final variation in eldelry

1. Elderly client Variations 1
Assessment of elderly
Patients
Rozina Somani
Senior Instructor
Health Assessment
Acknowledgement : Ms Shenaz
Cassum

2. APPROACH
 Common Medical Problems in Elderly patients
 Common Nursing Problems in Elderly patients
 Geriatric syndrome
 Interviewing Principles for Elderly Assessment
 Examination principles for Elderly Assessment
 Examination Findings
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3. Elderly Population
 Elderly Population have difficulty in carrying out
activities of daily living
(ADLs) include bathing, dressing, toileting,
transferring, and feeding.
 They also have difficulties with instrumental
activities of daily living (IADLs).
IADLs include ability to use the telephone,
shopping, food preparation, housekeeping,
laundry, using transportation, managing money
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Common medical problems:
 Arthritis
 Hypertension
 Heart disease
 Diabetes
 Visual impairments
 Hearing impairments
 Varicose Veins
 Dementia

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Varicose vein

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Nursing Problems
 Impaired physical mobility
 Self care deficit
 Altered home management
 Decreased nutrition
 Incontinence
 Social Isolation
 Sensory perceptual alterations
 High risk for fall / injury
 Confusion

9. Elderly client Variations 9
Geriatric Syndrome
(functional decline, morbidity and mortality)
 Mental status impairment (3Ds
Depression, Dementia, Delirium )
 Functional impairment (ADL, Fall)
 Poor nutrition
 Incontinence
 Sleep problems
 Inappropriate medication use
Relate this to FHP assessment form

10. Altered Clinical Presentation
In Elderly client
 Classic symptoms of disease is missing
E.g. Myocardial infarction may present with
mental confusion
 Presence of one condition may mask
another.
E.g. Symptoms of COPD and Ischemic Heart
Disease
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11. Accumulated life history
Treat older adults with respect for their
intelligence, wisdom, and accumulated life history.
Older adults may have long life history
To direct the interview say “ This is valuable
information that I would like to hear about at some
later point in time, but right now I need to focus on
your problem of dizziness”
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Interviewing Principles - Old Client
 Process may be longer and slower
 Physical or cognitive alterations (memory
loss, slow response, hearing /vision
impairment)
 Ask simple direct questions and avoid
shouting
 Face the patient to allow lip reading
 Allow the person to recall
 Avoid giving impression, this is not valued

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Examination Principles
 Assess degree of help needed for movement
 Give extra time to understand the
instructions
 Keep the person warm
 Alternative positions if impaired mobility
 Guard whenever required
 Inspect areas at risk of skin breakdown

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Examination Findings
 Skin:
 Wrinkling & sagging of skin
 Hypo pigmentation spots - Pseudoscar
 Hyper pigmentation - Senile lentigens
 Telangiectasias – dilated vessels
 Spider & cherry angiomas
 Senile purpura - easy bruising
 Dry skin – Xerosis / aesthiosis
 Seborrheic keratosis - raised warty benign
 Actinic keratosis- pink, dry scaly lesions
 Basal cell carcinoma-pearl nodule rolled
borders

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Wrinkling &
sagging of
skin Hypopigmentation Hyperpigmentation
Dilated vessels
Cherry Angioma
Senile Purpura

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Xerosis/ dry skin Seborrheic keratosis
Actinic keratosis-
Basal Cell Carcinoma

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Examination findings
 Nails & Hair:
 Thin/ less/ gray scalp, axilla & pubic hair
 Eyebrow, nostril & ear hair coarser, darker
 Nails may be thick / thin & split
 Eyes:
 Sunken eyes & ectropion
 Dry eye syndrome
 Cataract & Glaucoma
 Arcus senilis - grayish halo arc at limbus
 Presbyopia - poor accommodation,
and.vision
 Fundoscopy – yellow retina

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Sunken eyes
Arcus senilis
Presbyopia
yellow retina

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Examination findings
 Nose: Smell sensation less, dry mucosa
 Mouth:
 Taste ability intact, Dry mouth - xerostomia
 Less salivation - oral candidiasis
 Dental caries / periodontal disease
 Ears:
 Pinna size increase, cerumen dries, pruritis
& impaction – Conductive loss
 Presbycusis (S/N loss) - use of aids
 TM – translucent & rigid

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xerostomia oral candidiasis Periodontal disease
Presbycusis Translucent & Rigid Tympanic
membrane

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Examination findings
 Respiratory:
 Calcification ribs - less compliant chest wall
 Spinal changes - AP diameter increase
 Cardiac & Peripheral Vascular System
 Maximum heart rate & Cardiac Output
decreases
 Athero/ Arterioscleroses - Systolic HTN
 Orthostatic Hypotension
 Fibrosis of aortic valve – Systolic murmur
Abdomen:
 Muscle wasting or fatty, obese

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Examination findings
 Musculoskeletal System:
 Height, mass & strength decrease - kyphosis
 Osteoarthritis & Osteoporosis
 Heberden’s and Bouchard’s nodes
 Nervous system:
 Deep Tendon Reflex difficult to elicit, Tremors
(medicines)
 Vibratory sense decrease, Posture imbalance
 Delirium - Attention & sensory deficit
 Dementia- confusion, cognitive memory deficit

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Examination findings
 Male reproductive:
 Testosterone & testes size decrease
 Sperm motility & seminal fluid decrease
 Prostate enlargement
 Female reproductive:
 Estrogen decreases & intercourse b/c painful
 Vagina atrophies, Uterus, ovaries & cervix size
decreases
 Breast/Genitalia:
 Breast size less, Gland atrophies – pendulous

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PVS & MS: Changes in Elderly:
PVS: Pulse weak and thready, rate low, B.P. high,
160/90 with no symptoms, orthostatic hypotension DVT
and varicosities, skin pale and cooler.
MS:
Thinning of the intervertabral disks and shortening or
collapse of disc-loss of height.
Changes in spine-kyphosis- increase antero-posterior
diameter.
Cont…

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PVS & MS: Changes in Elderly:
Muscle mass and strength low, demonstrated by
presence of groove between the bones.
Osteoarthritis, particularly of spine, knee, hip and
fingers.
Prone for injury to cartilages leads to
deterioration of joint.
Loss of cartilage and joint capsule lead to bone
over growth cause pain, deformities, and limited
mobility called ostscophytes, common in distal
joint of finger called Heberden’s nodes and in
proximal joints of finger called-Boucherd’s nodes.

27. HUMOR:
THE PERKS OF BEING OVER 50
Contributed by James Kelly
 Kidnappers are not very interested in you.
 In a hostage situation, you are likely to be released first.
 People call at 8 PM and ask, "Did I wake you?"
 There's nothing left to learn the hard way.
 Things you buy now won't wear out.
 You can live without sex, but not without glasses.
 You have a party and the neighbors don't even realize it.
 You no longer think of speed limits as a challenge.
 Your investment in health insurance is finally beginning to pay off.
 Your joints are more accurate in predicting rain than the National Weather Service.
 Your secrets are safe with your friends, because they can't remember them either.
 Your supply of brain cells is finally down to a manageable size.
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Elderly client Variations

28. Elderly Clients Needs Nursing Care
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30.  Video
 Please go to this link
http://www.youpak.com/watch?v=5kz0ruJbR7I
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