Page 90 nursing.elitecme.com Complete Your CE Test Online - Click Here ● ● Monitoring of blood pressure and taking of anti-hypertensives as prescribed. ● ● Initiating daily aspirin therapy as prescribed by healthcare provider. ● ● Initiating high dose statin therapy. ● ● Lowering cholesterol levels with a low cholesterol diet including: ○ ○ Reduce the intake of saturated fats. ○ ○ Eat at least two servings of fish per week. ○ ○ Eat five or more servings of fruit and vegetables every day. ○ ○ Eat whole grains instead of white flour products. Nursing consideration: Although the onset of stroke may be abrupt, the risk factors leading to the stroke have often developed over a period of many years. Nurses must educate patients and families on stroke prevention measures such as achieving and maintaining a normal blood pressure, exercising, not smoking, maintaining a normal weight, and eating a heart healthy diet [9]. Seizure disorders Seizures occur when there is an acute, abnormal release of electrical activity in the brain. Seizures may be partial, focal, or generalized. Focal seizures include a brief change in level of consciousness characterized by a blank stare, rolling of the eyes, and/or a brief change in level of consciousness. Generalized seizures can include muscular jerks of the extremities or the entire body, incontinence, difficulty breathing, apnea, and loss of consciousness [9,13]. Nurses should assess when and how often seizures occur and what occurs during seizures. Some adults may have had seizures for many years due to problems such as epilepsy. They may also develop epilepsy in later in life. Adults over 75 are twice as likely to develop new-onset epilepsy compared to all adult age groups under 65 years of age [9,13]. Nurses should find out what, if anything, triggers seizures and what treatment measures are in place to control the occurrence of seizures. Patient education should stress the importance of adherence to treatment regimens and how to avoid injury in the event of seizures. Family members and caregivers must be involved in patient education as well. Patients and families should be helped to identify and avoid factors that precipitate seizures. They should also be taught to keep a seizure calendar that includes the date, time, duration, and descriptions of seizures. The importance of adhering to medication regimens must be emphasized [9,13]. Nursing consideration: During a seizure, the most important action to take is to prevent patient injury. Teach families and friends of the patients to place them on their sides during a seizure to prevent aspiration and to surround the patients with soft objects to avoid injury. Nothing should be put in the mouth once the seizure has begun. Families and friends should be instructed to call 911 if the patients have difficulty breathing or cease breathing after the seizure, if the seizure lasts for more than ten minutes, or if seizures occur in groups of rapid succession [9]. The gastrointestinal system The gastrointestinal system undergoes quite a few changes with aging. These changes can have significant impact on a person’s nutritional status and general health and well-being. The gastrointestinal (GI) system is responsible for digestion, absorption, secretion, and motility. The older adult needs a thorough GI assessment and evaluation to ensure adequate nutrition and a maximum state of health and wellness [9]. Normal age-related changes in the GI system include [9]: ● ● Decrease in salivary secretion and the number of taste buds, along with a decrease in saliva production leading to dysphagia. ● ● Decreased esophageal mobility which increases GERD. ● ● Decreased size and blood flow of the liver which leads to impaired clearance of drugs. ● ● Decreased rate of fat, mineral, and vitamin absorption, e.g., a decrease in calcium absorption, leading to bone loss. ● ● Tooth enamel and dentin erosion. ● ● Increased incidence of gastroesophageal reflux. ● ● Increased incidence of constipation. ● ● Delay in gastric mobility and emptying after fatty meal, prolonging gastric distention. Nursing consideration:Many medications can add to age-related changes in the GI system. These include antidepressants, antihistamines, antihypertensives, calcium channel blockers, diuretics, and laxatives [9,17]. When assessing GI and nutritional status, nurses must be sure to consider whether or not the patients are taking any medications that can adversely affect the GI system. When evaluating medications, be sure to include over-the-counter, weight loss/gain products, vitamins, minerals, and herbal supplements as part of the assessment. These following changes contribute to a number of common age-related disorders in older adults. Dysphagia Dysphagia is the most common esophageal problem in older adults [9]. It is characterized by trouble with any part of the mechanism of swallowing foods or liquids. This problem inhibits adequate nutritional intake and can adversely affect an older adult’s health and well-being. When assessing swallowing, the nurse should be aware or factors than increase the risk of dysphagia [9,14]. If any patient displays any of these symptoms, a swallow evaluation MUST be initiated before allowing the individual to have anything by mouth. If they do not pass a designated swallow evaluation, the patient must be kept NPO until a formal evaluation can be completed by a speech therapist. Factors that increase the of dysphagia are: ● ● Reports of dysphagia from patients, families, or caregivers. ● ● Observation of drooling and/or dribbling. ● ● Observation that patient has trouble controlling food or liquids in the mouth. ● ● Facial drooping or facial paralysis. ● ● Changes in mental acuity such as dementia or a new stroke. ● ● Slurred speech. ● ● Coughing after eating or drinking. ● ● Pocketing food in mouth. ● ● Changes in voice quality (e.g. weak voice, hoarse voice) when eating. ● ● Existence of neurologic problems and/or muscle disorders. Underlying causes such as tumors, dementia, neurologic diseases, etc. should be identified and corrected or treated. Here are some tips to help reduce dysphagia [9,13]: ● ● Be sure that the patient is seated comfortably in an upright position. ● ● Encourage a calm, pleasant atmosphere during meals. ● ● Avoid extensive conversation. Allow the patient to concentrate on eating and swallowing. ● ● Plan meals with patient’s food preferences in mind. Nursing consideration: When assessing patients with dysphagia, remember to assess mental health, emotional well-being, stress, and other mental health issues that can also have an impact on swallowing. Constipation Constipation affects up to 20% of older adults in the community and between 50% and 75% of those living in long-term care facilities [9]. Factors that contribute to constipation in older adults include lack of adequate fluid intake, lack of adequate fiber in the diet, and side effects of medications.