Breast
• Breast tissue shrinks with menopause
• Teach client breast self examination
Abdomen - Reproductive System
• Auscultation should be performed before palpation to prevent distortion of bowel sounds
• Tightening of abdominal muscles hinders accuracy of palpation and auscultation
• Warm hands before touching client’s abdomen.
• Men breathe abdominally; women breathe costally.
• Auscultate all four quadrants for bowel sounds
• Auscultate abdomen between meals
Musculoskeletal
• Older adults walk with smaller steps and need a wider base of support
Neurological
• Glasgow Coma Score
o not valid in patients who have used alcohol or other mind-altering drugs
o possibly not valid in patients who are hypoglycemic, in shock, or hypothermic (below 34C)
o should be compared to total of 10 when client is intubated
• Reflexes are normally less brisk or even absent in older clients
• Reflex response diminishes in the lower extremities before the upper extremities are affected
• Absent reflexes may indicate neuropathy or lower motor neuron disorder
• Hyperactive reflexes suggest an upper motor neuron disorder
Teaching client and family
• Teaching-learning process mirrors the nursing process
• Select teaching strategies that are compatible with the client’s learning style, age, culture, level of education
• Client teaching should be multi-sensory
• Always confirm the client’s understanding of the information presented
• Teaching must be geared to the level of the learner
• Repeat key information and summarize main points at intervals
• Explain medical terminology in lay terms
• Determine the client’s learning style and gear teaching methods to using that style
• Sequence information the way the client will use it
• Be concrete and use the simplest words and the shortest sentences when teaching low literacy clients, or any client under stress
