Common Nursing Diagnoses for Elderly Patients: A Comprehensive Guide

The global population is aging, and with this demographic shift comes an increasing need for specialized healthcare for older adults. Geriatric nursing plays a crucial role in meeting these needs, focusing on the unique health challenges and care requirements of the elderly. A cornerstone of effective geriatric nursing is the accurate identification and management of common nursing diagnoses. These diagnoses provide a framework for nurses to deliver personalized, evidence-based care that promotes health, well-being, and quality of life in older adults.

This guide delves into the essential aspects of nursing diagnoses in geriatric care. It aims to equip nurses, nursing students, and healthcare professionals with a comprehensive understanding of the most prevalent nursing diagnoses encountered in elderly patients. By understanding these diagnoses, healthcare providers can develop targeted interventions and care plans to address the specific needs of this vulnerable population.

Understanding Gerontological Nursing

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 physiological, psychological, social, economic, cultural, and spiritual dimensions of aging. As individuals age, they experience a multitude of changes that can impact their health and well-being. Geriatric nurses are experts in understanding these age-related changes and providing care that supports healthy aging and manages age-related health issues.

Geriatric nursing emphasizes a collaborative approach to care. It recognizes that optimal care for older adults often requires the involvement of a multidisciplinary team, including family members, community resources, and other healthcare professionals. By working together, this team can leverage diverse expertise and resources to enhance the quality of life for elderly individuals. The focus of geriatric nursing care is on promoting health, restoring function, optimizing well-being, increasing safety, preventing illness and injury, and facilitating healing throughout the aging process.

Nursing Care Plans and Geriatric Management

Nursing care plans are essential tools in geriatric management. They provide a structured, individualized approach to care, ensuring that the unique needs of each older adult are addressed effectively. In geriatrics, care planning is particularly crucial due to the complexity of health issues often seen in this population. Older adults are more likely to have multiple chronic conditions, age-related physiological changes, and psychosocial factors that influence their health.

Effective nursing care planning for geriatric patients involves comprehensive assessments, focusing on age-related changes, chronic conditions, functional abilities, mobility, medication management, cognitive health, and safety. The goal is to promote independence, optimize functional abilities, manage chronic illnesses, ensure medication safety, provide education on healthy aging, and create a safe and supportive environment. By systematically addressing these areas, nurses can develop care plans that enhance the quality of life and well-being of their elderly patients.

Prioritizing Nursing Problems in Geriatric Care

When caring for elderly patients, nurses must prioritize nursing problems to ensure the most critical needs are addressed first. Common priorities in geriatric nursing include:

Comprehensive Assessment and Individualized Care Plans: Conducting thorough assessments to identify specific needs and developing tailored care plans are paramount.
Chronic Condition and Cognitive Health Management: Older adults frequently manage chronic conditions such as diabetes, heart disease, and arthritis, and cognitive decline is also a significant concern.
Medication and Treatment Administration: Safe and accurate medication administration is crucial, considering age-related pharmacokinetic and pharmacodynamic changes.
Education and Support for Healthy Aging: Empowering older adults with knowledge and resources to promote healthy lifestyle choices is vital.
Assistance with Activities of Daily Living (ADLs) and Mobility Promotion: Many elderly patients require assistance with ADLs and strategies to maintain or improve mobility.
Interdisciplinary Collaboration and Community Resources: Working effectively with other healthcare professionals and leveraging community resources are essential for holistic care.
Fall Prevention Strategies and Environmental Safety: Falls are a major risk for older adults, making fall prevention a critical priority.
Emotional Support and Counseling: Addressing the emotional and psychological needs of elderly patients and their families is a crucial aspect of care.

Essential Nursing Assessments for Elderly Patients

A thorough nursing assessment is the foundation of effective geriatric care. It involves gathering both subjective and objective data to understand the patient’s health status comprehensively. Key assessment areas for elderly patients include:

Mobility: Assessing for decreased mobility, gait disturbances, and balance issues is crucial for fall risk identification.
Cognition and Memory: Evaluating cognitive function, memory, and the presence of confusion or delirium is essential, especially given the prevalence of dementia and Alzheimer’s disease in older adults.
Functional Status: Assessing the patient’s ability to perform ADLs such as bathing, dressing, eating, toileting, and mobility is vital for determining their level of independence and care needs.
Nutritional Status: Monitoring for changes in appetite, weight loss, and nutritional deficiencies is important as malnutrition is common in the elderly and can worsen health outcomes.
Sleep Patterns: Assessing for sleep disturbances, insomnia, and changes in sleep-wake cycles is important as sleep disorders are prevalent and impact overall health.
Mood and Psychological Well-being: Evaluating for mood changes, depression, anxiety, and social isolation is crucial as mental health issues are common and often underdiagnosed in older adults.
Sensory Function: Assessing for decreased vision and hearing is important as sensory impairments can significantly impact safety and quality of life.
Skin Integrity: Examining the skin for signs of breakdown, pressure ulcers, and increased vulnerability to infections is critical due to age-related skin changes.
Pain: Assessing for acute and chronic pain is important, as pain is common in older adults and can significantly impact function and quality of life.
Respiratory and Cardiovascular Function: Assessing respiratory rate, breath sounds, heart rate, and blood pressure is essential for detecting age-related changes and potential health problems.

Common Nursing Diagnoses in Geriatric Care

After a comprehensive assessment, nurses formulate nursing diagnoses to identify the health problems and needs of elderly patients. These diagnoses provide a basis for planning and implementing individualized care. While numerous nursing diagnoses may be relevant in geriatric care, some are particularly common due to the physiological and psychosocial changes associated with aging. Here are some of the most frequently encountered nursing diagnoses in elderly patients:

Risk for Falls: This is a highly prevalent diagnosis in geriatric nursing due to age-related changes in balance, mobility, vision, and muscle strength, as well as the increased incidence of chronic conditions and medication use that can contribute to falls.

Elderly woman using a walker with a nurse assisting, illustrating fall risk assessment and intervention.
Impaired Physical Mobility: Many older adults experience decreased physical mobility due to arthritis, osteoporosis, muscle weakness, neurological conditions, and pain. This diagnosis addresses limitations in movement and functional abilities.
Acute Confusion/Risk for Delirium: Delirium, a state of acute confusion, is common in hospitalized elderly patients and can be triggered by infections, medications, dehydration, and other medical conditions. Risk for delirium is also a relevant diagnosis for those predisposed to confusion.
Disturbed Sleep Pattern: Changes in sleep architecture, chronic pain, nocturia, and medical conditions contribute to sleep disturbances in older adults. Insomnia, fragmented sleep, and altered sleep-wake cycles are common concerns.
Constipation: Decreased bowel motility, medication side effects, inadequate fluid and fiber intake, and reduced physical activity contribute to constipation, a frequent gastrointestinal problem in the elderly.
Failure to Thrive: This complex diagnosis describes a state of decline in physical and/or cognitive function, often accompanied by weight loss, decreased appetite, social withdrawal, and fatigue. It is multifactorial and indicates a need for comprehensive assessment and intervention.
Risk for Aspiration: Elderly patients, particularly those with dysphagia, neurological conditions, or reduced level of consciousness, are at increased risk for aspiration, which can lead to pneumonia and other respiratory complications.
Deficient Fluid Volume/Risk for Deficient Fluid Volume: Age-related changes in thirst sensation, kidney function, and mobility limitations can lead to dehydration in older adults. Risk for deficient fluid volume is relevant for those with conditions that increase fluid loss or reduce fluid intake.
Risk for Infection: Immunosenescence, chronic conditions, decreased skin integrity, and invasive procedures increase the risk of infections in elderly patients. Urinary tract infections, pneumonia, and skin infections are common.
Risk for Impaired Skin Integrity/Risk for Pressure Ulcer: Thinning skin, decreased subcutaneous fat, impaired mobility, incontinence, and malnutrition increase the risk of skin breakdown and pressure ulcer development in older adults, especially those who are bedridden or chair-bound.

Setting Nursing Goals for Geriatric Patients

Nursing goals are desired outcomes for patient care. In geriatric nursing, goals are individualized and patient-centered, focusing on improving or maintaining function, safety, comfort, and quality of life. Examples of nursing goals for elderly patients include:

Fall Prevention: The patient will remain free from falls during hospitalization/care period. The patient and caregiver will implement home safety measures to prevent falls.
Respiratory Function: The patient will maintain a normal respiratory pattern and mental status for their baseline. Pulse oximetry or arterial blood gas results will be within acceptable limits.
Thermoregulation: The patient’s temperature and mental status will remain within their normal limits or return to baseline within a specified timeframe after interventions for hypothermia or hyperthermia.
Sleep: The patient will achieve adequate rest and report improved sleep quality. Mental status will remain intact.
Bowel Elimination: The patient will return to their normal bowel elimination pattern within a specified timeframe. Stools will be soft and easily passed without straining.
Nutritional Status: The patient will demonstrate improved nutritional status, evidenced by weight gain (if needed), increased appetite, and improved functional ability.
Swallowing Safety: The patient will swallow independently without choking or aspirating. Airway will remain patent, and lungs will be clear upon auscultation before and after meals.
Fluid Balance: The patient’s mental status, vital signs, and urine output will remain within normal limits. Mucous membranes will remain moist, and skin turgor will be normal.
Cognitive Function: The patient’s mentation will return to their normal baseline within a specified timeframe after interventions for confusion. The patient will remain free from injury related to altered mental status.
Infection Prevention: The patient will remain free from infection, as evidenced by orientation, normal vital signs, clear urine, and intact skin.
Skin Integrity: The patient’s skin will remain intact and free from redness or breakdown.

Nursing Interventions and Actions for Common Geriatric Diagnoses

Nursing interventions are specific actions taken by nurses to achieve patient goals and address nursing diagnoses. For each common geriatric nursing diagnosis, there are evidence-based interventions that can be implemented.

1. Promoting Safety and Preventing Falls & Injuries (Risk for Falls)

Preventing falls is paramount in geriatric care. Interventions include:

Comprehensive Fall Risk Assessment: Identify individual risk factors such as age, illness, sensory deficits, medications, and mobility aids.
Environmental Hazard Assessment: Evaluate the patient’s environment for tripping hazards, inadequate lighting, and unsafe furniture arrangement.
Level of Consciousness and Neurological Status Monitoring: Assess baseline LOC and mental status upon admission to detect changes indicative of confusion or delirium. Utilize tools like the Confusion Assessment Method (CAM).
Delirium Management: Identify and address the underlying causes of acute confusion, such as infection, dehydration, electrolyte imbalances, and medication side effects.
Memory Assessment: Test short-term memory to identify cognitive deficits that may increase fall risk.
Cardiac Monitoring: Monitor for dysrhythmias and other cardiac abnormalities that can contribute to falls due to decreased brain oxygenation.
Pain Management: Assess and manage pain, as pain can contribute to confusion and decreased mobility, increasing fall risk.
Hydration and Renal Function Assessment: Monitor fluid intake and output and assess renal function, as dehydration and impaired kidney function can contribute to confusion and falls.
Medication Review: Review medications, including OTC drugs, with a pharmacist to identify medications that may increase fall risk (e.g., sedatives, diuretics, anticholinergics).
Regular Toileting Schedule: Implement a regular toileting schedule, especially for patients with short-term memory problems, to prevent falls associated with urgency and incontinence.
Accessibility of Items: Keep frequently used items, like urinals, glasses, and hearing aids, within easy reach.
Familiar Environment: Encourage family to bring familiar items from home to promote orientation and comfort.
Frequent Observation: Check on confused patients frequently (every 30 minutes) and place them near the nurses’ station for closer monitoring.
Reorientation Strategies: Reorient the patient to their environment as needed, using clocks, calendars, and verbal reminders.
Music Therapy: Provide calming music instead of television, which can be disorienting for confused patients.
Simple Communication: Use simple, clear language when communicating with confused patients.
De-escalation Techniques: If the patient becomes agitated or hostile, de-escalate the situation by leaving the room and re-approaching later with a calm demeanor. Avoid arguing or questioning their reality.
Distraction Techniques: If the patient attempts to leave the hospital, use distraction techniques, such as walking with them and engaging in conversation, to redirect their behavior.
Family Involvement: Encourage family to visit or call to provide reassurance and support.
Bedside Safety Measures: If the patient tries to climb out of bed, offer toileting assistance or place them in a chair at the nurses’ station for closer supervision.
Behavioral Agreements: Attempt to establish agreements with the patient to stay in bed or the room for a set period.
Tube Management: Conceal tubes and lines if the patient attempts to pull them out, using stockinette dressings or securing them discreetly.
Medication Use with Caution: Use medications for behavior management cautiously, starting with low doses and monitoring for side effects. Short-acting benzodiazepines may be more effective for delirium-related anxiety than neuroleptics.
Restraint Use as Last Resort: Use restraints only as a last resort, according to hospital policy, and monitor for agitation.
Re-evaluate Interventions: Regularly re-evaluate the need for interventions and discontinue those that are no longer necessary or may be irritating.
Fall Prevention Wristband: Use a wristband to identify patients at high risk for falls to alert healthcare providers.
Assistive Devices and Accessibility: Ensure assistive devices and personal items are within reach.
Safe Transfer Protocols: Follow hospital protocols for safe patient transfers.
Low Bed Position: Keep the bed in the lowest position.
Prompt Call Light Response: Answer call lights promptly to prevent unassisted ambulation.
Side Rail Use: Use side rails as needed, considering patient safety and mobility needs.
Non-Slip Footwear: Advise patients to wear non-slip shoes or slippers.
Environmental Orientation: Orient patients to their surroundings and avoid rearranging furniture.
Adequate Lighting: Ensure the room is well-lit, especially at night.
Family Supervision: Encourage family or significant others to stay with the patient.
Vision and Hearing Checks: Ensure regular eye and hearing checks and that patients use glasses and hearing aids if needed.
Home Safety Education: Instruct patients and families on home safety measures, including handrails and removing tripping hazards.
Exercise and Gait Training: Encourage regular exercise and gait training to improve strength, balance, and coordination.
Medication Review for Fall Risk: Collaborate with healthcare teams to review medications that may contribute to fall risk and adjust dosages as needed.
Physical and Occupational Therapy Consultation: Evaluate the need for physical and occupational therapy to provide gait training, assistive devices, and home safety evaluations.

2. Improving Gas Exchange and Respiratory Function (Impaired Gas Exchange)

Optimizing respiratory function in older adults requires:

Respiratory Assessment: Monitor and record respiratory rate, depth, pattern, breath sounds, cough, sputum, and mental status regularly.
Subtle Change Monitoring: Assess for subtle changes in behavior or mental status (anxiety, disorientation, restlessness) that may indicate decreased oxygen levels. Monitor oxygen saturation via pulse oximetry and consider ABG analysis. Note that hemoglobin levels can affect pulse oximetry readings.
Lung Auscultation: Auscultate lungs for adventitious sounds. Be aware that crackles in the lower lung fields may be a normal age-related finding, but new or worsening crackles require further investigation.
Breathing and Coughing Exercises: Encourage deep breathing and coughing exercises and teach the use of incentive spirometry to promote alveolar expansion and secretion removal.
Hydration: Encourage increased fluid intake (unless contraindicated) to help mobilize secretions.
Hyperthermia, Pain, and Anxiety Management: Treat hyperthermia, manage pain, and reduce anxiety to decrease oxygen demand.
Oxygen Therapy Education: Educate patients on the use of prescribed oxygen devices, such as nasal cannulas or oxygen masks, to promote adherence.

3. Managing Hypothermia (Risk for Imbalanced Body Temperature)

Preventing and managing hypothermia in elderly patients involves:

Temperature Monitoring with Low-Range Thermometer: Use a low-range thermometer to accurately detect hypothermia, as normal temperature ranges may be lower in older adults (around 96°F or 35.5°C).
Accurate Oral Temperature Measurement: Ensure accurate oral temperature readings by placing the thermometer tip far back in the mouth.
Mental Status Assessment: Assess and record mental status, as altered mentation can be an early sign of hypothermia.
Medication Awareness: Be aware that sedatives, muscle relaxants, hypnotics, and anesthetics can increase the risk of hypothermia by reducing shivering.
Warming During Procedures: Provide blankets to patients during procedures or examinations, especially in cool environments.
Slow Rewarming for Mild Hypothermia: For mild hypothermia, increase room temperature, use warm blankets, and provide head coverings and warm circulating air blankets.
Internal Rewarming for Moderate to Severe Hypothermia: For temperatures below 95°F (35°C), use internal rewarming methods such as warm oral or IV fluids, warmed saline irrigations, or warmed humidified air.
Monitoring for Rapid Rewarming Complications: Monitor for signs of excessive rapid rewarming, such as irregular heart rate, dysrhythmias, and peripheral vasodilation.
Laboratory Investigations: If temperature does not improve with rewarming, anticipate laboratory tests for sepsis, hypoglycemia, and hypothyroidism, as these conditions can contribute to hypothermia.
Treatment of Underlying Conditions: Administer antibiotics for sepsis, glucose for hypoglycemia, or thyroid therapy as prescribed to address underlying causes of hypothermia.

4. Promoting Adequate Sleep and Improving Sleep Patterns (Disturbed Sleep Pattern)

Improving sleep in older adults requires addressing contributing factors:

Sleep Pattern Assessment: Assess and record the patient’s sleep pattern, including usual bedtime routines, sleep duration, and awakenings, gathering information from caregivers if needed.
Activity Level and Nap Assessment: Inquire about activity levels and daytime napping habits, as excessive napping can disrupt nighttime sleep.
Activity Level Management: Encourage daytime activity and limit late afternoon naps, unless the patient is excessively fatigued.
Nighttime Routine: Identify and try to maintain the patient’s typical nighttime routine to promote relaxation and sleep.
Cluster Care: Cluster nursing activities (vital signs, medications, toileting) to minimize nighttime interruptions.
Stimulant Avoidance: Discourage caffeinated beverages after 6 pm.
Quiet and Calm Environment: Provide a calm, quiet, and dark environment, minimizing noise and light interruptions. White noise generators may be helpful.
Comfort Measures: Administer pain medications as ordered, provide back rubs, and engage in pleasant conversation at bedtime to promote comfort and relaxation.

5. Restoring Bowel Function and Managing Constipation (Constipation)

Managing constipation in elderly patients involves a multi-faceted approach:

Bowel Pattern Assessment: Assess and record the patient’s normal bowel elimination pattern, including frequency, timing, habits, and previous constipation management strategies.
Roughage Management: Gradually increase dietary fiber intake, balancing it with hydration to avoid gas and bloating.
Hydration Status and Laxative Use: Assess hydration status and ensure adequate fluid intake. If constipation persists after 3 days without bowel movement, start with mild laxatives. Be aware that osmotic laxatives can cause dehydration.
Education on Hospital-Related Constipation: Educate patients that hospitalization can disrupt bowel habits and increase constipation risk. Encourage the use of familiar non-pharmacological management strategies.
Fluid Intake Promotion: Educate patients about the link between fluid intake and constipation. Encourage 2500 ml fluid intake daily (unless contraindicated). Monitor and record bowel movements (amount, date, time, consistency).
Dietary Fiber Promotion: Instruct patients to include roughage in each meal (raw fruits and vegetables, whole grains). For those with intolerance to raw foods, suggest bran cereals, breads, and muffins.
Activity Promotion: Educate patients about the link between physical activity and bowel function. Support optimal activity levels and encourage regular exercise to stimulate peristalsis.
Gastrocolic/Duodenocolic Reflex Utilization: Encourage using the gastrocolic or duodenocolic reflex to promote bowel emptying by scheduling toileting after meals, especially in the morning.
Previous Effective Measures: Use the patient’s previously effective constipation management strategies.
Pharmacological Hierarchy: When pharmacological intervention is needed, follow a stepwise approach, starting with the least invasive options:
- Bulk-forming agents (bran, methylcellulose, psyllium)
- Mild laxatives (apple/prune juice, Milk of Magnesia)
- Stool softeners (docusate calcium/sodium)
- Potent laxatives/cathartics (senna, bisacodyl, cascara sagrada)
- Medicated suppositories (glycerin, bisacodyl)
- Enemas (tap water, saline, sodium phosphate/biphosphate)
Avoid Premature Pharmacological Intervention: Do not intervene pharmacologically unless the patient has not had a bowel movement for three days.
Laxatives After Barium Studies: Administer laxatives as ordered after diagnostic imaging with barium to facilitate barium removal and prevent constipation.

6. Addressing Failure to Thrive in Older Adults (Failure to Thrive)

Managing failure to thrive requires a comprehensive and collaborative approach:

Comprehensive Physical Assessment: Conduct a thorough physical assessment to establish a baseline and identify underlying medical conditions.
Laboratory and Diagnostic Studies: Review laboratory results (CBC, albumin, pre-albumin, TSH, BMP) to identify nutritional deficiencies, electrolyte imbalances, and signs of infection.
History and Caregiver Involvement: Gather patient history, involving caregivers as needed, focusing on changes in behavior, appetite, medications, ADL/IADL decline, and psychosocial factors like bereavement.
Emotional Support and Venting: Allow patients to express feelings of fear, anger, despair, and frustration. Provide emotional support and acknowledge their feelings.
Education on Age-Related Changes: Explain age-related physiological changes and the concept of “failure to thrive” as a multifactorial syndrome involving physical frailty, disability, and neuropsychiatric impairment.
Interdisciplinary Collaboration: Collaborate with:
- Speech therapists and dieticians: Address swallowing difficulties and nutritional intake.
- Physical and occupational therapists: Assess physical limitations and develop rehabilitation plans.
- Social services: Assess social support networks and end-of-life planning needs.

7. Preventing Aspiration (Risk for Aspiration)

Preventing aspiration in elderly patients, especially those with swallowing difficulties, is critical:

Swallowing and Gag Reflex Assessment: Evaluate swallowing reflex by palpating laryngeal prominence during swallowing and assess gag reflex using a tongue blade. Document findings.
Food Intake Monitoring: Monitor food intake, noting consistency, placement in mouth, chewing and swallowing process, and time taken to swallow.
Swallowing Observation During Meals: Observe patients during meals for signs of choking, coughing, or difficulty swallowing.
Choking and Coughing Monitoring: Monitor for choking or coughing before, during, and after swallowing, which may indicate aspiration.
Speech Assessment: Check for wet or gurgling speech after swallowing, which can signal aspiration.
Respiratory Assessment for Silent Aspiration: Assess for abnormal breath sounds (crackles, rhonchi, wheezes), shortness of breath, dyspnea, cyanosis, fever, and deteriorating LOC, which may indicate silent aspiration.
Oral Food Retention Assessment: Check for food retention in the sides of the mouth, indicating poor tongue movement.
Drooling and Lip Closure Assessment: Assess for drooling and inability to close lips around a straw, indicating jaw, lip, or tongue weakness.
Video Fluoroscopic Swallowing Exam (VFSE) Anticipation: Anticipate VFSE or modified barium swallow exam to evaluate gag and swallow reflexes and identify aspiration risks.
Dietary Modifications: Based on VFSE results, anticipate orders for thickened fluids, mechanical soft, pureed, or liquid diets to reduce aspiration risk.
Speech Therapy Referral: Anticipate referral to a speech therapist for swallowing evaluation and therapy.
Head Positioning During Swallowing: For patients with impaired swallowing, tilt the head forward 45 degrees during swallowing. For hemiplegia, tilt the head toward the unaffected side.
Rest Before Meals: Encourage rest periods before meals to prevent fatigue-related aspiration.
Upright Position During Meals: Position patients upright with chin slightly tilted down during eating and drinking, using pillows for support.
Denture Fit: Ensure dentures fit properly to facilitate chewing.
Dementia-Specific Swallowing Instructions: For patients with dementia, instruct them to chew and swallow each bite and check for retained food.
Adequate Mealtime: Allow sufficient time for eating and drinking.
Supervision During Meals: Ensure someone stays with the patient during meals for safety.
Breathing and Coughing Exercises: Encourage breathing and coughing exercises to promote lung expansion and prevent infection.
Suction Availability: Keep suction equipment readily available in case of aspiration.
Aspiration Management: If aspiration occurs:
- Assess for complete airway obstruction (poor air exchange, cyanosis, inability to speak/breathe).
- Encourage forceful coughing for partial obstruction.
- Notify healthcare provider and obtain chest x-ray order for partial or complete aspiration.
- Implement NPO status until diagnosis is confirmed.

8. Maintaining Fluid Balance (Risk for Deficient Fluid Volume/Excess Fluid Volume)

Maintaining fluid balance in older adults is crucial:

Fluid Output Assessment: Assess and record amount, color, and frequency of urine, diarrhea, emesis, and other drainage to monitor fluid loss. Dark urine indicates dehydration.
Skin Turgor and Hydration Assessment: Assess skin turgor by gently pinching skin over forehead, clavicle, sternum, or abdomen. Tenting indicates dehydration. Furrowed tongue signifies severe dehydration.
Fluid Intake Monitoring and Promotion: Monitor fluid intake and encourage 2-3 liters per day unless contraindicated. Set intake goals for day, evening, and night shifts.
Level of Consciousness Assessment: Assess LOC, including orientation and ability to follow commands, as changes can indicate dehydration.
Daily Weight Monitoring: Weigh patient daily at the same time, using the same scale and clothing, to detect fluid shifts.
Self-Feeding Ability Assessment and Support: Assess patient’s ability to drink independently and ensure fluids are within reach. Use cups with lids to prevent spills.
Intake and Output Monitoring for Tube Feedings/Contrast Medium: Closely monitor I&O for patients receiving tube feedings or contrast medium, watching for third spacing (edema, decreased urine output).
Fluid Overload Monitoring for IV Infusions: For patients on IV fluids, monitor for fluid overload (increased HR, crackles, wheezes), assessing apical pulse and lung sounds.
Laboratory Value Monitoring for Dehydration: Anticipate elevated serum sodium, BUN, and creatinine levels in dehydrated patients.
Toileting Accessibility: Ensure easy access to toilet, urinal, or bedpan every 2 hours while awake and every 4 hours at night. Answer call lights promptly.
Frequent Fluid Offerings: Offer fluids frequently, providing preferred beverages (limiting caffeine).

9. Promoting Infection Control and Minimizing Infections (Risk for Infection)

Infection prevention in geriatric patients requires vigilance:

Baseline Vital Sign and Mental Status Monitoring: Monitor baseline vital signs, including LOC and orientation, and watch for increased heart rate (>100 bpm) and respiratory rate (>24 breaths/min). Auscultate lungs for adventitious sounds, noting that crackles may be normal at lung bases. Acute mental status changes are key infection indicators.
Skin Assessment: Assess skin for tears, breaks, redness, or ulcers and document skin condition regularly.
Temperature Monitoring with Low-Range Thermometer: Use a low-range thermometer as older adults may have lower baseline temperatures. Rectal temperatures may be more accurate if oral readings are inconsistent with clinical presentation.
Tympanic Thermometer Caution: Avoid tympanic thermometers if possible due to inconsistent reliability.
Urine Assessment: Assess urine quality and color and report changes. Be alert for urinary incontinence, which can signal UTI, a common infection in older adults, even without typical painful urination.
Limit Urinary Catheter Use: Minimize urinary catheter use to reduce UTI risk.
Anticipate Cultures: Anticipate orders for blood cultures, urinalysis, and urine culture to identify causative microorganisms.
White Blood Cell Count Monitoring: Anticipate WBC count, noting that elevated WBC may be a late sign of infection in older adults.
IV Fluid Therapy for Infection: If infection is confirmed, anticipate IV fluid therapy to improve hydration and liquefy secretions.
Chest X-Ray Anticipation: Anticipate chest x-ray order if lung sounds are unclear to rule out pneumonia.
Antibiotic, Antipyretic, and Oxygen Therapy Anticipation: Anticipate orders for broad-spectrum antibiotics, antipyretics, and oxygen inhalation for confirmed infections.

10. Preventing Pressure Ulcer Formation (Risk for Impaired Skin Integrity/Pressure Ulcer)

Pressure ulcer prevention in geriatric patients is essential:

Skin Assessment on Admission and Regularly: Assess skin upon admission and regularly thereafter, providing a baseline for skin integrity monitoring.
Bony Prominence Monitoring: Monitor skin over bony prominences (sacrum, heels, scapulae, etc.) for erythema.
Skin Condition Observation: Observe skin for redness, texture changes, or breaks in skin surface, requiring aggressive skin care if present.
Lift Sheet Use: Use lift sheets or rolling techniques during repositioning to prevent shear injury.
Turning Schedule: Implement a turning schedule at least every 2 hours to relieve pressure.
Pressure-Relieving Mattresses: Utilize pressure-sensitive mattresses (waterbed, airbed, alternating pressure) for bedridden or bedrest patients.
Bony Prominence Padding: Pad bony prominences with pillows or pads, even when patients are in wheelchairs or sitting for extended periods. Use gel pads for chairs.
Lotion Use: Apply lotions generously to dry skin, especially lanolin-containing lotions.
Promote Mobility and Utilize Lifting Devices: Assist patients out of bed frequently, using mechanical lifting devices for transfers. If bed mobility is limited, provide position changes every 2 hours.
Turning Schedule Documentation: Document turning schedules on care plans and at the bedside to ensure consistency.
Avoid Tubes Under Patient: Avoid placing tubes directly under the patient’s head or limbs; use padding for cushion.
Tepid Water and Mild Soaps: Use tepid water (90-105°F) and superfatted, non-perfumed soaps for bathing.
Partial Baths: Provide partial baths daily (face, axillae, genital areas) instead of complete baths daily to prevent excessive skin drying.
Nutritional Support: Record percentage of food intake and encourage family to provide preferred foods. Recommend nutritious snacks and consult a dietician for nutritional advice. High-protein, ascorbic acid-rich diets support skin health.
Limit Plastic Pad Use: Limit plastic protective pad use. If used, place a cloth layer between the pad and skin to absorb moisture. For incontinent patients, check pads every 2 hours. Avoid adult diapers unless ambulatory, going for tests, or in a chair, as they trap heat and moisture.

Recommended Resources

For further learning and in-depth information on nursing diagnoses and care planning, consider these resources:

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health

References and Sources

This guide is based on established nursing principles and best practices in geriatric care, drawing upon the following resources:

Nursing Care Plans (NCP): Ultimate Guide and Database
Head-to-Toe Assessment: Complete Physical Assessment Guide
Nursing Process: A Comprehensive Guide
7 Medication Safety Tips New Nurses Must Know
Fatigue & Lethargy Nursing Care Plans
Alzheimer’s Disease and Dementia Nursing Care Plans
Sleep & Insomnia Nursing Care Plans
Bowel Incontinence (Fecal Incontinence) Nursing Care Plan and Management
Constipation Nursing Care Plan and Management
Imbalanced Nutrition: Less Than Body Requirements Nursing Care Plan
Aspiration Risk & Aspiration Pneumonia Nursing Care Plan & Management
Impaired Gas Exchange Nursing Care Plan
Hypothermia Nursing Diagnosis
Hyperthermia Nursing Diagnosis and Nursing Care Plan
Risk for Infection and Infection Control Nursing Care Plan and Management
Wound Care and Skin or Tissue Integrity Nursing Care Plan and Management
Risk for Falls Nursing Care Plan
Acute Confusion Nursing Diagnosis and Care Plan
Acute Pain Nursing Care Plan and Management
Deficient Fluid Volume Nursing Diagnosis
Hypervolemia & Hypovolemia (Fluid Imbalances) Nursing Care Plans and Nursing Diagnosis
Impaired Swallowing (Dysphagia) Nursing Care Plan & Management
Impaired Physical Mobility Nursing Care Plan and Management
Self-Care Deficit & Activities of Daily Living (ADLs) Nursing Care Plan and Management
Caregiver Role Strain Nursing Diagnosis and Care Plan
Knowledge Deficit & Patient Education Nursing Care Plan and Management
Risk for Injury Nursing Diagnosis Care Plan Guide
Ineffective Airway Clearance Nursing Care Plan
Ineffective Breathing Pattern Nursing Care Plan and Management
Fluid Intake and Output (I&O) Monitoring Nursing Guide
Vital Signs: Assessing Body Temperature Nursing Guide
Performing Suctioning Nursing Guide
Patient Positioning: Nursing Positions Guide
Bladder Scanning Nursing Procedure
Intravenous (IV) Therapy Technique Nursing Guide
Cleaning Bedpans and Urinals Nursing Procedure
Normal Laboratory Values Guide for Nurses
Arterial Blood Gas (ABGs) Interpretation Guide
Administering Oxygen Therapy Nursing Guide
Urinary Tract Infection (UTI) Nursing Care Plans
Pneumonia Nursing Care Plans & Nursing Diagnosis
Cholera and Dehydration Nursing Guide
Hypercalcemia and Hypocalcemia (Calcium Imbalances) Nursing Care Plans and Nursing Diagnosis
Hypernatremia & Hyponatremia (Sodium Imbalances) Nursing Care Plans and Nursing Diagnosis
Furosemide Nursing Considerations and Patient Teaching [Drug Guide]
Antiseizure Drugs: NCLEX-RN Pharmacology Study Guide
Antiparkinsonism Drugs Pharmacology Study Guide
Psychotherapeutic Drugs: NCLEX-RN Pharmacology Study Guide
Anxiolytic & Hypnotic Drugs Pharmacology Guide
Antibiotics: Nursing Pharmacology Study Guide
Cardiotonic & Inotropic Drugs Pharmacology Guide
Registered Nurse Career Guide: How to Become an RN
Nursing Theories and Theorists: The Definitive Guide for Nurses
Blood Anatomy and Physiology
Skeletal System Anatomy and Physiology
Digestive System Anatomy and Physiology
Urinary System Anatomy and Physiology
Respiratory System Anatomy and Physiology
Special Senses Anatomy and Physiology
Cardiovascular System Anatomy and Physiology
Subcutaneous Administration of Medications
Intramuscular Injection Guide & Sites
Intradermal Injection Technique and Sites
Drug Dosage Calculations Practice Quizzes
Fecal Analysis (Stool Analysis) Nursing Guide
Collecting Stool Specimen: Procedure & Nursing Considerations
Helping patients to sleep will reduce their pain
Providing Evening Care (PM Care) to Patients
Chinese Nursing Home Financially Rewards Children Who Visits Their Parents
12 Funny Things That Wake Nurses at Night
5 Epiglottitis Nursing Care Plans
Croup Syndrome: Nursing Care Plans
Activity Intolerance and Generalized Weakness Nursing Care Plan and Management
Anxiety Nursing Diagnosis and Nursing Care Plan
Fear – Nursing Diagnosis and Care Plans
Delirium Nursing Diagnosis and Care Plan
Disturbed Thought Processes & Cognitive Impairment Nursing Care Plan and Management
Risk for Unstable Blood Glucose Levels (Hyperglycemia & Hypoglycemia) Nursing Care Plan and Management
Decreased Cardiac Output & Cardiac Support Nursing Care Plan and Management
Fluid Volume Excess (Hypervolemia) Nursing Care Plan & Management
Nursing Management: Guide to Organizing, Staffing, Scheduling, Directing and Delegation
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This comprehensive guide provides a robust foundation for understanding and addressing common nursing diagnoses in elderly patients. By utilizing this information, nurses can enhance their geriatric care practices and contribute to improved health outcomes for older adults.