nursing.elitecme.com Page 85 Complete Your CE Test Online - Click Here ● ● Facilitate the administration of low-molecular weight anticoagulant therapy (i.e. Lovenox) in conjunction with segmental compression devices. ● ● Apply compression stockings. ● ● Encourage early postoperative mobilization. ● ● Teach patients to change position and move lower extremities frequently. Smoking cessation Since smoking cessation is so critical to preventing and reducing the effects of lung and cardiac disease, it is worthwhile to spend some time discussing ways to facilitate the process. Some older adults (and some healthcare professionals as well) may believe that if they have smoked most of their lives, it will do no good to stop. This is not true as the effects of smoking can begin to reverse. If older adults stop smoking, their risk of heart attack, stroke, and caner goes down. Circulation improves and so does lung function. Eliminating tobacco products can also help to keep diseases such as COPD and bronchitis from becoming more serious [9]. Some older adults may think that they are more likely to return to smoking after they have quit. In fact, research shows that older smokers are much more likely than younger smokers to stay away from tobacco products. Older smokers also seem to know more about the health benefits of quitting smoking [9]! How can you help older patients stop smoking? Here are some suggestions: ● ● Involve the patient’s family, friends, and/or caregivers. It is not easy to quit smoking and the support of significant others in the patients’ lives can be a big help. ● ● Find out if the patient lives with, or has frequent contact with, people who smoke. It is very difficult to stay away from tobacco products if constantly in the company of others who are smoking. If possible, the patient should avoid the company of others who smoke. ● ● Consult with the patient’s physician or nurse practitioner regarding prescription and non-prescription aids for smoking cessation. ● ● Keep an objective, non-judgmental attitude. Stopping smoking is difficult and a feeling that nurses or other healthcare professionals disapprove of them or their behaviors only makes the process more difficult. Patients need encouragement and support to stop smoking. ● ● Find out about reputable smoking cessation programs in the community and on the Internet. Support groups can be very helpful. Many older adults often explore the Internet and seek out health information online. There are many excellent health resources online; however, there are also many fraudulent, inaccurate sources of information. Familiarize yourself with websites that are good sources of information and support for those trying to quit smoking. Older adults who have limited access to transportation or who have limited mobility may rely on the Internet for information and communication with others. Be able to guide them towards reliable online sources of smoking cessation programs. Nursing consideration: It is especially important to explain that quitting smoking can have health benefits regardless of age. Use the opportunity for counseling older adults to include their family members and friends in the education process when possible. The endocrine system The endocrine system is responsible for managing the body’s metabolic functioning. The endocrine glands manufacture and release hormones that trigger cellular responses and actions [9,14,54}. There are high incidences of endocrine disorders such as diabetes and thyroid disease in the older adult population. Normal age-related changes in the endocrine system include [9,13]: ● ● Decreased pancreatic secretion of insulin. ● ● Decreased sensitivity to insulin, causing a decrease in the body’s ability to respond to high blood glucose levels. ● ● The peripheral tissues of the body may also become resistant to insulin. This resistance is especially evident in persons who are obese. ● ● Increased fibrosis and thymic nodules, usually benign. ● ● Changes in thyroid function, usually a decrease in T4 production. These changes can lead to an increase in rates of hypo- and hyperthyroidism. The normal age-related changes in the endocrine system predominantly affect the body’s use of insulin and the ability of the thyroid to function. Therefore, let’s look at the effects of diabetes mellitus and thyroid malfunction. Diabetes mellitus Mr. Evens is 68 years old and was diagnosed with Type-II DM at the age of 60. He fairly well-controls diet, exercise, and oral hypoglycemic agents. Recently, however, his blood sugar has been rising. The nurse practitioner is conducting a patient education session with Mr. Evens and his wife. Mr. Evens is polite but says he believes that he is doing all he can and doesn’t really know what more he can learn. When questioned further, it appears that Mr. Evens never received any thorough education about the disease or what steps to take to decrease the risk of complications and to increase his state of health and wellness. The following information is important for Mr. Evens to receive. Diabetes mellitus (DM) is quite prevalent and its incidence is increasing in people who are over the age of 65. This increase is especially evident in persons who belong to racial and/or ethnic minorities [9, 13]. DM is the seventh leading cause of death in the U.S. and is a major cause of heart disease and stroke [9]. Type-1 DM is usually an autoimmune disease and most often affects children and young adults. However, Type-I DM can affect other age groups as well. Type-II DM most often begins as “insulin resistance” due to changes in the endocrine system and is likely to affect adults who may be sedentary, have a family history of DM, and those who are obese. The incidence of Type-II DM is increasing among older adults [9,13]. Risk factors for DM II include the following factors [9,13]: ● ● Over 45 years of age: risk increases with age. ● ● Obesity. ● ● Inactive lifestyle. ● ● Hypertension. ● ● Family history of DM. ● ● Black, Hispanic, Pacific Islander, Asian American, and Native American ancestry. ● ● Impaired glucose tolerance. EBP alert! About two to three people with DM die from stroke or heart disease. The risk for these diseases is two to four times higher in people with DM [9]. This makes it imperative that patients with DM be educated about cardiovascular health. Signs and symptoms of Type-II DM include fatigue, polyuria, dehydration, thirst, poor skin turgor, dry mucous membranes, and unexplained weight loss [13]. Older patients with DM may exhibit the following [9,13]: ● ● Excessive thirst: Older adults may not report excessive thirst because the thirst mechanism functions less effectively in older adults. ● ● Excessive hunger. ● ● Dehydration. ● ● Blurred vision. ● ● Vaginal infections. ● ● Frequent infections such as urinary tract infections (UTI’s). Pay close to attention to those individuals who are bedridden with indwelling catheters or lines. ● ● Tachycardia, or tachypnea. ● ● Skin infections. ● ● Difficulty healing. Nursing consideration: To help prevent urinary tract infections, encourage older patients to drink cranberry juice (unless medically contraindicated), which is believed to stop bacteria from sticking to the lining of the bladder [9]. The treatment regimen for DM in older adults is similar to that of younger adults. There are a few issues that deserve special emphasis in the older population, however. These include the following items [9,13]: