Care for the older Adult/Hygiene Flashcards
Variability among older adults
-Physiological, cognitive,
and psychosocial health
-Wide range of functional
ability
-Functionality
-Chronic conditions add to
the complexity of
assessment and care
-Do not assume that all
older adults have signs,
symptoms, or behaviors
representing disease
-Identify an older adult’s
strengths and abilities
Myths and stereotypes about older adults
older adults are….
- Ill, disabled, and unattractive
- Forgetful, confused, rigid, boring, and unfriendly
- Unable to learn and understand new information
- not interested in sex or sexual activities
these ideas demonstrate AGEISM, which is discrimination against people because of increasing age
NURSES’ ATTITUDES TOWARD
OLDER ADULTS
Nurses must assess their own attitude toward older adults and their
own aging.
Come from personal experiences with older adults, education,
employment experiences, and attitudes of co-workers and employing institutions
Forming positive attitudes toward them and gaining specialized knowledge about aging and the health care needs of older adults
are priorities for all nurses
Nurses need to gain knowledge about aging and health care needs of
older adults:
Respect
Dignity
Involvement in care decision and activities
Gerontology is?
Study of aging process
Gerontological nursing ?
Caring for the aging adult (will NOT expect you to memorize these stages of aging, but understand them and which is currently “booming”) 65-74 years of age: the young old 75-84 years of age: the middle old 85-99 years of age: the old old 100 years of age or older: the elite old The current fastest growing subgroup is the old old at 85-99
the current fastest growing subgroup is the old old at what age range?
85-99
ERIKSON’S DEVELOPMENTAL
TASK FOR OLDER ADULTS
-Maturity (65-death) Ego integrity vs. Despair: older adult need to look back on life and feel a sense of fulfillment, success at this stage leads to wisdom, failure results in regret and despair
DEVELOPMENTA L TASKS FOR OLDER ADULTS
adjustment
- decreasing health and physical strength
- Retirement and fixed income
-Death of a spouse, children,
siblings, friends
-To self as an aging person
(escalates w/age)
-Maintaining satisfactory living
arrangements
-Redefining relationships Spouse Adult children Siblings Maintaining quality of life
COMMUNITY-BASED AND
INSTITUTIONAL HEALTH CARE SERVICES
Where do the aging population live?
- private homes
- apartments
- retirement communities
- assisted living facilities
- nursing centers
- homeless shelters/ the streets
Assessment of the older adult
Assess readiness to learn
Are they physically well enough to be taught?
Are they in pain?
Wearing glasses &/or hearing aids?
- Sit facing the patient, good lighting so they can see your
facial expressions
Speak slowly and in a normal tone of voice. ENUNCIATE
Present one idea or concept at a time
Give time for response
Decrease environmental distractions
Use audio, visual and tactile cues
PHYSIOLOGICAL
CHANGES
Perception of wellbeing defines quality of life.
Perception is
dependent on the
ability to function
(Gordon’s)
Nurses need to be
aware of normal agerelated changes.
Not all physiological
changes are
pathological.
Physiological changes
Respiratory
NORMAL Variation
Increase; muscle strength, # alveoli, and cough reflex
decrease; AP diameter, wall rigidity, risk of infection
PHYSIOLOGICAL CHANGES
Cardio/vascular
(leading cause
of death for this
age group)
Increase; systolic BP r/t Thicker vessels/narrowing lumens
Decrease; contractile strength & calcification of valves = lower CO and decreases peripheral circulation
Physiological changes
GI
Normal variation
Periodontal disease, hemorrhoids, anal fissures (more info to come with GI system)
decrease saliva, GI peristalsis,
Neurological
Increase; Rate of impulses & neurotransmitters = slowed cranial nerve responses.
decrease; proprioception (balance!)
Physiological changes
Integumentary
normal variation
decrease elasticity and subcutaneous fat.
Pigmentation Changes, sebaceous gland decline = decreased oils/dryness.
Decrease Facial hair in men.
increase facial hair in women
Physiological changes
Sensory
normal variation
Eyes: decrease accommodation, slowed response to light/dark changes, yellowing lens, altered color perception, smaller pupils,
increase sensitivity to glare,
Ears: decrease acuity for high frequencies, thickened tympanic membrane, sclerosis of inner ear, increase wax
Taste/Smell/Touch: all diminished
Physiological changes
GU
Normal variation
decrease # nephrons, bladder capacity, & sphincter tone
increase Size of prostate
Physiological Changes
M/S
Normal Variation
decrease Muscle mass & calcium stores in bones
Degenerative joint disease
Physiological Changes
Reproductive
Normal variation
decrease Sperm count, rapidity of erections, estrogen levels
Atrophy of vagina, uterus, & breasts
Desires do not necessarily decline, just physical ability.
Physiological Changes
Endocrine
Normal variations
increase Thyroid secretions, pancreatic secretions, stress response
Physiological Changes
Immune
Normal Variations
decrease T-cell decreased immunity
Gordon’s Functional Changes
(understand what is happening but don’t memorize this list)
Health perception- management
Nutritional-metabolic
Elimination-excretion
Activity & exercise
Sleep and rest
Cognitive-perceptual patterns
Self perception/concept
Role-relationship
Sexuality-reproductive
Coping stress tolerance
Value-belief pattern
Gordon’s Functional Changes
Functional status includes
ADLS; sensitive indicator of health or illness
instrumental ADLS
-changes usually linked to illness disease and or degree of chronicity
Older Adults and Acute Care
Delirium
Dehydration
Malnutrition
Health care–associated infections
Urinary incontinence
Skin breakdown
Falls
-Medications, increased urine output, orthostatic BP
Risks go up with sleep deprivation, infections, dehydration, pain, sensory impairment, drug interactions, anesthesia, hypoxia.
Cognitive Disorders
The 3 D’s
Delirium
-Acute confusion state
Underlying medical condition (UTI, anesthesia, electrolytes, sleep deprivation, pain, etc….)
-Reversible
Dementia
-Gradual/chronic confusion/impaired cognitive functioning
-Irreversible
Depression
- Mood disturbance: sadness and despair
- Most common, yet most undetected and untreated, impairment in older adulthood.
GO to pp of care for older adults slide 22 look at the chart
Nursing Management of Dementia/Delirium
Safety!
Meet physical & psychosocial needs
Correct underlying physical problem
Maintain routine
Modify the environment for safety
Compensate for sensory deficits
Encourage fluids
Individualize nursing care to enhance quality of life
Maximize functional performance by improving cognition, mood, and behavior.
Illness in older adults
Confusion:
- Infection
- Acute illness
- Medications
Chronic dehydration esp. with illness
ADL decline can signal underlying illness
Depression common w/chronic illness
Monitor for drug to drug interactions and toxicity.
Illness in older adults(continued)
Classic S/S of disease are sometimes absent/atypical in older adults. EX:
- UTI presents w/confusion and incontinence, maybe no fever, but increased RR
- MI: dyspnea and anxiety rather than crushing pain
- Change in mental status, falls, dehydration, decreased appetite, loss of function.
Pain often undertreated: look for non-verbal cues (inspection/observation)
Nutrition and Hydration
Decreased nutrition and hydration
Increased need for Calcium, Vit’s D, C, A
Decreased metabolism: need for fewer calories
Decreased sense of smell/taste and dental care/dentures
Reduced income; starvation or fast foods
At risk for Geriatric failure to thrive: under nutrition, physical impairment, depression and cognitive impairment
Limit fluid consumption r/t immobility, diuretics, incontinence
