Nursing In the Elderly Essay Example

11Care Of The Elderly

Care of the Elderly

Elderly patients are normally grouped into 3 groups and these are the young old, the old and the very old.Mr. Demetriou is an old patient therefore. The history taking in the old will involve finding out the chief complains of the patient which in this case is the effects that will result from the tumor such as pain, difficulty in breathing and dysphagia (Balducci et al, 2004).

The past medical history Mr. Demetriou is a known diabetic and has been on oral hypoglycemic, metformine which he has stopped due to renal failure. In the history, the ability of Mr. Demetriou to hear and his eye sight will be assessed. He will also be assessed for behavior changes, if he is dependent on others and whether he is autonomous or is dependent on others. In the social history one would seek to find out whether he has any exercises, his daily habits such as smoking and alcoholism and whether he gets social support for example pension scheme for the care of the patient will require expenses such as the purchasing of medication and if the daughter will be able to offer care to the patient (Zulian, 2002). This will involve the use of bethels index to find out his daily living habits such as the (bowels, bladder) for continence or incontinence presence. The use of the toilet ,his feeding, mobility and movement and how the patient dresses and grooms himself will be assessed to find out if he is dependant or not. Review Mr. Demetriou systems will involve the observation of common things such as immobility, incontinence, instability and falls, intellectual impairment, pressure sore development if any, impared special senses (Zulian, 2002).

Examination for systems will be centered more on the cardiovascular system where Mr. Demetriou will be assessed to find out the presence of hypertension which will be characterized by high blood pressures and cardiomegally which results from the heart working for many years .also watching out for arrhythmias will be done. The older people also have the tendencies to develop aortic aneurisms. The skin should also be examined for bed sores, ulcers and wounds. If the patient will be immobile, two hourly turning of the patient will be recommended. Central nervous system should involve the examination of the higher centers i.e. (knowledge, language, speech, memory) and orientation. In the muscoskeletal systems the patient should be assessed for possible deformities such as kyphosis and osteoarthritis (Haley, 2003).

Glottic tumors are located in the glottic region. The glottic region normally houses the vocal cords which are vital in phonation and protection of the airways when swallowing. The vocal cords are also essential in coughing which goes a long way to offer clearance of the airway. In early disease, if the tumor originates from the glottis, the patient will have intermittent soreness and hoarseness with some changes in the voice, dysphagia, referred ear pain and shortness of breath will then ensue. The patient night also have bad breath and stridor. Risk factors for the development of the cancer would include heavy chronic alcohol consumption especially the neat spirits. Heavy smoking has also been associated with the cancer. The males are more predisposed to the development of the cancer compared to the female counterparts. Those individuals who are above 55 years of age will also be at a risk of developing the cancer (Haley, 2003).

In Pathophysiology, Symptoms of advanced laryngeal cancer would vary depending on which part of the larynx has been affected. The larynx is divided into three parts i.e. the upper part of the vocal cords which is the supra glottis, the middle part which include the vocal codes is the glottis the lower part which is the subglottis (Flint , 2002).The cancer more frequently affects the glottis. Tumors located in the supraglottic fold would tend to make patients exhibit, dysphagia, pain while swallowing, and changes in the voice, difficulty in breathing, stridor and ear pain that is referred (Cohen et al, 2006). The tumors in the vocal cords (glottic tumors) will cause the patient to present with hoarseness of the voice, difficulty in breathing, dysphagia and stridor. On the other hand subglottic tumors tend to exhibit difficulty in breathing and stridor. Glottic tumors are of squamous cell type. The glottic tumors are graded basing on their degree to differentiate or have mitotic capabilities and their cellular pleomorphism.They are thus grouped into well, moderately or poorly differentiated. Most of the glottis tumors tend to be moderately differentiated (Demiral et al, 2004). The glottic tumors metastasis to the regional lymph nodes and lungs or they can even spread to other parts of the body. Also they could spread by direct extension to the thyroid gland and jugular vein.

Early symptoms will include one having a hoarse voice, this will be followed by stridor or noisy sounds while breathing in which is caused by obstruction of the airways. The patient will then have difficulties in swallowing and coughing up of blood by the patient. The patient will also have a sensation presence of something within the throat. Later on the patient might have dib due to the growing tumor blocking the wind pipe. Glottic Cancers in early stages will have stage T1, which will only be composed of tumors affecting one site on larynx, there will be no metastasis and there will still be normal vocal fold motion and stage T2, the patient will have the cancer affecting more than one site of the larynx, the vocal fold function will be abnormal but will still be moving. In Glottic cancers that are in Advanced stages in stage T3 there will be complete non-movement of one of the vocal folds while stage T4 will involve the invasion of the thyroid cartilage or structures outside of the voice box. With the TNM Staging, the grouping of the tumor will be done in terms of the type, the presence or absence of lymph node involvement and the presence or absence of metastasis(Chwala, 2009).

Diagnostic evaluation based on the physical exam with such will involve taking of a complete history and conducting of physical exams. This will entail the collection of the symptoms the patients presents with such as pain, persistent sore throat, referred ear pain, dysphagia. History taking should keep into consideration of the risk factors such as tobacco and alcohol use. The patient will also be examined on the neck and head and will include the examination of the pharynx and oral cavity and this would employ the use of a laryngoscope (Schnieper et al, 2003). Physical exam will involve the palpation of the neck and supraclavicular fossa to confirm the presence of cervical adenopathy and other masses that might be present .This will include the checking for masses and also the palpation for the masses. Imaging studies could also be employed in the diagnosis of the cancer (Yeager et al, 2005). This will include the use of the computed topographic scan, magnetic resonance imaging of the larynx also the chest radiogragh.Identification of the cancer location and also to rule out possible metastasis will be achieved( Holsinger et al, 2005). Examination under anesthesia for biopsy could also be used to confirm the diagnosis and also to rule out the possible metastasis to adjacent structures i.e. supra glottis and the subglottic. This will involve the use of the laryngoscope, esophagoscopy and pharyngioscope and on indications by radiographs bronchoscopy could be done (Holsinger et al, 2005).

The patient is a known diabetic and has been on oralhypoglycaemics, metformine which has recently been stopped due to renal failure. The patient will therefore have to be put on the short acting insulin to enable him to control his blood sugars. The short acting insulin should be given 3 times a day. Since the patient has a daughter, the daughter will be required to provide care by assisting the patient to comply with his medication by administering the insulin as recommended. Due to the patient also being diabetic, this creates the likely hood of easily getting infections .therefore the patient should also be put on antibiotics to cover for infections. The patient should also watch his diet, there should be slight intake of the carbohydrates and the proteins. The diet will be monitored and regulated by the daughter (South-Paul et al, 2007).

The discharge plan will encompasses an inter-disciplinary team coming in to meet the health care of the patient. This care will involve the surgeon, a dentist, radiation oncologist for radiotherapy, an optician due to diabetes for fundoscopy and eye checkups with a psychologist for counseling (Brumund et al, 2005). Follow up appointments for the patient will be done basing on the complications that may arise and also to deal with the social and the psychological aspects associated with the cancer. The patient should have periodic examinations of the head and neck with each subsequent visit especially when the patient has the dysphagia, difficulty in breathing or even pain. They should also be reviewed by the dentist and the oncologist after radiotherapy (Guiney, 2008). The patient will then be scheduled for reviews basing on the patients characteristics, the schedules could either be on1st year the visit scheduled to 1-3months and the 2nd year the visits will be scheduled after 2-4 months, with the 3rd year post treatment scheduled after every 4months, 4th and 5th year being in the 4-6 months, after 5years the visits will be every 12 months. Radiographs should be done yearly to assess whether there is metastasis or not and also the progression of the illness. Liver function tests are also done yearly to check the integrity of the liver. Thyroid function tests are also to be conducted especially after the patient the patient has received lower neck radiations (Haley, 2003).

Evaluation of Self-care/indepence in adult daily activities of Mr. Demetriou

Mr. Demetriou requires assistance in activities of daily living. He already is immobile and he has muscle dystrophy and loss of lower limb strength and was using previously a scooter for mobility. The daily activities that he should be helped in include Mr. Demetriou being assessed if can dress himself without help or requires some help or even total dependency of the patient while dressing. Mr. Demetriou assessment of the bowel and bladder emptying will aimed at checking for incontinence whether he is continent or is partially continent or even incontinent.Mr. Demetriou feeding should be assessed to find out whether he can feed all by himself or whether he requires some or no help at all while feeding. Since Mr. Demetriou is immobile and has weak muscles, he should be assisted in mobility.Mr. Demetriou will require assistance in taking a bath as well as dressing or grooming since he might not be totally independent and this is because of the weakness of the muscles, the patent might therefore not be totally independent and therefore he would require assistance in carrying out of some of the activities (Lichtman et al, 2007).

Counseling of the patient should be given supportive counseling services in order to promote and also improve the quality of lives of the cancer patients. The family as well as the patient should be made to come in terms with the diagnosis arrived at and also the family should be offered mental health education on how to reduce stress and also how to cope and adjust to the diagnosis. The counseling will also be aimed at facilitating communication between the patient and the family (Braz et al, 2005). Psychosocial care is mainly a patient centered approach this is because the diagnosis as well as the treatment of cancer by itself could lead to emotional consequences for the patients and their respective families. The treatment of the emotional distresses of the cancer patients should therefore be viewed as an integral part of the quality of care they are supposed to receive. Emotional distress should therefore be established in the routine visits that the patient will make to the hospital (Zulian, 2002).

In conclusion, the care of Mr. Demetriou will require an interdisciplinary involvement to enable the success of the care being given to them. The elderly patients require more attention and assistance in the activities of daily living since these will go in the long run in facilitating or creating an enabling environment for recovery and dealing with the cancer (Haley, 2003).


Guiney M (2008). Radiation Therapy of Glottic Carcinoma: Peter Maccallum Cancer Institute Experience, Australian and New Zealand Journal of Surgery.

Chwala S. & Carney A.(2009). Organ Preservation Surgery For Laryngeal Cancer Department of Otolaryngology, Head And Neck Surgery, Flinders Medical Centre, South Australia, Australia Chawla And Carney; Licensee Biomed Central Ltd.

Schnieper I et al (2003). Early Glottic Carcinoma: Treatment According Patient’s Preference? Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrasse, Zurich, Switzerland.

. Elsevier Inc. All Rights Reserved.Curr Probl CancerOrgan Preservation Laryngeal Surgery in The Era of Chemo radiation. Holsinger et al (2005).

.Ann Otol Rhinol LaryngolFront lateral Vertical Partial Laryngectomy without Tracheostomy for Invasive Squamous Cell Carcinoma of the True Vocal Cord: A 25-Year Experience. Brumund et al, (2005).

.Otolaryngol Clin N Organ Preservation Surgery For Intermediate Size (T2 And T3) Laryngeal Cancer. Yeager et al (2005).

2005 Elsevier IncCurr Probl CancerSupracricoid Partial Laryngectomy: An Organ Preservation Surgery for Laryngeal Malignancy. Holsinger et al (2005).

Elsevier Inc.Quality of Life and Depression in Patients Undergoing Total and Partial Laryngectomy,Braz et al (2005).

. Elsevier IncAuris Nasus LarynxPrognostic Significance Of Egf Receptor Expression In Early Glottic Cancer. Demiral et al (2004).

2006,Ann Otol Rhinol LaryngolVoice-Related Quality Of Life In T1 Glottic Cancer: Irradiation Versus Endoscopic Excision. Cohen et al (2006).

Elsevier Inc.Otolaryngol Clin N.minimally Invasive Techniques for Management of Early Glottic Cancer. Flint Pw, (2002).

Balducci L Et Al. (2004). Comprehensive Geriatric Oncology (Ed 2) London, United Kingdom, Taylor and Francis, 2004

Lichtman et al, (2007) .International Society of Geriatric Oncology Chemotherapy Taskforce: Evaluation of Chemotherapy in Older Patients–An Analysis of the Medical Literature. J Clin Oncol.

Zulian G (2002).Geriatric Medical Oncology in the Care Of Elderly Cancer Patients, Top of Form Care of the Elderly 5Care of the Elderly 4Care of the Elderly 3Care of the Elderly 2Care of the Elderly 1Care of the Elderly
Bottom Of Form. Elsevier Science Ireland Ltd.

Haley W (2003).Family Caregivers of Elderly Patients with Cancer: Understanding and Minimizing the Burden of Care, School Of Aging Studies, University Of South Florida, Tampa, Florida.

Sessions Dg et al (2002).Management Of T3n0m0 Glottic Carcinoma: Therapeutic Outcomes. Department Of Otolaryngology-Head and Neck Surgery, Washington University School Of Medicine, St. Louis, Missouri.

Halasyamani L Et Al (2006). Transition Of Care For Hospitalized Elderly Patients—Development Of A Discharge Checklist For Hospitalists. Society Of Hospital Medicine, Philadelphia, Pennsylvania, Usa.

Jolley D Et Al (2004) Older People With Long-Standing Mental Illness: The Graduates. Advances In Psychiatric Treatment .

Abdul-Hamid W (2009). Older People With Enduring Mental Illness: A Needs Assessment Tool .Centre For Psychiatry, Barts And The London, Queen Mary’s School Of Medicine And Dentistry And Consultant Psychiatrist, The Linden Centre, Broomfield, Chelmsford, Uk.

South-Paul et al (2007).current diagnosis & treatment in family medicine,2nd edition. McGraw-Hill Companies.

Whelan C, (2008). Acute Hospital Care For The Elderly Patient: Its Impact On Clinical And Hospital Systems Of Care
.Elsevier Inc