GERONTOLOGICAL SAFETY ISSUES
Safety is a broad concept that means security and the prevention of accidents or injuries. When working with older clients the nurse must provide a standard of care that promotes safety and prevents foreseeable accidents or injuries, while also respecting individuals' autonomy to make decisions (Meiner, S.E. & Miceli, D.G., 2000)
FACTORS THAT AFFECT A PERSON'S SAFETY
Under each of the following main headings are factors that may adversely impact a person's life and lifestyle. For each of the listed factors imagine how your life or a loved one's life may change or be affected.
Age and Development:
Failing or Impaired memory
Decreased sensory perception
Slowed or impaired mobility
Impaired cognition related to Organic Brain Syndrome
Following is an example of a nursing diagnosis and goals that may be used for a person with impaired memory. We will pretend that this person lives alone and has been getting along well until the new construction work started in her apartment complex. Now with the noise and added stress of workmen coming and going she has been forgetting to take her noon medications.
Impaired Memory related to excessive environmental disturbances secondary to construction noise and workmen in apartment complex manifested by forgetting to take noon medications.
Patient's daughter will call patient daily at noon to remind her to take her noon medications until construction at patient's apartment is finished (approximate finish date is October 7th, 2003).
Patient will remember to take noon medications consistently by October 7th, 2003.
Activities of daily living
Following is an example of someone with a nutritional deficit:
Mrs. Cheng, an 84 year old patient was admitted to your unit for rehab after repair of a left fractured hip. The CNA's report to you, the RN, that Mrs. Cheng, has been eating very little since being transferred here two days ago. Recognizing how important good nutrition is to the healing and recovery process you go to see Mrs. Cheng. When you talk to Mrs. Cheng about her appetite, you discover that she is use to eating more traditional home-cooked Chinese meals and the food here does not appeal to her. As her RN, what nursing diagnosis would you consider adding to her chart? What nursing interventions would you like to see implemented for Mrs. Cheng? Check answers
Mobility and Health Status:
History of osteoarthritis or rheumatoid arthritis
History of Cerebral Vascular Accident (CVA), paralysis or limb amputation
Fracture(s) and or cast
General weakness due to surgery or illness (may be either acute i.e. pneumonia, or chronic i.e. diabetes)
What safety measures would you as the RN in charge want in place for a client newly diagnosed with a CVA (stroke)? Before answering think of all the areas of the brain that might be affected by a stroke and how your client's life might be affected. Following are some nursing diagnosis labels that might apply and how your client might be affected.
Impaired vision -- tripping/falls
Impaired hearing -- may not hear sirens/warnings
Impaired olfactory sense -- may not smell a fire/gases
Impaired touch sensation -- may not realize they are burned/injured
Impaired awareness (those that are unconscious, semi-conscious; disoriented)
Impaired cognitive perception (see/hear things that are not real)
Impaired judgment (disease; drugs; and medications)
Confusion, acute/chronic (fluctuations in cognition; misperceptions, etc.)
Anxiety, death (fear of dying; fear of loss of more physical and/or mental abilities prior to dying; may exhibit irrational thoughts/fears, decreased coping abilities, crying, inability to care for self)
Stress (may result in decreased concentration levels, errors in judgment and decreased awareness of external stimuli)
Depression (may result in alterations in thought processes and slowing of reactions to environmental stimuli)
Ability to Communicate:
Communication, verbal, Impaired (Aphasic persons or persons with language/reading barrier may not be able to ask for help or understand a warning; may be fearful of not having needs met; may become angry/defensive)
Knowledge deficit (Lack of knowledge regarding medications, medical regime, unfamiliar equipment; water safety; car safety; fire prevention; prevention of harmful substances)
Ineffective health maintenance (Preventive measures related to specific age-related hazards)
Knowledge related to safe home and work environments
Well maintained floors/carpets; functioning smoke/fire/gas alarms and fire escapes; fenced in swimming pools; adequate lighting, etc.