Age-related physiological changes: Nursing process (ADPIE)

Video summary

With aging, several physiological changes take place in our bodies. These include the reduction of cardiac output, an increase in the blood pressure as arteriosclerosis develops, a decrease in the vital capacity of our lungs, slowing down of alveolar gas exchange, a decline in our creatinine clearance, and so on. When providing nursing care to older people, the ADPIE framework can be used to help nurses systematically assess and address these changes:

A: Assessment: taking a complete health history and performing a physical exam to identify any changes since the last visit; D: Diagnosis: identifying any specific problems or concerns that need to be addressed; P: Planning: creating a care plan tailored to the individual's needs; I: Implementation: providing care based on the plan; and E: Evaluation: assessing how well the plan is working and making any necessary adjustments.

Chapters:

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Client Report0:00–0:24

Matilda K Noel is a 78 year old female client with a history of depression and osteoarthritis, who presents to the primary care clinic today with a report of frequent and prolonged episodes of constipation, along with bloating and abdominal pain.
Mrs. Noel lives alone and has no family close by, and she struggles to afford nutritious food due to her limited income.
Age-related physiological changes include all changes that normally occur in the body over time with aging. First, let's start with the integumentary system, which undergoes changes in collagen and elastin that eventually cause the skin to lose elasticity, become thinner, and develop wrinkles over time, while the hair becomes gray, thinner and may fall out, which may lead to baldness.

Pathology0:24–3:27

On the flip side, the muscular system atrophies over time, which often leads to a decrease in physical strength. While the skeletal system progressively loses bone mass and density, which typically leads to a gradual decrease in height and can result in osteopenia or osteoporosis.
Therefore, bones might break more easily, while joints may degenerate and develop arthritis. Cardiovascular age-related changes generally involve progressive degeneration of the heart, while the valves and large arteries become stiffer, ultimately causing hypertension or decreased cardiac output upon exertion.
On the other hand, changes of the respiratory system mainly involve the alveoli, which may lose their architecture and elasticity, which leads to a decreased lung capacity.
In addition, there's decreased mucociliary action and diminished cough reflex, so airway clearance is ultimately impaired.
The urinary system is affected by functional changes that decrease the filtration capacity of the kidneys. In addition, the bladder capacity is decreased, as there's instability of the detrusor muscle and decreased sensation of bladder fullness, which combined result in urinary frequency or even incontinence, while the reproductive system is associated with gradually decreased production of sex hormones, and females become infertile after menopause.
Also over time, the sensory system can deteriorate. Therefore, older clients often present with decreased vision and hearing abilities, and some clients may also have impaired sense of smell and taste.
Finally, gastrointestinal age-related changes include dysphagia due to decreased esophageal motility, which can increase the risk of choking or aspiration, as well as delayed gastric emptying, slow gut transit time, and decreased absorption of nutrients.
In addition, many clients have altered dentition, such as missing or loose teeth, which makes it difficult to chew certain foods.
Gastrointestinal age-related changes are among the most worrisome, as they can result in decreased food intake, ultimately leading to unintentional weight loss, malnutrition, constipation, and fecal impaction, as well as severe dehydration and electrolyte imbalance.
Now, these changes are most commonly caused by advanced age, poor nutrition and hydration, as well as side effects of certain medications like some antidepressants or opioids.
Some risk factors include previous gastrointestinal conditions and sedentary lifestyle, which can further worsen gastrointestinal age-related changes.

Diagnosis and treatment3:27–4:43

Now, diagnosis of gastrointestinal age-related changes is primarily based on history and clinical features, as well as assessing their changes in height, weight, and BMI for a nutritional deficit.
These clients typically present with signs of dehydration, like dry skin and mucous membranes, and poor skin turgor. In addition, they might complain of abdominal pain or bloating, and passing hard stools.
Lab tests can be done to assess the complete blood count, which may often reveal anemia associated with abnormal transferrin levels.
In addition, clients may present with decreased levels of nutrients such as vitamins like folate and B12, and electrolytes like potassium, sodium, and chloride, as well as a decline in albumin levels.
Additionally, imaging studies like X-rays can be performed to evaluate abdominal pain and bloating, and to detect fecal impaction.
Treatment of gastrointestinal age-related changes requires promoting adequate nutrition, hydration, and correction of electrolyte imbalance, as well as nutrient supplementation when necessary.
Finally, clients who are taking medications associated with gastrointestinal side effects should be switched to an alternative medication.

Assessment4:43–6:45

You begin your assessment by asking Mrs. Knowel how she's feeling today.
She informs you that she feels bloated and that her last bowel movement was a hard and lumpy stool 4 days ago. She denies blood in her stool and says she is still passing gas.
She goes on to tell you that she doesn't have an appetite and she's not interested in preparing meals for herself. She says food is so expensive these days.
When asked how much water she drinks each day, she says she's unsure. Her height is 5 ft 7 inches, weight is 115 lbs, or 52.2 kg.
Vital signs are a tympanic temperature 98.2 °F or 36.8 °C. Heart rate is 76 and regular.
Respiratory rate 16 breaths per minute with clear breath sounds bilaterally. BP 124/78 millimeters of mercury.
SPO2, 98% on room air, and pain, 0 of 10. You note bowel sounds are hypoactive in all four quadrants.
You continue your assessment by noticing that skin turgor is decreased and her mucous membranes are dry. You check her medical record and note that previous documentation from her last visit six months ago, shows a weight of 126 lbs, or 59 kg.
Recent laboratory results include potassium 5.3 milliequivalents per liter, sodium 133 milliequivalents per liter, chloride, 90 milliequivalents per liter, pre-albumin, 14.8 g per deciliter, albumin, 3.3 g per deciliter, transferrin, 200 mg per deciliter.
Home medications are amitriptyline daily and ibuprofen as needed. After documenting your assessment findings, you inform Mrs.
Knowel that the Advanced Practice registered nurse, or APRN will be in shortly to examine her and discuss the plan of care.
OK, now that you've completed your assessment, you establish your nursing diagnoses for Mrs. Knel.

Nursing diagnoses6:45–7:09

Imbalanced nutrition, less than body requirements related to anorexia and insufficient financial resources, constipation related to decreased dietary fiber intake and effects of amitriptyline, and risk for deficient fluid volume related to decreased fluid intake.

Planning7:09–7:36

All right, it's time to collaborate with Mrs. Knowel and the APRN to develop a plan of care.
By your follow-up appointment in one month, Mrs. Knowel will report an improvement in her dietary intake, and will use resources to assist her with obtaining sources of nutrition.
She will establish and maintain passage of a soft formed stool every 1 to 3 days without straining, and she will have an adequate fluid balance.

Implementation7:36–8:48

Now you're ready to implement the plan of care. The APRN has diagnosed Mrs.
Know with constipation and prescribed the bulk-forming laxative psyllium. He explained the importance of taking the medication as prescribed with 8 ounces of water.
He advised her to call the clinic should she experience abdominal pain or cramps. Additionally, she's counseled to continue with her regular medications of amitriptyline and ibuprofen.
To assist with her nutritional needs, you make an appointment for her with the clinic's registered dietitian, so that together they can design a budget-conscious diet plan, focused on increasing intake of fiber, protein, fruits and vegetables that also includes her personal preferences.
Then you make an appointment with the case manager who will help her locate nutritional resources in the community. You encourage Mrs.
Knowel to increase her fluid intake to about 88 ounce cups of liquid each day, and to avoid caffeinated beverages like coffee, tea, and soda.
You remind Mrs. Knowle that increasing her activity as she is able can also help her bowel movements to regulate.
Finally, you make an appointment for her to return in 1 month. OK, it's been 1 month, so let's check back in with Mrs.

Evaluation8:48–9:31

Knel and evaluate how she's doing. Mrs.
Knel is in good spirits and informs you that the case manager enrolled her in a nutritional assistance program to help her purchase food at the store.
She also visits a farmer's market and has lunch at the local senior center 3 days per week. She tells you that she's been conscientious about her fluid intake, and that she's been having a bowel movement about every 2 days without straining.
Her weight today is 118 lbs or 53.5 kg. You know regular bowel sounds are in all four quadrants.
Skinterger has improved and her mucous membranes appear moist. All right, as a quick recap, your client Matilda Knowel is a 78 year old female client with a history of depression and osteoarthritis, who presented to the primary care office with constipation.

Summary9:31–10:19

Your assessments identified altered bowel habits, weight loss, and signs of dehydration. Your nursing diagnoses included imbalanced nutrition, less than body requirements, constipation, and risk for deficient fluid volume.
The goals you plan focused on restoring normal bowel function through improved dietary intake, increased fluids, and helping her to gain access to a larger variety of nutritional sources.
Along with the healthcare team, you work to implement interventions to achieve the goals of the plan of care. As you care for Mrs.
Noel, you will continue to evaluate and revise your plan of care as needed.