded by government and is open to everybody
The private sector is supported by medical aids , to which individuals contribute at their own expense
Others can also use the service, but they have to pay full fees
Traditional healers are not yet part of the formal health care system
15
Q
explain the national healthcare system (Levels explained)
A
Each level of health services(district, provincial and national) provides a different service to the public
NATIONAL DEPARTMENT OF HEALTH:
Do not provide health care services
The legislative body that regulates what services are provided and the way in which this done
PROVINCIAL AND DISTRICT SERVICES:
all have specific services that they carry out for the public
16
Q
what are the levels that hospitals are named after
A
1) The first level of care include primary health care clinic, community health centres and district hospitals
2) The second level of care includes regional hospitals
3) The third level of care includes tertiary hospitals
Hospitals can be named according to their areas:- District-; Regional-; National or Specialised hospitals
OR
According to their level such as 1, 2 or 3
17
Q
what are the levels of care
A
The point of contact that the individual or population has with the healthcare system
PRIMARY CARE
SECONDARY CARE
TERTIARY CARE
QUATERNARY CARE
18
Q
what is primary care
A
The first level of contact with the health system
Can be promotive, preventive and curative interventions
Can be offered by community health worker (community care worker), the healthcare professional, the clinical practitioner or the medical specialist
19
Q
what is secondary care
A
Usually at the level of a general hospital for the purpose of curing disease
Usually includes general specialist care
20
Q
what is tertiary care
A
Includes advanced specialist care
Associated with medical schools and faculties of health
21
Q
what is quaternary care
A
The level at which the most advanced specialist care, such as organ transplant is offered
22
Q
in what year did PHC begin
A
1940’s
23
Q
Explain what the Pholela rural health project
A
● When starting a new rural health project at Pholela in KZN, the karks came up with a new way of running a health service
● They located the clinic that people can have easy access to it, they also based the services it offered in surveys of the community needs
● the karks considered the culture and the living conditions of the community and then involved the people in their own health issues
● the karks took a wide view of healthcare, focusing not only on curing disease, but also on prevention and promoting health among individuals and communities
● this became known as community oriented health care (COPHC), Which later influenced the primary healthcare approach
● in 1944- karks set up a health centre in pholela, but instead of waiting at the clinic for sick people to arrive, they also trained health workers from the community to make home visits. Each community health worker was given a set of households to look after
● during the visits the health workers collected health info which helped the health centre staff came to understand the health needs of the people
24
Q
what was the gluckman commission
A
● Impressed by the karks, henry gluckman who was the minister of health, tried to change the nature of the countrys health services in the early to mid 1940’s
● In an effort to improve the health of all south africans, gluckman commissioned a thorough study of the health services in SA.
● the commissions report identified the following problems that were preventing equal access to health for all.
● the report made some recommendations, which the smuts government agreed to this plan
● 1948 40/400 planned health centres had been set up instead
● instead of forming a central health service to provide equal access for all, the new apartheid laws further divided the services into different racial groups
25
what is top-down curative approach
aims at curing disease rather than investigating the health needs of the community and the socioeconomic and environmental causes of disease.
26
what is a bottom up approach
a bottom up approach works with communities to identify their health needs and prevent their health problems.
27
what are the missionary doctors
● missionary doctors linked to the world council of churches (wcc) began to discover the importance of getting local people and local resources involved in improving health
● the christian medical commission was the first to use the term primary health care to describe this new bottom up approach
● the term "primary healthcare" first appeared in the journal contact published by the wcc in 1970
28
what are the barefoot doctors
● the barefoot doctors are local farmers chosen by their communities and then given a few months training by doctors from urban hospitals
● they were taught to use simple technology and to combine western and traditional medicine to help their communities
● they then returned to their farms so that they remained a part of their community. this system helped to control epidemics, reduce child deaths and increase life expectancy in china in 1960's and 1970's
● the system of the barefoot doctors came to an end in 1990's. when the chinese government adopted a western hospital-based system of health care.
29
what is the alma-ata declaration
● during the 1970's there was a worldwide belief that healthcare services were too expensive and not accessible to all the people in all countries.
● as a result the USSR government hosted an international conference on PHC at alma-ata in september 1978
● the concept of PHC was an approach to healthcare that came into existance after the conference, which was organised by the united nations children fund (UNICEF)
● primary healthcare was accepted by the member countries of the WHO as the key to achieve the goal of "health for all" through a national health system that puts people at the centre of healthcare
● the alma-ata declaration emphasizes that everyone should have access to healthcare and everyone should be involved in it.
30
what is comprehensive approach
to health care is holistic, taking into account physical, social, psychological, economic, political and environmental wellbeing and being comprehensive in care, it includes a preventive, promotive, curative, rehabilitative, palliative and protective to health care.
31
define primary healthcare
is essential health care that improves health and makes universal health care available to all, especially the poor, through economic and social justice and equity.
32
what are socioeconomic conditions
are the conditions of people, including housing, sanitation, access to water, employment and food security.
33
define structural factors
are circumstances in the area where people live that can affect their health.
34
what is self worth
refers to an individual's ideas about how they value themselves
35
what is public health
(population health) is the science of protecting the safety and improving the health of populations
36
what is burden of disease
is the major cause of ill health in a country
37
what is mortality
is death due to a particular condition
38
what is life expectancy
is the average expected lifespan of a person in a society
39
what is morbidity
to the rate of disease in a population
40
what are social determinants of health
are the social and economic factors or conditions such as poverty that influence health.
41
define wellbeing
is living a favourable, good and satisfactory life.
42
what are epidemics
are a higher than expected level of a disease in a population
43
what is palliative care
refers to comprehensive and holistic end-of-life care
44
what is rehabilitation
refers to the implementation of interventions towards health. these can be medical, educational, vocational, psychosocial or community based interventions
45
what does inter-disiplinary mean
means to involve several different academic or professional specialties working together, not just doctors and nurses
46
what are health indicators
are numbers used to measure change over time. they are used to give an indication or measurement of the health of the people living within an area and the impact of these services on the people who use them.
47
what are expenditure on health per capita
refers to the amount of money spent on health per person in the province in 2014
48
what does medical scheme coverage
refers to the population that has medical aid cover.
49
what are the principles of an ideal clinic (ED CP IC AT)
EQUITABLE DISTRIBUTION: health services must be equally by all people irrespective of their ability to pay
COMMUNITY PARTICIPATION: an ongoing effort to foster meaningful involvement of the community in the planning, implementation and maintenance of health services
INTERSECTORAL COORDINATION: involvement of all related sectors and non-governmental organisations (NGOs)
APPROPRIATE TECHNOLOGY: this must be inline with resources that the community and the country can afford
50
what are the characteristics of primary health care (spencer plays cricket carefully since in December in winter)
● Address the socio-economic causes of poor health
● Make provision for basic health needs, i.e. organising health services around people’s needs and expectations
● Should encourage community empowerment i.e. ensuring that people are able to manage resources that are available to them
● Should provide a comprehensive quality healthcare,
-including promotive,
-preventive,
-curative,
-rehabilitative and
-palliative services
● Should foster the spirit of concerned and accountable health worker practice
● Should prioritised disadvantaged individuals and groups to ensure that health care is accessible, equitable and affordable to all
● Should recognise the importance of integrated service provision from primary to tertiary levels of care within a coherent healthcare system
● Should promote interdisciplinary, multi-professional and intersectoral collaborative teamwork and other stakeholder participation for effective service delivery
51
what are the 8 minumum core components of PHC
(EFWMIPTP)
1) Education concerning prevailing health problems and methods of preventing and controlling them
2) Promotion of food supply and proper nutrition
3) An adequate supply of safe water and basic sanitation
4) Maternal and child healthcare, including family planning
5) Immunisation against the major infectious diseases
6) Prevention and control of locally endemic diseases
7) Appropriate treatment of common diseases and injuries
8) Provisions of essential drugs
52
what is the 10 point strategic plan
1. Provision of strategic leadership and creation of a social compact for better health outcomes
2. Implementation of NHI
3. Improving the quality of health services
4. Overhauling the health care system and improving its management
5. Improving human resources management, planning and development
6. Revitalisation of infrastructure
7. Accelerated implementation of HIV & AIDS and Sexually Transmitted infections National strategic Plan 2007 - 11 and increased focus on TB and other communicable diseases
8. Mass mobilisation for better health for the population
9. Review of the drug policy and
10. Strengthening research and development.
53
what is the aim of re-engineering PHC
The re-engineering of Primary Health Care (PHC) aims to increase access of health services to the general public and to improve the quality of health services in general.
54
what are the 3 streams/aspects of phc reengineering
Community ward based PHC outreach teams
Strengthening of school health services
Institution of district-based clinical specialist teams, with focus on improving maternal and child health
55
describe PHC Package stream 1
New primary health care package(NHI):
-Community based services
-Increased emphasis on promotive, preventive services at household level
-Includes: oral, hearing, vision, rehabilitative
-School health services
-Aligned with District Hospital package
-Effective referral system
-Appropriate emergency and planned patient transport
56
describe PHC Package stream 2
-School Health Policy adopted in2003
-Implementation has been very limited due to resource constraints
-Minister of Health and the Minister of Basic Education are responsible
-Package includes reproductive health services and integrates HCT
57
describe PHC Package stream 3
-To address the unacceptably high infant, child and maternal mortality in most of our districts -National Health Council decided:
-Every district should be supported by a team consisting of:
Gynaecologist, Paediatrician, Anaesthetist, Family physician, advanced midwife, Primary health care nurse
58
what are the core principles of re-engineering
The focus is to deliver comprehensive care that include prevention, promotion and good quality essential care.
The aim is to reduce mortality and morbidity rates from major causes of ill-health.
To develop integrated, efficient and well supported Primary Health Teams
To concentrate and pay closer attention on the social determinants of health.
Strengthening and improve Primary Health Care services.
Establishing well functioning DHS
Strengthening School health services
59
what are the prevention levels vs care levels
prevention
-primary
-secondary
-tertiary
care
The specific point of contact that the individual or the population has with the healthcare system.
Primary, secondary, tertiary, quartenary care
60
what is the primary level of prevention
includes all actions that prevent the onset of illnesses, e.g. adequate exercise, a healthy diet, avoiding alcohol and drugs, avoiding cigarette smoking, immunisation, and screening for cancer. Primary prevention includes all health promotion activities.
61
what is the secondary level of prevention
includes the early diagnosis, treatment and cure of diseases.
62
what is the tertiary level of prevention
includes activities mainly concerned with rehabilitation, which is designed to restore normal functions and limit the damage caused by illness.
63
what are the factors that may affect the health of a family
social and economic factors
behavioural/lifestyle factors
environmental factors
64
what are the determinants of health
general and socio-economic
cultural and environmental
social and community influences
individual lifestyle factors
age, sex and heredity
living and working conditions
65
what are the non-modifiable factors
factors that you have no control over
-age
-sex
-genetics
-inherit characteristics from parents
66
what are the modifiable factors
determinants that can be controlled or altered
-individual lifestyle factors
-social/community influences
-living/working conditions
-general socio-economic factors
-cultural factors
-environmental factors
67
what are the socio-economic factors
(SPLCREEE)
social status
poverty
literacy levels
culture
religion
economic status
employment
educational status
68
what are lifestyle practices
tobacco smoking
dietary practices
alcohol and substance abuse
stress
exercise
underage sex
69
what are environmental factors
-waste (domestic and industrial)
-chemical pollution
-air pollution
-water pollution
-food pollution
-disaster
-land pollution
-climate change
70
what is epidemiology
it is the distribution of health in humans and the factors that determine health and disease
71
what are the 4 types of indicators
input
process
output
impact
72
what is prevalence rate
the number of cases of a specific disease present in a given population at a certain time
73
what is incidence rate
the rate of development of a disease and indicates the number of new cases of disease occuring over a period of time
74
what are social determinants of health
Social determinants of health are “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of- life outcomes and risks …
75
what are the non-communicable diseases of social determinants
(BBSLS)
Non-communicable diseases social determinants
Biological: Genes, Age, co-morbidities (Obesity, Hypertension)
Behavioural: Smoking, inactivity, Nutrition
Socio – cultural: Social exclusion, lack of support
Living, working conditions: Unemployment, Inequitable access to healthcare, local food environment
Structural: Urbanisation, Unregulated marketing of unhealthy food.
76
what is the national developmental plan
Aims to eliminate poverty, inequality
Raise the standard of living to a minimum level
Broadly aligned with the SDG’s
Implementation NHI (National health Insurance)
PHC Re-engineering – CHW
Recruitment, remuneration - employment
School Health Policy
Community involvement, Civic engagement
Inter –sectoral engagement
77
what are the challenges of NDP
Many social inequalities
Burden of disease : HIV, TB, Child mortality, non-communicable disease
No attention to intersectoral, levels of government collaboration, Community involvement, Civic engagement
Policy commitment in the health system, inter-sectoral partnerships remains elusive
Proposes Health sector’s advocacy in government to drive initiatives, achieve goals
78
what are the first 10 sustainable development goals
1) end poverty in all forms everywhere
2) end hunger, achieve food security and improved nutrition and promote sustainable agriculture
3) ensure healthy lives and promote wellbeing for all ay all ages
4) ensure inclusive and quality education for all and promote life long learning
5) achieve gender equality and empower woman and girls
6) ensure access to water and sanitation for all
7) ensure access to affordable, reliable, sustainable and modern energy for all
8) promote inclusive and sustainable economic growth, employment and decent work for all
9) build resilient infrustructure, promote sustainable industrialisation and foster innovation
10) reduce inequality within and among countries
79
what are the last 7 sustainable development goals
11) make cities inclusive, safe and sustainable
12) ensure sustainable consumption and production patterns
13) take urgent action to combat climate change and its impacts
14) conserve and sustainably use the oceans, seas, and marine resources
15) sustainably manage forests, combat deforestation, halt and reserve land degradation, halt biodiversity loos
16) promote just, peaceful and inclusive societies
17) revitalise the global partnership for sustainable development
80
what is an older person
An older person- is someone who has reached the age of 50 years
81
what is ageism
Ageism- refers to how we think (stereotype), feel (prejudice) and act (discrimination) towards others or ourselves based on age.
82
what is gerontology
Gerontology- is the study of the changes in the problems associated with the elderly.
83
what is geriatrics
Geriatrics- is the branch of medicine concerned with the diagnosis and treatment of disorders that occur in old age and with the care of the aged.
84
what do gerontologists include
Gerontologists- include researchers and practitioners, dentists, social workers, physical and occupational therapists, psychologists, psychiatrists, sociologists, economists, political scientists, architects, pharmacists, public health practitioners, housing specialists and anthropologists.
85
what is a terminal or life threatening illness
A terminal or life threatening illness- is an infection or disease that is considered ultimately fatal or incurable
86
what are some examples of terminal or life threatening illnesses
Some examples of terminal or life threatening illnesses:
Alzheimer's disease
Heart disease or cardiovascular disease
Cancer
Diabetes mellitus
A stroke
87
what are the general body changes of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
● Increase in body fat
● Decrease in body fluid distribution
Implications
● Increased distribution of fat-soluble drugs
● Decreased volume of distribution for water- soluble drugs
Nursing Assessment
● Take a history of all medication taken, prescribed, self-medication and herbal remedies
Nursing care strategies
● Consult the prescribing health professional and decrease dosages of medications
88
what are the skin changes of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
● Epidermal thinning
● Decrease in subcutaneous fat and vascularity of dermis
● Reduction in the number of sweat and sebacceous glands
● Wrinkling, sagging, hair loss and greying, degeneration of elastic fibres in the skin
Implications
● Possibility of damage, eg. decubitus ulcer, bruising, skin trauma, pallor
● Skin dryness, less natural oil
Nursing Assessment
● Monitor skin temperature
● Assess skin turgor
● Assess skin breakdown several times per day on skin surfaces
Nursing care strategies
● Hydrate client and increase fluid intake to prevent dehydration
● Handle gently when lifting and turning
● Turn client 2-hourly to reduce pressure over bony prominences
● Keep skin dry
● Use minimal soap, use emollient-ointment and use aqueous cream to wash skin
89
what are muscular and skeletal changes of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
● Decreased lean body mass replaced by fat
● muscles lose strength
● bone density
● fluid in intervertebral discs
● ligament and tendon strength
● Declining strength because of decreased blood supply to muscles
Implications
● Increase in potential for fractures
● risk of falls
● Decreased height
● Stature change-tends to stoop
● less muscle strength
● Increased curvature of the spine
● Gets tired easily
● Tendency to be immobile
● Risk of osteopenia
● Limited range of movement of joints
● Increased risk of osteoarthritis
Nursing Assessment
● Assess strength and function mobility
● Assess nutritional intake
● I.e improve calcium and vitamin D intake
● Do a history of physical activity
● Assess for possible hip fracture
● Assess the risk for disability
Nursing care strategies
● Provide assistance with walking as needed.
● Educate clients of the importance of calcium intake with vitamin D
● Encourage low-impact exercise to improve strength
● Assess and change the physical environment to
decrease the risk of falling
● Stop smoking
● Advise bone mineral density screening
90
what are the Cardiovascular system changes of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
● Decreased elasticity of aorta and arteries
● Arterial compliance and increased systolic BP
● Decreased cardiac muscle tone
● Cardiac output
● Elasticity of the heart muscle and blood vessels
● Increased heart size, especially left ventricle,
atherosclerosis
Implications
● Decreased tissue oxygenation leading to reduced cardiac output
● Compensation for decreased heart muscle tone
● Increased heart failure
● Decreased venous return
● Increased BP, weaker pulses
● Pulse rate and systolic BP increase
● Inflamed varicosities
● Will faint easily
Nursing Assessment
● Assess pulses
● Assess BP, lying, sitting and standing
● Assess ability to tolerate activity eg walking with a frame
or walking stick, for exercise
● Assess for possible hypertension
Nursing care strategies
●Listen to heart sounds
● Check for equal pulses on both sides of body
● When hypotensive, seek assistance
● Change position slowly, from lying to sitting/standing
● Instruct the client to rest, if short of breath or tired
91
what are the Blood and immune system changes changes of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
● Increased plasma viscosity
● Decreased red blood cell production, T-cell function, bone marrow reserve
Implications
● Increased risk of vascular occlusion
● Increased incidence of anaemia.
● Decreased immune response
● Increase in auto-immune disease
Nursing Assessment
● Monitor laboratory tests: haemoglobin, haemogluco test, leucocytes (WBC)
● Assess nutritional intake of supplements, eg protein, iron and vitamins
Nursing care strategies
● If any abnormalities are observed, report to physician at day hospital or professional nurse in charge of client in facility for the aged
● Administer nutritional supplements as prescribed
92
what are Respiratory/pulmonary changes of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
● Decreased pulmonary muscle strength
● Number of the cilia in the lungs
● Fall in elastic recoil of alveoli
● Reduced lung elasticity and increase in chest wall
stiffness and decreased cough reflex
● Increased cartilage calcifications
Implications
● Decreased cough reflex, ability to trap debris in mucus, ability to breathe deeply, lung capacity and vital capacity
● Increased risk of respiratory infections and residual volume
Nursing Assessment
● Assess cough and sputum production
● Assess for signs and symptoms of respiratory infection
● Assess susceptibility to pneumonia and bronchospams
● Dyspnoea on exertion
● Respiratory rate 12-24 bpm
Nursing care strategies
● Position to ensure the client can breathe easily ie no slouching
● Encourage breathing exercises and walking
● Encourage adequate fluid intake
● Stop smoking
● Encourage careful hand washing and disposal of
secretions
93
what are the Gastro-intestinal changes of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
● Increased dental caries and tooth loss, thirst perception
● Decreased saliva and gastric secretions, strength of muscles used for chewing, gastric motility with delayed emptying, gastric acidity, colon motility and peristalsis and liver function, metabolism of medication
● Atrophy (decreased in size) of protective mucosa
● Malabsorption of carbohydrates, vitamin B12 and vitamin D, folic acid and calcium
● Atrophy (decreased in size) of gums and bone tissue in jaw/mandible
● Impaired sensation to defaecate
● Decreased muscle tone of anal sphincters
Implications
● Decreased ability to chew normally, can lead to malnutrition
● Decreased digestion and absorption of nutrients ingested
● Increased risk of dehydration and constipation, flatulence, constipation
and impacted faeces
● Increased incidence of choking and aspiration, incidence of heartburn
● Decreased ability to metabolise drugs leading to increased risk of drug
toxicity, calcium absorption on empty stomach
● Risk of impaired fluid and electrolyte imbalances leads to poor nutrition
● Gastric changes, altered drug absorption, increased risk of gastro-oesophageal reflux disease
Nursing Assessment
● Assess oral cavity for dentition, condition of mucous membranes and hygiene
● Assess swallow and gag reflexes
● Monitor weight changes, calculate BMI
● Assess diet and nutritional status
● Assess abdomen for bowel sounds and bowel elimination patterns
● Assess oral cavity for chewing capacity, dysphagia.
Nursing care strategies
● Educate regarding good oral hygiene
● Stress need for adequate fluid intake
● Refer for dental care
● Encourage posture which facilitates swallowing ie sitting upright
● Wear well fitting dentures to enhance appearance
● Consult with speech therapist for assistance with swallowing and safe diet eg soft, moist food
● Weigh once per month, more often if client has fluid balance problem
● Educate regarding suitable diet relevant to chronic illness where
necessary
● Plan a bowel routine and educate about the importance of adequate
fluid, fibre and activity to prevent constipation and impaction
● Educate and/or provide laxatives, stool softeners, suppositories or
enemas when it is necessary.
94
what are the Liver and bile ducts changes of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
● Reduced liver function and hepatic flow of blood in liver and reduced enzyme activity
Implications
● Decreased albumin synthesis, and delayed metabolism of some drugs
● Reduced medication metabolism and elimination of medication, causing toxicity
● Altered drug metabolism
Nursing Assessment
● Evaluate possible drug interaction of medication being taken by client
● Careful monitoring of medication levels
Nursing care strategies
● Reduce doses of certain drugs. Avoidance of long-life drugs
95
what are the Urinary changes changes of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
●Reduced mass of kidneys, blood flow, glomerular filtration rate and medication clearance
● Loss of excretory pattern during the daytime, increased nocturnal urine production
● Reduced renal blood flow
● Decreased muscle tone of urinary bladder, tissue elasticity,
delayed perception of need to void/pass urine
Implications
● Decreased overall kidney function with reduced clearance of waste body products, bladder capacity and reduced excretion of medication through the kidney
● Increased concentration of urine, hesitancy and frequency of urination volume of residual urine
● Need to awaken to void or episodes of nocturnal incontinence and an increase in risk for infection and incidence of incontinence
● Altered fluid and electrolyte homeostasis with reduced water resorption.
Nursing Assessment
● Assess urine sample where necessary
● Monitor for signs of drug toxicity
● Assess for urinary frequency
● Assess for signs and symptoms of urinary tract infection.
Nursing care strategies
● Do urinalysis when client complains of dysuria, or when necessary
● Promptly notify physician/professional nurse of relevant
observations
● Make sure the person is near a toilet
● Check if the bladder is emptying completely.
96
what are the Genital changes of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
Female: vaginal/urethral mucosal atrophy Reduced pelvic floor muscle tone
Decreased oestrogen levels and tissue elasticity Increased vaginal alkalinity.
Male: Increased sizes of prostate
Decreased testosterone levels and circulation
Implications
● Decreased stream of urine
● Dyspareunia, bacteraemia
● Incontinence is common, when client coughs or laughs,
especially in woman
● Decreased vaginal secretions: pubic hair, size of uterus
and vaginal opening, breast tissue mass, amount of facial
hair and pubic hair
● Increased vaginal tissue, irritation and risk of vaginal
infection
● Decreased rate and force of ejaculation and speed
gaining an erection.
Nursing Assessment
● Assess frequency and timing of episodes of incontinence
● Assess muscle tone of pelvic floor muscles
● Assess signs and symptoms of infection or inflammation
● Assess factors that may interfere with sexual activity
Nursing care strategies
● Plan a toilet schedule based on assessment data
● Physician should reduce dosage of certain drugs
● Maintain fluid intake,if the client has CCF, be cautious
with fluid intake
● Advise kegel exercises to strengthen pelvic floor muscles
● Report unusual vaginal discharge to professional nurse
● Discuss normal physiological changes and the possible
effect of medications on sexual function
● Educate females regarding use of artificial lubrication
● Possible referral of males to physician for treatment of
erectile dysfunction
97
what are the Nervous system changes of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
● Decreased number of brain cell nerve fibers, of neuroreceptors, peripheral nerve function
● Slowed reaction time
Implications
● Slowed thought processes
● Decreased ability to respond to multiple stimuli and tasks, reflexes,
co-ordination
● Proprioception, perception of stimuli and motor responses
● Increased risk of ischaemic paraesthesia in extremities
Nursing Assessment
● Assess alertness level, recognition and functional abilities
● Assess balance and reflexes for possible gait training and use of
walking frame
● During acute illness assess functional status of client if living at
home or in facility for the elderly
Nursing care strategies
● Report abnormal findings to physician or professional nurse
● Refer for neurological evaluation
● Inform client of safety precautions and use of assistive devices
● Structure tasks to reduce confusion
● Allow adequate time to perform tasks and for client to respond
● Remove household hazards, like loose mats
98
what are the Sensory changes (vision) of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
● Decreased number of eyelashes and tear production
● Increased discolouration of lens, opacity
Implications
● Increased risk of eye injury, eye irritation, blurring, refractive errors, sensitivity to glare
● Decreased eye perception, diameter of pupil, night vision, peripheral vision
Nursing Assessment
● Assess the eyes for signs of irritation, inflammation and dryness
● Assess visual acuity, in doing so, assess ability to detect objects
within the environment
Nursing care strategies
● Encourage regular use of synthetic tear preparations to help reduce irritation
● Schedule regular professional eye examinations
● Educate regarding importance of adequate light with minimum
glare
● Explain importance of using spectacles for reading or
distance/driving
● Educate about good lighting or contrasting colours to highlight important structures, eg the edge of stairs, light fixtures, taps
99
what are the Sensory changes (Auditory) of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
● Degenerative changes of ossicles (bones), obstruction of eustachian tube, atrophy of external auditory meatus, atrophy of cochlear hair cells, loss of auditory neurons, decreased cerumen (wax) - cell producing cells in external ear canal
Implications
● Sensorineural hearing loss
● Decreased perception in high frequencies of sound, pitch
discrimination, impaired vestibular responses
● Increased problems with balance, risk for cerumen (wax)
impaction causing conductive hearing loss, problems with balance
Nursing Assessment
● Assess hearing and balance
● Inspect ear canal for wax (cerumen) impaction
● Assess functioning of hearing aid if used
● Assess for social isolation
Nursing care strategies
● Advise or refer to auditory testing as required
● Administration of prophylactic drops may reduce
impaction of wax
● Speak slowly and distinctively, if client does not use a
hearing aid
● Encourage socialisation in areas without excessive
changes to routine
100
what are the Sensory changes (Olfactory, nose, taste) of the elderly (physical, implications, nursing assessment, nursing care strategies)
Physical change
● Decreased number of papillae on tongue and number of nasal sensory neurons
Implications
● Decreased ability to taste
● Decreased ability to detect smells eg smoke
Nursing Assessment
●Assess ability to smell and taste
Nursing care strategies
● Teach importance of storing food properly to prevent food going bad
● Keep medication and chemicals separated from foods
101
what is delirium
Delirium is an acute confused state marked by a severe decline in attention and thinking ability.
● It is common for delirium to occur in those over the age of 65.
● Delirium is common in the elderly
102
what is the onset of delirium
(Differences between delirium and dementia)
Rapid
103
what is the onset of dementia
(Differences between delirium and dementia)
insidious
104
what is the cause of delirium
(Differences between delirium and dementia)
Medication, infection, dehydration, metabolic abnormality etc
105
what is the cause of dementia
(Differences between delirium and dementia)
Damage to the brain tissue
106
what is the Duration of delirium
(Differences between delirium and dementia)
Usually less than one month
107
what is the Duration of dementia
(Differences between delirium and dementia)
Months to years
108
what is the course of delirium
(Differences between delirium and dementia)
Reversible
109
what is the course of dementia
(Differences between delirium and dementia)
Irreversible, ultimately fatal
110
what is the level of consciousness of delirium
(Differences between delirium and dementia)
Usually changed, can be agitated, normal or dull
111
what is the level of consciousness of dementia
(Differences between delirium and dementia)
Normal
112
what is the orientation of delirium
(Differences between delirium and dementia)
Impaired short-term memory
113
what is the orientation of dementia
(Differences between delirium and dementia)
May be corrected in mild cases, first loses orientation to time, then place and person
114
what is the Thinking of delirium
(Differences between delirium and dementia)
Disorganised, incoherent, rambling
115
what is the Thinking of dementia
(Differences between delirium and dementia)
impoverished
116
what is the Attention of delirium
(Differences between delirium and dementia)
Usually disturbed, hard to direct or sustain
117
what is the Attention of dementia
(Differences between delirium and dementia)
Usually intact
118
what is the Awareness of delirium
(Differences between delirium and dementia)
Can be reduced, tends to fluctuate and to be worse at night (psychotic, unmanageable)
119
what is the Awareness of dementia
(Differences between delirium and dementia)
Usually intact. Alert during the day, may be hyper-alert
120
what is the sleepwalking of delirium
(Differences between delirium and dementia)
Usually disrupted
121
what is the sleepwalking of dementia
(Differences between delirium and dementia)
Normal for age, cycle disrupted as the disease progresses
122
what is the onset of dementia
(Differences between dementia and depression)
Cognitive deficits predate depressive symptoms
123
what is the onset of depression
(Differences between dementia and depression)
Depressive symptoms antedate cognitive deficits
124
what is the presentation of memory symptoms of dementia
(Differences between dementia and depression)
Client minimises or denies, often will guess or evade the question if he or she does not know the answer
125
what is the presentation of memory symptoms of depression
(Differences between dementia and depression)
May answer simple questions, such as name or date, with “i don't know”
126
what is the appearance and behaviour of dementia
(Differences between dementia and depression)
Social skills are preserved until the later stages
127
what is the appearance and behaviour of depression
(Differences between dementia and depression)
Often neglected or sloppy
128
what is the intellectual skills of dementia
(Differences between dementia and depression)
Consistently impaired
129
what is the intellectual skills of depression
(Differences between dementia and depression)
Inconsistent and often associated with poor effort
130
what is the affect of dementia
(Differences between dementia and depression)
Usually normal
131
what is the affect of depression
(Differences between dementia and depression)
Flat
132
what is the history of dementia
(Differences between dementia and depression)
Previous episodes of major depressive disorder earlier in life, especially chronic untreated
133
what is the history of depression
(Differences between dementia and depression)
Previous episodes of major depression
134
what kind of questions should you ask when assessing functional status of a patient
Assessing functional status is important and needs to be conducted with discretion. The following should be established:
● Can the client feed himself or herself unaided?
● Is the client mobile without a walking aid?
● Does the client undress, wash and dress without assistance?
● Can the client use the toilet without assistance?
● Does the client bath himself or herself unaided or with assistance?
● Can the client walk on a level surface?
● Can the client walk up and down the stairs?
● Does the client have bladder and bowel control?
● Does the client do his or her own shopping, use public transport, do housekeeping, do his or her own laundry/washing and handle his or her own finances?
● Is the client responsible for taking his or her own medications?
135
how do older people ageing healthy
A balanced diet and healthy lifestyle throughout life are ultimately responsible for healthy ageing but it is never too late to adopt healthy habits
● The following are practical measures to promote healthy ageing
○ Take part in some form of aerobic and resistance exercise, and also do static balance training for 12 minutes, 3 times per week.
○ Increase vitamin D and dietary calcium intake to slow the onset of osteoporosis
○ Stop smoking
○ Follow a varied and healthy diet , low in staurated fatty acids
○ Drink alcohol in moderation
○ Take part in social activities
136
what are the different types of risk factors associated with falls
behavioural
biological
socioeconomic
environmental
137
what are behavioural risk factors
Behavioural risk factors- include multiple medication use (polypharmacy) or using medication which is not prescribed, excessive alcohol intake, lack of exercise and ill-fitting footwear
138
what are biological risk factors
Biological risk factors- include age, gender and race. Chronic illnesses (eg.parkinsons, arthritis and osteoporosis), as physical, cognitive and affective capacity declines, lead to loss of muscle strength.
139
what are environmental risk factors
Environmental risk factors- include poor building access and design, slippery floors and stairs, loose rugs, insufficient lighting, and cracked or uneven paving.
140
what are socioeconomic risk factors
Socio- economic risk factors- include inadequate housing, limited access to health and social services, especially in the rural areas and lack of community resources such as adequate transportation.
141
what are the different types of abuse of the elderly
➔ Physical abuse
➔ psychological / emotional abuse
➔ Financial abuse
➔ Neglect
➔ Violation of rights
142
what are the solutions on a local level of obesity
Action at local level can include:
➢ urban planning (e.g. recreational spaces73 and retail environments;65
➢ support of early childhood feeding practices75 and household food gardens; and
➢ school and workplace nutritional interventions.
143
what are the solutions on a national level of obesity
Action at national level can include:
➢ fiscal measures (e.g. tax on sugary beverages);72
➢ food labelling and regulation of food advertising;
➢ policy congruence between ministries (e.g. healthy food options and information, education and communication, information, education and communication, physical activity possibilities in schools, supported by the Department of Health;73 and
➢ health education/mass media.74
144
what are the solutions on a global level of obesity
Action at global level can include:
➢ dissemination of positive examples of improved nutritional outcomes associated with policies such as tax on sugary drinks (Mexico)70 and school-feeding legislation (Brazil);71
➢ support of initiatives to increase corporate taxation and regulate tax avoidance; and
➢ measures to raise public awareness about the increasing dominance and unaccountability of TNCs and their associated detrimental impacts on health.
