ch 8 management of the older adult Flashcards
what is the leading cause of death in the older adult
cardiovascular disease
depression
most common affective disorder of older adult with high risk of suicide
depression symptoms
empty moods, hopelessness, irritability, restlessness, loss of interest, decreased energy & fatigue
depression risk factors
medical condition (stroke, cancer, thyroid), genetics, stress, sleep probelems, lack of exercise
medications in older adults for depression
SSRI/ SSNI
adverse effect of SSRI/SSNI medications
orthostatic hypotension
delirium
sudden onset of confusion, most common complication of hospitalized older adult, may be sign of underlying medical condition
outcomes of delirium
may cause long term cognitive decline, falls
confusion assessment methods (CAM) diagnostic algorithm
acute onset -> fluctuating course ->inattention -> disturbance of thought/ disturbance of consciousness -> delirium
hyperactive delirium
increased psychomotor activity, rapid speech, irritability, restlessness
hypoactive delirium
lethargy, slowed speech, decreased alertness, apathy
mixed delirium
shift between hyper & hypo active delirium
delirium management
use hospital admission risk profile, prevention activities (close to nurses station, watched closely), prompt treatment (CBC, urinalysis), supportive environment
dementia
a clinical syndrome of cognitive, functional, and behavioral changes/ progressive, NOT REVERSIBLE
dementia involves
subtle onset, slow progression, memory impairments
common forms of dementia
alzheimers, vascular, dementia with lewy bodies (effects people at younger age)
Alzheimers disease
fifth leading cause of death in older adults, increases with age (doubles every 5 years after 65 y.o), no known cause
some causes of Alzheimers
neurological changes, vascular changes, (things that accuse with HTN, stroke), stress hormones, head trauma, genetics, alcohol abuse
two types of AD
familial: genetic, early onset & sporadic: late onset
early signs of Alzheimers
forgetfulness, sudden memory loss, difficulty in work and social activities but still able to compensate
AD nursing management
support cognitive function (crosswords/ coloring), promote safety (remove rugs, car keys), promote independence in self care activities (don’t give to many choices), reduce anxiety (do not argue with them), improve communication, promote adequate nutrition, promote balanced activity & rest, avoid restraints, encourage & support advance care planning
geriatric syndrome
impaired mobility, dizziness (falls, urinary incontinence, changes in cognitive status), increased susceptible to infection, atypical responses (different adverse effects from younger pts), altered emotional impact
3 components/ signifies the components of geriatric triad
falls & falling, urinary incontinence, changes in cognitive status
Ohio revised code
mandated by law to report suspected abuse, and neglect
Ohio administrative code
abuse or neglect that occurs in long term care facility that is reported to department of health
risk factors of elder neglect and abuse
separated or divorce, low income area
types of abuse
physical, emotional, psychological, sexual, financial
physical abuse
physical force that may result in injury, pain, or impairment/ shaking, slapping, kicking, pinching, use of physical restraints, force feeding/ s/sx: bruises, black eye, injuries of various stages
psychological/ emotional abuse
infliction of pain or distress through verbal or nonverbal acts/ verbal threats, harassment, silent treatment, treating like an infant/ s/sx: extreme withdrawal, emotional upset
sexual abuse
non-consensual sexual contact/ unwanted touching, rape, nudity, sexual photography/ s/sx: genital bruising, unexplained STDs
financial exploitation/ abuse
taking advantage of elder for monetary or personal benefit/ numerous unpaid bills, credit cards missing, unable to pay for food or medications/ s/sx: expensive gifts to care giver, new will when elder is incapable of writing will, frequent checks to cash, false signatures
caregiver neglect
intentional or unintentional to meet the needs for the elders physical and mental wellbeing/ failure to provide necessities (food, water, shelter…), s/sx: dehydration, malnutrition, uirne burns, left alone
self neglect
personal disregard or inability to perform self care/ poor hygiene, unkept home environment/ s/sx: malnutrition, skin or nail infections, insect infestation
abandonment
willful desertion of an elder/ dropping off elder in the ED/ elder inappropriately left alone
institutional mistreatment
disregard of contractual arrangement resulting in abuse or neglect
delirium onset
acute, sudden, often at twilight
depression onset
recent, may correspond to life event, can be acute or chronic
dementia onset
slow and often unrecognized
delirium course
short, diurnal fluctuating, may be worse at night and upon awakening
depression course
diurnal effects, may be worse in morning, situational fluctuations
dementia course
long, symptoms progressive, but relatively stable over time
delirium factors/ triggers
physical illness, stress, environmental, sensory deficits
depression factors/ triggers
stress (loss of spouse, health, friends, independence, lifestyle)
dementia factors/ triggers
Alzheimers disease, multiple infarct dementia: AIDS, vit B12 deficiency
delirium is described as
fluctuating levels of consciousness with decreased attention
depression is described as
sadness; loss of pleasure and interest in usual activities
dementia is described as
memory impairment
