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Constipation in the Elderly课程教案、知识点、字幕

同学们好,今天我们来上 老年便秘的护理

便秘是指排便困难或排便次数减少

且粪便干结便后无舒畅感

老年人便秘属于慢性便秘

慢性便秘通常使用

罗马Ⅱ标准来诊断

便秘是老年人的常见症状

其便秘程度随着增龄而加重

据资料统计,我国60岁以上

人群中老人便秘的发病率

为15%~20%之间

随着年龄的增长,发病率不断地增加

84岁以上老年人便秘发生率

可达到20%~37%之间

在接受长期照护的老年人中

甚至可达到80%。

护理评估有四个方面,一 健康史

二 便秘的状况 三 辅助检查

四 心理-社会状况

健康史

1 一般资料

收集患者的年龄 性别 饮食习惯

生活方式等基本信息

2 既往史 了解患者的疾病史

用药史 家族史

3 便秘的原因

引起老年便秘的原因很多

需从心理因素

不良的饮食习惯生活方式

心理因素以及是否有并发症

等方面进行评估。

一 生理因素

随着年龄的增长

老年人的食量或体力活动明显减少

胃肠道分泌消化液减少 肠管的张力

蠕动减弱

腹腔盆底肌肉乏力

肛门内外括约肌减弱 胃结肠反射减弱

直肠敏感性下降

使食物在肠管内的滞留时间过久

水分过度吸收 引起便秘

二 不良饮食习惯

一 膳食纤维摄入

二 饮水不足 老年人的口渴感觉迟钝

对体内的高渗状态调节能力下降

易出现的轻度脱水 增加便秘的危险

三 不良的饮食行为

如饮水过少

3 活动减少

老年人肠内容物长时间滞留

在肠管内 水分被过度地吸收

而造成了排便困难

4 药物作用 抗胆碱能药

阿片类镇痛药

非甾体类药物利尿药

抗抑郁药均可抑制肠道运动

5 神经系统疾病和心理障碍

中枢或末梢神经病变者

均可导致便秘如帕金森病

糖尿病自主神经病变

二 便秘状况

1 便秘情况

询问便秘开始的时间大便的频率

性状

疾病和用药饮食

活动等情况

2 便秘的伴随症状

观察排便是否伴有口渴恶心

腹胀 腹痛 会阴胀痛等

3 便秘的并发症 粪便嵌塞

②粪石与粪瘤 ③粪性溃疡

④大便失禁 ⑤直肠脱垂

三 辅助检查

一 结肠镜直肠镜

钡剂灌肠

直肠肛门压力测定

球囊排出试验等

四 心理 社会状况

长期便秘会导致老年人烦躁

失眠 抑郁 焦虑等心理问题

严重影响着老年人的生活质量

同时也给个人

家庭社会造成沉重的经济负担

常见护理诊断

1便秘

与老化 活动减少 不合理饮食

药物副作用等有关

2焦虑

与患者担心便秘并发症及其预后有关

3 舒适度下降

与排便时间 排便困难

便后无舒畅感等有关

4知识缺乏

缺乏合理饮食 健康生活方式

及缓解便秘方法等相关知识

便秘治疗与护理的总目标

①患者便秘缓解或消失

②患者形成良好生活方式

且定时排便

③患者掌握便秘护理知识

能描述引起便秘的原因

一 排便护理

指导老年人养成良好的排便习惯

一 定时排便

早餐后或临睡前按时蹲厕

二 勿长期服用泻药

防止药物依赖性的发生

三 保证良好的排便环境

便器应清洁而保暖

二 指导使用辅助器

为体质虚弱的老年人提供

便器椅或在老年人面前放置椅背

三 人工取便法

老年便秘者易发生粪便嵌顿 无法自主排出

需采取人工取便法

四 排便注意事项

指导患者勿忽视任何一次便意

尽量不留宿便

注意排便技巧

如身体前倾 心情放松

先深呼吸 后闭住声门

先深呼吸 后闭住声门

向肛门部位用力等

五 生物反馈疗法

此疗法通便成功率为75%~90%

二 一般护理

1 调整饮食结构

饮食调整是治疗便秘的基础

(1) 多饮水

每天饮水量在2000~2500ml左右

清晨空腹饮一杯温开水

以刺激肠蠕动

(2) 摄取足够的膳食纤维

每日膳食纤维摄入量应在25-30g之间

以不可溶性纤维对预防便秘最为帮助

(3) 多食产气食物及维生素B丰富的食物

利用其发酵产气

促进肠蠕动

(4) 增加润滑肠道食物

如蜂蜜水

(5)少饮浓茶或含咖啡因的饮料

二 调整生活方式

行动完全不受限制患者

建议每日行走15-20min或每天2次

不能行走或只能卧床休息者

推荐在椅子或床上运动

通过转动身体

推动手臂等方式进行锻炼

三 满足老年人的私人空间需求

三 用药护理

原则上是指导患者勿长期服用泻药

防止药物依赖性的发生

1、口服泻药

2、 外用简易通便剂

3、灌肠法

4、心理调适

(1) 耐心听取患者的倾诉

取得患者的信任

(2)及时发现并解决问题

增加治疗信心

(3) 讲解便秘发生的原因

调节患者情绪

使其精神放松

(4) 鼓励患者参与集体活动

提高患者的家庭支持和社会支持水平

五 健康指导

1 适当运动和锻炼

(1) 参加一般活动

老年人根据自身情况参加运动

(2)避免久坐久卧

避免长期卧床或坐轮椅等

(3) 腹部按摩

(4) 收腹运动和提肛肌运动

(5) 卧床锻炼方法等

2 建立健康的生活方式

一 培养良好的排便行为

二 改变不良的饮食习惯

三 高血压 冠心病 脑血管

意外等患者应避免用力排便

3 应正确使用通便药物

一 容积性泻药服用时需饮水250ml

二 润滑剂的泻药也不可长期服用

以免引起脂溶性维生素的吸收

三 温和的口服泻药宜在睡前1个小时服用

老年护理学(Gerontological Nursing)课程列表:

CHAPTER 1: General Introduction to Geronological Nursing

-1.1 Human Life Expectancy and Age Classification of the Elderly

--Human Life Expectancy and Age Classification of the Elderly

--【Vedio Recommendation】 How do we measure life expectancy ?

-1.2 Population Aging

--Population Aging

--【Literature Recommendation】World Report on Ageing and Health: 2015

-1.3 Influence and Countermeasures of Population Aging

--Influence and Countermeasures of Population Aging

--【Literature Recommendation】World Population Ageing Highlights:2019

-1.4 Goals and Principles of Elderly Care

--Goals and Principles of Elderly Care

--【Book Recommendation】Evidence-Based Geriatric Nursing Protocols for Best Practice

-1.5 Theories Related to Elderly Care

--1.5.1 Personality Development Theory and Life Review

--1.5.2 Disengagement Theory and Activity Theory

--1.5.3 Self-efficacy and Chronic Disease Management

--【Vedio Recommendation】8 Stages of Development by Erik Erikson

--【Literature Recommendation】Activity Theory, Disengagement Theory, and Successful Aging

--【Book Recommendation】Self-Efficacy in Changing Societies

--【Literature Recommendation】Obstacles and Policies of the Social Capital Participates in the Combination of Medical Care and Pension: A Literature Review

-1.6 Elderly Support and Elderly Care

--1.6.1 Concepts of Elderly Healthcare, Elderly Support and Elderly Care

--1.6.2 Home-based Elderly Care Model

--1.6.3 Institutional Elderly Care Model

--1.6.4 Integrated Medical and Nursing Care Model

--【Vedio Recommendation】Day in the Life of Home Care

--【Website Recommendation】Official Website of the National Institutes of Health

-Concept Map

--【Concept Map】General Introduction to Geronological Nursing

-【Test】CHAPTER 1

-【Case Discussion】CHAPTER 1

CHAPTER 2: Elderly Health Assessment

-2.1 Aging Changes in the Elderly

--2.1.1 Aging of the Respiratory System

--2.1.2 Aging of the Cardiovascular System

--2.1.3 Aging of the Digestive System

--2.1.4 Aging of the Urinary System

--2.1.5 Aging of the Endocrine System

--2.1.6 Aging of the Motor System

--2.1.7 Aging of the Nervous System

--2.1.8 Aging of the Sensory System

--【Literature Recommendation】Exercise Attenuates the Major Hallmarks of Aging

--【Book Recommendation】Hazzard's Geriatric Medicine and Gerontology

-2.2 Comprehensive Health Assessment of the Elderly

--Comprehensive Health Assessment of the Elderly

--【Literature Recommendation】Instruments to evaluate mental well-being in old age: a systematic review

-2.3 Principles of Elderly Health Assessment

--Principles of Elderly Health Assessment

-2.4 Assessment of the Functional Status of the Elderly

--Assessment of the Functional Status of the Elderly

--【Literature Recommendation】The Lawton Instrumental Activities of Daily Living (IADL) Scale

-2.5 Assessment of Cognitive Function in the Elderly

--Assessment of Cognitive Function in the Elderly

-2.6 Assessment and Adjustment of the Living Environment for the Elderly

--Assessment and Adjustment of the Living Environment for the Elderly

--【Literature Recommendation】Age-friendliness of living environments from the older person’s viewpoint: development of the Age-friendly Environment Assessment Tool

-Concept Map

--【Concept Map】Elderly Health Assessment(1)

--【Concept Map】Elderly Health Assessment(2)

-【Test】CHAPTER 2

-【Case Discussion】CHAPTER 2

CHAPTER3: Elderly Mental Health and Mental Health care

-3.1 Overview of the Psychological Characteristics of the Elderly

--Overview of the Psychological Characteristics of the Elderly

-3.2 Influencing Factors of Psychological Changes in the Elderly

--Influencing Factors of Psychological Changes in the Elderly

-3.3 Common Psychological Issues and Their Management in the Elderly

--3.3.1 Common Psychological Issues and Their Management in the Elderly (1)

--3.3.2 Common Psychological Issues and Their Management in the Elderly (2)

--【Book Recommendation】Development Through the Lifespan

-3.4 Depression in the Elderly

--3.4.1 Overview of Depression in the Elderly

--3.4.2 Clinical Symptoms of Depression in the Elderly

--3.4.3 Caring for Elderly Patients with Depression

--【Website Recommendation】

--【Documentary Recommendation】Depression:Out of the Shadows

--【Literature Recommendation】Management of depression in older adults:A review depression in older people

-3.5 Elderly Patients with Dementia

--3.5.1 Identification of Dementia Symptoms in the Elderly

--3.5.2 Intelligence Rehabilitation of Elderly Patients with Dementia

--3.5.3 Safety Care of Elderly Patients with Dementia

--【Website Recommendation】The Global Voice on Demaentia

-Concept Map

--【Concept Map】Elderly Mental Health and Mental Health Care

-【Test】CHAPTER 3

-【Case Discussion】CHAPTER 3

CHAPTER4: Elderly Daily Care

-4.1 Precautions for Daily Care of the Elderly

--Precautions for Daily Care of the Elderly

-4.2 General Care of Elderly Skin

--4.2.1 Characteristics and General Care of Elderly Skin

--4.2.2 Skin Itching and Its Management in the Elderly

--【Website Recommendation】American Academy of Dermatology

-4.3 Clothing Hygiene for the Elderly

--Clothing Hygiene for the Elderly

--【Literature Recommendation】The Design Methods of Functional Clothing for the Elderly

-4.4 Dietary Care for the Elderly

--4.4.1 Nutritional Needs of the Elderly and Influencing Factors of these Needs

--4.4.2 Dietary Care for the Elderly

--【Book Recommendation】Nutrition Care of the Older Adult: a Handbook for Dietetics

--【Website Recommendation】Nutrition for older persons

-4.5 Sleep Guidance for the Elderly

--4.5.1 Sleep Characteristics of the Elderly

--4.5.2 Sleep Guidance for the Elderly

--【Book Recommendation】An Occupational Therapist's Guide to Sleep and Sleep Problems

--【Website Recommendation】American Academy of Sleep Medicine

-4.6 Exercises Guidance for the Elderly

--4.6.1 Evaluation of Exercise Intensity in the Elderly

--4.6.2 Precautions Elderly Undertaking Exercises

--【Website Recommendation】American College of Sport Medicine

--【Book Recommendation】Handbook of Activities for the Elderly

-Concept Map

--【Concept Map】Elderly Daily Care

-【Test】CHAPTER 4

-【Case Discussion】CHAPTER 4

CHAPTER5:Medication Safety and Care for the Elderly

-5.1 Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly

--Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly

--【Website Recommendation】How Drugs Work In the Elderly

-5.2 Common Adverse Drug Reactions and Their Causes in the Elderly

--Common Adverse Drug Reactions and Their Causes in the Elderly

-5.3 The Principles of the Use of Medications in the Elderly

--The Principles of the Use of Medications in the Elderly

--【Literature Recommendation】The American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

-5.4 Prevention of Adverse Drug Reactions in the Elderly

--Prevention of Adverse Drug Reactions in the Elderly

--【Literature Recommendation】Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies

-5.5 Medication Compliance in the Elderly

--Medication Compliance in the Elderly

-Concept Map

--【Concept Map】Medication Safety and Care for the Elderly

-【Test】CHAPTER 5

-【Case Discussion】CHAPTER 5

CHAPTER6:Nursing Care for the Elderly with Common Health Problems and Diseases

-6.1 Falls in the Elderly

--6.1.1 Epidemiological Characteristics of Elderly Falls

--6.1.2 Risk Factors for Falls in the Elderly

--6.1.3 Prevention of Falls in the Elderly

--【Website Recommendation】CDC STEADI(Stopping Elderly Accidents, Deaths & Injuries Tool Kit)

-6.2 Dysphagia in the Elderly

--Dysphagia in the Elderly

-6.3 Urinary Incontinence in the Elderly

--Urinary Incontinence in the Elderly

-6.4 Constipation in the Elderly

--Constipation in the Elderly

--【Literature Recommendation】Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management

-6.5 Dry Mouth in the Elderly

--Dry Mouth in the Elderly

--【Website Recommendation】Academy of Nutrition and Dietetics

-6.6 Elderly Nutritional Deficiencies

--Elderly Nutritional Deficiencies - emaciation

-6.7 Visual Impairment in the Elderly

--Visual Impairment in the Elderly

--【Website Recommendation】Senior Eye Exams

-6.8 Senile Deafness

--Senile Deafness

-6.9 Elderly Delirium

--Elderly Delirium

-6.10 Elderly Frailty

--Elderly Frailty

--【Literature Recommendation】Frailty in elderly people/Frailty in older people

-6.11 Pneumonia in the Elderly

--Pneumonia in the Elderly

-6.12 Hypertension in the Elderly

--Hypertension in the Elderly

--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension

-6.13 Stroke in the Elderly

--Stroke in the Elderly

-6.14 Stable Angina in the Elderly

--Stable Angina in the Elderly

--【Literature Recommendation】2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

-Concept Map

--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases

-【Test】CHAPTER 6

-【Case Discussion】CHAPTER 6

CHAPTER7 Hospice Care for the Elderly

-7.1 Concept of Hospice Care

--Concept of Hospice Care

--【Website Recommendation】 Definition of Palliative Care,WHO

-7.2 Death Education

--7.2.1 Death Education (1)

--7.2.2 Death Education (2)

--【Book Recommendation】The Meaning of Death by Herman Feife

-7.3 Nursing for Pain in the Dying Elderly

--Nursing for Pain in the Dying Elderly

--【Journal Recommendation】

-7.4 Nursing for Major Bleeding in the Dying Elderly

--Nursing for Major Bleeding in the Dying Elderly

-7.5 Nursing for Delirium in the Dying Elderly

--Nursing for Delirium in the Dying Elderly

-7.6 Nursing for Dyspnea in the Dying Elderly

--Nursing for Dyspnea in the Dying Elderly

--【Website Recommendation】The Hospice and Palliative Nurses Association,HPNA

-7.7 Psychological Problems and Nursing in the Dying Elderly

--Psychological Problems and Nursing in the Dying Elderly

--【Book Recommendation】On Death and Dying ,by Elisabeth Kübler-Ross

-7.8 Grief Counseling for the Widowed Elderly

--Grief Counseling for the Widowed Elderly

--【Book Recommendation】I Wasn't Ready to Say Goodbye,by Noel·Brook,Blair·Pamela

-Concept Map

--【Concept Map】Hospice Care for the Elderly

-【Test】CHAPTER 7

-【Case Discussion】CHAPTER 7

Constipation in the Elderly笔记与讨论

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