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Geriatric Care in Nursing - Common Disorder | 12th Nursing : Chapter 7 : Geriatric Care

Chapter: 12th Nursing : Chapter 7 : Geriatric Care

Common Disorder

Immobility and rehabilitation, Frequent falls, Urinary incontinence


·           Immobility and rehabilitation

·           Frequent falls

·           Urinary incontinence

·           Stroke rehabilitation

·           Pressure / bed sores

·            Laterogenic drug reactions

·           Hypertension in the elderly

·           Diabetes in older adults

·           Arthritis and osteoporosis

·           Prostate enlargement

·           Eye diseases

·           Cancer


1. Immobility and Rehabilitation

·           Age changes in neurological and musculoskeletal system lead to high prevalence of disorders such as stroke, Parkinson disease, osteoarthritis and osteoporosis interact to make poor mobility.

·           The goal of rehabilitation to reduce limitations of movement and to improve mobility.


Therapies to reduce pain and to increase in range of motion.

Heat, cold, massage, electro therapy, hydrotherapy and ultraviolet radiation.

Occupational therapy and braces, splints and prostheses, crutch may be used to enhance function.


2. Frequent Falls


·           Several factors such as neurological, cardiovascular, musculoskeletal, otological and drugs (hypertension, bradycardia of sick sinus syndrome) causes falls.

·           Poor vision

·           Muscle weakness

·           Insufficient lighting

·           Uneven carpet or slippery floor


·           Careful history and physical examination.

·           Assessment of standing balance and gait.

·           CT of the brain, blood pressure monitoring.


3. Urinary Incontinence


The involuntary leakage of urine it means a person urinates when they do not want to


·           Involuntary passage of urine due to loss of bladder control.

·           Drugs, abdominal surgery, neurological diseases and physical disability either lead to percipitate inconvenience.

·           Obesity

·           Smoking

·           Stress


·           Toilet training to anticipate and overcome episodes of incontinence

·           Bladder relaxant

·           Treatment of the cause

·            Therapeutic devices( catheters)


4. Stroke

Definition: The sudden death of brain cells due to lack of oxygen caused by blockage of blood flow or rupture of an artery to the brain.


·            Hypertension

·            Smoking

·            Alcohol

·            Diabetes

·            Cardiac diseases


·           Prevention and treatment of acute complications.

·           Rehabilitation to minimise disability.

·           Medical intervention to minimise impairment.

·           Nursing Intervention (nutrition, skin care, positioning, bladder and bowel care)

·            Drug therapy with anti platelet agents and hunting co-coagulants.


5. Arthritis and Osteoporosis

Definition of Arthritis

It is a painful inflammation and stiffness of the joints. Arthritis simply means inflammation of the joints. The symptoms include pain, swelling and stiffness with limitation of joint movements.


·            Abnormal metabolism

·            Genetic inheritance

·            Infection

·            Systemic lupus erythematosus

Definition of Osteoporosis

Osteoporosis means “porous bones” causing bones to become weak and brittle.


·            Low bone mass

·            Calcium and vitamin D deficiency

·            Sedentary life style

·            Thyroid problems

·            Smoking


Taking diet rich in calcium and Vitamin D

·            Avoiding tobacco, alcohol and excess of tea and coffee

·           Brisk physical exercise

·           Be active which really helps bone and prevents osteopenia.

·           Reduce your chance of falling by making your bones safer.


6. Benign Prostatic Hypertrophy


Enlargement of the periurethral position of the prostate lead to theobstruction of urinary outflow which begin with the fracture of prostatic hyperplasia and ends with urinary obstruction.


·            Ageing

·            High level of Dihydro testosterone

·            Genetic


·           Transurethral resection of prostate was the mode of surgical treatment.

·           Medical management with specific long activity adrenergic antagonists and a reductase inhibitors have been and with excellent results.


7. Diabetes in Older Adults

Definition: Diabets mellitus is a chronic multisystem disease characterized by hyperglycemia related to abnormal insulin production and impaired insulin utilization.


·            Auto immune

·            Environmental factors


·           The lifestyle modifications, diet and nutrition, physical exercise.

·           Overweight elderly should be advised to loss weight and abstain from alcohol and smoking.

·           Oral hypoglycaemic drugs in NIDDM and insulin in IDDM.

·           Insulin is indicated in NIDDM for proper control despite oral hypoglycaemic drugs in the presence of infections, ketosis, hyperosmolar state, surgery and diabetic heuropathy.


8. Hypertension in the Elder


Hypertension is defined as a persistent Systolic BP of 140mm Hg or more, Diastolic BP 90mm Hg or more.


·            Over production of sodium retaining hormones.

·            Increased sodium intake

·            Diabetes

·            Tobacco use

·            Excessive alcohol intake


·           Weight and salt reduction and change in Lifestyle.

·            Initially low dose diuretics of beta blockers are recommended.


9. Pressure Ulcer/Bed Sores

Definition: Pressure ulcer is localized injury to the skin and underlying tissue as a result of pressure or pressure in combination with shear.


·            Excessive moisture

·            Obesity

·            Diabetes mellitus

·            Occur due to ischemia, necrosis and ultimate ulceration of the tissue due to constant pressure at sites with are pressure prove.

·            Immobile following surgery or a spinal cord injury can lead to bed sore


·            Optimal nutrition can aid in the healing process –food rich in zinc and vitamin c (green, red and orange vegetables)

·           keeping the wounds clean to prevent infection

·           speed the healing process by keeping the wound moist and the surrounding skin dry

·           pain management with more serious ulcer


10. Eye Diseases


A cataract is an opacity within the lens. Cataract is the commonest cause of Visual impairment in old age. Cataract is characterized by painless burning gradual loss of vision increased sensitivity to glare under general darkening of vision.



·            Maternal rubella

·            Radiation or ultraviolet exposure  Long term topical corticosteroids  Diabetes mellitus


Surgery after the removal of the lens, which has now been replaced by the implantation of an inter ocular lens which restore hear normal focusing ability.


11. Glaucoma


Glaucoma is a group of disorders characterized by increased IOP and the consequences of elevated pressure, optic nerve atrophy, and peripheral visual field loss.


·           Lens bulging due to aging

·           Damage to the optic nerve.

·            Reduction in the outflow of aqueous humor


12. Cancer


Cancer is a group of diseases characterized by uncontrolled and unregulated growth of cells. Among elderly men concern of the prostrate and colon are the most common while for women it is a breast cancer. Other concern found in geriatric patients are skin, lung and pancreas, bladder, rectum and stomach.


·           Smoking and tobacco

·           Diet and physical activity

·           Sun and other type of radiation

·           Viruses and other infection


·           Quit smoking

·            Moderate your diet, diets high in fruits and vegetables may have a protective effect against many cancers.

·            Avoid excessive exposure to ionizing radiations.

·            Regular physical activity and maintain a healthy body weight.


13. Drug Reactions

·           Older patients are two of three times more vulnerable to drug reaction.

·           Drug clearance is markedly reduced due to reaction in Renal blood flow and glomerular filtration rate.

·           Distribution of the drug is also affected in old age due to reduction in total body weight content and their relative increases in body fat.

·           Protein binding of the drug is decreased due to fall in serum albumin in old age.


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