4. Sleep disturbances.
1. Nursing goal/implementation: promote restful sleep and prevent sleep deprivation with sleep care strategies:
1. Maintain normal sleep pattern: arrange medications and therapies to minimize sleep interruptions.
2. Encourage daytime activity; discourage daytime naps.
3. Support bedtime routines/rituals: bedtime reading, listening to music, quiet television.
4. Promote comfort: mattress, pillows, wrinkle-free linen, loose bed covering.
5. Promote relaxation: warm milk or soup if not contraindicated, back rub.
6. Avoid!minimize stimulation before bedtime: no caffeine after dinner, reduce fluid intake before sleep, refrain from smoking.
7. Avoid/minimize drugs that negatively influence sleep, such as ranitidine, diltiazem, atenolol, nifedipine.
8. Create a restful environment: turn off lights, reduce or eliminate noise, minimize disruptions for therapy or monitoring.
5. Skin breakdown.
1. Assessment:
1. Age-related changes: slower rate of epidermal proliferation; thinner dermis; decreased - dermal blood supply, melanocytes (gray hair), moisture, sweat and sebaceous glands.
2. Predisposing risk factors: exposure to ultraviolet rays (sunlight, excessive tanning); adverse medication effects; personal hygiene habits (too frequent bathing); limited activity, heredity.
3. Functional consequences: dry skin; skin wrinkles; delayed wound healing; increased - susceptibility to burns, injury, infection, altered thermoregulation, skin cancer, cracking nails.
2. Nursing goal/implementation: treatment for pressure sores.
1. Stage I - reddened broken skin: cover and protect (use sprays, gels, transparent films, transparent occlusive wafers).
2. Stage II - blister or partial-thickness skin loss: cover, protect, hydrate, insulate, and absorb exudate (use transparent films, occlusive wafer dressings, calcium alginate for absorbing exudate; polyurethane foam, moistened gauze dressing).
3. Stage III - full-thickness skin loss: cover, protect, hydrate, insulate, absorb, cleanse, prevent infection, and promote granulation (use occlusive wafer dressings, absorption dressing, calcium alginate, and moistened gauze dressings).
4. Stage IV - full-thickness skin loss involving muscle, tendon, and bone: same as stage III except before promote granulation dead eschar (tissue) is removed (use absorption dressing, calcium alginate, and moistened gauze dressings).
6. Polypharmacy - concurrent use of several drugs increasing the potential for adverse reactions, drug interactions, and self-medication errors
1. Lack of communication among multiple health care providers.
2. Lack of information about over-the-counter drug use.
3. Lack of information about patient noncompliance.
4. Use of complementary (alternative, folk medicine) therapies and fear of telling health care provider.
5. Assumption that once medication is started, it should be continued indefinitely and not changed.
6. Assumption that if there are no early side effects, there will not be any later.
7. Changes in daily habits (smoking, activity, diet/fluid intake).
8. Changes in mental-emotional status that may affect consumption patterns.
9. Changes in health status.
10. Financial limitations (drug substitution).
1. Nursing goal/implementation: assist the older adult to use medications safely and try nonpharmacological interventions for common health problems.
1. Constipation: exercise, relaxation, biofeedback; increase fluid and fiber intake.
2. Stress incontinence: pelvic muscle exercises, biofeedback.
3. Anxiety, depression: counseling, exercise, meditation, relaxation techniques; touch, music, and pet therapy.
4. Arthritis: acupuncture, heat therapy, therapeutic exercise, postural or alignment aids; touch, music, and pet therapy.
5. Chronic neuromuscular problems: massage, body work, touch and music therapy.
6. Sleep problems:

Medications That Should Not be Used by Older Adults