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ADULT HEALTH > Chapter 12 - Care of the Older Adult > Flashcards

Chapter 12 - Care of the Older Adult Flashcards

1
Q

What is the definition of Gerontology?

A

The scientific study of the aging process

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2
Q

What is the “geriatric cascade”?

A

When the frail older person will suffer a rapid decline & decompensation as a result of acute illness or worsening of chronic condition.

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3
Q

What are characteristics of the healthy older adult?

A

healthy eating
exercise
positive outlook

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4
Q

What are age related changes in the Cardiovascular system?

A

Decreased cardiac output
slower heart recovery rate
decreased pacemaker cells = reduced stroke volume

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5
Q

What is essential to check as a result of changes of aging causing the baroreceptors to be less efficient?

A

postural blood pressure (detects postural hypotension & teaches pt. to prevent falls by changing positions slowly)

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6
Q

What are the components of maintaining cardiovascular system in the older adult?

A 
cardiovascular assessment at rest & with activity
regular exercise
weight control
low saturated fat & cholesterol diet
avoid stress
stop smoking
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7
Q

What are age related changes in the body systems in relation to the respiratory system?

A

Decreased production of protective mucous in large airways
Diminished cough reflex
Changes in alveoli(less elastic tissue)
Decrease gas exchange in the lungs
Skeletal changes that influence chest expansion
Muscular weakness (expansion and contraction)
Reduced recoil incr. residual volumes after expiration; reduced vital capacity
Macrophages in lungs are less effective reducing ability to neutralize viruses

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8
Q

What are the nursing implications for Nursing in the respiratory system of the older adult?

A 
Respiratory assessment
positioning
deep breathing
regular exercise
fluid intake (oral and IV)
Pneumonia vaccine/Influenza vaccines
avoid smoke
aspiration risk (pneumonia)
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9
Q

What is the “tripod” position?

A

When older patients with COPD lean over tables to stretch out their torsos so that more air can enter and exit during respiration.

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10
Q

What is cacaxia?

A

muscle wasting

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11
Q

What are the changes for the older adult in the Integumentary system?

A

Decreased subq fat
Capillary fragility
Diminished secretion of natural oils

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12
Q

What are nursing strategies for the older patient skin care?

A

Limit solar exposure to 10-15 min/day for Vitamin D
Use sunscreen
lubricate skin w/ lotions that contain petroleum or mineral oil
skin check/assessment on a regular basis for pressure ulcers (especially feet and heels)

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13
Q

What is Lentigo?

A

Age spots

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14
Q

What are changes experienced by older adults in the hair and nails?

A

Graying and balding
Toenails thicker and more difficult to cut
Nails grow more slowly
Lusterless, hard thick & brittle with yellowish appearance
Physical limitations make nail care difficult
Prone to skin breakdown & infection if nails irritate surround skin

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15
Q

What is the importance of Vitamin D levels in the older adult?

A

Older adults should ask their primary care provider to check a vitamin D blood level to maintain adequate calcium absorption. If the older person resides in a colder climate, check this level during winter months when sunlight exposure is more likely to be minimal.

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16
Q

What are the changes in the Endocrine System of the older adult?

A

Less efficient function
Decreased responsiveness of target tissues
Diabetes Mellitus and Thyroid Disease
Decreased sensitivity to insulin resulting in variation fo blood glucose levels
Decreased secretion of insulin
Peripheral tissues may become insulin resistant, especially w/ obesity

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17
Q

What changes occur in the immune system of the older adult?

A 
B & T cells are not as active
Body defense mechanisms less effective
Thymus gland decreases in size
Delayed hypersensitivity reaction
Increase autoimmune disorders
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18
Q

What are the changes experienced in the Reproductive System of the older adult?

A

Degenerative changes in reproductive organs
Decrease levels of hormones
Andropause & Menopause
Life-span sexuality

19
Q

What are the changes within the Musculoskeletal System of the older adult?

A

Bone resorption exceeds bone formation
Osteopenia: gradual loss of bone mass
Osteoporosis: pathological loss of bone mass
Cartilage in bone joints b/c rough/with reduced H2O
Strength of tendons & ligament decrease
Incr. muscle weakness

20
Q

What are risk factors for Osteoporosis?

A 
Female
Age
Caucasian or Asian Race
Low body wgt/Petite body build
Estrogen deficiency
Cigarette smoking
Heredity
Inadequate Calcium/Vit. D intake
Alcoholism
Excessive caffeine
Inactivity
21
Q

What are common symptoms of hearing impairment?

A

Inability to hear t.v./radio at normal volumes
Freq. complaints that others “mumble” or slur speech when talk
Repeated req. to speak louder
Leaning in closer or cupping hand over ear
Difficulty understanding speech on the telephone
More difficulty in hearing voice of children and women
Inappropriate responses or misinterpretations during convo

22
Q

What are nursing implications for hearing and sight when caring for the older adult?

A 
Position self to foster communication
Adequate lighting
Speak clearly & slowly
Lower pitch of yr voice
Do Not Shout
Use touch
Illness will affect the energy to communicate
23
Q

What are changes for the older adult within the gastrointestinal system?

A
  • Has fewest chgs but most complaints from pt.*
  • Dilation & pressure changes in esophagus
  • Gastric emptying & motility slower
  • Shrinkage of mucus membranes in stomach
  • Decreased tone of intestinal muscle
  • Gallbladder may not empty as easily
  • Reduced liver blood flow
  • Reduced hepatic cells
24
Q

What are Nursing implications for gastrointestinal when caring for the older adult patient?

A 
Assessment
Medications
Nutrition
Constipation
Gastric Distress
Stress Ulcers
Nausea/Vomiting/Diarrhea
25
Q

What are changes in the urinary system of the older adult?

A
  • Renal blood flow reduced fm approx. 600ml/min to 100ml/min
  • GFR reduced (may be 50% less by age 75)
  • Decr. ability of kidney to concentrate or dilute urine
  • Loss of muscle tone & elasticity
  • Incr. residual urine in bladder
  • Incr. bladder contractions
  • Urinary freq. & urgency
  • Red. bladder capacity (500cc to 250cc)
  • Enlarge prostate in men
26
Q

What are nursing implications for urinary system when caring for the older adult?

A
  • Assessment: I&O, Creatinine/BUN/GFR, Fever/Confusion, Behavioral changes
  • Medications & IV fluids
  • Dehydration/Fluid Overload
  • Infection
  • Urinary Incontinence/Urgency/Frequency
  • Safety
27
Q

What should the nurse consider when caring for a pt. taking diuretics?

A

The nurse should help to identify onset and peak action of the diuretic, and then aid in developing a toileting schedule to maximize continence.

28
Q

True or False. Growth and development moves forward in the elderly.

A

True.

29
Q

What are common critical illness found in the older adult?

A 
Pneumonia
Congestive Heart Failure
Renal Failure
Parkinson's
Diabetes
30
Q

What is dementia?

A
  • Dysfunction or loss of memory, orientation, attention, language, judgement reasoning
  • Agitation, delusions, hallucinations
  • Inability to perform activities of daily living
  • Over 100 causes: neurodegenerative or vascular
  • 60-80% have diagnosis of Alzheimer’s Disease
  • Mini-Mental Exam
  • Care decisions
31
Q

What are the characteristics of Alzheimer’s?

A
  • AD has no cure
  • Only treatment are drugs that slow AD for short time
  • AD begins w/mild memory loss & confusion
  • Gradually develops into complete memory loss & complete inability to care for one self
  • 70% of AD adults live @ home and are looked after by family members.
32
Q

How is Alzheimer’s Disease defined?

A

AD is an irreversible, progressive neurodegenerative (brain) disease that slowly destroys memory and thinking skills; functional abilities and eventually even the ability to carry out the simplest tasks.
Early Onset: 60 years of age
Familial Alzheimer’s Disease: clear pattern of inheritance
Sporadic Alzheimer’s Disease: No family connection

33
Q

What are three hallmarks of AD?

A
  • Beta-amyloid plaques
  • Neurofibrillary tangles (misfolded proteins)
  • Loss of connections b/t cells leading to diminished cell function and cell death.
34
Q

What are the warning signs of Tau Tangles?

A
  • memory loss that affects job skills
  • difficulty performing familiar tasks
  • problems w/ language
  • disorientation to time & place
  • poor or decreased judgement
  • problems w/ abstract thinking
  • misplacing things
  • chgs in mood or behavior
  • changes in personality
  • loss of initiative
35
Q

What could prevent extreme catastrophic reaction during combativeness of an AD pt.?

A
  • acknowledge and respect need for attention
  • log characteristic signs of pending reaction
  • may hold hand or shoulder, but sometimes physically holding may appear like a sign of attack
  • when patient upset, immediately stop what is upsetting her and let her relax
36
Q

How should the nurse communicate / understanding with the AD pt.?

A 
make sure he hears you 
eliminate distractions
use short words or phrases
ask one simple question at a time
ask to do one task at a time
wait patiently for response
remain calm and pleasant
use other signals besides words (point,touch)
avoid assuming complex reasons for behavior
37
Q

After Alzheimer’s disease, what is the most common neurodegenerative disease?

A

Parkinson’s Disease

38
Q

What is ploypharmacy?

A

Use of 5 or more medications per day

39
Q

What are treatments/precautions for “wandering” behavior in an AD patient?

A
  • provide a pocket card w/ simple directions
  • pt. must hv memory impaired bracelet w/ identifying info
  • exercise & purposeful activity
  • meds may worsen behavior & add to confusion
  • surround pt. w/ familiar objects
  • home based wandering devices (door alarms & high door locks)
40
Q

What are suggested causes of “sundowning”?

A 
afternoon fatigue/reduced stress tolerance
afternoon caregiver fatigue
lessened stimulation
over stimulation
may feel neglected
lower levels of lighting
41
Q

What are safety precautions for “sundowning”?

A

may require brighter light
may need safety locks on cabinets and drawers
put away dangerous items in home
bathroom frequently most dangerous room in house
auto turn off/remove knobs on burner and stove
can pt. lock himself in a room?
sturdy handrails on stairs, gate
attpt to have pt room on main floor
security locks on windows and o/s doors

42
Q

How does an adult adult process medication differently than that of a healthy pt?

A
  • bio transformation of meds takes longer
  • CO is reduced
  • Mucosal cells in the GI are reduced
43
Q

What are tips in helping a pt with a “freeze” attack from PD?

A
  • imagine a line and try to step over it
  • hum or imagine marching to a tune
  • rock from side to side to get started
  • drug timing to maximize the “on” time
  • companion dog to initiate a “cue” to move
  • dogs can open doors,retrieve object, decrease falls.
  • DO NOT push pt. to encourage movement
44
Q

In the musculoskeletal system of the older adult, what could cause a pathological fracture?

A

osteoporosis

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