Chapter 3 Common Health Problems of Older Adults Flashcards
What is the fasting growing subgroup in late adulthood?
The old old, sometimes referred to as the advanced older adult population.
What are some common health issues and problems that often older adults in the community?
- Decreased nutrition and hydration
- Decreased mobility
- Stress and loss
- Accidents
- Drug use and misuse
- Mental health/behavioral health problems (including substance abuse)
- Elder neglect and abuse
What does OTC stand for?
Over-the-counter drugs
What are the four subgroups of late adulthood?
65 to 75 years of age: the young old
75 to 84 years of age: the middle old
85 to 99 years of age: the old old
100 years of age or older: the elite old
! Nursing safety priority
Action Alert
Perform nutritional screening for older adults in the community who are at risk for inadequate nutrition-either under-nutrition or obesity. Ask the individual about unintentional weight loss or gain, eating habits, appetite, prescribed and over-the-counter drugs, and current health problems. Determine contributing factors for older adults who have or are at risk for poor nutrition, such as transportation issues or loneliness. Based on these data, develop and implement a plan of care in collaboration with appropriate members of the healthcare team.
! Nursing safety priority
Action Alert
Older adults sometimes limit their fluid intake, especially in the evening, because of problems associated with mobility, prescribed diuretics, and urinary incontinence. Teach older adults that fluid restrictions make them susceptible to dehydration and electrolyte imbalance is (especially sodium and potassium) that can cause serious illness or death. Incontinence may actually increase because the urine becomes more concentrated and irritating to the bladder and urinary sphincter. Teach older adults the importance of drinking 6 to 8 glasses of water a day plus other fluids as desired. Remind them to avoid excessive caffeine and alcohol because they can cause dehydration.
Define “geriatric failure to thrive”
A complex syndrome including under-nutrition, impaired physical functioning, depression, and cognitive impairment.
What does GFTT stand for you?
Geriatric failure to thrive
Define “relocation stress syndrome”
Physiologic or psychosocial distress following transfer from one environment to another, such as after admission to a hospital or nursing home; also called “relocation trauma”
Define “fallophobia”
In some older adults, the fear of falling and sustaining a serious injury.
Define “presbyopia”
An age-related impairment of vision characterized by a loss of lens elasticity and the ability to accommodate. The near point of vision increases, and near objects must be placed farther from the eye to be seen clearly
Define “polymedicine”
The use of many drugs to treat multiple health problems for older adults
Define “polypharmacy”
They use multiple drugs, duplicative drug therapy, high-dosage medications, and drugs prescribed for too long a period of time. In other words, polypharmacy occurs when there is inappropriate or unnecessary prescribing that results in negative outcomes.
What is a creatinine clearance test?
Creatinine clearance test measures the glomerular filtration rate of the kidneys. A commonly used formula for calculating creatinine clearance for men rather than directly measuring it is: (140 - Age in years) x Lean body weight in kg / Serum creatinine in mg / dl x 72
What does ADES stand for?
Adverse Drug Events
What are some Common Adverse Drug Events in older adults?
Edema Severe nausea and vomiting Anorexia Dehydration Dysrhythmias Fatigue Weakness Dizziness Syncope Urinary retention Diarrhea Constipation/impaction Hypotension Acute confusion
What are some examples of BEERS criteria for potentially inappropriate medication used in older adults?
meperidine (Demerol) cyclobenzaprine (Flexeril) digoxin (Lanoxin) (Should not exceed 0.125 mg daily except for atrial fibrillation) ticlopidine (Ticlid) fluoxetine (Prozac) amitriptyline (Elavil) diazepam (Valium) promethazine (Phenergan) ketorolac (Toradol) Short-acting nifedipine (e.g. Procardia) ferrous sulfate (Iron) (Should not exceed 325 mg/day) chlorpropamide (Diabinese) diphenhydramine (Benadryl)
! Nursing safety priority
Drug Alert
Tricyclic antidepressants should not be used because they have anti-cholinergic properties that can cause acute confusion, severe constipation, and urinary incontinence. For older adults who may be prescribed this group of drugs, question healthcare provider and request an SSRI or other treatment.
Define “legally competent”
A person 18 years of age or older, a pregnant or married minor, a legally emancipated (free) minor who is self-supporting, or a person not declared incompetent by a court of law.
Define “guardian”
A person appointed to make healthcare decisions for a patient who is determined to not be legally competent.
Define “clinically competent”
The condition of being legally competent and having decisional capacity.
Define “depression”
A response to multiple life stresses, a single situation, the primary disorder, or a problem associated with dementia; this response can range from mild, transient feelings of sadness to a severe sense of helplessness and hopelessness.
Define “Geriatric Depression Scale”
A valid and reliable screening tool to help determine if an older patient has clinical depression.
Define “dementia”
A syndrome of slowly progressive cognitive decline with global impairment of intellectual function. Most common type is Alzheimer’s disease.
Define “delirium”
An acute state of confusion, usually short-term and reversible within three weeks. Often seen among older adults in a hospital or other unfamiliar setting.
! Nursing safety priority
Action alert
Acutely confused patients who are discharged from the hospital are at an increased risk for functional decline, falls, and incontinence at home. Therefore carefully assess older patients in any setting for acute confusion
What does CAM stand for?
Confusion Assessment Method
What is the confusion assessment method?
- Acute onset and fluctuating course (e.g., Is there evidence of an acute change in mental status from the patient’s baseline?)
- Inattention (e.g., Does the patient have difficulty focusing attention or keeping track of what is being said?)
- Disorganized thinking (e.g., Is the patient’s thinking and conversation disorganized or incoherent?)
- Altered level of consciousness (e.g., Is the patient lethargic, hyperalert, or difficult to arouse?)
The diagnosis of delirium by the CAM is the presence of features 1 and 2 and either 3 or 4.
Define “neglect”
In nursing, failure to provide for a patient’s basic needs.
Physical abuse
The use of a physical force such as hitting, burning, pushing, and molesting the patient, that results in bodily injury.
Define “financial abuse”
Mismanagement or misuse of the patient’s property or resources.
Define “emotional abuse”
The intentional use of threats, humiliation, intimidation, and isolation to another person.
What does Fulmer SPICES stand for?
S sleep disorders P problems with eating or feeding I incontinence C confusion E evidence of falls S skin breakdown
Define “fall”
And unintentional change in body position that results in the patient’s body coming to rest on the floor or ground.
Define”nocturia”
The need to urinate excessively at night. Also called nocturnal polyuria.
Define “restraint”
Any device (physical restraint) or drug (chemical restraint) that that prevents the patient from moving freely
! Nursing Safety Priority
Drug Alert
Closely monitor older adults receiving antipsychotics for adverse drug events (ADEs). Assess patients for?
Anti-cholinergic effects, the most common problem, causing constipation, dry mouth, and urinary retention
Orthostatic hypotension, which increases the patient’s risk for falls and fractures
Parkinsonism including tremors, bradycardia, and a shuffling gait
Restlessness and the inability to stay still and anyone position
Hyperglycemia and diabetes mellitus, which occur more with drugs like risperidone (Risperdal) and quetiapine (Seroquel)
! Nursing Safety Prioity
Action alert
Supervise unlicensed assistive personnel (UAP) for frequent turning in repositioning for the patient who is immobile. Assess the skin every 8 hours for reddened areas that do not blanch. Remind you UAP to keep the skin clean and dry. Use pressure-releaving mattresses, and avoid briefs or absorbent pads that can cause skin irritation and excess moisture.
What are some of thebest practices for patient safety and quality care using restraint alternatives?
- If the patient is acutely confused, reorient him or her to reality as often as possible
- If the patient has dementia, use validation to reaffirm his or her feelings and concerns
- Check the patient often, at least every hour
- If the patient pulls tubes and lines, cover them with roller gauze or another protective device; be sure that IV insertion sites are visible for assessment
- Keep the patient busy, with activity, pillow or apron, puzzle, or art project
- Provide soft, calming music
- Place the patient in an area where he or she can be supervised (if the patient is agitated, do not place him or her in a noisy area)
- Turn off the television if the patient is agitated
- Ask a family member or friend to stay with the patient at night
- Help the patient to toilet every 2 to 3 hours, including during the night
- Be sure that the patient’s needs for food, fluids, and comfort are met
- If agency policy allows, provide the patient with a pet visit
- Provide familiar objects or cherished items that the patient can touch
- Document the use of all alternative interventions
- If a restraint is applied, use the least restrictive device (e.g. mitts rather than wrist restraints, a roller belt rather than the vest)
