Chapter 20 - The Aging Adult Flashcards
When are we old?
Definitions of Old Age AARP- 50 Retail Outlets-55 or 60 Medicare- 65 Social Security- 65-70 Degrees of Aging Young Old 65 to 74 Middle Old 75-84 Old-Old 85 +
You are only as old as you feel
Theories of Aging
Genetic
Immunity
Cross-Linkage
Free Radical
The Middle Adult
Physiologic changes
Gradual normal internal & external changes
Affect men and women differently
Modify self-image and self-concept to accept and adapt to these changes
Cognitive development
Little change from young adulthood
Increase motivation to learn
Problem-solving abilities remain but ↑ response time
The Middle Adult
Psychosocial development
Erikson’s “generativity versus stagnation”
Adjusting to the changes
Employment
Spousal relationships
Children and aging family members
The Middle Adult
Moral development
Believe that the rights of others take precedence and take steps to support those rights
Spiritual development
Less rigid in beliefs, increase faith and trust in spirituality strength
Health status
Major health problems are cardiovascular, pulmonary, cancer, arthritis, diabetes, obesity, alcoholism, and depression
Recovery takes longer, chronic illness has a major effect on self-concept
Developmental Tasks of Middle Adulthood
Establish and guide the next generation
Accept middle-age changes
Adjust to the needs of aging parents
Reevaluate one’s goals and accomplishments
The Older Adult
A unique population
Ageism
Common stereotypes
Physiologic changes
All organ systems decline
Interrelated effects of organ systems and loss of physiologic reserve
Chronic disorders are HTN, stroke, cancers, arthritis and osteoporosis
More likely to develop complications and recover more slowly
The Older Adult
Cognitive development
Cognition does not change with aging
Take longer time to respond and react
Mild short-term memory loss is common, long-term memory remains intact
Neurological disorders can cause cognitive impairments
The Older Adult
Psychosocial development
Disengagement theory
Erikson’s theory (“ego integrity versus despair”, life review)
Moral and Spiritual development
At conventional level, follow society’s rules in response to others’ expectations
Integrating faith and truth
Self-transcendence
Adjusting to the changes of Older Adulthood
Physical strength and health Retirement and reduced income The health of one’s spouse Relating to one’s age group Social roles Living arrangements Family and role reversal
Health of the Older Adult
Chronic Illness Polypharmacy Accidental Injuries Changes in vision, hearing, muscle mass and strength, ↓ reflexes, ↓ reaction time Dementia, depression, and delirium Sundowning syndrome Reality orientation Elder abuse Neglect, physical, emotional and psychological Adult Protective Services
Skin
Wrinkling & sagging Dryness and scaling Uneven pigmentation and moles Decrease thickness of dermis Keratosis (warty lesions) Vascular frailty Senile purpura (skin hemorrhages) Dull, brittle, thick fingernails and toenails Decrease sweat gland activity Pruritus (itching) Hair
Skin: Nursing Interventions
Risk assessment and documentation on admission and every shift
Braden Scale.
Culturally sensitive early assessment for stage I pressure ulcers in clients with darkly pigmented skin:
Compare skin over bony prominences to surrounding skin - may be boggy or stiff, warm or cooler.
Assess skin daily.
Clean skin at time of soiling; avoid hot water and irritating cleaning agents.
Use moisturizers on dry skin.
Do not massage bony prominences.
Protect skin of incontinent clients from exposure to moisture.
Use lubricants, protective dressings, and proper lifting techniques to avoid skin injury from friction/shear during transferring and turning of clients.
Turn and position bed-bound clients every 2 hours if consistent with overall care goals.
Use a written schedule for turning and repositioning clients.
Use pillows or other devices to keep bony prominences from direct contact with each other.
Raise heels of bed-bound clients off the bed; do not use donut-type devices.
Use a 30-degree lateral side lying position; do not place clients directly on their trochanter.
Keep head of the bed at lowest height possible.
Skin: Nursing Interventions
Use lifting devices (trapeze, bed linen) to move clients rather than dragging them in bed during transfers and position changes.
Use pressure-reducing devices (static air, alternating air, gel or water mattresses).5
Reposition chair- or wheelchair-bound clients every hour. In addition, if client is capable, have him or her do small weight shifts every 15 minutes.
Use a pressure-reducing device (not a donut) for chair-bound clients.
Keep the patient as active as possible; encourage mobilization.
Do not massage reddened bony prominences.
Avoid positioning the patient directly on his or her trochanter.
Avoid using donut-shaped devices.
Avoid drying out the patient’s skin; use lotion after bathing.
Avoid hot water and soaps that are drying when bathing elderly. Use body wash and skin protectant.7
Teach patient, caregivers, and staff the prevention protocols.
Skin: Nursing Interventions
Manage moisture:
Manage moisture by determining the cause; use absorbent pad that wicks moisture.
Offer a bedpan or urinal in conjunction with turning schedules.
Manage nutrition:
Consult a dietitian, and correct nutritional deficiencies
Increase protein and calorie intake and A, C, or E vitamin supplements as needed
Offer a glass of water with turning schedules to keep patient hydrated.
Manage friction and shear:
Elevate the head of the bed no more than 30 degrees.
Have the patient use a trapeze to lift self up in bed.
Staff should use a lift sheet or mechanical lifting device to move patient.
Protect high-risk areas such as elbows, heels, sacrum, and back of head from friction injury.
