What nursing diagnosis will appear after the elderly are widowed?

Nursing care of elderly patients with common mental disorders I. Overview of population aging (-) Current situation and trend of population aging 1. Trends and characteristics of world population aging (1) population aging is accelerating (2) the focus of the elderly population is shifting from developed countries to developing countries (3) the average life expectancy is prolonged (4) the elderly are growing rapidly (5) elderly women account for the majority of the elderly population. 2. Trends and characteristics of population aging in China (1) The absolute number of elderly people ranks first in the world. (2) The population is aging rapidly. (3) The aging trend of the elderly population is very obvious. (4) The population grows old before it gets rich. The economic pressure is great. (5) The regional distribution of the elderly population is uneven. (6) The problem of rural population aging is increasingly prominent. (2) The influence of population aging is 1. The social burden has increased. 2. The development of social and cultural welfare can't keep up with the needs of the elderly. 3. Weakening the family pension function. Old people will be more dependent on society. 4. The demand of the elderly for medical care, health care, nursing and life services greatly exceeds that of other groups. 2. Nursing care of patients with common mental disorders in the elderly (1) Depression in the elderly refers to the depression existing in the specific group of the elderly (□60 years old), including primary depression (including onset in youth or adulthood and recurrence in the elderly) and various kinds of depression visible in the elderly. It is characterized by persistent depression, mainly manifested as depression, anxiety, procrastination and physical discomfort, and cannot be attributed to physical diseases and brain organic diseases. Depression is one of the most common mental diseases of the elderly. The prevalence rate of depression among the elderly over 65 years old abroad is 8%~ 15% in the community and about 30% in the nursing institutions for the elderly. The prevalence of depression among the elderly in China is about 1.57% in Beijing and 5.28% in Shanghai, and it will increase with the progress of an aging society. Related studies have found that 50%~70% of the elderly suicides and attempted suicides are secondary to depression. Nursing evaluation 1. Health history Most patients have physical symptoms for several months, such as headache, dizziness, fatigue, general uncertainty and discomfort, insomnia and constipation. Some patients suffer from chronic diseases, such as hypertension, coronary heart disease, diabetes and pain, or have physical dysfunction. In addition, the incidence of depression in the elderly is related to the following factors: (1) genetic factors (2) biochemical abnormalities (3) neuroendocrine dysfunction (4) psychosocial factors. 2. Clinical manifestations The symptoms of elderly patients with depression are basically similar to those of young and middle-aged patients. The three main symptoms are depression, mental retardation and behavioral inhibition, but there are also some characteristics. (1) hypochondriasis (2) agitation (3) concealment (4) tardiness (5) delusion (6) suicidal tendency: suicide is the most dangerous symptom of depression. Suicide behavior is very common and certain in elderly patients with depression. (7) depressive pseudodementia (8) seasonality 3. Auxiliary examination can use standardized rating scales to evaluate the severity of depression, such as Geriatric Depression Scale (gds), Center for Epidemiology Depression Scale (ces-d), Hamilton Depression Scale (hamd), zung Depression Rating Scale (sds) and beck Depression Questionnaire (bdi), among which gds is more commonly used. Ct and mri showed ventricular enlargement and cortical atrophy. 4. Psychosocial Status Many studies have confirmed the role of life events encountered in old age, such as retirement, widowhood, living alone, family disputes, economic difficulties, physical illness and so on. In the generation and development of senile depression. In addition, people with neurotic personality are more prone to depression. The depression of the elderly is also related to negative cognitive coping styles such as self-blame, avoidance and fantasy. Positive cognitive coping style is conducive to maintaining physical and mental health. Common nursing diagnosis/problems 1. Personal ineffective coping is related to failure to meet role expectations, inability to solve problems, thinking that they have lost their ability to work and become disabled, social participation in change, loss of confidence in the future, and improper use of psychological defense mechanisms. 2. The disorder of thinking process is related to the slow thinking and behavior activities of depression. 3. Sleep pattern disorder is related to depression, anxiety and excitement, pessimism and world-weariness, difficulty in falling asleep, early awakening and difficulty in falling asleep after waking up. 4. The risk of suicide is related to severe depression and pessimism, thoughts of self-incrimination, negative thoughts and suicidal attempts and behaviors, attaching importance to the characteristics of morning over night, and feeling worthless. The overall goal of nursing plan and implementation of treatment and nursing care is that elderly patients with depression can relieve depressive symptoms, reduce the risk of recurrence, improve the quality of life, promote physical and mental health, and reduce medical expenses and mortality. Treatment principles include: individualized treatment, early treatment, and general non-hospitalization treatment. However, those who have serious suicidal attempts or behaviors, or are obviously weak or severely agitated, need hospitalization treatment, mainly drug treatment, combined with psychotherapy and electroconvulsive therapy. The specific nursing measures are as follows: 1. Daily life care (1) Maintain reasonable rest and sleep (2) Strengthen nutrition (1) Closely observe the efficacy of drugs and possible adverse reactions, and report to doctors in time: The antidepressants currently used in clinic mainly include; □ Tetracyclic antidepressants: oral drugs that do not inhibit amine intake; Oral selective serotonin reuptake inhibitor (ssri). In recent years, these drugs have developed rapidly, with great safety and few side effects. The main applications are fluoxetine, paroxetine, fluvoxamine, sertraline and citalopram, commonly known as "five golden flowers". (2) Insist on medication: long-term medication should be emphasized. For most patients, medication should be continued for 2 years, and for patients with multiple recurrences, medication time should be longer. 3. Prevent suicide (1) Identify suicide trends (2) Environmental layout (3) Special care (4) Tools and drug management (4) Psychological care (1) Stop negative thinking (2) Encourage patients to express their thoughts (3) Learn new coping skills (5) Health guidance (/kloc-) Cultivate interest (2) encourage children to live with the elderly (3) attach importance to social nursing evaluation. Nurses can evaluate whether individuals can face reality, solve inner conflicts, enhance their ability to cope with anxiety and stress, enhance their self-confidence and sense of self-worth, rebuild and maintain interpersonal relationships and social life, and whether they have suicidal thoughts or behaviors from the perspectives of emotion, behavior and cognition. (2) Senile dementia refers to a group of diseases with dementia as the main clinical manifestation caused by various reasons such as brain degenerative diseases, cerebrovascular diseases, brain injuries, brain tumors, brain infections, poisoning or metabolic disorders. Senile dementia mainly includes Alzheimer's disease (AD), vascular dementia (VD) and dementia caused by Parkinson's disease, alcohol dependence, trauma and other reasons. Among them, ad and vd account for 70%~80% of all dementia fishing. Ad is a group of primary degenerative brain diseases with unknown etiology. Ad can occur in the pre-senile period (Alzheimer's disease), but the incidence of AD is higher in the elderly. The most prominent histopathological features of ad are the formation of a large number of senile plaques between nerve cells with amyloid β-protein and aβ β protein (aβ) as the core and the existence of neurofibrillary tangles (nft) in nerve cells. Vd refers to dementia caused by brain circulation disorder caused by various cerebrovascular diseases and brain function decline. VD； They all started to get sick after 70 years old, and they are more common in men, patients with hypertension and/or diabetes and smokers. According to the statistics of European and American countries, the prevalence of dementia in the elderly over 60 years old is 6%~ 12%, and that in the elderly over 85 years old is 20~40%, of which more than half are ad, and the global incidence of senile dementia is as high as 120,000. According to the survey of "Epidemiological Study of Alzheimer's Disease and Parkinson's Disease", the average prevalence rate of Alzheimer's disease among people over 65 years old is 6.6%. It is estimated that there are more than 5 million Alzheimer's patients in China, and the number is increasing exponentially with the aging process. Alzheimer's disease has brought misfortune to the elderly, pain to the family and burden to the society, which has aroused widespread concern. At present, ad and vd have become the research focus. Nursing evaluation 1. Health history (1) To know whether the elderly have brain trauma, cardiovascular and cerebrovascular diseases, diabetes, previous stroke history, smoking, etc. (2) Possible factors to evaluate whether the elderly have ad: oral genetic factors; The decrease of oral neurotransmitter acetylcholine affects memory and cognitive function; Oral immune system dysfunction; Chronic oral viral infection; Accumulation of aluminum; Old age; The level of oral education is low. 2. Clinical manifestations (1) Both AD and vd have memory impairment and constitute mental symptoms of dementia. (2)ad and vd have different manifestations in the following aspects: 1) onset and course of disease 2) cognitive function 3) personality 4) nervous system signs 5) specific manifestations: the clinical manifestations of vd are closely related to the location, size and frequency of attacks, which are mainly divided into two categories: memory disorder, mental symptoms and focal neuropsychiatric symptoms of brain injury; Ad is generally divided into three stages according to the evolution of the disease: the first stage, the forgetting stage and the early stage; The second period, the chaotic period and the intermediate period; The third stage, extreme dementia stage, late stage. 3. auxiliary examination imaging examination: for ad patients, ct or mri shows brain atrophy, which is gradually aggravated; Positron emission tomography (pet) showed that glucose utilization and cerebral perfusion decreased in some brain regions (parietal lobe and temporal lobe in the early stage of onset, and prefrontal cortex in the later stage). For vd patients, ct or mri examination found multiple cerebral infarction, or multiple lacunar cerebral infarction, mostly located in thalamus and frontotemporal lobe, or showed subcortical arteriosclerotic encephalopathy. Psychological test: mmse and Hasegawa Dementia Scale can be used for dementia screening; Wechsler memory scale and clinical memory scale can be used to check memory; Wechsler Adult Intelligence Scale can be used to measure intelligence. Hachinski Ischemia Scale (Table 8- 1) can be used to distinguish ad from vd. 4. Psychosocial status (1) Psychological aspects (2) Common nursing diagnoses/problems in society 1. Memory impairment is related to progressive memory decline. 2. Self-care deficiency is related to cognitive behavior disorder. 3. The disorder of thinking process is related to thinking disorder. 4. Language communication disorder is related to thinking disorder. 5. Caregiver's role stress is related to the elderly's serious illness, unpredictable course of disease, caregivers' lack of care knowledge and physical and mental fatigue. The overall goal of nursing planning and implementation of treatment and nursing is to make Alzheimer's patients maintain their memory and communication skills to the maximum extent, improve their self-care ability in daily life, give full play to their residual functions, improve their quality of life, and enable their families to cope with and care for Alzheimer's patients. The prevention and treatment principles include: focusing on prevention, early detection, early diagnosis and early treatment, actively treating known vascular diseases and preventing risk factors of stroke. The specific nursing measures are as follows: 1. Daily life care (1) Daily life care and nursing guidance for Alzheimer's patients (1) Dressing (2) Eating (2) Sleeping (3) Self-care ability training (3) Patients should be given special care when they are completely unable to take care of themselves (2) Medication care (3) Intelligent rehabilitation training (1). Training of understanding and expression ability (4) Training of social adaptability (4) Safety nursing (5) Psychological nursing (6) Support and guidance of caregivers (7) Health guidance (1) Early detection of dementia (2) Early prevention and nursing evaluation of dementia After prevention, treatment and nursing, the cognitive ability of the elderly has been improved, and their social skills and self-care ability in daily life have been maintained to the maximum extent.