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.
Musculoskeletal
↓ subcutaneous tissue and weight ↓ muscle mass and strength ↓ bone mass ↑ fatty tissue ↓ total body water composition ↓ reaction time Joints stiffen, ↓ flexibility, ↓ROM ↓ mobility, stoop posture
Musculoskeletal: Nursing Interventions
Encourage physical activity maintain function
Pain medication to enhance functionality
Implement strategies to prevent falls
Prevent osteoporosis by adequate daily intake of calcium and vitamin D, physical exercise, smoking cessation
Advise routine bone-mineral density screening
Pressure ulcer assessment and prevention
Cardiopulmonary
Stiffening of vascular system
↓ compensatory mechanisms
↓ pulmonary elasticity, ↓ ciliary action
↑ respiratory rate, ↓depth
Cardiac and respiratory diseases are usually a result of many years of poor diet & inadequate exercise, not an age related problem
Cardiopulmonary: Nursing Interventions
Safety precautions for orthostatic hypotension
Avoid prolonged recumbency; rise slowly from lying or sitting position; wait 1-2 minutes after position change to stand or transfer.
Institute fall prevention strategies.
Encourage lifestyle practices to attain a healthy body weight (BMI 18.5-24.9 kg/m2).
Medications for optimal normal blood pressure.
Healthful diet
Increase physical activity
smoking cessation.
Maintain patent airways through upright positioning/repositioning, suctioning, and bronchodilators.
Provide oxygen as needed.
Incentive spirometry as indicated, particularly if immobile or declining in function.
Maintain hydration and mobility.
Education on cough enhancement
Immune System
Decline in Immune system capabilities
↓ lymphocytes production
↓ production and response duration of antibodies
More likely to produce autoantibodies
rheumatoid arthritis
Atherosclerosis (hardening of the arteries).
Early detection of infections difficult
The body still has the ability to generate fevers and other immunity responses, but the CNS is simply less sensitive to immune signals and doesn’t react as quickly or efficiently to infection.
Typical symptoms often not present
Immune System: Nursing Interventions
Wash hand
Antibiotic use
Increase physical exercises
Watch for SxS of infection
Neurologic
Decline in CNS response
↓motor strength, ↓sensation in extremities
↓reaction time
↓reflexes
Difficult in balance, coordination, fine movements, & spatial orientation
↓ temperature regulation
↓ perception of pain and pressure
↓ sleep time, easily awaken
Decreased brain weight
Some loss in short-term memory and immediate recall
Overall cognitive abilities remain intact
Neurologic: Nursing Interventions
Institute fall preventions strategies
Pressure ulcer assessment and prevention
To maintain cognitive function, encourage lifestyle practices of regular physical exercise
Increase intellectual stimulation
Healthful diet
Recommend reaction time training and safe driving courses to improve safety
Senses
Decline of visual acuity
↓ night vision, ↑ sensitivity to glare, ↓depth perception
↓ color discrimination
Difficulty reading small print
Decline of hearing acuity
Distortion of sounds
Decline in sense of taste and smell
↓ sensitivity in oders
Senses: Nursing Interventions
Fall prevention strategies
Glasses
Hearing aids
Hygiene needs
Gastrointestinal
↓ digestive juices production
↓ nutrition absorption
Malnutrition and anemia are common
Indigestion and constipation are common
Gastrointestinal: Nursing Interventions
Assess abdomen, bowel sounds.Assess oral cavity, chewing and swallowing capacity, dysphagia (coughing, choking with food/fluid intake)
If aspiration, assess lungs (rales) for infection and typical/atypical symptomsMonitor weight, calculate BMI, compare to standards
Determine dietary intake, compare to nutritional guidelines
Assess for GERD, constipation and fecal incontinence; fecal impaction by digital examination of rectum or palpation of abdomen
Monitor drug levels and liver function tests if on medications metabolized by liver
Assess nutritional indicators Educate on lifestyle modifications and OTC medications for GERD Educate on normal bowel frequency, diet, exercise, recommended laxatives
Encourage mobility, provide laxatives if on constipating medications
Encourage participation in community-based nutrition programs; educate on healthful diets
Genitourinary
Decline in renal blood flow
↓ nephron units by 50 %, ↓ GFR & ability to concentrate urine
↓ filter and excretion of waste products & medications
↓ bladder capacity by 50 %
↑ stress incontinence & voiding frequency
↓ perineal structure in women
↑ UTI’s and vaginal infections
Hyperplasia of prostate in men
↑urinary hesitancy and retention
Diminished stream, post void dribble
No change in sexual activity ability
Decreased vaginal lubricant & longer time for vaginal expansion
Slower arousal rate and erection time
Genitourinary: Nursing Interventions
Assess renal function (creatinine clearance).
Assess choice/need/dose of nephrotoxic agents and renally cleared drugs
Assess for fluid/electrolyte and acid/base imbalances. Minimum 1,500-2,500 ml/day from fluids and foods for 50 to 80 kg adults to prevent dehydration
For nocturnal polyuria: limit fluids in evening, avoid caffeine, use prompted voiding schedule
Evaluate nocturnal polyuria, urinary incontinence, BPH
Assess UTI symptoms and teach SxS of infection Assess fall risk if nocturnal or urgent voiding
Functional Assessment
ADL’s
6 areas of basic self-care
IADL’s (instrumental activities of daily living)
Physiologic changes
Acute & chronic diseases, falls, hearing
Psychological changes
Self-esteem, self-concept
Functional Assessment: Nursing
Interventions
Assess self-care ability
Assess home situation and support system
Assess fall risk, nutrition, medications
Ability to manage acute and chronic diseases
Promote self-care, self-esteem, self-worth
Community resources
Healthy Aging
Dictionary
Ability to continue to function mentally, physically, socially and economically as the body slows down its processes
Medical/Gerontological
Absence of chronic illness, the ability to overcome chronic illness, or the elimination of risk factors that lead to chronic illness
Psychological/Sociological
Personal accommodation, autonomy, attitude, and supportive environments
Nursing
Adequate functional status, supportive environment, health maintenance practices and psychological independence
Attributes of Healthy Aging
Acceptance of slowing down of body processes
Adaptation
Compensation
Resilience
Self-defined and individualistic
Desire to continue to actively participate in life processes
Ability to function physically, cognitively, and socially
Continual modification, self-assessment, and redefinition of self and abilities
Acceptance and movement towards death
Attributes of Healthy Aging
Adaptation: the ability to redefine oneself in terms of independence and autonomy
Compensation: the ability to change one’s lifestyle to accommodate the physical changes that have occurred
Resilience: the ability to bounce back, to change and to adapt
Successful aging: the ability to establish and maintain stated goals or lifestyles and involvement in prescribed roles
Independence: the ability to live on one’s own terms and actively participate in one’s own care
Autonomy: the ability and the desire to make decisions regarding one’s care
