As the global population ages, the demand for specialized healthcare for older adults is escalating. Geriatric nursing plays a pivotal role in meeting these needs, focusing on the unique physiological, psychological, and social aspects of aging. Central to effective geriatric nursing care is the accurate identification and application of nursing diagnoses for geriatric care. These diagnoses are not merely labels; they are the foundation upon which personalized care plans are built, ensuring the comfort, safety, and well-being of our elderly patients.
This guide delves into the essential nursing diagnoses frequently encountered in geriatric care. It serves as a practical resource for nurses and healthcare professionals seeking to enhance their understanding and skills in providing optimal care for older adults. By focusing on evidence-based interventions and patient-centered goals, we aim to empower nurses to address the complex healthcare needs of the geriatric population effectively.
Understanding Gerontological Nursing and its Core Principles
Gerontological nursing, also known as geriatric nursing, is a specialized field dedicated to the care of older adults. It encompasses a holistic approach, addressing the multifaceted needs of aging individuals across physical, psychological, social, economic, cultural, and spiritual dimensions. Recognizing that aging is a natural process, geriatric nursing emphasizes collaborative care, involving not only nurses but also families, communities, and interdisciplinary healthcare teams. This collaborative approach leverages diverse expertise and resources to optimize the quality of life for older adults.
At the heart of geriatric nursing lies the commitment to promoting healthy aging, restoring function, and enhancing safety. Nursing care plans are strategically designed to prevent illness and injury, facilitate healing, and optimize health and functional abilities. This proactive and patient-centered approach is crucial in managing the unique challenges and complexities associated with aging.
Nursing Care Plans: The Blueprint for Geriatric Patient Management
Nursing care plans for geriatric patients are meticulously crafted to promote independence, optimal health, and an enhanced quality of life. These plans are built upon comprehensive assessments that consider age-related physiological changes, chronic conditions, and individual patient needs. Key elements of geriatric nursing care plans include:
- Comprehensive Assessment: Thorough evaluation of physical, cognitive, emotional, and social status.
- Addressing Age-Related Changes and Chronic Conditions: Tailoring interventions to manage conditions common in older adults, such as arthritis, heart disease, dementia, and diabetes.
- Promoting Functional Abilities and Mobility: Implementing strategies to maintain or improve mobility and independence in activities of daily living (ADLs).
- Medication Management and Safety: Ensuring safe and effective medication regimens, considering polypharmacy and age-related pharmacokinetic changes.
- Education on Healthy Aging Practices: Empowering patients and caregivers with knowledge about nutrition, exercise, fall prevention, and other health-promoting behaviors.
- Safe and Supportive Environment: Creating environments that minimize risks and maximize comfort and safety.
Effective nursing care planning in geriatrics requires a deep understanding of the aging process and its implications for health and well-being. It also necessitates a compassionate and patient-centered approach, recognizing the unique experiences and perspectives of each older adult.
Prioritizing Nursing Problems in Geriatric Care
When developing nursing care plans for geriatric patients, nurses must prioritize key problem areas. These priorities guide the focus of assessment, intervention, and outcome evaluation. Common nursing priorities in geriatric care include:
- Individualized Care Plan Development: Conducting thorough assessments to create personalized care plans tailored to each older adult’s specific needs.
- Chronic Condition and Cognitive Health Management: Addressing prevalent chronic diseases and promoting cognitive function and mental well-being.
- Medication and Treatment Administration: Safely and effectively administering medications and treatments, considering age-related factors.
- Education and Support for Healthy Aging: Providing education and resources to support healthy lifestyle choices and adapt to aging-related changes.
- Assistance with ADLs and Mobility Promotion: Supporting independence in daily activities and encouraging safe mobility.
- Interdisciplinary Collaboration and Community Resource Utilization: Working effectively with other healthcare professionals and connecting patients with appropriate community services.
- Fall Prevention and Environmental Safety: Implementing strategies to minimize fall risks and create safe living environments.
- Emotional Support and Counseling: Addressing the emotional and psychological needs of older adults and their families.
These priorities reflect the holistic nature of geriatric nursing, emphasizing not only physical health but also cognitive, emotional, and social well-being. By focusing on these key areas, nurses can significantly impact the quality of life for their geriatric patients.
Comprehensive Nursing Assessment in Geriatric Care
A thorough nursing assessment is the cornerstone of effective geriatric care. It involves gathering both subjective and objective data to understand the patient’s overall health status and identify specific needs. Key assessment areas for geriatric patients include:
- Mobility: Assessing for decreased mobility, gait disturbances, and limitations in range of motion.
- Balance: Evaluating balance issues and risk for falls.
- Cognition and Memory: Assessing for changes in cognitive function, memory impairment, and signs of dementia or delirium.
- Fatigue: Evaluating levels of fatigue and its impact on daily activities.
- Appetite and Weight: Monitoring for changes in appetite, unintentional weight loss, and nutritional status.
- Sleep Patterns: Assessing for sleep disturbances, insomnia, and changes in sleep-wake cycles.
- Mood: Evaluating for mood changes, depression, anxiety, and social isolation.
- Sensory Function: Assessing for decreased vision or hearing and their impact on safety and communication.
- Skin Integrity: Examining skin for signs of breakdown, pressure ulcers, and delayed wound healing.
- Vulnerability to Infection: Assessing for increased susceptibility to infections and delayed healing.
Gathering this comprehensive data allows nurses to formulate accurate nursing diagnoses for geriatric care, which in turn guide the development of individualized and effective care plans.
A nurse assisting an elderly patient with mobility, showcasing geriatric nursing care.
Common Nursing Diagnoses in Geriatric Care
Following a comprehensive assessment, nurses formulate nursing diagnoses to articulate the health challenges and needs of geriatric patients. These diagnoses are clinical judgments that describe a patient’s response to actual or potential health problems. In geriatric care, nursing diagnoses are crucial for guiding interventions and achieving desired patient outcomes.
While the specific nursing diagnoses will vary based on individual patient needs, several diagnoses are commonly encountered in geriatric care. These can be broadly categorized based on the major health challenges faced by older adults. Here are examples of common nursing diagnoses for geriatric care, organized by category:
1. Risk for Falls and Injury
Falls are a significant concern in geriatric care, leading to injuries, disability, and reduced quality of life. Age-related changes in balance, vision, muscle strength, and bone density increase the risk of falls. Medications, chronic conditions, and environmental hazards can further contribute to this risk.
Common Nursing Diagnoses:
- Risk for Falls: Related to age-related physiological changes, impaired mobility, medication side effects, environmental hazards, and cognitive impairment.
- Risk for Injury: Related to falls, impaired mobility, sensory deficits, cognitive impairment, and polypharmacy.
Nursing Goals:
- The patient will remain free from falls and injuries during their care.
- The patient and caregiver will implement strategies to enhance safety and prevent falls in the home environment.
Nursing Interventions:
- Comprehensive Fall Risk Assessment: Identify intrinsic and extrinsic risk factors for falls, including mobility, balance, vision, medications, and environmental hazards.
- Environmental Safety Modifications: Remove tripping hazards, improve lighting, install handrails, and ensure clear pathways.
- Assistive Devices and Mobility Aids: Provide and educate on the proper use of canes, walkers, wheelchairs, and other assistive devices.
- Medication Review and Management: Collaborate with the healthcare team to review medications and minimize those that increase fall risk (e.g., sedatives, diuretics, antihypertensives).
- Exercise and Physical Therapy: Encourage participation in exercise programs to improve strength, balance, coordination, and flexibility.
- Education on Fall Prevention: Educate patients and caregivers about fall prevention strategies, home safety modifications, and safe ambulation techniques.
- Regular Vision and Hearing Checks: Ensure regular eye and hearing exams to address sensory impairments that can contribute to falls.
- Monitoring Level of Consciousness and Cognitive Status: Assess for changes in mental status, confusion, or delirium, which can increase fall risk.
- Use of Restraints (with Caution): Utilize restraints only as a last resort and according to hospital policy, monitoring for agitation and adverse effects.
- Wristband Identification for Fall Risk: Utilize wristbands to alert healthcare providers to patients at high risk for falls.
- Bed in Lowest Position and Side Rails: Keep the bed in the lowest position and use side rails as needed to prevent falls from bed.
- Non-Slip Footwear: Advise patients to wear shoes or slippers with non-slip soles when ambulating.
- Prompt Response to Call Lights: Answer call lights promptly to prevent patients from attempting to ambulate without assistance.
- Family and Caregiver Involvement: Encourage family and caregivers to stay with the patient, especially those at high risk for falls.
2. Impaired Gas Exchange and Respiratory Function
Age-related changes in the respiratory system, such as decreased lung elasticity and reduced respiratory muscle strength, can compromise gas exchange and respiratory function in older adults. Chronic respiratory conditions like COPD, pneumonia, and influenza are also more prevalent in this population.
Common Nursing Diagnoses:
- Impaired Gas Exchange: Related to age-related lung changes, respiratory infections, chronic lung disease, and decreased mobility.
- Ineffective Airway Clearance: Related to decreased cough reflex, increased mucus production, and impaired mobility.
- Ineffective Breathing Pattern: Related to decreased lung capacity, pain, anxiety, and respiratory muscle weakness.
Nursing Goals:
- The patient will maintain adequate gas exchange and respiratory function, as evidenced by normal respiratory rate, depth, and pattern, clear breath sounds, and oxygen saturation within normal limits.
- The patient will demonstrate effective coughing techniques to clear airway secretions.
Nursing Interventions:
- Respiratory Assessment: Monitor respiratory rate, depth, pattern, breath sounds, cough, sputum production, and oxygen saturation regularly. Assess for subtle changes in mental status that may indicate hypoxia.
- Oxygen Therapy: Administer supplemental oxygen as prescribed to maintain adequate oxygen saturation.
- Breathing and Coughing Exercises: Encourage deep breathing and coughing exercises to promote alveolar expansion and clear airway secretions. Teach the use of incentive spirometry.
- Positioning: Position the patient in an upright or semi-Fowler’s position to promote lung expansion.
- Hydration: Encourage adequate fluid intake to help mobilize secretions, unless contraindicated by medical conditions.
- Medication Administration: Administer bronchodilators, expectorants, and other respiratory medications as prescribed.
- Management of Hyperthermia and Pain: Treat fever and pain promptly to reduce oxygen demand.
- Suctioning: Perform suctioning as needed to clear airway secretions in patients unable to cough effectively.
- Patient Education: Educate patients and caregivers on proper use of oxygen equipment, breathing exercises, and strategies to prevent respiratory infections.
- Smoking Cessation: Encourage smoking cessation for patients who smoke.
- Pulmonary Rehabilitation: Refer patients with chronic respiratory conditions to pulmonary rehabilitation programs.
3. Risk for Imbalanced Body Temperature (Hypothermia)
Geriatric patients are at increased risk for hypothermia due to age-related changes in thermoregulation, including decreased subcutaneous fat, diminished muscle mass, and impaired thermoregulatory responses. Reduced ability to generate and conserve heat makes older adults more susceptible to cold environments.
Common Nursing Diagnosis:
- Risk for Imbalanced Body Temperature: Related to age-related thermoregulation changes, decreased subcutaneous fat, exposure to cold environments, and certain medications.
- Hypothermia: Body temperature below 36°C (96.8°F) related to prolonged exposure to cold, impaired thermoregulation, and underlying medical conditions.
Nursing Goals:
- The patient will maintain a normal body temperature within the geriatric range (36°C – 37.5°C or 96.8°F – 99.5°F).
- The patient will demonstrate understanding of measures to prevent hypothermia.
Nursing Interventions:
- Temperature Monitoring: Monitor body temperature using a low-range thermometer if available. Assess mental status for signs of hypothermia, such as confusion or lethargy.
- Environmental Temperature Control: Maintain a comfortable room temperature (ideally above 20°C or 68°F). Provide blankets and warm clothing as needed.
- Minimize Exposure to Cold: Limit exposure to cold environments, especially during procedures or examinations. Provide warm blankets during tests or X-rays.
- Warm Fluids and Food: Offer warm beverages and meals to help raise core body temperature.
- Rewarming Measures: For mild hypothermia, increase room temperature, apply warm blankets, and use head coverings. For moderate to severe hypothermia, provide warmed oral or IV fluids and consider internal rewarming methods as prescribed.
- Medication Review: Review medications that may contribute to hypothermia, such as sedatives, muscle relaxants, and hypnotics.
- Education on Hypothermia Prevention: Educate patients and caregivers about the risk of hypothermia, preventive measures (e.g., dressing warmly, maintaining adequate home heating), and signs and symptoms to watch for.
- Monitor for Complications of Rewarming: Watch for signs of rapid rewarming complications, such as dysrhythmias or vasodilation.
- Investigate Underlying Causes: If hypothermia is persistent or unexplained, investigate for underlying medical conditions such as sepsis, hypoglycemia, or hypothyroidism.
4. Disturbed Sleep Pattern
Sleep patterns often change with age, with older adults experiencing decreased deep sleep, increased awakenings, and overall reduced sleep duration. Factors such as chronic pain, nocturia, medications, and medical conditions can further disrupt sleep.
Common Nursing Diagnosis:
- Disturbed Sleep Pattern: Related to age-related sleep changes, chronic pain, nocturia, medical conditions, environmental factors, and psychological stress.
- Insomnia: Difficulty initiating or maintaining sleep, or non-restorative sleep, related to various factors as listed above.
Nursing Goals:
- The patient will achieve adequate rest and report improved sleep quality.
- The patient will establish a regular sleep-wake cycle and implement strategies to promote sleep.
Nursing Interventions:
- Sleep Assessment: Assess and document the patient’s sleep patterns, including bedtime routines, sleep duration, sleep quality, daytime napping, and factors that disrupt sleep.
- Promote Regular Sleep Schedule: Encourage a consistent bedtime and wake-up time, even on weekends.
- Optimize Sleep Environment: Create a quiet, dark, and cool sleep environment. Minimize noise and light exposure. Consider using white noise machines if needed.
- Limit Daytime Napping: Discourage excessive daytime napping, especially in the late afternoon, as it can interfere with nighttime sleep.
- Establish Bedtime Routine: Encourage a relaxing bedtime routine, such as a warm bath, reading, or listening to calming music.
- Limit Caffeine and Alcohol: Advise patients to avoid caffeine and alcohol, especially close to bedtime.
- Manage Nocturia: Limit fluid intake in the evening and ensure easy access to the bathroom for patients with nocturia.
- Pain Management: Provide effective pain management to minimize pain-related sleep disturbances.
- Medication Review: Review medications that may be contributing to sleep disturbances.
- Promote Physical Activity: Encourage regular physical activity during the day, but avoid strenuous exercise close to bedtime.
- Comfort Measures: Provide comfort measures such as back rubs or comfortable bedding to promote relaxation and sleep.
- Pharmacological Interventions (as Prescribed): Administer sleep medications cautiously and as prescribed, considering potential side effects and interactions in older adults.
5. Constipation
Constipation is a common gastrointestinal issue in geriatric patients, often due to age-related changes in bowel function, decreased physical activity, inadequate fluid and fiber intake, medication side effects, and underlying medical conditions.
Common Nursing Diagnosis:
- Constipation: Decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool, related to age-related changes, decreased physical activity, inadequate fluid and fiber intake, medications, and medical conditions.
Nursing Goals:
- The patient will re-establish a regular bowel elimination pattern and experience relief from constipation.
- The patient will pass soft, formed stools without straining.
Nursing Interventions:
- Bowel Assessment: Assess and document the patient’s usual bowel pattern, including frequency, consistency, and any previous measures used to manage constipation.
- Increase Fluid Intake: Encourage adequate fluid intake (at least 1.5-2 liters per day, unless contraindicated) to soften stools.
- Increase Dietary Fiber: Encourage a diet rich in fiber from fruits, vegetables, whole grains, and legumes. Consider adding bran to the diet.
- Promote Physical Activity: Encourage regular physical activity and exercise to stimulate bowel peristalsis.
- Establish Regular Toileting Schedule: Encourage toileting at regular times, especially after meals, to take advantage of gastrocolic reflexes.
- Privacy and Positioning: Provide privacy and comfortable positioning for defecation.
- Medication Review: Review medications that may contribute to constipation (e.g., opioids, anticholinergics).
- Non-Pharmacological Measures: Implement non-pharmacological measures first, such as increased fluids, fiber, and activity.
- Pharmacological Interventions (as Needed): If non-pharmacological measures are insufficient, consider using stool softeners, bulk-forming laxatives, mild laxatives, or osmotic laxatives as prescribed. Use stimulant laxatives and enemas sparingly and as a last resort.
- Avoid Routine Use of Laxatives: Educate patients about the risks of routine laxative use and encourage reliance on lifestyle modifications for bowel regularity.
- Monitor Bowel Movements: Monitor and document the frequency, consistency, and amount of bowel movements.
6. Failure to Thrive (Adult)
Failure to thrive in older adults is a complex syndrome characterized by unintentional weight loss, decline in functional abilities, decreased appetite, and overall decline in health status. It is often multifactorial, involving physical, psychological, and social factors.
Common Nursing Diagnosis:
- Failure to Thrive (Adult): Progressive decline in physical and cognitive function, weight loss, decreased appetite, social withdrawal, and dehydration, related to complex interactions of physical, psychological, and social factors.
- Imbalanced Nutrition: Less Than Body Requirements: Related to decreased appetite, dysphagia, medical conditions, depression, and social isolation.
- Self-Care Deficit: Related to decreased physical strength, cognitive impairment, depression, and chronic illness.
- Social Isolation: Related to loss of spouse or friends, decreased mobility, sensory deficits, and depression.
- Hopelessness: Related to chronic illness, functional decline, social isolation, and perceived lack of control.
Nursing Goals:
- The patient will demonstrate improved nutritional intake and maintain or gain weight.
- The patient will participate in activities of daily living to the extent possible.
- The patient will express feelings of hope and improved quality of life.
Nursing Interventions:
- Comprehensive Assessment: Conduct a thorough physical, psychological, and social assessment to identify contributing factors to failure to thrive. Assess nutritional status, functional abilities, cognitive function, mood, and social support.
- Nutritional Support: Provide nutritional support, including dietary counseling, meal planning, and assistance with feeding if needed. Offer small, frequent meals, nutrient-dense foods, and preferred foods. Consider oral nutritional supplements as prescribed.
- Appetite Stimulation: Implement strategies to stimulate appetite, such as creating a pleasant eating environment, offering social interaction during meals, and addressing underlying medical conditions that may affect appetite.
- Dysphagia Management: Assess swallowing function and implement aspiration precautions if needed. Modify food consistency as appropriate.
- Functional Rehabilitation: Collaborate with physical and occupational therapists to develop a rehabilitation plan to improve functional abilities and mobility.
- Psychosocial Support: Provide emotional support and counseling to address depression, anxiety, and social isolation. Encourage social interaction and participation in meaningful activities.
- Address Underlying Medical Conditions: Identify and manage underlying medical conditions that may contribute to failure to thrive.
- Interdisciplinary Team Approach: Collaborate with a multidisciplinary team, including physicians, dietitians, therapists, social workers, and family members, to develop a comprehensive care plan.
- Caregiver Support: Provide support and education to caregivers to reduce caregiver burden and enhance their ability to provide care.
- Monitor Weight and Nutritional Status: Monitor weight regularly and assess for signs of malnutrition or dehydration.
- Palliative and End-of-Life Care: Consider palliative care or hospice referral for patients with advanced failure to thrive and limited prognosis.
7. Risk for Aspiration
Aspiration, the entry of food or fluids into the airway, is a serious risk for geriatric patients due to age-related changes in swallowing function, decreased gag reflex, and increased prevalence of conditions like dysphagia and neurological disorders. Aspiration can lead to pneumonia and other respiratory complications.
Common Nursing Diagnosis:
- Risk for Aspiration: Related to impaired swallowing, decreased gag reflex, altered level of consciousness, presence of feeding tubes, and conditions affecting swallowing function (e.g., stroke, dementia, Parkinson’s disease).
- Impaired Swallowing: Difficulty in swallowing related to neuromuscular impairment, structural abnormalities, fatigue, or decreased level of consciousness.
Nursing Goals:
- The patient will swallow safely without aspiration.
- The patient’s airway will remain patent and lungs clear upon auscultation.
Nursing Interventions:
- Swallowing Assessment: Assess swallowing reflex and gag reflex prior to oral intake. Observe for signs of dysphagia, such as coughing, choking, or wet voice during or after swallowing.
- Positioning During Feeding: Position the patient upright (90 degrees) during meals and for at least 30-60 minutes after eating. Tilt the head forward slightly during swallowing. For patients with hemiplegia, tilt the head towards the unaffected side.
- Diet Modification: Modify diet consistency as recommended by speech therapist or physician (e.g., thickened liquids, pureed foods, mechanical soft diet).
- Feeding Techniques: Provide small bites, allow adequate time for chewing and swallowing, and avoid rushing the patient during meals. Ensure dentures fit properly.
- Reduce Distractions: Minimize distractions during mealtimes to improve focus on swallowing.
- Oral Hygiene: Maintain good oral hygiene to reduce bacteria in the mouth and decrease the risk of aspiration pneumonia.
- Aspiration Precautions: Implement aspiration precautions for patients at high risk, including keeping suction equipment readily available, monitoring for signs of aspiration (coughing, choking, wheezing, fever, changes in breath sounds), and maintaining NPO status if aspiration is suspected.
- Speech Therapy Referral: Refer patients with swallowing difficulties to a speech therapist for comprehensive evaluation and management.
- Education on Aspiration Prevention: Educate patients and caregivers about aspiration risks, proper feeding techniques, and signs and symptoms of aspiration.
- Monitor Lung Sounds: Auscultate lung sounds regularly for adventitious sounds that may indicate aspiration.
8. Risk for Deficient Fluid Volume
Geriatric patients are at increased risk for dehydration due to age-related physiological changes, including decreased thirst sensation, reduced kidney function, and decreased total body water. Medical conditions, medications (e.g., diuretics), and decreased mobility can further contribute to fluid volume deficit.
Common Nursing Diagnosis:
- Risk for Deficient Fluid Volume: Related to age-related physiological changes, decreased thirst mechanism, impaired kidney function, medication side effects (diuretics), decreased mobility, and inadequate fluid intake.
- Deficient Fluid Volume: Dehydration characterized by decreased skin turgor, dry mucous membranes, concentrated urine, decreased urine output, and elevated serum sodium levels.
Nursing Goals:
- The patient will maintain adequate fluid balance, as evidenced by normal skin turgor, moist mucous membranes, adequate urine output, and stable vital signs.
- The patient will drink adequate fluids to meet daily fluid needs.
Nursing Interventions:
- Fluid Balance Assessment: Assess fluid intake and output, skin turgor, mucous membranes, urine specific gravity, and vital signs. Monitor for signs of dehydration (e.g., thirst, dry mouth, dizziness, confusion, decreased urine output, concentrated urine).
- Encourage Oral Fluid Intake: Encourage oral fluid intake of at least 1.5-2 liters per day, unless contraindicated. Offer fluids frequently throughout the day, especially between meals and with medications. Offer a variety of preferred fluids.
- Fluid Intake Goals: Set daily fluid intake goals and track intake.
- Address Barriers to Fluid Intake: Identify and address barriers to fluid intake, such as mobility limitations, swallowing difficulties, or cognitive impairment. Offer assistance with drinking fluids.
- IV Fluid Administration (as Prescribed): Administer intravenous fluids as prescribed for patients with severe dehydration or inability to take oral fluids.
- Monitor for Fluid Overload: Monitor for signs of fluid overload in patients receiving IV fluids, especially those with cardiac or renal conditions.
- Medication Review: Review medications that may contribute to fluid loss, such as diuretics.
- Education on Hydration: Educate patients and caregivers about the importance of hydration, signs of dehydration, and strategies to maintain adequate fluid intake.
- Easy Access to Fluids: Ensure fluids are easily accessible to the patient. Use cups with lids if needed to prevent spills.
- Offer Fluids Frequently: Offer fluids whenever interacting with the patient.
- Monitor Laboratory Values: Monitor serum electrolytes, BUN, and creatinine levels for indicators of dehydration.
9. Risk for Infection
Older adults are more susceptible to infections due to age-related changes in the immune system (immunosenescence), chronic conditions, decreased mobility, and potential skin breakdown. Infections can present atypically in older adults, with subtle signs and symptoms.
Common Nursing Diagnosis:
- Risk for Infection: Related to age-related immune system changes, chronic illness, decreased mobility, impaired skin integrity, invasive procedures, and environmental exposure.
- Infection: Presence of pathogenic organisms in the body, manifested by fever, elevated WBC count, purulent drainage, redness, warmth, pain, and/or changes in mental status.
Nursing Goals:
- The patient will remain free from infection.
- The patient will demonstrate understanding of infection prevention measures.
Nursing Interventions:
- Infection Assessment: Monitor vital signs, including temperature, heart rate, respiratory rate, and blood pressure. Assess for subtle changes in mental status, which may be an early sign of infection in older adults. Assess skin integrity for breaks or redness. Monitor urine for clarity and odor.
- Hand Hygiene: Practice meticulous hand hygiene before and after patient contact. Encourage patients and caregivers to perform frequent hand hygiene.
- Standard Precautions: Adhere to standard precautions and transmission-based precautions as indicated.
- Skin Care: Provide meticulous skin care to maintain skin integrity and prevent breakdown.
- Oral Hygiene: Promote good oral hygiene to reduce oral bacteria.
- Catheter Care: Minimize the use of indwelling urinary catheters and provide meticulous catheter care if necessary.
- Wound Care: Provide appropriate wound care for any skin breaks or wounds.
- Nutritional Support: Ensure adequate nutrition to support immune function.
- Hydration: Maintain adequate hydration to promote overall health and immune function.
- Vaccination: Encourage recommended vaccinations, such as influenza and pneumococcal vaccines.
- Early Detection of Infection: Be vigilant for subtle signs and symptoms of infection in older adults, such as changes in mental status, weakness, fatigue, or anorexia, even in the absence of fever.
- Monitor Laboratory Values: Monitor WBC count and other laboratory values as indicated.
- Antibiotic Administration (as Prescribed): Administer antibiotics as prescribed for confirmed infections.
- Environmental Control: Maintain a clean and safe environment.
- Education on Infection Prevention: Educate patients and caregivers on infection prevention measures, such as hand hygiene, wound care, and recognizing signs and symptoms of infection.
10. Risk for Impaired Skin Integrity and Pressure Ulcers
Geriatric patients are highly susceptible to skin breakdown and pressure ulcers due to age-related skin changes, including decreased elasticity, thinning of the skin, reduced subcutaneous fat, impaired circulation, and decreased mobility. Immobility, malnutrition, and incontinence further increase the risk.
Common Nursing Diagnosis:
- Risk for Impaired Skin Integrity: Related to age-related skin changes, decreased mobility, immobility, incontinence, malnutrition, and friction/shear forces.
- Impaired Skin Integrity: Alteration in epidermis and/or dermis, manifested by redness, skin breaks, blisters, or pressure ulcers.
- Risk for Impaired Tissue Integrity: Damage to mucous membrane, corneal, integumentary, or subcutaneous tissues.
Nursing Goals:
- The patient will maintain intact skin integrity without development of pressure ulcers.
- Existing skin breakdown will heal.
Nursing Interventions:
- Skin Assessment: Assess skin condition upon admission and regularly thereafter, paying particular attention to bony prominences. Use a validated risk assessment tool (e.g., Braden Scale) to identify patients at high risk for pressure ulcers.
- Pressure Relief: Implement pressure relief measures, such as frequent repositioning (at least every 2 hours), use of pressure-redistributing mattresses and cushions, and padding bony prominences with pillows or pads.
- Turning Schedule: Establish and follow a turning schedule. Use lift sheets to reposition patients to avoid friction and shear.
- Skin Hygiene: Keep skin clean and dry. Use tepid water and mild, non-perfumed soaps. Avoid hot water and harsh soaps.
- Moisturize Skin: Apply moisturizing lotions to dry skin, especially after bathing.
- Incontinence Management: Implement strategies to manage incontinence and prevent skin breakdown from moisture. Use barrier creams as needed. Cleanse skin gently after each episode of incontinence.
- Nutritional Support: Ensure adequate nutrition, especially protein and vitamin C, to support skin health and wound healing.
- Hydration: Maintain adequate hydration to promote skin turgor and prevent dryness.
- Mobility Promotion: Encourage mobility and activity as tolerated to improve circulation and reduce pressure on bony prominences.
- Wound Care: Provide appropriate wound care for any existing skin breakdown or pressure ulcers, following established protocols and physician orders.
- Specialty Mattresses: Utilize specialty mattresses (e.g., air mattresses, air-fluidized beds) for patients at high risk for pressure ulcers or with existing ulcers.
- Avoid Shearing and Friction: Use proper lifting and transfer techniques to avoid shearing and friction forces on the skin.
- Education on Pressure Ulcer Prevention: Educate patients, family, and caregivers on pressure ulcer prevention strategies, including repositioning, skin care, and nutrition.
Alt text: Nurse carefully assessing a senior patient’s leg skin, emphasizing skin integrity evaluation as crucial for nursing diagnosis in geriatric care and pressure ulcer prevention.
Conclusion: Enhancing Geriatric Care Through Accurate Nursing Diagnoses
Nursing diagnoses for geriatric care are indispensable tools for nurses and healthcare professionals dedicated to the well-being of older adults. By providing a framework for identifying and addressing the unique health challenges of aging, these diagnoses empower nurses to create personalized, effective care plans. This guide has outlined ten essential nursing diagnoses frequently encountered in geriatric practice, along with corresponding nursing goals and evidence-based interventions.
Effective geriatric nursing extends beyond treating illnesses; it encompasses promoting health, independence, and quality of life for older adults. By mastering the application of nursing diagnoses, nurses can significantly enhance their ability to provide compassionate, patient-centered care that meets the complex needs of our aging population. Continuous learning, collaboration, and a commitment to evidence-based practice are essential for advancing the field of geriatric nursing and ensuring optimal outcomes for older adults in all healthcare settings.
