NURSING CARE OF OLDER ADULT IN WELLNESS

NCM 114: Care of Older Adult

Professor: Judith Bufete, RN, MAN BSN 3-C

SUBJECTIVE DATA
A. ASSESSMENT ● Subjective data is information
● Some important considerations obtained from the patients and/or
when assessing older adults family members and can provide
include using all senses to gather important cues about functioning
data, allowing extra time for and unmet needs requiring
assessments, and providing a assistance.
comfortable environment that ● Subjective data is considered a
accounts for sensory and mobility symptom because it is something
changes. the patient reports.
● Important considerations when OBJECTIVE DATA
assessing older adults include ● Objective data is information
using experience and expertise observed through your senses of
when working with them, allowing hearing, sight, smell, and touch
extra time for assessments as older while assessing the patient.
adults may have trouble focusing, ● It is obtained during the physical
and providing a comfortable examination component of the
environment through modifications assessment process.
like adequate lighting and seating. ● Examples: V/S, physical
SYSTEMATIC GERIA ASSESSMENT examination findings, and lab
● A comprehensive geriatric results.
assessment involves evaluating an HEALTH HISTORY
older adult’s physical, cognitive, ● A comprehensive health history
psychological, social and functional investigates several areas:
abilities. ○ Demographic and biological
● It is conducted by an data
interdisciplinary healthcare team ○ Reason for seeking health
and aims to develop an care
individualized care plan. ○ Current and past medical hx
● The assessment evaluates several ○ Family health hx
domains including activities of daily ○ Functional health and
living, medical history, medications, activities of daily living
social supports, and identifies ○ Review of body systems
medical conditions common in
older adults.
● A thorough assessment requires
common sensitivity, appropriate
environmental adaptations, and an
understanding of an individual’s
values and preferences.

Transes by: Karen Joy C. Cuebillas ౨ৎ

 ● This framework includes the
following categories:
○ Nutritional-Metabolic:
Food and fluid consumption
relative to metabolic need
○ Elimination: Excretion
including bowel and bladder
○ Activity-Exercise: Activity
and exercise
○ Sleep-Rest: Sleep and rest
○ Cognitive-Perceptual:
FUNCTIONAL HEALTH PATTERNS
Cognition and perception
● Functional health assessment
○ Coping-Stress Tolerance:
collects data related to the patient’s
Coping and effectiveness of
functioning and their physical and
managing stress
mental capacity to participate in
○ Value-Belief: Values,
Activities of Daily Living (ADLs) and
beliefs, and goals that guide
Instrumental Activities of Daily
choices and decisions
Living (IADLs), Activities of Daily
○ Self-Perception and
Living (ADLs) are daily basic tasks
Self-Concept: Self-concept
that are fundamental to everybody
and mood state
functioning (e.g., hygiene,
○ Health Perception-Health
elimination, dressing, eating,
Management: A patient’s
ambulating/moving)
perception of their health
● Information obtained when
and well-being and how it is
assessing functional health
managed. This is an
provides the nurse a holistic view of
umbrella category of all
a patient’s human response to
categories above and
illness and life conditions.
underless performing a
● It is helpful to use an assessment
health history.
framework, such as Gordon’s
POSITIVE BODY LANGUAGE
Functional Health Patterns, to
● Head Tilted to One Side
organize interview questions
○ Listening keenly, or is
according to evidence-based
interested in what is being
patterns of human responses.
communicated.
● Using this framework provides the
● Rubbing Hands Together Briskly
patient and their family members
○ Listening keenly, or is
an opportunity to identify
interested in what is being
health-related concerns to the
communicated.
nurse that may require further
● Palms Open and Facing Upward
in-depth assessment.
○ Sign of openness and
● It also verifies patient
honesty.
understanding of conditions so that
misperceptions can be clarified.

Transes by: Karen Joy C. Cuebillas ౨ৎ

● Stroking Your Chin or Beard ● Sitting on the Edge of Your Seat
○ In deep thought and used ○ It signals that you are
unintentionally when an physically or mentally on
individual is trying to come edge.
to a decision about a B. NURSING DIAGNOSIS
matter. It indicates ● Following a thorough assessment,
thoughtfulness and interest. a nursing diagnosis is formulated to
● Head Nodding specifically address the challenges
○ A simple way to show associated with geriatric clients
you’re listening and based on the nurse’s clinical
agreeable is to nod in judgment and understanding of the
acknowledgement of good patient’s unique health condition.
points or questions that C. PLANNING FOR HEALTH
don’t require a verbal PROMOTION, HEALTH
answer. Smiling while you MAINTENANCE AND HOME
nod makes this action even HEALTH CONSIDERATIONS
more positive. ● Older adults are at higher risk for
chronic health problems like
NEGATIVE BODY LANGUAGE
● Arms Crossed Over at Chest diabetes, osteoporosis, and
○ Indicate that a person is Alzheimer’s disease.
being defensive. It can also ● In addition, 1 in 3 older adults fall
demonstrate disagreeing each year, and falls are a leading
with the opinions or actions cause of injury for this age group.
of other individuals with ● Physical activity can help older
whom they are adults prevent both chronic disease
communicating. and fall-related injuries.
● Nail Biting HEALTH CARE FOR OLDER ADULT
○ Demonstrate stress,
nervousness, or insecurity.
Oftentimes, people bite their
nails without even realizing
it.
● Hand Placed on Cheek
○ Indicate that a person is lost
in thought or is considering
something. Sometimes if
accompanied by a furrowed HEALTH CARE CONSIDERATION
brow means not paying ● Retirement
attention anymore. ○ In addition to the
● Tapping or Drumming Fingers physiological changes that
○ Demonstrates that a person occur with aging, older
is growing impatient or tired adults vary in their level of
of waiting. It is a sign of activity.
boredom. ○ For example, many older
adults continue working into

Transes by: Karen Joy C. Cuebillas ౨ৎ

 their seventies and beyond. ○
Modification may be needed
Individuals may choose to to the home environment to
continue to work because of promote safety and
their sense of purpose or independence.
because of a need for ○ For example, grab bars,
income. elevated toilet seats, and
○ Some older individuals other modifications may be
experience a loss of identity needed in the bathroom,
when they retire because along with good lighting,
their work role was an minimization of clutter, and
important aspect of their removal of rugs throughout
life. the home.
○ Retirement can bring a ○ Assessment of the home
sense of freedom and environment for safety and
adventure, as well as a case of mobility is an
need to find a new identity important aspect of home
and purpose. care nursing.
● Social Isolation APPLYING THE NURSING PROCESS
○ Retirement and the loss of
daily interaction with
coworkers, as well as death
of family members and
friends can lead to social
isolation in the aging
population.
○ Social support impacts a
person’s health and quality
of life and should be
included as part of the
assessment.
○ It is helpful for nurses to be
familiar with community FULNER’S S-P-I-C-E-S TOOL
resources that provide S: Sleep Disorders
socialization opportunities P: Problems with Eating or Feeding
and provide referrals for I: Incontinence
patients in need of C: Confusion
additional services. E: Evidence of Falls
● Modified Living Environment S: Skin Breakdown
○ Although many aging adults HEALTH PROMOTION
live in assisted living ● Nutrition
facilities or skilled nursing ○ Heart disease, cancer,
centers, many older adults chronic lung disease, and
prefer to live at home stroke are the leading
especially in the philippines. causes of death in older
adults.

Transes by: Karen Joy C. Cuebillas ౨ৎ

 ○ Nurses can provide patient ○ Musculoskeletal problems,
education that focuses on such as impaired balance
good nutrition, physical and arthritis, can impair an
activity, smoking cessation, individual’s ability to walk or
and moderate alcohol use participate in regular
to promote improved health exercise.
outcomes. ○ Helping older adults find
○ However, nutrition can pose appropriate ways to
special challenges for the maintain activity is an
older adult. important nursing
○ Chewing can be a problem intervention.
if there are difficulties with ○ Nurses can advocate for the
dentition. older adults that limit their
○ Lack of oral care, missing activity.
teeth, or poorly fitting ○ They should be reassured
dentures can cause that pain is not considered a
individuals to avoid intake of normal part of aging and
healthy foods. can be effectively treated so
○ Regular dental care should they can maintain physical
be encouraged when activity comfortably.
working with older adults. ● Safe Medication Use
○ Finances often impact ○ Because of the increased
nutritional intake when older incidence of chronic
adults have difficulty disease, many older adults
meeting their basic needs of take multiple medications to
housing, food, and health manage their symptoms
care. and conditions.
○ Additionally, the inability to ○ Polypharmacy, the use of
plan, shop, and prepare medications, increases a
meals because of activity person’s risk for adverse
intolerance, cognitive medication effects.
impairments, or physical ○ Older adults may be
limitations can impact prescribed medications by
nutrition. multiple providers, and they
● Physical Activity can become confused when
○ Physical activity is important attempting to safely
throughout the lifespan. manage their daily
○ Older individuals may be medication use.
limited in their ability to ○ There are also changes in
engage in physical activity absorption, distribution,
due to various factors such metabolism, and excretion
as physical limitations, pain, of drugs as an individual
and fear of failing. ages that impact the safe
use of medications.

Transes by: Karen Joy C. Cuebillas ౨ৎ

● Psychosocial Well-Being individual’s knowledge.
○ As individuals age, they Skills, and abilities.
often experience loss of ○ For example, some older
significant others, family adults readily engage in
members, and friends. using electronic technology,
These losses create but others have low digital
increased risk for social literacy or experience
interaction and depression. difficulty when assessing
○ Poor mobility and electronic health resources
transportation issues can ○ Nurses should adapt patient
also add to social isolation. education to the needs of
○ As male older adults the individual and provide
experience multiple losses, verbal, written, or electronic
their risk for suicide resources as needed, while
increases. considering any sensory,
○ Nurses can provide cognitive, or functional
information about impairments.
community resources and ○ The ultimate goal of health
outreach programs to promotion and patient
promote social interactions education is to improve their
for individuals experiencing understanding, motivation,
isolation. and engagement in
○ Aging individuals continue self-management and
to have sexual needs, and promote their quality of life.
this aspect of their overall
health should not be
ignored.
○ Assessment of these needs
allows the nurse to integrate
these aspects into the
patient’s plan of care and
make appropriate referrals
when necessary.
● Adapting Patient Education
○ There are many
considerations when
working with the older adult
population and promoting
optimal health and quality of
life.
○ It is also important to modify
patient education methods
depending on the

Transes by: Karen Joy C. Cuebillas ౨ৎ