H.

Nursing Care of Physiologic & Psychologic Disorders

1.Cardiovascular Function
 Hypertension
 Coronary Artery Disease
 Arrhythmia
 Congestive heart Failure
 Peripheral Artery Occlusive Disease
2.Respiratory Function
 Obstructive Pulmonary disease
 Tubeculosis
 Pneumonia
3. Endocrine Function
 Diabetes
 Hperthyroidism
 Hypothyroidism
4. Gastrointestinal Function
 Dysphagia
 Gastroesophageal reflux
 Ulcers
 Intestinal Obstruction
 Polyps
 Cirrhosis
 Colorectal Cancer
 Cholelithiasis/cholecystitis

1. CARDIOVASCULAR DISORDER
A. HYPERTENSION
- hypertension increases with advancing age and is the most prevalent cardiovascular
disease of older adults, making it a problem the gerontological nurse commonly
encounters. Many older individuals have high blood pressure arising from the
vasoconstriction associated with aging, which produces peripheral resistance.

Assessment Guide:
Assessment of the cardiovascular system can begin at the moment you see the patient by
observing indicators of cardiovascular status. Such observations would note the following:
Generalized coloring: Note pallor, which can accompany cardiovascular disorders.
Energy level: Note fatigue and the amount of activity that can be tolerated.
Breathing pattern: Observe respirations while the patient ambulates, changes position, and
speaks. Acute dyspnea warrants prompt medical attention because it can be a symptom of
myocardial infarction in older adults.
Condition of nails: Inspect the color, shape, thickness, curvature, and markings in nail beds,
which can give insight into problems. Nails may be thick and dry in the presence of
cardiovascular disease. Check blanching; circulatory insufficiency can delay the nails’ return to
pink after blanching. Advanced cardiac disease can cause clubbing of the nails.
Status of vessels: Inspect the vessels on the extremities, head, and neck. Note varicosities, as
well as redness on the skin above a vessel.
Hair on extremities: Hair loss can accompany poor circulation.
Edema: Swelling of the ankles and fingers is often indicative of cardiovascular disorders.
Mental status: Inadequate cerebral circulation often manifests itself through confusion; evaluate
cognitive function and level of consciousness.

INTERVIEW
Symptoms:
- Inquire regarding the presence of dizziness, light-headedness, edema, cold extremities,
palpitations, blackouts, breathing difficulties, coughing, hemoptysis, chest pain, or unusual
sensations in the chest, neck, back, or jaws.
-Elicit information through questions such as the following:
“Do your arms or legs ever become cold or numb?”
“Do dark spots or sores ever develop on your legs?”
“Do your legs get painful or swollen when you walk or stand?”
“Do you ever have periods of feeling dizzy, light-headed, or confused?”
“Does one leg ever look larger than the other?”

Changes in Function:
Ask the patient if he or she has noted changes in physical or mental function:
“Do you have difficulty or have you noticed any changes in your ability to walk, work, or take
care of yourself?”
“Do you ever have periods in which your thinking doesn’t seem clear?”
“Have you had to restrict activities or change your lifestyle recently?”

LIFESTYLE PRACTICES:
“How often do you exercise, for what length of time, and what type of exercise do you do?”
“What is your pattern of alcohol consumption?”
“Do you consume any illegal or recreational drugs, and if so, what type and how frequently?”
“What supplements (vitamin, herbal, and homeopathic) are you using?”
“Do you do anything to promote health (e.g., take a daily aspirin and follow a special diet)?”

PHYSICAL EXAMINATION:
-Inspect the patient from head to toe, noting areas of irritation or redness over a vessel,
distended vessels, edema, and pallor. Blanching of the nail beds gives information about
circulation. An examination of the extremities should include palpitation of the pulses and
temperature of the extremities and observation of hair distribution on the legs.
- Assessment of apical and radial pulses should normally reveal a pulse that ranges between 60
and 100 beats/min. Remember that older hearts take longer to recover from stress; thus,
tachycardia may be detected as a result of a stress that occurred several hours earlier. If
tachycardia is discovered in an older person, reassess in several hours.
- Assess blood pressure in lying, sitting, and standing positions to determine the presence of
postural hypotension; positional drops greater than 20 mm Hg are significant.
- Auscultate the heart to detect thrills and bruits. Palpate the point of maximal impulse to
identify displacement, which can occur with problems such as left ventricular hypertrophy.
Measure jugular venous pressure.
- Palpate pulses bilaterally for condition of the vessel wall, rate, rhythm, quality, contour, and
equality at the following sites:
o Temporal pulse, the only palpable artery of the head, located anterior to the ear,
overlying the temporal bone; normally appears tortuous.
 o Brachial pulse located in the groove between the biceps and triceps; usually
palpated if arterial insufficiency is suspected.
o Radial pulse branching from the brachial artery, the radial artery extends from
the forearm to the wrist on the radial side and is palpated on the flexor surface
of the wrist laterally.
o Ulnar pulse also branching from the brachial artery, the ulnar artery extends
from the forearm to the wrist on the ulnar side and is palpated on the flexor
surface of the wrist medially; usually palpated if arterial insufficiency is
suspected.
o Femoral pulse; the femoral artery is palpated at the inguinal ligament midway
between the anterosuperior iliac spine and the pubic tubercle.
o Popliteal pulse located behind the knee; the popliteal artery is the continuation of
the femoral artery. Having the patient flex the knee during palpitation can aid in
locating this pulse.
o Posterior tibial pulse palpable behind and below the medial malleolus.
o Dorsalis pedis pulse palpated at the groove between the first two tendons on the
medial side of the dorsum of the foot; this and the posterior tibial pulse can be
congenitally absent.
-Rate pulses on a scale from 0 to 4: 0 = no pulse 1 = thready, easily obliterated pulse 2 =
pulse difficult to palpate and easily obliterated 3 = normal pulse 4 = strong, bounding pulse,
not obliterated with pressure
- While assessing pulses, inspect the vessels for signs of phlebitis. Signs could include redness,
tenderness, and edema over a vein. Sometimes, visible signs of inflammation may not be
present, and the primary indication that phlebitis exists can be tenderness of the vessel
detected through palpation. A positive Homans’ sign (i.e., pain when the affected leg is
dorsiflexed) can accompany deep phlebitis of the leg.
- Inspect the legs for discoloration, hair loss, edema, scaling skin, pallor, lesions, and
tortuouslooking veins.
- Assess skin temperature by touching the skin surface in various areas.
- Alterations in cerebral circulation can cause disruptions to cognitive function; therefore, a
mental status evaluation can provide useful information about circulatory problems.
- The nurse should carefully assess the patient’s blood pressure by checking it several times
with the person in standing, sitting, and prone positions. Anxiety, stress, or activity before the
blood pressure check should be noted, because these factors may be responsible for a
temporary elevation.
- Hypertensive older patients are advised to rest, reduce their sodium intake, and, if necessary,
reduce their weight. Aggressive antihypertensive therapy is discouraged for older persons
because of the risk of a sudden dangerous decrease in blood pressure.
- In the management of the older hypertensive person, it is a challenge to achieve a blood
pressure level high enough to provide optimum circulation yet low enough to prevent serious
related complications.

B. CORONARY ARTERY DISEASE

- Coronary artery disease is the popularly used phrase for ischemic heart disease. The
prevalence of coronary artery disease increases with advanced age, so that some form of this
disease exists in most persons 70 years of age or older.
ANGINA
- the anginal syndrome presents in an atypical pattern in older adults, making detection
difficult.
- The type of pain described and the relationship of the onset of pain to a meal may cause the
patient and the health professional to attribute this discomfort to indigestion. As this condition
progresses, the patient may experience precordial pain radiating down the left arm. Other
symptoms can include coughing, syncope, sweating with exertion, and episodes of confusion.
- Nitroglycerin has been effective in preventing and treating anginal attacks. Older persons are
more likely to experience orthostatic hypotension with nitrates resulting from loss of vasomotor
and baroreceptor reactivity. Because this drug may cause a drop in blood pressure, lower
dosages may be indicated.
- To prevent anginal syndromes, the nurse teaches and helps the patient to avoid factors that
may aggravate this problem, such as cold wind, emotional stress, strenuous activity, anemia,
tachycardia, arrhythmias, and hyperthyroidism.
- the pain associated with an MI may be similar to that of angina, patients should be instructed
to notify the physician or nurse if pain is not relieved by nitroglycerin.

MYOCARDIAL INFARCTION
- MI is frequently seen in older persons, especially in men with a history of hypertension and
arteriosclerosis.
- Symptoms include pain radiating to the left arm, the entire chest, the neck, jaw, and the
abdomen; numbness in arms, neck, or back; confusion; moist, pale skin; decreased blood
pressure; syncope; shortness of breath; cough; low-grade fever; and an elevated sedimentation
rate.
- The trend in treating MI has been to reduce the amount of time in which the patient is limited
to bed rest and to replace complete bed rest with allowing the patient to sit in an armchair next
to the bed.
- Early ambulation following an MI is encouraged. Typically, patients are allowed out of bed
within a few days of an uncomplicated MI and are ambulating shortly thereafter. Getting out of
bed early can be beneficial for the heart (using a bedpan puts more work on the heart than
using a commode), maintains the body’s condition, and assists in the prevention of
complications associated with immobility.
- Nurses should be alert to signs of developing pulmonary edema and CHF, potential
complications for the geriatric patient with an MI.
- Fitness programs have shown to be beneficial for older persons with coronary artery disease
in improving cardiac functional capacity, reducing ischemic episodes, decreasing the risk of
complications, and promoting a sense of well-being and control over the disease

C. ARRHYTHMIA
- Digitalis toxicity, hypokalemia, acute infections, hemorrhage, anginal syndrome, and coronary
insufficiency are some of the many factors that cause an increasing incidence of arrhythmias
with age. Of the causes mentioned, digitalis toxicity is the most common.
- Tranquilizers, antiarrhythmic drugs, digitalis, and potassium supplements are part of the
therapy prescribed; cardioversion may also be done. Patient education may be warranted to
help the individual modify diet, smoking, drinking, and activity patterns.
-The nurse should be aware that digitalis toxicity can progress in the absence of clinical signs
and with blood levels within a normal range and that the effects can be evident even 2 weeks
after the drug has been discontinued.
-This reinforces the importance of nursing assessment and monitoring to detect subtle changes
and atypical symptoms. Older people have a higher mortality rate from cardiac arrest than
other segments of the population, emphasizing the need for close nursing observations and
early problem detection to prevent this serious complication.

D. Peripheral Artery Occlusive Disease

ARTERIOSCLEROSIS
- common problem among older persons, especially those who have diabetes. Unlike
atherosclerosis, which generally affects the large vessels coming from the heart, arteriosclerosis
most often affects the smaller vessels farthest from the heart.
-Arteriography and radiography can be used to diagnose arteriosclerosis, and oscillometric
testing can assess the arterial pulse at different levels. If surface temperature is evaluated as a
diagnostic measure, the nurse should keep the patient in a warm, stable room temperature for
at least 1 hour before testing.
-Persons with diabetes, who have a high risk of developing peripheral vascular problems and
associated complications, commonly display diabetes-associated neuropathies and infections
that affect vessels throughout the entire body
-Arterial insufficiency can present in several ways. Resting pain may occur as a result of
intermittent claudication; arterial pulses may be difficult to find or totally absent; and skin
discoloration, ulcerations, and gangrene may be present.

ANEURYSMS
-Some aneurysms can be seen by the naked eye and are able to be palpated as a pulsating
mass; others can only be detected by radiography.
-A thrombosis can develop in the aneurysm, leading to an arterial occlusion or rupture of the
aneurysm—the most serious complication associated with this problem.
-Aneurysms of the abdominal aorta most frequently occur in older people. Patients with a
history of arteriosclerotic lesions, angina pectoris, MI, and CHF more commonly develop
aneurysms in this area.
-A pulsating mass, sometimes painful, in the umbilical region is an indication of an abdominal
aortic aneurysm. Prompt correction is essential to prevent rupture.
-Peripheral aneurysms can usually be palpated, thus establishing the diagnosis. The most
serious complication associated with peripheral aneurysms is the formation of a thrombus,
which can occlude the vessel and cause loss of the limb.

Varicose Veins
-Varicosities, a common problem in old age, can be caused by lack of exercise, jobs entailing a
great deal of standing, and loss of vessel elasticity and strength associated with the aging
process. Varicosities in all ages can be detected by the dilated, tortuous nature of the vein,
especially the veins of the lower extremities.
-The effects of the varicosities make the skin more susceptible to trauma and infection,
promoting the development of ulcerative lesions, especially in the obese or diabetic patient
-Venous ulcers result from chronic deep vein insufficiency or severe varicosities.
The nurse teaches patients with venous ulcers to promote tissue perfusion and prevent
complications as follows:
1. Use gravity to promote circulation and reduce edema by elevating the lower extremity when
sitting and by avoiding prolonged standing, sitting, and crossing the legs.
2. Prevent pressure on the ulcer by using an overbed cradle to keep linens from touching the
extremity.
3. Prevent constriction to circulation by avoiding tight socks or garters.
4. Control pain by using an analgesic; taking an analgesic approximately 30 minutes prior to the
dressing change can reduce some of the discomfort associated with the procedure.
5. Change the dressing as prescribed (if the patient is unable to perform the procedure
independently, instruct a caregiver).
6. Promote circulation by exercising (e.g., walking, swimming, stationary bicycling, dorsiflexion
of the feet).

Venous Thromboembolism
-An increasing incidence of venous thromboembolism is found among older adults.
- The symptoms and signs of venous thromboembolism depend on the vessel involved. The
nurse should be alert for edema, warmth over the affected area, and pain in the sole of the
foot.
-The location of the thromboembolism will dictate the treatment used. Elastic stockings or
bandages, rest, and elevation of the affected limb may promote venous return.

GENERAL NURSING CONSIDERATIONS FOR CARDIOVASCULAR CONDITIONS:

Prevention
1. Primary: to prevent disease from developing in healthy older adults
2. Secondary: to strengthen the abilities of persons who are diagnosed with disease to avoid
complications and worsening of their conditions and achieve maximum health and function
3. Tertiary: to maximize capabilities through rehabilitative and restorative efforts so that the
disease doesn’t create additional problems.

The measures for promoting cardiovascular health described at the beginning of this chapter
are advantageous to incorporate into any health promotion plan for older adults.

2. RESPIRATORY DISORDERS

A. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

-represents a group of diseases including a form of asthma, chronic bronchitis, and
emphysema. The incidence of COPD is higher in women and in smokers.

 ASTHMA
- older persons are affected with asthma throughout their lives; others develop it during
old age. Its symptoms and management in older adulthood do not differ much from
those in other age groups. Because of the added stress that asthma places on the heart,
however, older asthmatics have a high risk of developing complications such as
bronchiectasis and cardiac problems. They also have higher rates of mortality from this
condition. The nurse should help detect causative factors (e.g., emotions, mouth
breathing, and chronic respiratory infections) and educate the patient regarding early
recognition of and prompt attention to an asthma attack when it does occur.
- Careful assessment of the older asthmatic patient’s use of aerosol nebulizers is
advisable. Due to the difficulty some older people have in properly using inhalers, a
spacer or holding chamber may be helpful to allow the inhalant medication to penetrate
deep into the lungs.
 - Precautions to avoid adverse drug effects are important. Overuse of sympathomimetic
bronchodilating nebulizers creates a risk of cardiac arrhythmias leading to sudden death.

 Chronic Bronchitis
- older persons demonstrate a persistent, productive cough; wheezing; recurrent
respiratory infections; and shortness of breath caused by chronic bronchitis. These
symptoms may develop gradually, sometimes taking years for the full impact of the
disease to be realized, when, because of bronchospasm, patients notice increased
difficulty breathing in cold and damp weather.
- Episodes of hypoxia begin to occur because mucus obstructs the bronchial tree and
causes carbon dioxide retention. As the disease progresses, emphysema may develop,
and death may occur from obstruction.
- Management of chronic bronchitis, aimed at removing bronchial secretions and
preventing obstruction of the airway, is similar for all age groups. Older patients may
need special encouragement to maintain good fluid intake and to expectorate
secretions. The nurse can be most effective in preventing the development of chronic
bronchitis by discouraging chronic respiratory irritation, such as from smoking, and by
helping older adults prevent respiratory infections.
 EMPHYSEMA
- occurs with increasing incidence in the older population. Factors causing this
destructive disease include chronic bronchitis, chronic irritation from dusts or certain air
pollutants, and morphologic changes in the lungs, which include distension of the
alveolar sacs, rupture of the alveolar walls, and destruction of the alveolar capillary bed.
-Cigarette smoking also plays a major role in the development of emphysema. The
symptoms are slow in onset and initially may resemble age-related changes in the
respiratory system, causing many patients to experience delayed identification and
treatment of this disease.
- Treatment usually includes postural drainage, bronchodilators, the avoidance of
stressful situations, and breathing exercises, which are an important part of patient
education.
-Cigarette smoking should definitely be stopped.
- If oxygen is used, it must be done with extreme caution and close supervision. It must
be remembered that for these patients, a low oxygen level rather than a high carbon
dioxide level stimulates respiration.
- Respiratory infections should be prevented, and any that do occur, regardless of how
minor they may seem, should be promptly reported to the physician.
- The patient must learn to pace activities, avoid extremely cold weather, administer
medications correctly, and recognize symptoms of infection.

B. PNEUMONIA
- Pneumonia, especially bronchopneumonia, is common in older adults and is one of the
leading causes of death in this age group. Several factors contribute to its high incidence:
a. Poor chest expansion and more shallow breathing due to age-related changes to the
respiratory system.
b. High prevalence of respiratory diseases that promote mucus formation and bronchial
obstruction
c. Lowered resistance to infection Reduced sensitivity of pharyngeal reflexes, which
promotes aspiration of foreign material.
 d. High incidence of conditions that cause reduced mobility and debilitation
e. Greater likelihood for older adults to be hospitalized or institutionalized and to develop
nosocomial pneumonia than for younger persons.

-The signs and symptoms of pneumonia may be altered in older persons, and serious
pneumonia may exist without symptoms being evident.
-Pleuritic pain, for instance, may not be as severe as that described by younger patients.
Differences in body temperature may cause minimal or no fever.
-Symptoms may include a slight cough, fatigue, and rapid respiration. Confusion, restlessness,
and behavioral changes may occur as a result of cerebral hypoxia. Nursing care for the older
patient with pneumonia is similar to that used for the younger patient.

ASSESSMENT GUIDE IN RESPIRATORY FUNCTION:

GENERAL OBSERVATIONS
Much can be determined regarding the status of the respiratory system through careful
observation of the following:
Color: Coloring of the face, neck, limbs, and nail beds can be indicative of respiratory status.
Ruddy, pink complexions often occur with emphysema and are associated with hypoxia, which
is caused by a high carbon dioxide level in the blood that inhibits involuntary neurotransmission
from the pons to the diaphragm for inspiration. In the presence of chronic bronchitis, patients
can have a blue or gray discoloration caused by the lack of oxygen binding to the hemoglobin.
Chest structure and posture: The anteroposterior chest diameter increases with age—
significantly so in the presence of chronic obstructive pulmonary disease (COPD). Note
abnormal spinal curvatures (e.g., kyphosis, scoliosis, and lordosis).
Breathing pattern: Observe the chest for symmetrical expansion during respirations, as well as
the depth, rate, rhythm, and length of respirations. Decreased expansion of the chest can be
caused by pain, fractured ribs, pulmonary emboli, pleural effusion, or pleurisy. Ask the patient
to change positions, walk, and cough to see if these activities result in any changes.
Cough: Note the presence and characteristics of any cough that may be observed.

C. Influenza
-Most deaths from influenza occur in the older population, emphasizing the seriousness of this
infection to older adults. Of the two subtypes of influenza, influenza A is the most frequent
cause of serious illness and death in older adults; influenza B is less severe, although it can
produce serious problems for older adults. Age-related changes, including an impaired immune
response to the virus, cause older persons to be highly susceptible to influenza. Typically,
influenza causes fever (although not as high as in younger adults), myalgia, sore throat, and
nonproductive cough. Once it attacks, influenza destroys ciliated epithelial cells of the
respiratory tract and depresses mucociliary clearance. Secondary bacterial infections and other
complications increase the risk of older adults dying as a result of influenza.
-Patients with chronic respiratory, cardiac, or metabolic disease are at particularly high risk for
developing secondary bacterial pneumonia. Non pulmonary complications can include myositis,
pericarditis, Guillain-Barré syndrome, encephalitis, and a temporary loss of smell or taste.
-The serious consequences of influenza for older adults necessitate preventive measures.
Because influenza is acquired through inhalation of infected droplets, reducing contact with
persons with known or suspected influenza is important. Prevention also can be achieved by
annual influenza vaccination, which is recommended for persons over age 65 years.
-Preventing Complications Once respiratory diseases have developed, close monitoring of the
patient’s status is required to minimize disability and prevent mortality. Close nursing
observation can prevent and detect respiratory complications and should include checking the
following:

 respiratory rate and volume pulse (e.g., a sudden increase can indicate hypoxia)
 blood pressure (e.g., elevations can occur with chronic hypoxia)
 temperature (e.g., not only to detect infection but also to prevent stress on the
cardiovascular and respiratory systems as they attempt to meet the body’s increased
oxygen demands imposed by an elevated temperature)
 neck veins (e.g., for distension)
 patency of airway coughing (e.g., frequency, depth, and productivity) quality of
secretions mental status

3. Endocrine
A. Hypothyroidism
- Thyroxine (T4) and triiodothyronine (T3) are essential hormones produced by the thyroid
gland. Aging affects the thyroid gland in several ways, including moderate atrophy, fibrosis,
increasing colloid nodules, and some lymphocytic infiltration. Although production of T4
declines with age, this is believed to be a compensatory process related to decreased tissue
use of the hormone; serum levels of thyroid hormones do not significantly change.
-A subnormal concentration of thyroid hormone in the tissues is known as hypothyroidism.
This condition increases in prevalence with age and is more common in women than in men.
-Hypothyroidism can be either primary, resulting from a disease process that destroys the
thyroid gland, or secondary, caused by insufficient pituitary secretion of thyroid-stimulating
hormone (TSH). Primary hypothyroidism is characterized by low free T4 or free T4 index with
an elevated TSH level; secondary hypothyroidism displays low free T4 or free T4 index and
low TSH. A subclinical hypothyroidism can exist in which the person is asymptomatic but has
an elevated TSH level and normal T4. If symptoms are present but TSH, T3, and T4 levels are
normal, checking the thyrotropin-releasing hormone (TRH) level may benefit the patient; the
TRH level is more sensitive than the other thyroid levels and could help reveal subnormal
thyroid function.
o Symptoms Symptoms of hypothyroidism can be easily missed or attributed to other
conditions and include the following:
-Fatigue, weakness, and lethargy
-Depression and disinterest in activities
-Anorexia
-Weight gain and puffy face
-Impaired hearing
-Periorbital or peripheral edema
-Constipation
-Cold intolerance
-Myalgia, paresthesia, and ataxia
-Dry skin and coarse hair
o Treatment :
-includes replacement of thyroid hormone using a synthetic T4 (e.g., synthroid and
thyroxine). Initially, a low dose is recommended to avoid exacerbation of asymptomatic
 coronary artery disease that could occur from rapid replacement. Desiccated thyroid
preparations are avoided. Regular monitoring provides feedback for the need for dosage
adjustments.
-Nursing measures should support the treatment plan and assist patients with the
management of symptoms (e.g., prevention of constipation and provision of extra clothing
to compensate for cold intolerance). It is important that patients understand that thyroid
replacement will most likely be a lifelong requirement.

B. Hyperthyroidism
-At the other extreme from hypothyroidism is a condition known as hyperthyroidism. In this
disorder, the thyroid gland secretes excess amounts of thyroid hormones. Hyperthyroidism is
less prevalent than hypothyroidism in older adults; it affects women more than men.
-A potential cause of hyperthyroidism in older patients that should be considered is related to
the use of amiodarone, a cardiac drug containing iodine that deposits in tissue and delivers
iodine to the circulation over very long periods of time.
-Amiodarone induced thyroid dysfunction is prevalent; initial screening and periodic monitoring
should be done with patients on amiodarone to evaluate its impact on thyroid function (Farhan
et al., 2013). -Diagnostic testing can be challenging because blood tests do not always reflect
hyperthyroidism. This is particularly true in malnourished older people, whose T3 levels are
reduced due to their nutritional status; thus, the excess secretion will cause the T3 to fall within
a normal range. Diagnosis relies on evaluation of T4 and free T4, TSH, and increased uptake of
radionuclide thyroid scans.

Symptoms:
- Classic symptoms of hyperthyroidism include diaphoresis, tachycardia, palpitations,
hypertension, tremor, diarrhea, stare, lid lag, insomnia, nervousness, confusion, heat
intolerance, increased hunger, proximal muscle weakness, and hyperreflexia. However, as with
hypothyroidism, hyperthyroidism can present with atypical symptoms in older adults. For
example, increased perspiration may not occur, and for the person with a history of chronic
constipation, diarrhea may be displayed by now having regular bowel movements.

Treatment:
- Treatment of hyperthyroidism depends on the cause. In Graves’ disease, an autoimmune
disorder that leads to the production of an antibody to the TSH receptor that stimulates thyroid
growth and overproduction of thyroid hormone, or when there is a single autonomous nodule,
treatment typically includes antithyroid medications or radioactive iodine. If toxic multinodular
goiter is the underlying cause, surgery may be preferred due to the delayed and incomplete
response to medications. Hypothyroidism can develop as a complication in persons who have
had surgery or radioactive iodine therapy
-Patients with a history of thyroid disease need special monitoring when experiencing an acute
illness, surgery, or trauma because this can precipitate extreme thyrotoxicosis (thyroid storm).
Hospitalization may be required to return their thyroid level to a normal range.

3. Diabetes Mellitus
-A blend of various knowledge and skills is required when caring for older adults who have
diabetes. Type 2 diabetes, the seventh leading cause of death among older adults, affects 20%
of the older population and has a particularly high prevalence among African Americans and
people who are 65 to 74 years of age.
- nurses must be adequately informed of how the detection and management of diabetes in
older adults differ from those in other age groups. Glucose intolerance is a common occurrence
among older adults; several explanations are offered for this.
- it was thought that a physiologic deterioration of glucose tolerance occurred with increasing
age; however, increased amounts of fat tissue present in older persons who are obese and
inactive are now considered significant to the development of this condition.
-This may be a factor in the high incidence of diabetes throughout the general population. Also,
diagnostic techniques have been improved, enabling more persons with the condition to be
detected. Regardless of the reason, it is agreed that different standards must be applied in
evaluating glucose tolerance in older adults.

-The diagnosis of diabetes is usually established if one of the following criteria exists:
1. Symptoms of diabetes and a random blood glucose concentration ≥200 mg/dL.
2. Glycosylated hemoglobin (HbA1c) ≥6.5%.
3. Fasting blood glucose concentration of ≥126 mg/dL (8-hour fast).
4. Blood glucose concentrations 2 hours after an oral glucose intake ≥200 mg/dL during an oral
glucose tolerance test. The test should be performed as described by the World Health
Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose
dissolved in water.

Patient Education:
ASSESS READINESS TO LEARN- Discomfort, anxiety and depression may block learning and the
retention of knowledge. Relieving these symptoms, and allowing time for patients to develop to
the point where they desire and can cope with information may be necessary.
ASSESS LEARNING CAPACITIES AND LIMITATIONS Consider the patient’s educational level,
language problems, literacy, present knowledge, willingness to learn, cultural background, and
previous experience with the illness, memory, vision, hearing, speech, and mental status.
OUTLINE CONTENT OF PRESENTATION Your outline should not only be specific and clear but
also consider learning priorities. Nurses sometimes feel obligated to teach every detail about an
illness, condensing a multitude of new facts and procedures into a short time frame. Most
people need time to receive, absorb, sort, and translate new information into behavioral
changes; older adults are no different. Altered cerebral function or slower responses may
further interfere with learning in the aged. Patients and their families should have a role in
setting teaching priorities; the most vital information should be given first, followed by other
relevant material. Visiting nurses and other resources should be used after hospital discharge to
continue the teaching plan if the proposed outline is not completed during the hospitalization.
ALTER THE TEACHING PLAN IN VIEW OF CAPACITIES AND LIMITATIONS
-The nurse may feel that an explanation of the physiologic effects of diabetes is significant for
new diabetics. However, the older person who tends to be confused or has a poor memory may
not have long-range benefit from this type of information. It may be better to use that time to
reinforce diet information or to make sure the most significant information required for self-care
is retained.
PREPARE THE PATIENT FOR THE TEACHING–LEARNING SESSION
-Patients should understand that education is an integral part of care. Whenever possible,
arrange a specific time in advance to avoid conflict with other activities and to allow the family
to be present if desired.
PROVIDE ENVIRONMENT CONDUCIVE TO LEARNING
-An area that is quiet, clean, relaxing, and free from odors and interference will help create a
good atmosphere for learning. Distraction should be minimal, especially in view of the aged
people’s reduced capacity to manage multiple stimuli.
USE THE MOST EFFECTIVE INDIVIDUALIZED EDUCATIONAL MATERIAL
- It is important to recognize the limitations of standard teaching aids and the importance of
individualized methods. An aid that was successful for one person may not be effective for
another. The variety of sophisticated audiovisual aids that are commercially prepared and
available in many agencies as resources for nurses are impressive, but they may not necessarily
be effective for the given patient. The quality of an audio recording may be excellent, but it is
of little benefit to the older person with a hearing problem. A slide presentation, even slowly
paced, may present facts more rapidly than can be absorbed by an older person with a delayed
response time. The print on a commercial pamphlet may appear minute to older eyes. The
language used in many commercial materials may not be one to which the person is
accustomed. Original handmade aids suited for the individual’s unique needs may have a value
equal to or greater than commercially prepared ones. Selectivity in methodology is essential.
USE SEVERAL APPROACHES TO THE SAME BODY OF KNOWLEDGE
-The greater the number of different exposures to the new material, the higher the probability
that the material will be learned. Combine verbal explanation with charts, diagrams, pamphlets,
demonstrations, discussions with other patients, and audiovisual resources.
LEAVE MATERIAL WITH THE PATIENT FOR LATER REVIEW
-Often, it is helpful to summarize the teaching session in writing, using language familiar to the
patient. This provides concrete material that the patient can review independently later and
share with the family.
REINFORCE KEY POINTS
-Reinforcement should be regular and consistent, with all staff members supporting the
teaching plan. For example, if the objective of the nurse caring for the patient has been to
increase competency in self-injection of insulin, then the person substituting on the nurse’s day
off should comply with the established objectives rather than administering the insulin for the
individual. Informal reinforcement of information during other daily activities should also be
planned.
OBTAIN FEEDBACK
-Evaluate whether the patient and family have received and understood accurately the
information communicated. This can be done by observing return demonstrations, asking
questions, and listening to discussions among patients. REEVALUATE PERIODICALLY
-To ascertain retention and effectiveness of the teaching sessions, informally reevaluate at a
later time. Remember that retention of information may be especially difficult for the older
individual.
DOCUMENT
-Describe specifically what was taught, when, who was involved, what methodology was used,
the patient’s reaction and understanding, and future plans for remaining learning needs. This
assists the staff caring for patients during their hospitalization and serves as a guide for those
providing continued care after discharge.

Drug Therapy:
-A variety of medications may be used to control hyperglycemia. Metformin is an oral
antidiabetic agent that carries a low risk of causing hypoglycemia and often is the preferred
first-line treatment for persons who have type 2 diabetes and are not insulin-dependent.
Metformin should not be used when there is renal insufficiency, hepatic disease, alcoholism,
severe congestive cardiac failure, severe peripheral vascular disease, and severe chronic
obstructive pulmonary disease. Metformin should be administered immediately after meals to
avoid gastrointestinal disturbances; starting with a smaller dose can reduce this side effect.
Sulfonylurea drugs, such as glibenclamide, stimulate insulin secretion by blocking adenosine
triphosphate– sensitive potassium channels on pancreatic β cells.
-This is a particular risk in patients with dementia; research has shown that sulphonylureas
cause severe hypoglycemia in patients with dementia and should be used with caution
(Abbatecola et al., 2015). Due to these risks, glipizide and gliclazide, which have shorter half-
lives and few or no active metabolites, are preferred sulfonylurea agents in older persons with
diabetes. The latest generation sulfonylurea, glimepiride, appears to be more selective than the
earlier agents and carries a lower risk for causing vasoconstriction of small vessels. Besides
exhibiting less hypoglycemia compared with glibenclamide, this drug appears to be more
specific for islet cell potassium channels and is less likely to produce coronary artery
vasoconstriction. Sulfonylurea tablets should be taken a half-hour before meals. It is
recommended that the drug be started at a low dose, about half of the usual adult dosage, and
gradually increased if required.
-Acarbose, an α-glucosidase inhibitor, reduces postprandial hyperglycemia with a lesser effect
on fasting glucose levels and is safe for older adults. Gastrointestinal disturbance, particularly
flatulence, is the major side effect of acarbose, which can be minimized by starting with a
smaller dose and gradually increasing the dosage if required. Repaglinide is a short-acting
insulinotropic antidiabetic agent that has similar effectiveness and safety in older and younger
adults. It acts principally by augmenting endogenous insulin secretion from the pancreas in
response to a meal. This drug can be taken with meals.
-Rosiglitazone and pioglitazone are thiazolidinediones that can be used alone or in combination
with sulfonylureas, metformin, or insulin for the management of type 2 diabetes mellitus. They
act principally by increasing insulin sensitivity in target tissues, as well as decreasing hepatic
gluconeogenesis; they do this without stimulating insulin release from pancreatic β cells,
thereby reducing the risk of hypoglycemia. The reduced risk of hypoglycemia makes them well
suited for use in older adults. The cardiac function must be assessed in all patients before
starting these drugs as they can precipitate cardiac failure in patients with cardiac dysfunction.
Caution is needed in patients with liver disease; liver enzymes should be monitored closely for
all patients using these drugs.
-Some individuals require only oral hypoglycemic agents to control their diabetes. Those on
insulin therapy who have lost weight or have not been ketoacidosis may have their insulin
substituted by oral hypoglycemic agents. Still others will need periodic changes in their insulin
dosages to meet changing demands. These factors, combined with other management
difficulties in the older diabetic person, necessitate frequent reevaluation of the patient’s status.
The continuation of health supervision is an essential part of diabetic management.

Patient Self-care and Monitoring I

-an older person with diabetes must self-inject insulin, one factor that must be considered is the
patient’s ability to handle a syringe and vial of insulin. Several repeat demonstrations of this skill
should be performed during the hospitalization, especially on days when arthritis discomfort is
present. Also, because most older persons have some degree of visual impairment, the nurse
must evaluate their ability to read the calibrations on an insulin syringe. Some of the new
insulin pens that are available can assist older adults in delivering the correct amount of insulin
easily. The older individual can be hyperglycemic without being glycosuric.
-Higher blood glucose levels are common in older adults, and minimal or mild glycosuria is
usually not treated with insulin. Although nurses are not responsible for prescribing insulin
coverage, they need to be aware that the insulin requirements of older patients are
individualized. Responses to various insulin levels should be carefully observed and
communicated to the physician.
-Many diabetic patients must perform blood glucose level testing using a finger-prick method.
Patients must be instructed in this technique and must demonstrate competence in performing
it. The finger-prick technique will most likely be replaced in the near future by an infrared
device that determines the blood glucose level by measuring how light is absorbed by the body.
The patient sticks a finger into a small meter that shines infrared light through the skin. --The
infrared method should make glucose testing more convenient and pain-free for diabetic
persons. The hemoglobin A1c test (also called HbA1c, glycated hemoglobin test, or
glycohemoglobin) measures the amount of glycosylated hemoglobin in the blood and is used to
monitor the effectiveness of disease control. Glycosylated hemoglobin is a molecule in red blood
cells that attaches to glucose. Hemoglobin A1c provides an average of the patient’s blood
glucose control over a 6- to 12-week period; the normal range is between 4% and 6%. For
persons with diabetes, the goal is HbA1c below 7%. This test is usually performed quarterly.
-Triglyceride monitoring is also important. People with diabetes are at risk for metabolic
syndrome, characterized by the combination of high triglycerides, low high-density lipoprotein,
and central obesity. The risk of premature death from cardiovascular disease is increased in
persons with these factors. The American Diabetes Association recommends that people with
diabetes maintain their triglyceride levels below 150 mg/dL.

Exercise and Nutrition

-Regular exercise is important for older diabetic patients and provides multiple health benefits,
including improved glucose tolerance increased muscle strength, decreased body fat, improved
maximal oxygen consumption, and improved lipid profile.
-Physical activity can improve the patient’s response to insulin during the period in which the
exercise regimen is done if the exercise is sufficient to lower the resting heart rate. In the
diabetic individual, however, a vigorous exercise program or changes in an exercise program
must be reviewed with the physician to prevent adverse consequences. For example, moderate
to vigorous exercise increases the absorption of insulin and heightens the use of glucose by the
exercising muscles, potentially leading to hypoglycemia.

4. Gastrointestinal
• Effects of aging in gastrointestinal health:
 The gastrointestinal system and accessory structures experience significant changes
with age. The tongue atrophies, affecting the taste buds and decreasing taste
sensations. Changes in taste sensations can also be related to xerostomia (dry
mouth), the effects of some medications, diseases, and smoking.
-Saliva production decreases and swallowing may be more difficult. There is thinning
of the oral mucosa and a weakening of the muscles involved in mastication, leading
to a reduction in chewing efficiency.
-The gingival recession of the buccal surfaces of the teeth loosens tooth support.
Presbyesophagus, the degenerative changes in the smooth muscle lining of the
lower esophagus, results in weaker esophageal contractions and weakness of the
sphincter. As esophageal and stomach motility decrease, food can remain in the
upper gastrointestinal system for a longer period of time; as a result, there is a risk
of indigestion and aspiration.
-Decreased elasticity of the stomach reduces the amount of food that the stomach
 can accommodate at one time. The stomach has a higher pH as a result of the
declines in hydrochloric acid and pepsin; this contributes to an increased incidence of
gastric irritation in late life. The reduced presence of pepsin can interfere with the
absorption of protein, whereas the decrease in hydrochloric acid can interfere with
the absorption of calcium, iron, folic acid, and vitamin B12 . There are fewer cells on
the absorbing surface of the intestinal walls affecting the absorption of dextrose,
xylose, calcium, iron, and vitamins B, B12 , and D. Slower peristalsis, inactivity,
reduced food and fluid intake, drugs, and a diet low in fiber are responsible for the
high incidence of constipation in older individuals. Decreased sensory perception
may cause the signal for bowel elimination to go unnoticed, which can promote
constipation. There is also a tendency toward incomplete emptying of the bowel with
one bowel movement; 30 to 45 minutes after the initial movement, the remainder of
the bowel movement may need to occur, and if not heeded, problems may develop.
The structure of the gallbladder and bile ducts is unchanged with age; bile salt
synthesis decreases, however, contributing to the risk of gallstone development.
-The pancreas experiences fibrosis, atrophy, and fatty acid deposits, along with a
reduction in pancreatic secretions; this can affect the digestion of fats and contribute
to intolerance for fatty foods. Although liver size decreases with age, the liver
function remains within normal limits. Hepatic blood flow can be reduced as a result
of decreased cardiac output.

Oral Health Practices for Older Adults:

 Brush all tooth surfaces and the tongue at least twice daily with a soft-bristled
toothbrush and fluoridated toothpaste. Use an up-and-down brushing motion. If
arthritis, weakness, or other problems interfere with the ability to adequately brush
teeth, obtain a large-handled, battery-powered, or electric-powered toothbrush.
 Floss between teeth daily. Floss aids are available to compensate for arthritic fingers or
other problems that can interfere with flossing.
 If mouthwash is used, avoid those that contain alcohol. (Mouthwash is not a substitute
for brushing.)
 Swab sticks (e.g., lemon–glycerin) should be avoided as they dry the oral mucosa and
erode tooth enamel.
 Brush the teeth or rinse the mouth after consuming candy or other sweets
 If dentures are worn, remove them at night and soak them in water. Clean the dentures
and the gums of the mouth before replacing the dentures in the mouth.
 If hard candy and gum are desired, use the sugar-free varieties.
 Visit a dentist every 6 months. Less frequent visits are acceptable if a complete set of
dentures is worn, but to detect oral diseases, dental evaluation remains important;
consult with a dentist as to suggested frequency of visit.

A. DYSPHAGIA
- As swallowing depends on complex mechanisms involving several cranial nerves and the
muscles of the mouth, face, pharynx, and esophagus, anything that impacts those
structures can cause dysphagia. Gastroesophageal reflux disease (GERD) is a common
cause, as are stroke and structural disorders.
-Dysphagia can be oropharyngeal, characterized by difficulty transferring food bolus or
liquid from the mouth into the pharynx and esophagus and more common in persons with
neurologic damage, or esophageal, involving difficulty with the transfer of food down the
esophagus and more common in persons with motility disorders, sphincter abnormalities, or
mechanical obstructions caused by strictures.
-Symptoms can be mild, such as occasional difficulties swallowing certain types of food, to a
complete inability to swallow.
-Careful assessment and observation assist in diagnosing the cause of the problem. The
nurse should ask patients with dysphagia:
When the problem began
What other symptoms accompany the dysphagia (chest pain, nausea, or coughing)
What types of foods trigger symptoms (e.g., solids or liquids)
If the problem is intermittent or present with every meal Observing food intake can offer
insights into the nature of the problem. Referral to a speech–language pathologist is
essential to developing an effective plan of care.
-Prevention of aspiration and promotion of adequate nutritional status are major goals in
the care of patients with dysphagia.
-The nurse should follow the recommendations of the speech-language therapist closely.
Often, a soft diet and thickening of liquids are recommended to promote ease of
swallowing; however, there are various levels of dietary modification that can be prescribed
ranging from pureed to mechanically altered to regular.
-Patients with dysphagia should eat in an upright position, ingesting small bites in an
unhurried manner.
-Verbal cues may be needed. An easily accessible suction machine is beneficial in the event
of choking. It is important to monitor food intake and weight.

B. Hiatal Hernia
-The two types of hiatal hernia are sliding (axial) and rolling (paraoesophageal).
-The sliding type is the most common and occurs when a part of the stomach and the
junction of the stomach and esophagus slide through the diaphragm.
-Most patients with GERD have this type of hiatal hernia.
-In the rolling or paraoesophageal type, the fundus and greater curvatures of the stomach
roll up through the diaphragm. Heartburn, dysphagia, belching, vomiting, and regurgitation
are common symptoms associated with hiatal hernia.
-These symptoms are especially problematic when the patient is recumbent.
-Pain (sometimes mistaken for a heart attack) and bleeding also may occur.
-Diagnosis is confirmed by a barium swallow and esophagoscopy

Several small meals throughout the day, rather than three large ones, not only are
beneficial in the management of hiatal hernia but also have advantages for the
gastrointestinal health of all older adults

C. PEPTIC ULCER
-In addition to stress, diet, and genetic predisposition as causes, particular factors are
believed to account for the increased incidence of ulcers in older persons, including
longevity; more precise diagnostic evaluation; and the fact that ulcers can be a complication
of chronic obstructive pulmonary disease, which is increasingly prevalent.
-Drugs commonly prescribed for older adults that can increase gastric secretions and reduce
the resistance of the mucosa include aspirin, reserpine, tolbutamide, phenylbutazone,
colchicine, and adrenal corticosteroids.
- Other risk factors include smoking, heavy alcoholic beverage consumption, caffeine, stress,
and Helicobacter pylori infection. Peptic ulcers tend to present with more acute symptoms in
older adults, such as pain, bleeding, obstruction, and perforation.
-Diagnostic and therapeutic measures resemble those used for younger adults. Addressing
risk factors is important.
-The nurse should be alert to complications associated with peptic ulcer, which are more
likely to occur with older adults, such as constipation or diarrhea caused by antacid therapy
and pyloric obstruction resulting in dehydration, peritonitis, hemorrhage, and shock.

D. COLORECTAL CANCER
-Although the pattern of symptoms frequently varies for each person, some common
symptoms include the following:
 Rectal bleeding, bloody stools
 Change in bowel pattern
 Feeling of incomplete emptying of bowel
 Anorexia
 Nausea
 Abdominal discomfort, pain over affected region
 Weakness, fatigue
 Unexplained weight loss
 Anemia
-Some older patients ignore bowel symptoms, believing them to be from constipation, poor
diet, or hemorrhoids. The patient’s description of bowel problems is less reliable than a
digital rectal examination, which detects half of all carcinomas of the large bowel and
rectum.
-Fecal occult blood testing is effective for early detection of colonic tumors.
-Diagnostic tests include colonoscopy with biopsy and CT colonography (virtual
colonoscopy). Surgical resection with anastomosis or the formation of a colostomy is usually
performed.

An annual stool occult blood and digital rectal examination are recommended because they
can detect many cancers of the large bowel and rectum. In addition, a flexible
sigmoidoscopy every 5 years or a colonoscopy every 10 years is advised as an important
means to detect colorectal cancer. Risk factors may warrant more frequent screening.

-It is important to realize that a colostomy can present many problems for older adults. In
addition to having to adjust to many bodily changes with age, a colostomy presents a major
adjustment and a threat to a good self-concept.
-Older adults may feel that a colostomy further separates them from society’s view of
normal. Socialization may be impaired by the patient’s concern over the reactions of others
or by fear of embarrassing episodes.
-Reduced energy reserves, arthritic fingers, slower movement, and poorer eyesight are
among the problems that may hamper the ability to care for a colostomy, thus causing
dependency on others to assist with this procedure.
-Tactful, skilled nursing intervention can promote psychological as well as physical
adjustment to a colostomy. Continued follow-up is beneficial to assess the patient’s
changing ability to engage in this self-care activity, identify problems, and provide ongoing
support and reassurance.
CONSTIPATION - is a condition in which there is an infrequent passage of dry, hard stools.
Some of the findings consistent with constipation include decreased frequency of bowel
movements (as compared with the patient’s normal pattern); straining to have bowel
movement; hard, dry stools; abdominal distension and discomfort; palpable mass and sense
of pressure or fullness in the rectum; poor appetite; backache, headache; reduced activity
level; and request for or use of laxatives or enemas.
-Causative or contributing factors: Age-related decrease in peristalsis, inactivity, immobility,
hemorrhoidal pain, poor dietary intake of fiber and fluids, dehydration, certain diseases
(e.g., hypothyroidism), surgery, dependency on laxatives or enemas, and side effects of
medications (e.g., antacids, calcium, anticholinergics, barium, iron, and narcotics).
-Goal: The patient establishes a regular pattern of bowel elimination and passes a stool of
normal consistency without straining or experiencing discomfort.
-Interventions:
 Establish and maintain record of frequency and characteristics of bowel movements.
Ensure patient consumes at least 1,300 mL fluids daily (unless contraindicated).
 Review dietary pattern with patient and educate as needed regarding the inclusion of
high-fiber foods in diet; monitor dietary intake.
 Assist patient in developing a program to increase activity level as appropriate.
 Assist patient in developing a regular schedule for toileting; provide toileting assistance
as needed; ensure privacy is provided during toileting; if bedpan must be used, be sure
patient is in upright position, unless contraindicated, and made comfortable.
 Consider use of herbs with laxative effects, such as aloe, dandelion root, cascara
sagrada, senna, and rhubarb.
 Consult with physician regarding use of vitamin C supplements several times daily until
stool is soft (not to exceed 5,000 mg/d).
 Administer laxatives, as prescribed; avoid long-term use of laxatives unless patient’s
condition warrants otherwise.
 Monitor for fecal impaction.
 Assess patient’s use of laxatives and enemas; if dependency on laxatives or enemas for
bowel elimination exists, educate patient about hazards associated with this dependency
and develop a plan to gradually taper usage of laxative or enema (abrupt
discontinuation is contraindicated).
 Educate patient as to nonpharmacologic means to stimulate bowel movement.

Measures to promote bowel elimination include scheduling a regular time for this function,
incorporating high-fiber foods into the diet, and rocking the trunk from side to side and
back and forth while sitting on the toilet.

E. INTESTINAL OBSTRUCTION
-Partial or complete impairment of flow of intestinal contents in the large intestines most
often occurs due to cancer of the colon; adhesions and hernias are the primary cause of
obstructions in the small intestine. Other causes of blockage include diverticulitis, ulcerative
colitis, hypokalemia, vascular problems, and paralytic ileus, a mechanical obstruction that
can occur following surgery due to nerves being affected by the extended lack of peristaltic
activity.
-Symptoms vary depending on the site and cause of the obstruction:
 Small bowel obstruction causes upper and mid-abdominal pain in rhythmic recurring
waves related to the small intestine’s attempt to push the contents through the
obstruction. Vomiting occurs and may bring some relief.
 Obstructions occurring past the ileum cause abdominal distension so severe that the
raised diaphragm can inhibit respirations. Vomiting is more severe than with small bowel
blockages and initially is composed of semi-digested food and later contains bile and is
more watery.
 Obstruction of the colon causes lower abdominal pain, altered bowel habits, distension,
and a sensation of the need to defecate. Vomiting usually does not occur until late,
when the distension reaches the small intestine.
-Timely intervention is essential to prevent bowel strangulation and serious complications.
X-rays and blood evaluation typically are done to determine the cause and extent of the
problem.
-Intestinal intubation is the major treatment and often helps to decompress the bowel and
allow the obstruction to be broken. If medical management is unsuccessful or if the cause is
due to vascular or mechanical obstructions, surgery is required. In addition to supporting
the medical or surgical treatment plan, nurses need to promote the patient’s comfort and
ensure that fluid and electrolyte balance is restored and maintained.

SUMMARY:
Although most of the gastrointestinal problems experienced by older adults are not life
threatening, they can significantly affect the quality of life and health status of this
population, thereby making their effective management important. Some gastrointestinal
conditions can be prevented by good health practices, including regular oral hygiene, sound
dietary practices, regular bowel elimination, and prompt attention to symptoms.
-Gastrointestinal symptoms, although common, can indicate serious medical problems in
older adults and need to be taken seriously. Conditions such as xerostomia, dysphagia,
hiatal hernia, esophageal cancer, peptic ulcer, cholelithiasis, and cancer of the stomach,
colon, and pancreas occur with greater frequency in older adults.
-Diagnosis of these problems can be difficult because of atypical symptomatology, self-
medication that masks symptoms, and easy confusion with disorders of other systems.
Astute questioning and alertness to subtle symptoms during the assessment can help these
conditions to be diagnosed and treated early.