HLT07 Health Training Package
Learner resource
Version 2
Training and Education Support
Industry Skills Unit
Meadowbank
Product Code: 5573
HLTEN515B
Implement and monitor nursing care
for older clients
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HLTEN515B Implement and monitor nursing care for older clients
© TAFE NSW (Training & Education Support, Industry Skills Unit Meadowbank) 2012
Acknowledgments
The TAFE NSW Training and Education Support Industry Skills Unit, Meadowbank
would like to acknowledge the support and assistance of the following people in the
production of this learner resource guide:
Writers:
Glenys Wensor
Kylie Brennan
TAFE NSW
Reviewers:
Beth Rutherford
Chaya(Margaret)Bowring
Amanda Culver
Sherryl Dismorr
TAFE NSW
Project Manager:
Di Dawbin
Education Programs Manager
Training and Education Support, Industry Skills Unit, Meadowbank
TAFE NSW
Enquiries
Enquiries about this and other publications can be made to:
Training and Education Support Industry Skills Unit, Meadowbank
Meadowbank TAFE
Level 3, Building J,
See Street,
MEADOWBANK NSW 2114
Tel: 02-9942 3200 Fax: 02-9942 3257
ISBN 978-1-74236-310-3
© TAFE NSW (Training and Education Support, Industry Skills Unit
Meadowbank) 2012
Copyright of this material is reserved to TAFE NSW Training and Education
Support, Industry Skills Unit Meadowbank. Reproduction or transmittal in
whole or in part, other than subject to the provisions of the Copyright Act, is
prohibited without the written authority of TAFE NSW Training and Education
Support, Industry Skills Unit Meadowbank.
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HLTEN515B Implement and monitor nursing care for older clients
© TAFE NSW (Training & Education Support, Industry Skills Unit Meadowbank) 2012
Table of contents
Introduction ........................................................................................ 7
1. General introduction .............................................................................. 7
2. Using this learner guide ......................................................................... 8
3. Prior knowledge and experience ............................................................ 10
4. Unit of competency overview ................................................................ 10
Section 1 Theories of ageing/changing demographics .................. 13
Section 2 Age related changes ....................................................... 17
Section 3 Stereotypes and ageism ................................................. 25
Section 4 Mental health issues/behaviours of concern .................. 29
Section 5 Elder abuse .................................................................... 47
Section 6 Preventative health assessment tools ............................ 53
Section 7 Communication strategies ............................................. 59
Section 8 Prioritise and address needs of clients with complex/special needs .................................................. 63
Section 9 Community services ....................................................... 67
Section 10 Documentation ............................................................... 75
Section 11 Care of the dying ............................................................ 77
Section 12 Medication administration principles ............................. 83
Section 13 Funding mechanisms that impact on aged care provision ........................................................................ 85
Section 14 Current legal and ethical issues in aged care ................. 89
Section 15 Health promotion in the older person ............................ 91
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HLTEN515B Implement and monitor nursing care for older clients
© TAFE NSW (Training & Education Support, Industry Skills Unit Meadowbank) 2012
Section 16 Impact of complex issues on the carer(s) ..................... 93
Section 17 Analyse a nursing care plan for the older person with complex needs and evaluate .................................. 99
Reference list .................................................................................. 101
Resource Evaluation Form ............................................................... 107
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Section 1 Theories of ageing/changing
demographics
Growing older is not just an accumulation of years. The ageing process affects us all
in different ways. Some people seem to age faster than others and for others time
seems to leave few traces. The various aspects of ageing, whether physical or
psychosocial, don‟t occur at the same rate for all. Factors which may contribute to the
ageing process include heredity, congenital conditions, nutrition, environment and
lifestyle to name a few. It is important to acknowledge that the ageing process is one
which is natural, part of the human lifespan and should be considered a time of
growth and new challenges and not inevitable decline.
In contemporary Western society getting older is often regarded as a negative
experience. How and why we age is not often considered. The process of ageing is
difficult to explain and thus there are numerous theories as to why ageing occurs.
Ageing is unavoidable and an understanding of why we age will assist us to age more
gracefully or even retard the ageing process. Various theories have been developed
e.g. biological, psychosocial, disengagement and wear and tear. You will be
researching some of these theories and providing your understanding of them in
Activities 2 and 3.
More and more young people are seeking to delay the effects of ageing and to
surgically enhance their looks, in an effort to boost their self esteem. Older people
choose to undergo plastic surgery in an effort to appear younger as there is a stigma
attached to growing old. Either way no-one wants to get older!
There are many new terms associated with ageing that you will learn as you study
this unit. Some useful terms for you to familiarise yourself when nursing the older
person include „gerontology‟ which means the study of ageing. It is also used to
describe a specialty area for health care workers and other professions.
The word „geriatrics‟ refers to the diagnosis and treatment of disorders which occur in
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Research is being conducted to increase our understanding of the ageing process:
does the body „wear out‟ like a machine, do our changing roles in society cause us to
age or is ageing due to lack of an understanding of how ageing occurs or poor
lifestyle choices? There are many theories of ageing and all sound very plausible.
Activity 2
Access websites, or texts of your choice and create a mind-map of the theories
of ageing which you have found. Write a brief explanation next to each of the theories
to assist you with understanding what they mean. An example is given below.
Activity 1
To assist in your understanding of ageing and the ageing process,
define the following terms:
Life expectancy ____________________________________________________
__________________________________________________________
Life span ____________________________________________________
__________________________________________________________
Morbidity ___________________________________________________
__________________________________________________________
Co-morbidity ________________________________________________
__________________________________________________________
Mortality ____________________________________________________
__________________________________________________________
Senescence __________________________________________________
__________________________________________________________
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Section 2 Age related changes
Growing old is a new experience for the person who experiences it and for their
relatives and friends as well. Your nursing experiences may bring you into contact
with older clients in a variety of settings, from residential aged care to homecare,
from acute care to hospice/palliative care. Providing appropriate basic nursing care to
the older client requires an understanding of the normal progressive changes which
affect the physical, psychological and social aspects of the client.
Activity 1
Refer to related text about the age-related changes which affect each body
system. You will find it useful to document your findings briefly in the form of a
table for your easy reference. In the last column write down some of the disease
processes which may affect individual systems.
Body system Physical changes of ageing Disease processes /
Conditions
Cardiovascular
more prominent
arteries in head, neck and extremities
valves become thicker and more rigid
stroke volume
decreases by 1% per
year
heart pigmented with lipofuscin
less elasticity of vessels
less efficient oxygen utilisation
aorta becomes dilated and elongated
cardiac output
decreases
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Activity 1 (continued)
Body system Physical changes of ageing Disease processes /
Conditions
Respiratory
loss of elasticity and
increased rigidity of costal cartilage
blunting of cough and laryngeal reflexes
alveoli fewer in number and larger in size
thoracic muscles more
rigid
lungs are smaller and
more rigid and have less recoil
forced expiratory volume reduced
lack of basilar inflation
decreased ciliary action
Musculoskeletal
muscle fibres reduced in size
muscle strength diminishes
tendons shrink and harden
reflexes lessened
muscle cramping occurs
bones more brittle
impaired flexion and extension movements
shortening of vertebrae
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Activity 1 (continued)
Body system Physical changes of ageing Disease processes /
Conditions
Integumentary
skin loses resilience and moisture
epithelial layer thins
elastic collagen fibres shrink
wrinkling of face and neck
spots and lesions present
angiomas may be found on the trunk
seborrhoeic lesions or keratoses
pressure ulcers
Thermoregulation
lower normal body
temperature
reduced ability to respond to cold/heat
cooler extremities
decreased perspiration
Gastrointestinal
decreased taste sensation
reduced saliva and salivary ptyalin
oesophagus more dilated
liver smaller in size
reduced intestinal blood flow
decreased oesophageal motility
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Activity 1 (continued)
Body system Physical changes of ageing Disease processes /
Conditions
Genitourinary
bladder muscle weakens
and bladder capacity decreases
micturition reflex delayed
decrease renal filtration and renal efficiency
increased incontinence
Female:
diminished breast tissue,
pendulous flabby condition
decreased oestrogen and
vaginal secretions
decreased uterine size
atrophy of epithelial lining of vagina
urgency and stress incontinence
Male:
decreased testosterone,
sperm count and testicular
size
increased prostatic size
urinary frequency and
retention
Neurological
neurons are steadily lost in the brain
synthesis and metabolism
of neurotransmitters are
diminished
brain mass is progressively lost
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