Medical Surgical Nursing

• AT THE END OF THE SEMINAR, THE STUDENTS

WILL BE ABLE TO GAIN KNOWLEDGE ON
AGING AND WILL ABLE APPLY IN CLINICAL
PRACTICE
At the end of the seminar, the group will be able to,
• Define aging
• Verbalise the concept of aging
• Enumerate the myths of aging
• Discuss facts of aging
• Enumerate the theories of aging
• Enlist the body system changes in aging
• Identify the health problems in aging and its management
• Enlist and discuss the nursing management of aging
problems
• Discuss current issues related to aging
• Aging, the normal process of time – related
changes, begins with birth and continues
throughout life
• As the older population increases, the number of
people who live to be very old also increases.
• Health professionals have a greater challenge to
take care of this age group as many chronic
conditions commonly found among old people
have to be managed.
• According to state World Population 2019 report
by the United Nations Population Fund (UNFPA)
released, India’s population in 2019 stood at 1.6
billion, growing from 942.2 million in1994 and 6
% of India’s Population was of the age 65 and
above.
• India also recorded an improved life expectancy
at birth, which was 47 years in 1969, growing to
60 years in 1994 and 69 in 2019.
• Aging can be defined as the time- related
deterioration of the physiological functions
necessary for survival and fertility.
• https://www.youtube.com/watch?v=GASaqPv
0t0g

GROWTH AND DEVELOPMENT: INFANCY

MATURITY: TEENAGE

SENESCENCE: AFTER THE AGE OF 30 YEARS

MYTH:
With aging there is deterioration in mental and
physical abilities:

FACT:
- Increased physical activity and improving diet
can effectively tackle many of the problems
frequently associated with old age, such as
change in lean body (muscle) mass, strength,
basal metabolic rate, body fat, aerobic capacity,
blood pressure, blood sugar tolerance, bone
density, body temperature regulation.
MYTH:
Most older people have similar needs:
FACT:
- Older people have diverse needs, especially
given differences according to sex, ethnicity
and culture.
- We must recognize these differences and deal
with them
MYTH:
Creativities and making a contribution to society is
not old man’s cup of tea:
FACT:
• Elderly carry their knowledge with them.
Business and Political leaders are often above the
age of 60 years. There are many examples which
shows age is just the number
• Many politician and businessmen are above the
age of 60 years
MYTH:
Old people wants to be left in peace and quiet
FACT:
- Some older people look forward to having more time
for reading and just relaxing, particularly when they
have a surviving spouse to share thus tranquility.
- Nevertheless, given the opportunity, most older people
do not withdraw or disengage from social interaction.
- Research into leisure activities throughout life shows
that the frequency of the activities taking place in the
home appears equal for all adult age groups.
MYTH:
Hospital beds and nurses are the main issue
FACT:
- When older people do need care, families are still
the main providers, including older people
themselves who care for spouses or other relatives.
- Studies across world show the extent and variety
of care from such caregivers but also their need for
support for them to continue is this essential task
without harming their own life and health
MYTH:
Providing for old people takes away resource from
young people
FACT:
- This is a misconception. Many of the changes needed to
improve the quality of life of older people benefit all age
groups.
- Take as an example safety measures-safe crossing on
busy roads save lives at any age. Better lighting in the
streets and at home reduces the risk of falling for
everyone.
- Investing in quite simple home adjustments such as
easily accessible bathing facilities and support handles
can also rescue accidents that are painful, expensive to
treat and can result in high mortality among older people.
- Safer cooking facilities would protect young children as
well as their grandparents.
MYTH:
Spending on old people is waste of resources

• Spending on appropriate services for older people can save

money. For e.g, people can be kept mobile and active in
their social networks, reducing their need for additional
care, if comparatively small amounts of money are spent on
- Providing spectacles, handing aids and aids to walking,
including chiropody,
- Ensuring the correct use of pharmaceuticals
- Providing advice on diet and exercise
• Erickson(1963) theorized
• Havighurst
SOCIOLOGICAL THEORIES OF AGING:
• The activity theory proposes that life satisfaction
in normal aging requires maintaining the active
lifestyle of middle age. (Havighurst, 1972)
• The continuity theory proposes that successful
that successful adjustment to old age requires
continuing life pattern across a lifetime. (Atchley
1989)
 CARDIOVASCULAR SYSTEM

• Leading cause of death

• Heart valves become thick and stiff
• Heart muscle and arteries lose their
elasticity
• Calcium and fat deposit accumulate
within arteries
• The cardiac output decreases
• HTN is major problem for stroke
• Heart failure
 RESPIRATORY SYSTEM

• Affects lung capacity and function

• Increase anteroposterior chest
diameter, osteoporotic collapse of
vertebra resulting in kyphosis
• Diminished efficiency of respiratory
muscles, increase lung rigidity and
decrease alveolar surface area
• Gas exchange and diffusing capacity
also decrease
 INTEGUMENTARY SYSTEM
• Epidermis and dermis becomes thin
• Elastic fibers are reduced in number
and collagen becomes stiffer
• Subcutaneous fats diminishes
particularly in extremities
• Decrease capillaries & blood supply
 REPRODUCTIVE SYSTEM
• Ovarian production of estrogen and
progesterone ceases with menopause
• Thinning of vaginal wall, vaginal
dryness, involution of uterus
• Penis and tests decrease in size level of
androgen decrease
• Erectile dysfunction
 URINARY SYSTEM
• Decreased filtration rate, diminished
tubular function
• Stress related or urge incontinence or
both.
• Benign prostatic hyperplasia
 DIGESTIVE SYSTEM
• Periodontal disease- teeth decay
• Salivary flow diminishes(dry mouth)
• Dysphagia, causing risk for aspiration
• Diminished secretion of acid and
pepcine reduces the absorption of
iron, calcium, vit b12
• Decreased GI motility
 MUSCULOSKELETAL SYSTEM
• Loss of bone density
• Muscles diminished in size and loss od
strength, flexibility, and endurance
with decreased activity
• Fracture as a result of bone
reabsorption or ostioporosis
 NERVOUS SYSTEM
• Structural and function changes
• Reduced cerebral blood flow
• Autonomic nervous system performs
less effectively
• Dementia and Alzimers are commonly
seen
 CAUSES
• Periodontal issue, reduced
taste buds
• Decreased physical activity and
slow metabolic rate reduces
calorie intake
• Digestive juices changes
• Budgetary constrain
compromises nutrition

MANAGEMENT:
• Small and frequent diet
• Should contain 20-25% fat, more protein and carbohydrate
• Reduce salt intake
• 8-10 glasses of water every day
• Appetizers and multi vitamin supplements can be considered
 CAUSES
• 50% of people above age of
65years have insomnia
• Often experience sleep-wake
cycle

MANAGEMENT:
• Avoid day time sleeping
• Avoid eating before sleeping
• Cary out daily activities within range
• A warm water shower and warm glass of milk can induce sleep
 • Most commonly seen in old
age
• Depression disrupts quality
of life, increases the risk of
suicide, and becomes self-
perpetuating
• Alcohol abuse related to
depression is significant in
the elderly.

MANAGEMENT:
• Antidepressants like SSRI and Tricyclic antidepressants
• Encourage to socialize
• Listening is the best therapy
 • Delirium often called acute
confessional state, begins with
confusion and progresses to
disorientation
• altered level of consciousness
ranging from stupor to
excessive activity.

MANAGEMENT:
• Delirium is a medical emergency.
 • Symptoms are usually subtle in
onset and often progress slowly
until they are obvious and
devastating
• three categories: cognitive,
functional and behavioral
• Reversible causes of dementia
include alcohol abuse,
medication use, psychiatric
disorders and normal pressure
hydrocephalus.

• The three most common nonreversible dementias are Alzheimer’s

disease, multi-infarct dementia, mixed Alzheimer’s and multi
infarct dementia.
• Dysfunction of pelvic floor can be greatly improved with Kegel
exercises
• Detrusor hyperactivity with impaired contractility is a type of urge
incontinence that is predominantly seen in elderly population.
Risk for fall
Common reasons include age, impaired physical mobility, loss of muscles strength, use
of medication, dizziness, disorientation etc
NURSING INTERVENTION RATIONAL

NURSING ASSESSMENT
Identify factors that increase the level of fall risk Helps to determine intervention necessary for
the patient. Risk factors include age, presence of
an illness, sensory and motor deficits, any
medication, and inappropriate use of mobility
aids the level of fall risk.
Assess the patients environmental problems If the patient is not familiar to the environment
he is at risk to fall
THERAPEUTIC INTERVENTION
Secure wrist band to assure vulnerable status of Helps to identify the patient at high risk for fall
the patient
Place assistive devices and common used items To provide easy access and prevent fall
within reach
Keep the patients bed at lower level and keep Bed at lower level will reduce injury in case of fall
the side rails in use
Orient and re-orient the patient to the To familiarize the patient to the environment
environment
Disturbed sleep pattern
Common causes include new hospital environment, medication use
NURSING INTERVENTION RATIONAL
NURSING ASSESSMENT
Assess and record the patient’s sleeping pattern, Elderly people usually sleep less and are awake at
gathering information from the patient’s relatives night
or caregiver
Monitor patients activity level To assess if the patient has day time nap
THERAPEUTIC INTERVENTION
Try to arrange activities together such as doing This reduces the frequency of interruption and
vital signs, taking medication and toileting. promote rest and sleep
Refrain the patient from drinking caffeinated The effect of stimulants includes increase
coffee, cola, and tea after 6pm alertness, insomnia and frequent nighttime
awakenings to urinate.
Provide a calm and quite environment and lessen Exposure to bright lights, unnecessary noises,
interruption during sleeping hours snoring roommates, and loud talking can result in
sleep deprivation. Use of white noise sound
generators may facilitate sleep.
Administer pain medications as ordered, give a To promote comfort and enhance sleep
back rub and pleasant communication during
sleep
Provide a calm and quiet environment and lessen Exposure to bright lights, unnecessary noises,
interruptions during sleep hours. snoring roommates, and loud talking can result in
sleep deprivation. Use of white noise sound
generators may facilitate sleep.
Constipation
Common causes include, change in dietary pattern
because of periodontal issue, decreased activities, use of
drugs like anti depression etc
NURSING INTERVENTION RATIONAL
NURSING ASSESSMENT
During admission, assess and record the To have a baseline data
patient’s normal bowel elimination pattern
(frequency, time of the day, associated
habits, and previous measures to manage
constipation).

THERAPEUTIC INTERVENTION
Encourage use of more roughage in diet To increase the bulk
Increase the fluid intake Increasing in fluid intake can soften the
stools
Encourage the patient to perform activities Activities can encourage gastric motility
with their limit
Self care deficit:
Common causes include aging, malnutrition, musculoskeletal changes
NURSING INTERVENTION RATIONAL
NURSING ASSESSMENT
Assess the level of activities the patient To have a baseline data and to plan
can perform activities of the patient
THERAPEUTIC INTERVENTION
Receive the patient near to the nurse’s To have an easy access to the patient
station
Give them an answering call bell To ask to assistance
Assist in the activities of daily living
 DISTURBED THOUGHT PROCESS
Common causes include aging, hypoxia, infection,
malnutrition, late life depression and degenerative process.
NURSING INTERVENTION RATIONAL
NURSING ASSESSMENT
Assess attention span and ability to make Determines the patient’s ability to make
decisions decisions and participate in planning process

Check the ability to send, check and interpret Help assess the degree of impairment
information
THERAPEUTIC INTERVENTION
Orient and re-orient the patient to the To familiarize the patient with the environment
environment
Keep all required article in reach To ease the activities of the patient
Protect the patient from sensory overload and Sensory overload may increase confusion
allow for frequent rest episodes

Encourage memories of the past events Promotes sensory continuity and aids in
memories
Encourage patients to voice feelings and Help ventilate feeling and reduce anxiety
concern about the lost memories

Speak slowly and clearly. Allow ample of time Reduce confusion and aids in task completion
for the patient to respond
 Urinary
Imbalance Incontinence Adult Failure
nutrition to thrive

Risk for Impaired

Injury Gas
Exchange

Risk for fluid

volume Hypothermi
deficit a
Risk for
Aspiration
• INDIRA GANDHI NATIONAL OLD AGE
PENSION SCHEME
Objective: To disburse pension to the destitute
old age person
Assistance provided: Rs.400/ per person
Beneficiary:
- Beyond 65 years of age, belonging to BPL and
60 years above who are affected with leprosy,
blindness, insanity, paralysis or loss of limb
• HEPLAGE INDIA • NATIONAL POLICY ON
It is a secular, nonprofit OLD AGE PERSON
able, largest voluntary Formed in 1999, January
organization which was under ministry of social
set in 1978 justice and
empowerment
The goal of the national
policy is the well being of
old people
• Annapurna Scheme
• Ministry of Railways: Concession to senior
citizen are hiked from 30- 40 % for men above
60 years and for women above 58 years for
booking and cancellation of railway tickets
• Ministry of Civil Aviation: 50% concession for
senior citizen in economic class
Merging current health care trends:
innovative perspective in aging care
• To summarize, aging is a lifelong process of growing up and
growing old. There are many myths and related facts about
aging process. Every system in the body including
cardiovascular, respiratory, integumentary, musculoskeletal,
nervous and sensory undergoes age related changes.
• There are different aging related issues like falls, delirium,
dementia, impaired mobility, constipation, incontinence etc
which is a major challenge every individual, family,
healthcare worker has to undergo with aging.
• These problems can be identified at an early stage with
proper knowledge and can make aging gracefull.
• Aging is an inevitable change that starts from
the birth and ends with death. Every
individual has to go through aging. As
healthcare professionals we have to be
knowledgeable and skillful to take care of this
age group
• BIBLIOGRAPHY:
• Suzanne C Smelter , Brenda Bare. Brunner & Suddarth's Textbook of
Medical-Surgical Nursing. (10th edition ed.). Philadelphia: Brunner
& Suddarth; 2004.
• Mary A Miller, Debohra C. Wirwicz, ‘You Can Teach Med- Surg
Nursing’, Springer Publishing Company, NewYork, 2015
• Linta S Williams,Paula D Hopper, Understanding Medical Surgical
Nursing(3rd Edition), F.A Davis Company, Philadephia,2007

• REFERENCE:
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203171/
• https://www.todaysgeriatricmedicine.com/archive/083109p34.sht
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