11 Geriatric Nursing Care Plans (Older Adult)

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In this nursing care plan guide are 11 nursing diagnosis for the care of the elderly (older adult) or geriatric nursing or also known as gerontological nursing. Learn about the assessment, care plan goals, and nursing interventions for gerontology nursing in this post.

Gerontology nursing or geriatric nursing specializes in the care of older or elderly adults. Geriatric nursing addresses the physiological, developmental, psychological, socio-economic, cultural and spiritual needs of an aging individual.

Since aging is a normal and fundamental part of life. Providing nursing care for elderly clients should not only be isolated to one field but is best given through a collaborative effort which includes their family, community, and other health care team. Through this, nurses may be able to use the expertise and resources of each team to improve and maintain the quality of life of the elderly.

Geriatric nursing care planning centers on the aging process, promotion, restoration, and optimization of health and functions; increased safety; prevention of illness and injury; facilitation of healing.

Nursing Care Plans

Here are 11 nursing care plans (NCP) and nursing diagnosis for geriatric nursing or nursing care of the elderly (older adult):

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  1. Risk for Falls
  2. Impaired Gas Exchange
  3. Hypothermia
  4. Disturbed Sleep Pattern
  5. Constipation
  6. Adult Failure to Thrive
  7. Risk for Aspiration
  8. Risk for Deficient Fluid Volume
  9. Risk for Injury
  10. Risk for Infection
  11. Risk for Impaired Skin Integrity
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Risk for Aspiration

Nursing Diagnosis

Risk Factors

Here are the common risk factors for Risk For Aspiration nursing diagnosis:

  • Impaired cough and gag reflexes or ineffective esophageal sphincter

Defining Characteristics

  • Not applicable for risk diagnosis. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

The commonly used expected outcomes or patient goals for Risk for Aspiration nursing diagnosis:

  • The patient will swallow independently without choking.
  • The patient’s airway will be patent and lungs are clear upon auscultation both before and after meals.

Nursing Interventions and Rationale

The following are sample nursing interventions and rationale (or scientific explanation) for the Risk for Aspiration that you can use for your nursing care plan for geriatric nursing or gerontological nursing care plans:

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Nursing InterventionsRationale
Nursing Assessment
Evaluate the patient’s swallowing reflex by putting your thumb and index finger on both sides of the laryngeal prominence and instruct the patient to swallow. Assess gag reflex by gently touching one side and then the other palatal arch with a tongue blade. Record these findings.Ability to swallow and an intact gag reflex are important to avoid aspiration and choking before the patient puts foods/fluids in the mouth.
Monitor food intake. Record patient’s food consumption (including amount and consistency), where the patient puts food in the mouth, how the patient manipulates or chews prior swallowing, and the duration of time before the patient swallows the food bolus.This information can be useful for some caregivers during the succeding feedings.
Monitor the patient during swallowing.This evaluation will help assess the patient’s swallowing ability without choking. Deficiencies may require aspiration precautions.
Monitor the patient for choking or coughing before, during, or after swallowing.Choking or coughing can happen within a few minutes following food or fluid placement in the mouth and indicates aspiration of material into the airway.
Check for a wet or gurgling sound upon speaking after the patient swallow.Wet sounding speech may signal a pulmonary aspiration and can indicate restricted or absent gag and swallow reflex.
Assess the patient for breath sound abnormalities (e.g., crackles [rales], rhonchi, wheezes), shortness of breath, dyspnea, cyanosis, increasing temperature, and deteriorating level of consciousness).These are indicative of silent aspiration. For example, elder patients are at higher risk for silent aspiration since their sphincter fails to close completely between swallows.
Watch out for food retention on the sides of the mouth.This can signal a poor tongue movement.
Check for drooling of saliva or food or inability to close the lips when using a straw.These are signs of a restricted jaw, lip, or tongue movement.
Therapeutic Interventions
Anticipate a video fluoroscopic swallowing exam (VFSE) or modified barium swallow exam (MBS) to evaluate the patient’s gag and swallow reflexesThis noninvasive procedure is used to determine whether patients are aspirating, consistency of foods and liquid most likely to be aspirated, and aspiration cause. Using four consistencies of barium, the radiologist and speech therapist check for the presence of decreased or impaired tongue function, reduced peristalsis in the pharynx, delayed or absent swallow reflex, and restricted ability to close the epiglottis that guards the airway.
Based on the results of the swallowing video, fluoroscopy, thickened fluids may be prescribed.Thickening agents are added to the fluid to increase its viscosity and improve swallow safety. Likewise, mechanical soft, pureed, or liquid diets may be ordered to permit patients to take in food with low risk for aspiration.
Anticipate the need for a speech therapist as indicated.This collaboration will address the problem of gag and swallow reflexes.
Tilt the head forward 45° during swallowing for patients with impaired swallowing reflex.

 

Note: Tilt the head toward the unaffected side for patients with hemiplegia.

This head position will help prevent inadvertent aspiration by closing off the airway.
Encourage adequate rest periods prior meals.Low energy or exhaustion raises the risk of aspiration.
Put the patient in an upright position with the chin tilting down slightly during eating or drinking, and place pillows on the side to maintain the upright position.This position lessens the possibility of choking and aspirating by closing off the airway and promoting a gravitational flow of foods and fluids into the stomach and through the pylorus.
Make sure that the patient’s denture fit properly and stay in place.Chewing well decreases the risk of choking.
Instruct patients with dementia to chew and swallow with every bite. Watch out for retained food between sides of the mouth.A patient with dementia tends to forget to chew and swallow.
Allow sufficient time for the patient to finish eating and drinking.Usually, patients with swallowing problems need twice as much time for eating and drinking as those whose swallowing is intact.
Allow someone to stay with the patient during meals or fluid intake.Promotes safety in case of choking or aspiration.
Encourage breathing and coughing exercise every 2 hours while awake and every 4 hours during the night.These measures facilitate lung expansion and help avoid infection.
Have the suction machine available in case of aspiration.Suction equipment should be readily available at the bedside especially for patients with high risk for aspiration.
If aspiration occurs, do the following measures:
  • Assess indications of a complete airway obstruction based on the American Heart Association (AHA) guidelines such as signs and symptoms of poor air exchange, cyanosis, inability to speak or breathe.
Complete airway obstruction requires immediate intervention.
  • Assess for any alterations in the breathing pattern and respiratory rate every 1-2 hours following a suspected aspiration.
This assessment helps determine that a change in the patient’s condition has occurred.
  • Encourage a patient with partial airway obstruction to forcefully cough as possible.
This measures will relieve and clear the airway.
  • Suction the airway using a large-bore catheter (e.g., Yankauer or tonsil suction tip) for unconscious or nonresponsive patients with partial airway obstruction.
Suctioning will remove the obstruction.
  • For either a complete or partial aspiration, notify the health care provider and get a request for chest x-ray examination.
X-ray findings and result will confirm if food or fluids obstruct the airway.
  • Institute nothing by mouth (NPO) status until a diagnosis is established.
NPO will lessen the risk to the patient.
  • Anticipate the use of antimicrobial agents.
A possibility of the occurrence of aspiration pneumonia.
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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

More care plans related to basic nursing concepts:

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  1. Cancer (Oncology Nursing) | 13 Care Plans
  2. End-of-Life Care (Hospice Care or Palliative) | 4 Care Plans
  3. Geriatric Nursing (Older Adult) | 11 Care Plans
  4. Prolonged Bed Rest | 8 Care Plans
  5. Surgery (Perioperative Client) | 13 Care Plans
  6. Systemic Lupus Erythematosus | 4 Care Plans
  7. Total Parenteral Nutrition | 4 Care Plans

References and Sources

Here are the references and sources for this Geriatric Nursing Care Plan:

  • Boltz, M., Capezuti, E., Fulmer, T. T., & Zwicker, D. (Eds.). (2016). Evidence-based geriatric nursing protocols for best practice. Springer Publishing Company.[Link]
  • Carpenito-Moyet, L. J. (2009). Nursing care plans & documentation: nursing diagnoses and collaborative problems. Lippincott Williams & Wilkins. [Link]
  • Gilje, F., Lacey, L., & Moore, C. (2007). Gerontology and geriatric issues and trends in US nursing programs: a national survey. Journal of Professional Nursing23(1), 21-29. [Link]
  • Mauk, K. L. (Ed.). (2010). Gerontological nursing: Competencies for care. Jones & Bartlett Publishers. [Link]
  • Wold, G. H. (2013). Basic Geriatric Nursing-E-Book. Elsevier Health Sciences. [Link]

Paul Martin is a registered nurse with a bachelor of science in nursing since 2007. Having worked as a medical-surgical nurse for five years, he handled different kinds of patients and learned how to provide individualized care to them. Now, his experiences working in the hospital is carried over to his writings to help aspiring students achieve their goals. He is currently working as a nursing instructor and have a particular interest in nursing management, emergency care, critical care, infection control, and public health. As a writer at Nurseslabs, his goal is to impart his clinical knowledge and skills to students and nurses helping them become the best version of themselves and ultimately make an impact in uplifting the nursing profession.
  • I’m an LPN for 30 years of med surg, rehab, surg, geriatric care, addiction, and psych care. I love my career of caring for people. I want to join a team that wants to continue to improve nurse care. Please keep me a part of your network. I also like to be called Penny.

  • It is very useful lesson for improving geriatric patient health care provision.
    I like it to have more.
    Or the whole course, if possible.

  • I utilize your web page/info on all of my care plans, thank you
    I am an LVN Case Manager for mostly geriatric and disabled members in managed care.

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