1.0 Human Flourishing Flashcards
Factors that affect functional health of older adult
Acute vs chronic illness Optimum wellness Prevention of chronic illness Rehabilitation Continuing care **frailty and vulnerability: multisystem reduction in physiological capacity, lower recovery
Common health problems
Middle adult
Obesity CV disease Cancer DM Substance abuse Stress
Common health problems
Older adult
Obesity CV disease Cancer DM Substance abuse Stress Chronic, multisystem disease Injury (fall, fire, MVA) Pharmacologic effects
Acute VS chronic illness
Acute:
rapid onset, short term, self limiting
Chronic:
Persistent and progressive
70% deaths in US and 85% health care spending
Increasing problems
Requires LT management: lifestyle modification
Periods of remission and exacerbation possible
Individual response and challenges
Adaptation and complication prevention- goals
Significant role for nurses
Challenges of chronic illness
Recognize and respond to symptoms
Medication
Manage ongoing treatment plan
Lifestyle modification
Coping with psychosocial effects
Maintaining feelings of control
Interaction with healthcare system
Optimal wellness
Potential for the individual is optimized
Functional focus
Promoting optimal health
Health promotion: (primary prevention) true prevention
Illness prevention: (secondary prevention) screenings, risk factor identification
Health restoration: (tertiary prevention) rehabilitation and recovery, reduce effects
Health promotion
Primary prevention examples
Immunizations Exercise/activity Nutrition Sleep Safety Eliminate smoking Focus: true prevention
Immunizations for adult
Pneumonia:
Pneumovac (PPSV23)
Prevnar 13 (PCV13)
Influenza
Tdap
Herpes Zoster (shingles): Shingrix (RZV) 50+ yr, 2 shots. Zostavax (ZVL) 60+ yr, 1 shot (no longer recommended)
Covid
Exercise guidelines
Integrate exercise into lifestyle Weight bearing: bone benefits Resistance/agility: reduce falls risk Walking Community resources Middle age: moderately strenuous, 30+ min, 5 days/wk Older adult: moderately strenuous 30-60 min/day
Factors affecting nutrition in elderly
Cost
Availability
Mobility: carrying home heavy groceries
Nutrient deficiency in older adults
Dehydration risk Protein deficiency Reduced Vit D synthesis Anemia Zinc deficiency Dental health problems Taste changes Mobility problems Motility problems Reduced GI secretion Social issues
Illness prevention
Secondary prevention
Secondary prevention: early diagnosis and treatment Screening Lifestyle and diet management Specific treatment for illness Focus: diagnosis and prompt intervention
Screening
Secondary prevention
Secondary prevention: Physical exams- annual HTN: BP CAD: cholesterol, lipids Diabetes: blood sugars/Hgb A1C Breast cancer: mammogram and BSE Cervical cancer: pap Colorectal cancer: FOB (fecal occult blood), colonoscopy Prostate cancer: DRE (digital rectal exam), PSA (prostate surface antigen) Eye exam
Medicare overview
Part A: hospital (80% coverage at 65 years old)
Part B: medical (not required, outpatient, doc office)
Part D: prescription drug (required to purchased)
Medicare Advantage Plans: all of the above plus, but may have coverage limits (hospital system, coverage limits, approved providers)
Medicaid
Health restoration
Tertiary prevention
Tertiary prevention
Rehabilitation
Focus: minimize disease and disability
Prevent decline and complications
Restorative and continuing care options
Tertiary prevention
Tertiary prevention:
Home care (who qualifies for Medicare reimbursed skilled care?= Home bound, need of skilled services such as PT/OT etc)
Assisted living
Extended care: skilled/basic
Skilled rehab
Respite care: provides relief to care givers
Adult day care
Hospice
PACE: program of all inclusive care for the elderly) LifeCycles and Tanglewood
Define exacerbation
Increases in the gravity of a disease or disorder as marked by greater intensity in signs and symptoms
Define remission
Partial or complete disappearances of the clinical and subjective characteristics of chronic or malignant disease; remission may be spontaneous or the result of therapy
Daily energy needs after age 50 decrease by?
Women 2200 to 1920 kcal
Men 2900 to 2300 kcal
Risk factors for malnutrition in older adults
Alcoholism Anorexia Chewing/swallowing, dysphagia Consuming only one meal/day Dental difficulties Depression/dementia Diabetes Diminished physical functioning Feeding problems Food purchasing/preparation difficulties Impaired acuity of taste/smell Living in long term care Loss of spouse Taking multiple medications Nerve disorder Poverty Pulmonary disease Surgery
Strategies for overcoming bariers to good nutrition
Counteract decreased sense of taste/smell:
refrain from smoking 1 hour before meals
sipping water before and during meals (moisten mouth)
amplify flavors with seasonings, no salt
recommend chewing food thoroughly
vary food textures and flavors
Encourage social interaction:
share food prep and mealtimes
congregate meal programs
lighting to see food
Provide outside support:
meals on wheels
supplemental nutrition assistance programs (SNAP)
grocery store delivery
Primary prevention examples (true prevention)
Primary prevention: is true prevention; it precedes disease or dysfunction and is applied to pt considered physically/emotionally healthy.
Health education programs
Immunizations
Nutrition programs
Physical fitness activities
Secondary prevention examples (Illness prevention)
Secondary prevention: focuses on individuals who are experiencing health problems/illness and are at risk for developing complications/worsening conditions.
Diagnosis and prompt interventions (reducing severity)
Tertiary prevention examples (Health restoration)
Tertiary prevention: occurs when defect/disability is permanent/irreversible. Involves minimizing the effect of long term disease/disability by interventions directed at preventing complication/deterioration
ADL’s, wheel chair
PT/OT
Physical changes of aging
Middle adult 40-65 yr
40-65 yr physical changes:
Skin: decreased turgor, moisture, SQ fat (deposited in ab/hip)
Hair: loss of melanin causing graying, hairline recedes for males
Sensory: near vision decreases, high frequency sounds decrease, taste diminishes
Musculoskeletal: mass decreases, thinning intervertebral disk, postmenopausal low bone density/osteoporosis
Cardio: vessels lose elasticity, systolic B/P increase
Respiratory: vital capacity loss
GI: large intestine loses muscle tone, constipation may result, gastric secretions decrease
GU: hormonal changes; women estrogen decrease, men testosterone decrease
Endocrine: decrease in glucose tolerance
Physical changes in older adult 65+
65+ physical changes:
Skin: decrease turgor, sebaceous gland activity, age spots
Hair/nails: scalp, axillary, pubic hair thins, nose/ear hair thickens, women may facial hair, nails grow slowly brittle/thick
Sensory: visual narrows, depth perception distorted, cataracts. pupils smaller reducing light. lenses yellow resulting in green/blue/violet tones increased sensitivity. tears decreases, smell decreases, hearing loss, pain/touch increases, physical position
Musculoskeletal: mass/strength/movement loss, bone deterioration of joint cartilage, kyphosis, fracture risks, ROM restrictions
Cardio: systolic B/P rises, cardiac output decreases, peripheral resistance increases, cap walls thicken
Respiratory: vital capacity loss, lungs become less elastic/rigid. anteroposterior chest diameter and residual volume increases, O2 levels decrease 10-15%
GI: decreased saliva, loss of taste buds, gag reflex decreases, stomach motility reduced, delayed gastric emptying. large/small atrophy w/ decreased peristalsis, liver decreases in weight/storage, gallstones increase, pancreatic enzymes decrease
GI: kidneys lose mass, glomerular filtration is reduced, bladder capacity decrease, urinary retention, stress incontinence, enlarged prostate
Reproductive: men: testosterone/sperm count decrease, testes smaller, ED. Women: estrogen/breast tissue decrease, vagina/uterus/ovaries/urethra atrophy, lubrication decrease, secretions alkaline
Endocrine: pituitary loses weight/vascularity, thyroid more fibrous, plasma t3 decrease, pancreas releases insulin slowly, increase glucose levels, adrenal produce less cortisol
Pneumococcal conjugate (PCV13) and pneumococcal polysaccharide (PPSV23)
Schedule?
Administration?
Schedule:
PCV13:
Age: 19-64 years, 1 dose
Age: 65 years, 1 dose if never received previous dose or provider recommended
PPSV23:
Age: 19-64 years if indicated (at risk), 2 doses with 5 year between each dose.
ex: 50 year old, never received dose but is at risk (COPD, smoker, DM etc) can get one dose then can have another dose at 55 or after 65.
Admin: IM
Needle gauge: 22-25
Length: 1-1.5”
Influenza vaccine?
Adminstration?
Influenza: Given annually starting at 6 mo Admin: IM Needle gauge: 22-25 Length: 1-1.5"
Tdap vaccine?
Administration?
Tdap: Given every 10 years Admin: IM Needle gauge: 22-25 Length: 1-1.5"
Herpes Zoster (Shingles)?
Shingrix
Zostavax
Admin?
Herpes Zoster (Shingles):
Shingrix (RZV): 2 doses starting at age 50, not a live vaccine, 2-6 months between each injection
Zostavax (ZVL): no longer recommended vaccine however still given due to shortage of the RZV vaccine
**RZV and ZVL are not interchangeable
Admin: SQ
Needle gauge: 23-25
Length: 5/8”
