Urinary Incontinence in the Elderly : Stress, Urgency, Overflow, Functional

Urinary Incontinence in the Elderly : Stress, Urgency, Overflow, Functional

Urology Nursing   November 30, 2013

There are several clinical categories on the urinary incontinence. Let us consider one by one.


Stress urinary incontinence

Maybe you've come across people who when laughing or coughing followed by discharge of urine, either a little or a lot. Generally, the incident caused by the weakening of the muscles in the pelvic floor.

Although not the sole cause, but the frequency of occurrence of urinary incontinence due to a weakening of the pelvic muscles. This category incontinence usually occurs in the elderly who are aged in their 70s and often suffered by women.


Urgency urinary incontinence

Some of the neurological problems associated with urinary urgency incontinence, such as dementia, Parkinson's disease, stroke, or spinal cord injury. That occurs in this type of urinary incontinence is the patient complained of insufficient time to get to the toilet, but the urine was out first.

The process is very fast between the desire to urinate and the urine before patients are in the bathroom. This type usually occurs in old age people, over 70s.


Overflow urinary incontinence

Perhaps this type of incontinence rather rare. Uncontrolled urine that comes out in this type of incontinence is associated with the occurrence of prostate enlargement or multiple sclerosis, which can cause the patient to contract the bladder.

Factor drugs can also cause this overflow incontinence. How it happened? Patients who suffer from overflow incontinence is usually only a few passing urine without feeling the sensation when her bladder is full.


Functional urinary incontinence

For this type, mostly occurs due to severe dementia, environmental factors, and psychological factors. In patients who suffer from this type of incontinence is usually accompanied by the emergence of a variety of symptoms and urodynamic picture of the occurrence of more than one type of urinary incontinence.

Factors Influencing Health Status of The Elderly

Factors Influencing Health Status of The Elderly

Geriatric Nursing   October 06, 2013

There are several factors that affect the mental health of the elderly. These factors shall be addressed wisely so that the elderly can enjoy their life happily. As for some of the factors facing the elderly are greatly affecting their mental health is as follows:

1. Decrease in Physical Condition

After someone entered the elderly, generally ranging seized their physical condition, which is pathological regression (multiple pathology), for example, reduced power, decreased energy, more wrinkled skin, the more teeth fall out, the more brittle bones, etc..

In general, the physical condition of a person who has entered a period of elderly decline exponentially. This all may cause interference or physical dysfunction, psychological and social, which in turn can lead to a state of dependence on others. In the lives of the elderly in order to maintain a healthy physical condition, it is necessary to align with the physical needs psychological and social conditions, so inevitably there must be efforts to reduce the activities of a physical memforsir. An elderly should be able to set a good way of life, such as eating, sleeping, rest and work in balance.



2. Decrease Function and Sexual Potency

Decrease function and sexual potency in the elderly is often associated with a variety of physical disorders such as:

1. Heart problems.
2. Metabolic disorders, eg, diabetes mellitus.
3. Vaginitis.
4. Recently completed operations: for example prostatectomy.
5. Malnutrition, due to imperfect digestion or appetite is very less.
6. The use of certain medications, such as antihypertensives, steroid group, tranquilier.
7. Psychological factors that accompany the elderly, among others:
   • Sense of taboo or embarrassment when maintaining sexual life of the elderly.
   • Attitudes families and communities that lack support and strengthened by tradition and culture.
   • Fatigue or boredom due to lack of variation in his life.
   • Spouse has died.
   • Sexual dysfunction due to hormonal changes or other mental health problems anxiety, depression, dementia, etc..

3. Changes in Psychosocial Aspects

In general, after entering the elderly then it decreased cognitive and psychomotor function. Cognitive function includes the process of learning, perception, comprehension, understanding, attention and others that cause reactions and behaviors of the elderly become increasingly slow. While psychomotor function (conative) covers matters relating to such will boost the movement, action, coordination, resulting in that the elderly become less nimble.
With the decrease in both functions, the elderly also experience changes in psychosocial aspects related to the state of kepabrikan elderly. Some of these changes can be differentiated based on 5 elderly personality types as follows:

1. Construction personality , usually this type is not a lot experienced turmoil , calm and steady until very old .
2. Independent personaliy , there is a tendency in this type of experience post power syndrome , especially if in the future be filled with the elderly are not activities that can provide autonomy on him .
3. Dependent personality , in this type usually greatly affected family life , family life always harmonious if the elderly are not volatile at times , but if the spouse dies, the spouse left behind will be miserable , especially if you do not get up from his position .
4. Hostility personality , in this type after entering the elderly are still not satisfied with his life , a lot of desire that is sometimes not in the carefully calculated , causing economic conditions to be messy .
5. Self Hate Personality , the elderly of this type generally looks miserable , because the behavior itself is difficult aided by others or themselves tend to be difficult .

Nursing Diagnosis and Interventions of Activity Intolerance in Elderly

Nursing Diagnosis and Interventions of Activity Intolerance in Elderly

Nursing Diagnosis and Interventions   October 06, 2013

Assessment

1. Physical examination:

• Musculoskeletal: decreased tone, strength, muscle size and endurance; range of motion of joints and skeletal strength.
• Cardiovascular: the formation of thrombosis, thrombophlebitis signs include: erythema, edema, tenderness and signs of positive Humans.
• Respiration: atelectasis and pneumonia symptoms, early signs include an increase in temperature and heart rate.
• Integument: ischemia injury against the first tissue is inflammatory, early changes seen on the surface of the skin as an irregular area of erythema.
• Urinary function: physical signs such as urinating a little and often, lower abdominal distension and bladder limits that can be touched.
• Gastrointestinal: constipation and faecal going small, hard and dry.
• Environment: bathroom without handles, loose rugs, lighting is not adequate, a high ladder, slippery floor and toilet seat that lowers the client mobility.

2. Assessing the skeletal body: The deformity and alignment. Abnormal bone growth due to bone tumors. Shortening of limb, amputation and body parts that are not in anatomical alignment. Abnormal angulation of the long bones or movement at a point other than the joints usually indicate the presence of fractures.

3. Assessing the spine:

• Scoliosis (curvature of the lateral deviation of the spine)
• Kyphosis (curvature of the spine increase the chest)
• Lordosis (quack, the curvature of the lumbar spine over)

4. Assessing joint system: Broad movement was evaluated both active and passive, deformity, stability, and the lumps, the joint stiffness.

5. Assessing muscle system: The ability to change the position, muscle strength and coordination, and the size of each muscle. Limb circumference to mementau or atropfi edema, muscle pain.

6. Assessing how patients walk: The irregular movements are not considered normal. If one limb shorter than the other. A variety of neurological conditions associated with abnormal gait (eg walking spastic hemiparesis way - stroke, patients go step by step - lower motor neuron disease, patients walked vibrate - Parkinson's disease).

7. Assessing the skin and the peripheral circulation: palpation of the skin can indicate a temperature hotter or colder than others and the edema. Peripheral circulation was evaluated by assessing peripheral pulses, color, temperature and capillary refill time.

8 . Assessment of functional status :

• Baths : Told independent when in client activity just need help to scrub or clean up a certain portion of the body member , said the dependent if the client requires assistance to more than one body part .
• Dress : Independent if unable to take his own clothes in a closet or drawer .
• To the toilet : Independent when the elderly can not afford to own a toilet , getting out of the toilet and hem itself . Dependent when it need a bed pan or pot .
• Transferring : Independent themselves when able to climb down from a bed or wheelchair . Dependent if always require assistance for activities above or unable to perform one or more activities of transferring .
• Continence : Independent shitting themselves when able ( urinary and defecation ) . When dependent on one or both of micturition or sefekasi require enema or catheter .
• Eating : Independent if it is able to bribe their own food , take away from the plate .

Nursing Diagnosis and Interventions of Activity Intolerance in Elderly

Nursing Diagnosis : Impaired Physical Mobility related to depression

Goal : Depression can be resolved and activities to do.

Outcomes:

Clients can perform daily activities , and depression disappeared .

Intervention :

1. The prevention of osteoporosis , either through medical intervention , nutrition , as well as lifestyle adjustments .
2. The prevention of falls in accordance with the results of the assessment of the environmental factors as well as risk factors does surgery on the risk of environmental factors .
3. Maintenance of strength and resilience of the musculoskeletal system , which includes daily exercise conditioning program both isometric and isotonic muscle contraction , strengthening and aerobic activity , nutrition and protein anabolism to increase bone formation and attitude of commitment to exercise .
4. Maintaining the flexibility of the joints involved in range of motion exercises , proper positioning and activities of daily living .
5. Maintenance of normal ventilation and hyperinflation include mobilization and eliminate secretions .
6. Maintenance of adequate circulation include supporting measures to maintain vascular tone , compression stockings to put external pressure on the limbs and adequate fluid intake to prevent dehydration effect on blood volume .
7. Maintenance of urinary and bowel function were normal relies on nutritional support and environmental structure and routines to facilitate elimination .

7 Ways to Take Care of Elderly Affected Hypertension

7 Ways to Take Care of Elderly Affected Hypertension

Hypertension   September 26, 2013

Hypertension is a condition where a person experiences an increase in blood pressure above normal indicated by the systolic number (top) and the bottom number (diastolic) blood pressure on examination using a blood pressure measuring device either in the form of mercury cuff (sphygmomanometer) or other digital devices .

The normal value of a person's blood pressure with height, weight, activity level and general health normal is 120/80 mmHg. In daily activities, normal blood pressure is stable with a numeric value range. But in general, the numbers decreased blood pressure during sleep and increased time when activity or exercise.

Here are some important things to consider in caring for elderly people who have hypertension:

1. Elderly affected by hypertension, decreased organ function, including the sense of taste. Usually the elderly will likely feel less salt or food was bland, although according to the usual size, salinity was fitting. Because of this, you need to do is to add sugar or spices cooking on food, but it is recommended not to use because of the flavor flavoring has a high salt content. In addition, if you want to buy food such as snacks and fast food, consider the salt content listed on the packaging.

2. Reduce foods containing sodium to less than 100 mmol / day (less than 6 g of sodium chloride, or less than 2.4 g of sodium per day).

3. Help the elderly to reduce weight up to a healthy weight and eat a diet rich in fruits and vegetables.

4. Help the elderly to limit consumption of caffeine and alcohol.

5. Accompany the elderly to light exercise such as walking, tai-chi, gymnastics heart that can be done 3-5 times / week for 30-45 minutes. However, avoid the habit of standing in a long time and perform strenuous activities, such as going up - and down the stairs.

6. Remind elderly, to change positions slowly. For example, when Elderly want to stand up from a lying position, preferably in advance Elderly sitting for about 5 minutes. If it does not feel dizzy, then stand slowly.

7. Help the elderly to measure blood pressure to elderly health worker, clinic or other health facility.

Home Health Care for The Elderly

Home Health Care for The Elderly

Home Health Care for The Elderly   September 26, 2013

Metabolic diseases such as hypertension, diabetes mellitus, osteoporosis, and stroke often complained about by parents in the elderly stage.

Older people with age above 50 years old are very susceptible to diseases, which include: diabetes mellitus, hypertension, and Osteoporosis. Therefore, for early prevention, you should always remind parents to avoid foods that are hard, dense, and too salty, sour or sweet.

Diet for the Elderly

Then you also have to adjust their diet. Reducing the share of food in the elderly needs to be done, because the energy needs of the parents dropped so drastically. In order not to affect the stamina and health of the elderly, you can make gradual reduction in size of the meal. You should also begin to provide food that is rather soft, easily digested by the stomach.

Right Food for the Elderly

In addition to adjusting the diet, other things that are needed to maintain the health of the elderly is that calcium can be obtained from drinking milk. Calcium is a substance used to strengthen bones, prevent body bent and reduce osteoporosis. so drinking milk on a regular basis, is highly recommended for the elderly.

Other substances are also very important for the elderly is Omega 3. Substances that are very useful for the body, can be obtained from fish, vegetables, fruit and fish oil, with the aim to prevent the occurrence of symptoms of stroke in elderly parents.

Right Sport for the Elderly

In addition to providing nutritious food intake for the elderly and maintaining the proper diet, you also have to set a routine exercise for the elderly. Indeed sporting activities undertaken not as heavy as you are still young. However, for the elderly walking is the simplest activity and relatively safe. Walking activity can train the heart muscle strength, leg and maintain smooth breathing for the elderly.

Conclusion:

• Metabolic diseases such as diabetes mellitus, hypertension, stroke and osteoporosis often complained of by the elderly,
• To keep Health Care, can be done with lifestyle and healthy eating, as well as light exercise on a regular basis.

Nursing Care of The Elderly with Immobility and Functional Mobility

Nursing Care of The Elderly with Immobility and Functional Mobility

Nursing Care Plan   September 24, 2013

Various changes occur in the musculoskeletal system, including bone loss (osteoporosis), enlarged joints, tendon stiffness, limited motion, thinning of the intervertebral disc, and muscle weakness, occurs in the aging process.

In the elderly, the collagen structure is less able to absorb the energy. Joint cartilage degeneration and areas that support the body longer to heal. This resulted in the occurrence of osteoarthritis. So also in muscle mass and strength is also reduced.

Definition

Mobility is the movement that gave freedom and independence for someone. Although this type of activity changed throughout human life, mobility is central to participate in and enjoy life. Maintaining optimal moblitas very important for the mental and physical health of all elderly.

Mobility is not an absolute and static in determining the ability to walk; optimal but mobility is something individualistic, relative, and depends on the dynamic interaction between environmental factors and social, afetif and physical function. For one, optimal mobility may be running about 8 kilometers per day; for others, mobility may involve limited movement with the help.

Immobility is broadly defined as the level of activity that is less than optimal mobility. Barriers to physical mobility nursing diagnosis, potential disuse syndrome, and activity intolerance providing a more limited definition of immobility and immobility included in a broader definition.

Immobility, activity intolerance and disuse syndrome often occurs in the elderly. Studies on the incidence of nursing diagnoses used for the elderly who are in care institutions revealed that barriers to physical mobility is the first or the second diagnosis most often appear. The prevalence of this problem extends beyond the institutions to involve the entire elderly.


Impaired Physical Mobility

Definition

A state of the limited ability of independent physical movement experienced by a person.

Defining characteristics :

• Inability to move with purpose in the environment, including bed mobility, move, and ambulation.
• Reluctance to perform the movement.
• Limitation of range of motion.
• Decrease the power, control, or muscle mass.
• Experienced restrictions on movement, including protocols and medical mechanical.
• Impaired coordination.

Related factors :

• Activity intolerance.
• Decreased strength and endurance.
• Pain and discomfort.
• Perceptual or cognitive disorders.
• Neuromuscular disorders.
• Depression.
• Severe anxiety.

Potential Disuse Syndrome

Definition

A state of someone who is at risk to suffer damage as a result of the body's systems of musculoskeletal inactivity recommended by the physician or unavoidable.

Risk factors :

• Paralysis
• Mechanical immobilization
• Immobilization recommended by the doctor
• severe pain
• Changes in level of consciousness

Activity Intolerance

Definition

A state of energy insufficiency in physiological or psychological on a person to survive or complete activities of daily living is needed or desired.

Defining characteristics :

• Verbal report of fatigue or weakness.
• Heart rate or blood pressure is not normal to the activity.
• Discomfort or dyspnea after the move.
• Electrocardiographic changes indicating the presence of dysrhythmias or ischemia.

Related factors :
Bed rest and immobility
General weakness
Sedentary lifestyle
Imbalance between oxygen supply and requirement


Internal Factors

Various internal factors resulted in the immobilization of the body or body parts. Detailed discussion of internal factors which contribute to immobility can be found in the related chapters in this text.

Internal factors that cause or contribute to the immobilization

• Musculoskeletal function decline
• Muscles (atrophy, dystrophy, or injury)
• Bones (fractures infection, tumor, osteoporosis, or osteomalacia)
• Joints (arthritis and tumors)
• Combination structure (and cancer drugs)

Changes in neurological function

• Infection (eg, ensevalitis)
• Tumor
• Trauma
• Drugs
• Vascular disease (eg, stroke)
• Demyelinating disease (eg, multiple sclerosis)
• Degenerative diseases (eg, Parkinson's disease)
• Exposure to toxic products (eg, carbon monoxide)
• Metabolic disorders (eg, hypoglycemia)
• Nutrition disorders

Pain

• Multiple and varied causes such as chronic illness and trauma

Perceptual deficits

• Excess or shortage of input sensory perception

Reduced ability cognitive
Koqnitif process disturbances, such as severe dementia

Fall

• Physical effects: injury or fracture
• Psychological effects: syndrome after fall

Changes in social relations

• Actual factors (eg, loss of a spouse, moving away from family, or friends)
• Perceptual factors (eg, change of mindset as depression)

Psychological aspects

• Helplessness in learning.
• Depression

External Factors

Many external factors that alter the mobility of the elderly. These include therapeutic program, the characteristics of residence and staff, nursing care delivery systems, barriers, and institutional policies.

1.) Therapeutic program
Medical treatment program has a strong influence on the quality and quantity of patient movement. Examples of programs include restrictions on mechanical factors and pharmacological, bed rest, and restrein.
2.) Occupant characteristics Institutions
Mobility levels and patterns of behavior of a group of peers may affect client mobility patterns and behavior.
3.) characteristics of staff
Three characteristics of the nursing staff is affecting the mobility patterns of knowledge, commitment, and the amount.
4.) Nursing care delivery systems
Type of nursing care delivery system in use at the institution can affect the mobility status of its inhabitants.
5.) Barriers
Physical and architectural barriers can interfere with mobility. Physical barriers include the lack of available tools for mobility, knowledge in the use of mobility aids inadequate for foot rest.
6.) Institutional policies
Another important environmental factor for Lasia are the policies and procedures of the institution.

Theories of Aging Process (Biology, Sociology and Psychology)

Theories of Aging Process (Biology, Sociology and Psychology)

Geriatric Nursing   September 24, 2013

Theories of Aging Process : Biology

1. Theory "Genetic Clock"

This theory states that occur as a result of the aging process at the genetic program inside nuclei. This clock will spin in a certain period of time and if the clock has run out of rotation then, would impede the process of mitosis. This is demonstrated by the results of the study Haiflick, (1980) cited Darmojo and Martono (1999) on the theory that stated the relationship between the ability of cells to divide in culture with somatic mutation of species age (error catastrophe theory) Another important thing to consider in analyzing factors actor is the cause of the aging process of the environmental factors that cause the occurrence of somatic mutations. It is now known that radiation and chemicals can shorten the life. According to this theory that progressive mutations in somatic cell DNA, will cause a decline in the ability of these cells functionally.

2. Theory "Error"

One hypothesis is that associated with somatic cell mutations are hypothesized "Error castastrophe" (Darmojo and Martono, 1999). According to the theory of aging caused by accumulated an assortment of errors throughout the human life. As a result of these errors will result in errors of metabolism that can cause cell damage and cell function slowly.

3. The theory of "autoimmune"

Aging process may occur due to changes in post-translational protein which can result in reduced ability of the body's immune system to recognize - self recognition. If the somatic mutation causes abnormalities in the cell surface, then this will result in the body's immune system considers cells undergoing changes as foreign cells and destroy Goldstein (1989) quoted by Aziz (1994). This is evidenced by the rising prevalence of auto-antibodies in the elderly (Brocklehurst, 1987 quoted from Darmojo and Martono, 1999). On the other hand the body's own immune system defenses decreased in the aging process, the antigen being attacked to decrease, resulting in pathological cells increases with age menigkatnya (Suhana, 1994 dikutif of Nuryati, 1994)

4. Theory "Free Radical"

Aging can occur due to the interaction of the components of free radicals in the human body. Free radicals can be: superoxide (O2), Hydroxyl radicals (OH) and hydrogen peroxide (H2O2). Free radicals are very damaging because it is highly reactive, so it can react with DNA, proteins, and unsaturated fatty acids. According Oen (1993) dikutif of Darmojo and Martono (1999) states that the older the age of the more free radicals are formed, so that poses destruction continues, the more damage cell organelles cells eventually die.

5. Wear & Tear Theory

Excess effort and stress cause the damaged body cells.

6. Collagen Theory 

Increase the amount of collagen in the tissue causing tissue damage and slowing the speed of repair tissue cells.


Theories of Aging Process : Sociology

1. Activity theory
Aging will cause a decrease in the number of activities directly.

2. Continuity theory
Continued existence of a personality that led to the existence of a pattern of behavior that increase stress.

3. Disengagement Theory
Lose touch with the outside world such as community relations, relationships with other individuals.

4. Age stratification theory
Because the people who fall in old age will accelerate the aging process.


Theories of Aging Process : Psychology

1. Maslow's theory of human needs
People who can reach 5% actualization according to research and not everyone can achieve that requirement perfectly.

2. Jung's theory
There are levels of living which has the task in the development of life.

3. Course of Human Life Theory
A person in relation to the environment is no maximum level.

4. Development Task Theory
Each stage of life has age-appropriate developmental tasks.

Disturbed Sleep Pattern related to Alzheimer's Disease

Disturbed Sleep Pattern related to Alzheimer's Disease

Nursing Diagnosis and Interventions   September 17, 2013

Nursing Care Plan for Alzheimer's Disease - Nursing Diagnosis : Disturbed Sleep Pattern

Alzheimer's disease is the most common form of dementia. Dementia is a group of symptoms associated with a decline in the way the brain functions, affecting the memory and the way behave. There is no cure for the disease, which worsens as it progresses, and eventually leads to death. Early symptoms are often mistakenly thought to be 'age-related' concerns, or manifestations of stress. In the early stages, the most common symptom is difficulty in remembering recent events.

As the disease advances, symptoms can include confusion, irritability, aggression, mood swings, trouble with language, and long-term memory loss. As the sufferer declines they often withdraw from family and society. Gradually, bodily functions are lost, ultimately leading to death. Since the disease is different for each individual, predicting how it will affect the person is difficult. AD develops for an unknown and variable amount of time before becoming fully apparent, and it can progress undiagnosed for years.

The cause and progression of Alzheimer's disease are not well understood. Research indicates that the disease is associated with plaques and tangles in the brain. There are no available treatments that stop or reverse the progression of the disease.

Because AD cannot be cured and is degenerative, the sufferer relies on others for assistance. The role of the main caregiver is often taken by the spouse or a close relative. Alzheimer's disease is known for placing a great burden on caregivers; the pressures can be wide-ranging, involving social, psychological, physical, and economic elements of the caregiver's life. In developed countries, AD is one of the most costly diseases to society.

Disturbed Sleep Pattern

Time-limited disruption of sleep (natural periodic suspension of consciousness)

Defining Characteristics:

• Prolonged awakenings;
• sleep maintenance insomnia;
• self-induced impairment of normal pattern;
• sleep onset >30 minutes;
• early morning insomnia;
• awakening earlier or later than desired;
• verbal complaints of difficulty falling asleep;
• verbal complaints of not feeling well-rested;
• increased proportion of Stage 1 sleep;
• dissatisfaction with sleep;
• less than age-normed total sleep time;
• three or more nighttime awakenings;
• decreased proportion of Stages 3 and 4 sleep (e.g., hyporesponsiveness, excess sleepiness, decreased motivation);
• decreased proportion of REM sleep (e.g., REM rebound, hyperactivity, emotional lability, agitation and impulsivity, atypical polysomnographic features);
• decreased ability to function

Nursing Diagnosis for Alzheimer's Disease : Disturbed Sleep Pattern related to changes in sensory

Goal: changes in sleep patterns can be resolved client

Outcomes:

• No changes in behavior and appearance (restless).
• Able to create adequate sleep patterns with a decrease of the mind hovering (daydreaming).
• Able to determine the cause of inadequate sleep.

Nursing Interventions:

1. Provide a comfortable environment for improving sleep (turn off the lights, ventilation adequate space, suitable temperature, avoid noise).
R /: Constraints on cortical reticular information will be reduced during sleep, improving the automatic response, thus increasing cardiovascular response to noise during sleep.

2. Encourage exercise during the day and lower mental activity / physical in the afternoon.
R /: Physical activity and mental fatigue that lead to long can increase confusion, which is programmed activities without excessive stimulation increased sleep time.

3. Give afternoon snacks, warm milk, bath, and massage the patient's back.
R /: Improve relaxation with drowsiness.

4. Lower the number of drinks the afternoon. Voiding before bed.
R /: Reduce the need for up to urinate during the night.

5. Encourage clients to listen to soft music.
R /: Lowering the sensory stimulation by blocking other sounds from the surrounding environment that would inhibit sleep.