Nursing Care Plan for Elderly Patients - Activities of Daily Living (ADLs)

Definition of Elderly

Elderly is a phase of decreased mental and physical abilities, which begins with some changes in life. As is known, when humans reach adulthood, have the ability to reproduce and give birth to children. When living conditions change, a person loses these tasks and functions, and enters later, that is, old age, then dies. For normal people, who are the people, of course they are ready to accept new conditions in each phase of their lives and try to adapt to their environmental conditions (Darmojo, 2004).


Aging Process

According to Constantindes (1994) said that the aging process is a process of slowly disappearing the ability of the network to repair itself or replace and maintain its normal function, so it can not survive the infection and repair the damage suffered. The aging process is a continuous process that naturally starts at birth and every individual is not as fast. Aging is not a disease status but is a process of decreasing the body's resistance in dealing with stimulation from within and from outside the body.

That way humans will progressively lose their resistance to infection and will accumulate more metabolic and structural distortions called degenerative diseases such as hypertension, atherosclerosis, diabetes mellitus and cancer that will cause us to face the end of life with dramatic terminal episodes such as stroke, myocardial infarction, coma acidosis, cancer metastases and so on (Martono & Darmojo, 2004).


Age Limits

Some gerontologists have recognized the diversity of old age by defining sub-groups. One study distinguishes the young old (60 to 69), the middle old (70 to 79), and the very old (80+). Another study's sub-grouping is young-old (65 to 74), middle-old (75–84), and oldest-old (85+). A third sub-grouping is "young old" (65–74), "old" (74–84), and "old-old" (85+).


Theory of Aging

Planners and decision makers pay attention to the healthy and sickly aspects of the elderly given their longevity, but sickness will drain a lot of resources and will disrupt the daily activities of the elderly. With the index of daily activities according to Katz, it can be predicted how old life expectancy is active in a community. From various studies it was concluded that the functional status of daily activities is closely related not only to age, but also to disease. Movement limitations are a major cause of disruption of activities of daily living (ADL) and IADL (ADL Instruments) (Guraalnik, et al in Tamher, 2009).


Steps to Maintain Activity of Daily Living (ADLs) in the Elderly

The things that need attention in establishing a relationship with the elderly are as follows:
1. Environment (physical and psychological)

• Prepare an adequate area. Example: client in a wheelchair
• The atmosphere is calm and not noisy. Example: TV sound, radio
• Comfortable and not hot
• Use a rather dim light, avoid direct light
• Place it in a comfortable position when changing positions or ask if you want it in bed
• Provide enough time and drinking water
• Privacy must be maintained
• Calculate the client's energy level and abilities
• Patient, relaxed, and not in a hurry. Give clients time to answer questions
• Watch for signs of fatigue (complaining, response becomes slow, constricted, and offended)
• Plan what will be reviewed
• Conduct an assessment when the client's energy increases. Example: after eating

2. Interviewers (nurses' attitudes: feelings, values, and beliefs)

• Know the myths surrounding the elderly
• Explain the purpose of the interview
• Use a variety of techniques to balance data collection needs with client interests
• Record data must be licensed by the client
• At the beginning of the interaction the nurse must plan with the client the most effective and convenient way
• Using touch
• Adjust the circumstances of the interview
• Speak not too loud

3. Clients

• Some cultures that influence the ability of clients to participate are very meaningful in interviews.
• Factors that influence the aging process are heredity, nutrition, health status, life experience, environment and stress.
• Nurses must be aware of these factors because the ability of the elderly to communicate all important information is largely determined by the completeness and appropriateness of the interview.

Nursing Care Plan for Elderly Patients - Activities of Daily Living (ADLs)

The nursing process in the elderly includes the following:

1. Nursing Assessment

• Health status in the elderly is assessed comprehensively, accurately and systematically. Information collected during the assessment must be understood and discussed with team members, client families, and interdisciplinary service providers.
• The purpose of conducting the assessment is to determine the client's ability to care for himself, complete the basic data to create a nursing plan, and give the client time to communicate. This assessment covers physical, psychological, social, and spiritual aspects by conducting data collection activities through interviews, observations and examinations (CGA: comprehensive geriatric assessment).
• Assessment of the elderly in the family is done by involving the family as the closest person who knows about the health problems of the elderly. Whereas the assessment of the elderly group in the institution or in the community was carried out by involving the person in charge of the elderly, cultural groups, community leaders, and health workers.
• For this reason, the assessment format used is the assessment format for the elderly which is developed in accordance with the existence of the elderly. The format developed at least consists of: basic data (identity, address, age, education, occupation, religion and ethnicity); biopsychosocial, spiritual, cultural data; environment; functional status; existing health support facilities; and physical examination.

2. Nursing Diagnosis

• The nurse uses the results of the assessment to determine the nursing diagnosis. Nursing diagnoses can be in the form of individual nursing diagnoses, family nursing diagnoses with the elderly, or nursing diagnoses in the elderly group.
• Nursing problems encountered include nutritional disorders: lack of / over; sensory perception disorder; hearing, vision; lack of self care; activity intolerance; sleep disturbance; changes in elimination patterns; impaired physical mobility; risk for injury; social isolation; withdraw; low self-esteem; anxiety; grieving reaction; angry; and rejection of the aging process.

Examples of nursing diagnoses in elderly with nursing problems sensory perception disorders: vision are as follows:

• Nursing diagnosis in elderly individuals: Disturbed Sensory Perception: vision related to decreased visual acuity.
• Nursing diagnosis in families with elderly: Disturbed Sensory Perception: in mothers S in the family of father A is related to the inability of families to treat elderly with cataracts.
• Nursing diagnosis in the elderly group at the nursing home: risk for injury to the elderly at the nursing home X is related to decreased vision, characterized by 80% of the elderly at the nursing home X saying they cannot see far, 20% of the elderly at the nursing home X have fallen into the ditches because they do not see the road clearly , 80% of the elderly in care X have cloudy eye lenses.

Nursing Interventions

The nurse develops a service plan related to the elderly and other related matters. The goals, priorities, and nursing approaches used in the treatment plan include therapeutic, promotive, preventive and rehabilitative interests.

Nursing plans help clients obtain and maintain health at the highest level, welfare and quality of life can be achieved, as well as to approach death peacefully. Plans are made for the continuity of service in an unlimited time, according to the client's response or needs.

The things that must be considered in preparing a nursing plan.

• Adjust it to specific objectives which are directed at meeting basic needs.
• Involve the client and family in planning.
• Collaboration with related health professions.
• Determine priorities. The client may be satisfied with his condition, generate change but don't force it, security and comfort are the main things
• Allow enough time for the client.
• Document the nursing plan that has been made.

Nursing Implementation

Nurses perform nursing actions in accordance with the plan of care that has been made. Nurses provide health services to maintain the functional abilities of the elderly and prevent complications and increase disability. Nursing actions are based on the nursing plan of each nursing diagnosis that has been made based on the concept of gerontic nursing care.

Nursing actions taken in the elderly:

1. Cultivate and foster trusting relationships by calling client names.
2. Provide sufficient lighting: sunlight, ventilation of the house, avoid glare, lighting in the bathroom, kitchen, and other rooms at all times.
3. Increase sensory stimulation through large printed books and provide visible colors.
4. Maintain and train the power of reality orientation: calendar, hours, photographs, and the large number of visits.
5. Providing circulation care: avoid narrow clothing, tying / pressing, changing positions, supporting activities, and slow rubbing in the bath.
6. Provide breathing care by cleaning the nose, protecting it from the wind, and increasing breathing activity with deep breathing exercises (coughing exercises). Be careful with oxygen therapy, watch for signs of anxiety, excessive sweating, visual disturbances, muscle spasms, and hypotension.
7. Provide care for the digestive organs: feed small but frequent portions, feed attractive and warm conditions, provide preferred foods, foods that are sufficiently fluid, eat lots of vegetables and fruit, provide food that does not form gas, and the attitude of the fowler when eating .
8. Provide genitourinary treatment by preventing incontinence by explaining and motivating the client to urinate every 2 hours and observing the amount of urine during sleep.
9. Providing skin care. Bathing: use soap that contains fat, avoid rubbing the skin hard, cut fingernails and feet, avoid scratching hard, and give moisturizer (lotion) to the skin.
10. Provide musculoskeletal care: move with limitations, change positions every 2 hours, prevent osteoporosis with active / passive exercise, and encourage families to make clients independent.
11. Providing psychosocial care: explain and motivate for socialization, help in choosing and participating in activities, facilitating conversation, touching hands to maintain trust, giving appreciation, and being empathetic.
12. Maintain safety: try to keep the bed fence (safety) fixed, the position of the bed is low, the room and floor are not cluttered and slippery, enough lighting, help to stand up, and provide support when standing up when needed.

Tag : Activities of Daily Living, Nursing Care Plan