Needs in the Elderly

According to Virginia Henderson

Work done by:
• Angela Robinson • David • Nelio Goncalves Santos
INTRODUCTION
This work has the overall objective to disclose basic needs, according to Virgin
ia Henderson, and elucidate the importance of nursing care in its maintenance, t
hat is, provide a better quality of life for seniors, to keep them independent a
nd able of self care for a longer period of time.
INTRODUCTION
According to Virginia Henderson health professionals, rather, nurses should not
only treat but also give due importance to care, since this is the main means of
preventing new diseases in the elderly, so we can say that deal requires care.
• "Caring comes from the Latin" cogitare "which means pay close attention, be in
teresting, to mind, to ensure. • Treat comes from the Latin "tractare" and means
something to devote care to preserve its good looks or to maintain its function
ality;
Dictionary of Portuguese
INTRODUCTION
Despite being the fourteen needs of Virginia Henderson, we will only deal with s
even needs: • Breathing, Eating and drinking •, • Delete, Move and • maintain go
od posture, sleep and rest •, • Dressing and undressing • Maintain body temperat
ure within normal limits
Nursing and Gerontology
Definition of Gerontology:
• is the science of aging, thereby "aging is a physiological process of progress
ive degeneration that occurs in any organism, with the passage of time," ie, som
ething we do not control, is considered as another phase of development in dimen
sion of a person's life. Is to change bio physiological, psychological and behav
ioral organism, progressive and irreversible effects of which lead to increased
risk of disease
Nursing and Gerontology
Definition of nursing gerontology:
• Defining the profession of nursing, this being "... an act whose object is to
identify the health needs of people, contribute to the diagnostics, deliver and
monitor nursing care required by health promotion, prevention of illness, treatm
ent and rehabilitation, as well as the fact that providing care according to a p
rescription "(Gouvernement du Quebec, cited by, Luoise Berger 1995 p.11), ie in
the profession, it is the nurse inform the population about the problems of heal
th.
Nursing and Gerontology
Definition of the nursing process:
• It is an "intellectual process consists of several logically ordered steps whi
ch aims at the welfare of the customer" (Phaneuf, M. sitado by Louse Berger 1995
p.73) • This is actually a method of systematic work that allows nurses to take
informed decisions about the care situations, ie to develop interventions based
on a critical appreciation of nursing itself rather than a process of trial and
error.
Nursing and Gerontology
Nursing Process:
Four steps: • Collection of data; • Analysis and interpretation of data; • Plann
ing of care; • Evaluation;
Nursing and Gerontology
Data collection:
• allows you to make an inventory of everything that customer. Informs us about
what it is about its complaints about the living habits and the state of satisfa
ction of their needs.
Nursing and Gerontology
Analysis and interpretation of data:
• make it possible to identify their specific dependency problem and the source
of the trouble originates. Allow for the nursing diagnosis.
Nursing and Gerontology
Care planning:
• Allows certain purposes targeted hair care nursing in order to replace the cus
tomer what he can do on its own to meet their needs and solve their problem of a
ddiction. • It has two strands: the development objectives of care and planning
of interventions.
Nursing and Gerontology
Rating:
• is to go back to assess the process undertaken and to ascertain whether the re
sults are valid or not. This review shows whether objectives were achieved and n
ew data raised by the evolution of the customer, are needed.
Nursing and Gerontology
So the nursing process:
• allows developing plans of nursing care to manage the health problems that are
the responsibility of the nurse.
Needs
• Necessity is the "nature of what is essential and therefore can not be exempt.
"
• Next
will address the first seven requirements relating them to the gerontology in ge
neral and the elderly in particular and analyze the needs according to the nursi
ng process.
BREATHING
• The
respiratory function plays an essential role in maintaining physical and mental
activity of humans. • Aging is one of several factors, which may disturb the res
piratory function of man.
Physiological changes of the respiratory system:
• loss of elasticity of the tissues surrounding the alveoli and alveolar ducts;
• Loss of elasticity of the lung tissue; • Ability to lung expansion limited by
changes in thoracic structure; • Decreased inspiratory capacity by costal cartil
age calcification;
• Decreased inspiratory muscle contractility; • Weakness of the diaphragm and in
tercostal muscles; • Increased residual capacity; • Decreased vital capacity; •
Decreased activity bronchial ciliary membranes.
NURSING PROCESS
Collection of data: • To assess the respiratory function of the elderly, the nur
se should consider the following aspects: • Symptoms, Risk Factors •, • chronic
pathologies, • functional limitations;
Analysis of data: • Analysis and interpretation of data collected; • Problems of
current or potential dependence; • Causes that difficult; • Initial assessment
of respiratory function; • Situation Analysis;
There are three categories of diagnoses related to respiratory function: • Clean
ineffective airway • Commitment • Ineffective breathing pattern of gas exchange
Planning of care: Nursing interventions must begin by knowing the habits related
to satisfying this need;
Preventive interventions: 1. 2. 3. 4. 5. 6. 7. Breathing exercises frequent mode
rate physical activities Posture facilitator of chest expansion Proper hydration
humidity and ambient temperature within normal limits adequate ventilation envi
ronment of relaxation exercises, through proper breathing
Therapeutic interventions: The elderly who have an issue belonging to the above
categories should follow a program of pulmonary hygiene adapted to their needs.
1. 2 breathing exercises. Technical cough 3. General measures to promote health
Evaluation: The nurse makes the evaluation of interventions to improve the chang
es of respiratory function.
Revel
Eating and drinking:
A balanced nutritional status promotes physical and emotional health by preven
ting or delaying the onset of disease more frequent during the aging process.
The human needs for nutrients: • Living • Ensure growth • Store • Maintain healt
h and homeostasis and coordinate uses and complex physiological mechanisms.
Factors influencing food choices: • Availability of food • aesthetic factors; •
Budgets; • socio-economic factors:
Physiological changes: • Change of taste and smell; • Difficult to cut, chew and
salivate; • Decreased secretion of saliva; • Problems swallowing • Difficulty i
n absorbing fats; • Loss of appetite • Decreased sensation of thirst ;
NURSING PROCESS
Data collection: • The nurse should assess the need to eat and drink, taking int
o account the main symptoms associated with nutrition and hydration, recognizing
the risk factors and chronic diseases, but also its limits.
The analysis and interpretation of data shows the nurse: • Indexes of satisfacti
on of the need to eat and drink; • Problems of dependence and potential; • Main
sources of difficulty; • Interaction with other requirements of this need;
Care planning: • The nurse should try, through selected measures to correct or p
revent problems due to excess or deficiencies related to nutrition and hydration
.
Assessment: When assessing, the nurse should consider: • The problems produced b
y various disease states (in terms of nutrition, pain, discomfort, anorexia and
food) • To check the effect of their activities; • Verify the results of a teach
ing program ;
Eliminate
It is a fundamental need, to the extent that, to stay healthy, the body must e
liminate the products of metabolism, reject noxious or useless referring to this
 process by elimination. It is understood by elimination, the urinary eliminat
ion, intestinal, respiratory and skin. The removal is particularly affected by
aging,€as other needs.
"Though aging modify the intestinal and urinary systems, can not alone explain a
ll the problems of dependency of the elderly, related to the disposal. Biophysio
logic changes affecting urinary and bowel-related vulnerable elderly people to u
rinary problems and / or intestinal components that are exacerbated by psycho. "
Berger (1995, p. 264)
Physiological changes
Urinary System
- Rim:
• • • • Loss of nephrons; Arteriosclerosis of the renal arteries; Decreased tubu
lar function, 46% decrease in glomerular filtration rate between 20 and 90 years
.
- Urethra:
• Changes in structure; • Weakness of the sphincter.
- Bladder:
• Decreased retention capacity • Decreased muscle tone; • It takes nerve stimuli
responsible for the involuntary urination and bladder emptying; • Increased bla
dder volume.
gastrointestinal system - Bowel:
• Loss of muscle tone of the sphincter of the large intestine, muscle tone • Dec
rease intestinal motility and lubrication of the intestine glands of the intesti
nal mucosa.
Nursing process
Intestinal elimination
Data collection
The main factors that may cause disruption of this function:
2. 3 bowel elimination habits. Diet 4. Fluid intake 5. Family and cultural belie
fs 6. 7 previous surgeries and pathologies. Surroundings 8. Level of activity in
September. Symptoms 10.medicamentos
Analysis and interpretation of data
The change of intestinal function is identified with the help of three diagnos
es:
1.Obstipação 3.Diarreia 5.Incontinência fecal
Planning of preventive care interventions
1.Horário elimination 2.Ingestão enough fluids 3.Active or exercise 4.Conhecimen
to food and liquids that promote intestinal elimination 5.Técnica relaxation
therapeutic interventions
1.Laxantes and enemas 2.Regime food 3.Hidratação 4.Exercício 5.Medicamentos 6.Ho
rário intestinal elimination
Evaluation
• Number of laxatives, enemas or suppositories used; • Respect for diet and exer
cise; • Beneficiary satisfaction regarding the frequency of stools; • Absence of
fecal incontinence; • Absence of fecal impaction; • No skin change, • Lack of e
lectrolyte disturbance .
Urinary elimination
 The urinary elimination problems are very common in the elderly, however, are
poorly documented. Knowing that one is incontinent elderly have very little me
aning. "The term incontinence is a very broad word that does not provide relev
ant information about the problems with urinary control in the elderly." Burnsid
e (1981), cited by Berger.
Data collection The nurse can make its assessment through:
• • • • • NOTE NOTE urinary elimination of physical examination of the state of
the skin of the abdomen Palpation Assessment of the beneficiary's ability to dre
ss and undress, when he goes to the bathroom
Analysis and interpretation of data
When the disposal is not satisfied, there follows a change in urinary function
which is identified with the help of two diagnoses:
1.Retenção urinary urinary 2.Incontinência
urinary retention and incontinence influence the satisfaction of other basic n
eeds.
Urinary incontinence, under pathophysiological point of view, is divided:
• Functional Incontinence Detrusor Instability • • • Total Incontinence Stress I
ncontinence
Functional incontinence is the state in which the elderly have difficulty movi
ng to the toilet, due to factors of physical or environmental. The detrusor in
continence is the state where the individual voluntarily gives urine because of
the urgency to urinate. The total incontinence is the state in which the elder
ly urine continuously and unpredictably. Stress incontinence is the state in t
he elderly lose small amounts of urine during physical exertion.
Planning of preventive care interventions
1.Explicar in simple terms the changes biophysiologic urinary system and the mec
hanism of micturition. 2.Demonstrar the importance of hydration. 3.Recomendar hi
m to urinate so feel the need. 4.Ensinar you relaxation techniques. 5.Recomendar
him to always empty the bladder before going shopping. 6.Aconselhá you to consu
lt the doctor at the first sign of urinary changes.
"incontinence depends on many factors of order biophysiological,€sociological
and cultural elements to be taken into account in the selection of care tailored
to the needs of each recipient. "Matteson (1988), cited by Berger. To this en
d, we must take into account that there are two types of incontinence: the irrev
ersible and reversible, each with their interventions.
When a beneficiary suffers irreversible incontinence, the intervention consist
s of:
Probing your own feelings in the face of this chronic problem The nurse shou
ld help the recipient to become aware of your emotions, accept them, analyze the
m and find new ways to meet the needs of the beneficiary should also explain t
o the family and care staff in the reactions of the recipient
The nurse should encourage the beneficiary to participate in activities to pre
vent social isolation Assist the recipient to engage in social activities, the
nurse can enumerate some interventions, such as advising the use of incontinenc
e briefs, so prevent wet clothes.
However, treatment of incontinence reversible aims to reduce, eliminate or neu
tralize the factors responsible for incontinence.
Therapeutic Interventions
• Be empathetic and understand the psychological barrier and the feelings of the
 recipient, • advise increased consumption of liquids • Tone through adequate ex
ercise the detrusor muscle, • diuretic beverages should be avoided, and where th
ey are consumed, the beneficiary must urinating about a half hour later.
Evaluation
1. The recipient feels the need for information related to physiological functio
n or urinary symptoms? 2. We conducted a medical evaluation in which we detected
urinary symptoms? 3. Number of involuntary urination had the user in the last f
ortnight? 4. The recipient shows signs of side effects such as social isolation
and / or alteration of skin integrity? 5. Take any medications that interfere wi
th urinary function?
Move and maintain good posture
It is a necessity that every human being has, through coordinated movements.
Maintaining good body alignment allows the organism to perform all its function
s effectively. In a precise way, thus preventing injury.
Nursing process
Collection of data • The assessment of independence, can be very complex due to
multiple factors, hence the need to evaluate various parameters such as:
• • • • • • • State motor function, quality and type of physical diseases Drug A
ttitude Psychological Environment Other factors (such as age, habits, pain and w
eakness).
Analysis and interpretation of data analysis and interpretation of data collecte
d by nurses for identifying:
• Declarations of independence of the beneficiary; • Problems of dependence and
potential; • Main sources of difficulty, as well as interactions with other this
need.
The dependence of this need, not only affects the mobility and activity as other
basic needs.
Planning of preventive care interventions
1.Motivação the nurse and the recipient; 2.Força and muscular endurance; 3.Flexi
bilidade joints.
Therapeutic interventions
They aim to eliminate the detrimental effects of immobility, maximizing mobili
ty in accordance with the limits for each person.
These interventions are based on the same points that preventive interventions
. (Motivation of the nurse and the recipient, the muscle strength and endurance,
joint flexibility).
Evaluation
The effectiveness of preventive and therapeutic interventions can be assessed th
rough:
• Muscle Tonus; • Strength and size of muscles; • Strength and range of motion.
Sleep and Sleep
The home and sleep depend on muscle relaxation. "The rest progresses to slee
p when there is no longer total interaction with the outside." Callista Roy Sl
eep, "an altered state of consciousness or a state of partial awareness of what
a person can go through appropriate incentives."
Dimension biophysiological
 Light / Darkness; Body temperature; naps; Diseases; Drug; Stimulants
.
Psychological Dimension
Stress; Anxiety; Depression; Fears; Caring.
Sociological Dimension
Routine Change; Noise; Degree of shared intimacy; Temperature; Solitud
e; boredom.
Cultural Dimension
Beliefs; Values.
Associated Problems
Heart; Respiratory; Gastric; Endocrine; Emotional and psychological;
Neurological.
Nursing Process
Data collection
Daily sleep; Description of the problem by the user; Information obtained
from the people closest to the wearer; Medical Treatment and Pathology.
Analysis and interpretation of data can be: Revealed current or potential prob
lems; Nursing Diagnoses (changes in sleep patterns)
Care planning
Therapeutic Interventions: Reduce the effects of dependency problems. Preventi
ve Interventions: Maintain the independence of the beneficiaries.
Evaluation
In an initial assessment, the nurse must observe the user during sleep. Must
be performed from the quality and sleep pattern of the recipient.
Dressing and undressing
Affected by need: Aging; Problems; Diseases; Importance of the clothing.
Reasons for choice of clothing: Improve the physical appearance; Respect the
personality; impress; Make yourself accept; affirm their status; Get pe
rsonal satisfaction.
Dimension biophysiological
neuromuscular capacity, which can be altered by aging and certain endocrine di
seases.
Psychological Dimension
"The respect for the modesty of the client must take into account their age, g
ender, socio-cultural group ... otherwise their fundamental need is not met." Ev
elyn Adam
Sociological Dimension
The social norms and fashion; Time of day; Climate; The socio-economic d
evelopment.
Cultural Dimension
To preserve the tradition, some people, different costumes take to better dist
inguish them from others.
Associated Problems
Pain; discomfort; Fatigue; Agitation; cognitive and perceptual deficit
s; Change of mobility; Parkinson's disease.
Nursing Process
Data collection
History
• Importance given to clothing; • habits of dress.
Physical Examination
• Member of motor function; • Independence in activities of daily living.
Review of mental functions
• Short-term memory; • Ability to solve problems.
Analysis and interpretation of data
Analyze, through the choice of clothing:
• • individuality and the physical and emotional.
Care planning At home:
• Problems caused by certain tissues; • Changes that these can cause the level o
f thermoregulation and the musculoskeletal system • Choice of clothing depending
on climate and type of activity.
Planning of care (cont.)
In health institutions:
• Must meet the tastes and time that the elderly want to dress.
Evaluation
Improved dress; Accept help to dress and undress; Be able to use appropria
te equipment to facilitate their independence interested to get into it during
the day.
Maintain Body Temperature
Temogénese Thermoregulation Thermolysis
Dimension biophysiological The elderly have a body temperature lower than the
adult; In women at menopause there is a stabilization of body temperature.
Psychological Dimension
Emotions; Anxiety; Stress.
Sociological Dimension
life situation; Climate; Comfort accommodation; Temperature extremes.
Cultural Dimension Many seniors always dress the same way regardless of the se
ason. dark clothing in summer
hypothermic cardiac arrest; pulmonary edema; gastrointestinal bleeding;
Death (down to 24 º C).
Hyperthermia Cardiac arrest; Acute renal failure; Cerebral edema; Dehydr
ation; Shock; Death (44 º or 45 º C)
Nursing Process
Data collection
Body temperature; Response of the elderly to changes in temperature and exte
rnal affairs; Use of therapeutic measures can alter the body temperature; So
cio-economic factors; Level of activity; physiological factors;
Analysis and interpretation of data potential change in body temperature; po
tential hypothermia, hyperthermia potential; Thermoregulation ineffective.
Care planning Maintenance and restoration of independence of the beneficiary;
therapeutic actions; Prevention.
Evaluation
Check if the recipients: Know means for maintaining body temperature; Know h
ow to react to stressful situations; Do you know a reliable method for assessi
ng body temperature; Recognize signs of hypothermia and hyperthermia.
CONCLUSION
It is necessary to take into account the provision of these needs as well as the
rest of nursing care in the aid relationship between the patient and health pro
fessionals, more properly the nurse, since this aid relationship goes beyond the
mere exchange functional€the nurse must demonstrate special ability to listen a
nd learn certain fundamental attitudes such as empathy, respect, consistency and
clarity.