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NURS3313 Adult Health > Chapter 8 Considerations for the Older Adult > Flashcards

Chapter 8 Considerations for the Older Adult Flashcards

1
Q

What two factors affect life expectancy?

A

Gender & Age

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2
Q

True or False: Women live longer than men.

A

True

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3
Q

Most deaths occur in which age group?

A

Adults ages 65 or older

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4
Q

Leading Causes of Death Among Older Adults

A

Heart Disease

Cancer

Unintentional injuries

Chronic lower pulmonary diseases

Stroke

Alzheimer’s disease

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5
Q

Goal of Older Adult Care

A

Help older adults sustain maximum functional level & dignity despite physical, social, and psychological losses

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6
Q

Intrinsic Aging

A

Changes caused by the normal aging process that are genetically programmed and essentially universal

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7
Q

Cardiovascular Changes in the Older Adult

A

Myocardial hypertrophy->Decreased CO

Increased fibrosis/calcified tissues-> Reduced stroke volume

Calcium and fat deposits accumulate w/in arterial walls-> HTN & increased workload

Slower recovery response to stress or exercise

Likely to have dyspnea or neurologic symptoms associated with heart disease

Absence of chest pain is not a reliable indicator of the absence of heart disease

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8
Q

Optimal Blood Pressure

A

<130/88 mmHg

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9
Q

Nursing Interventions for Orthostatic Hypotension

A

Assess BP in 2 positions & educate patients to rise slowly

Avoid straining when having bowel mvmnt

Consider 5-6 small meals each day to min hypotension that can occur after a large meal

Avoid extreme temperatures

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10
Q

How does extremely high temperatures affect blood pressure?

A

Causes vasodilation-> BP drops

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11
Q

How does extremely low temperatures affect blood pressure?

A

Causes vasoconstriction-> BP rises

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12
Q

Respiratory System Changes in Older Adults

A

Diminished response efficiency

Reduced maximal inspiratory & expiratory force

Diseases manifest less typical symptoms (fatigue, lethargy, anorexia, dehydration

Lung mass decreases & residual volume increases

Smoking is the most significant risk factor

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13
Q

Nursing Interventions for Respiratory System Changes

A

Encourage regular exercise and appropriate fluid intake,

Encourage COVID shot and booster, pneumococcal vaccination, and yearly flu shot

Educate patient to avoid people who are ill

Remind hospitalized patients to cough and take deep breaths_ frequently

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14
Q

Integumentary System Changes in Older Adults

A

Epidural proliferation decreases-> dermis becomes thinner

Elastic fibers reduced-> collagen becomes stiffer

Subcut fat diminishes-> less likely to conserve body heat

Loss of resiliency with wrinkling and sagging ->Drier and more susceptible to burns, injury, and infection

Hair pigmentation may change

Balding may occur

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15
Q

Strategies to Promote Healthy Skin Function

A

Smoking cessation

Limit alcohol consumption

Avoid sun exposure & use sun protection factor of 15 or wear protective clothing

Use emollient skin cream

Avoid hot soaks in the bathtub

Maintain optimal _____________ and ______________

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16
Q

Reproductive System Changes in Older Adults

A

Less intense response to sexual stimulation

Decline in sexual activity , but no loss in sexual desire

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17
Q

Female Reproductive System Changes in Older Adults

A

Vaginal narrowing

Decreased elasticity & secretions

Involution of uterus & ovaries

Decreased tone

Changes can cause vaginal bleeding & painful penile-vaginal intercourse

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18
Q

Male Reproductive System Changes in Older Adults

A

Less firm testes but may continue to produce viable sperm up to 90 years of age

Diminished production of testosterone at about age 50 Decreased libido and ED may develop but likely associated with other factors

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19
Q

Nursing Interventions for Reproductive System Changes in Older Adults

A

Encourage use of water-soluble lubricants

Assess causes of decreased libido or ED

Show sensitivity, expert knowledge, and support during communication

Provide information on available non-pharmacologic, pharmacologic, and surgical methods

Consult w/provider to offer referral to a gynecologist, urologist, or sex therapist, if warranted

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20
Q

Genitourinary Changes in Older Adults

A

Increased susceptibility to UTIs

Changes may be a combo of aging & pathologic conds (HTN)

Decreased filtration rate

Diminished tubular function w/less efficiency in reabsorbing & concentrating the urine

Slower restoration of acid-base balance in response to stress

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21
Q

Male Genitourinary System Changes in Older Adults

A

Benign prostatic hyperplasia: gradual increase in urine retention and overflow incontinence

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22
Q

Female Genitourinary System Changes in Older Adults

A

Relaxed perineal muscles, detrusor instability (urge incontinence), urethral dysfunction (stress urinary incontinence)

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23
Q

Urgency/Frequency Syndrome

A

Decreased “warning time”, drops of urine lost w/laugh, cough, & position change

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24
Q

Nursing Interventions for Genitourinary Changes

A

Encourage adequate fluid intake helps to reduce the risk of bladder infections and helps to decrease urinary incontinence

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25
Q

Examples of bladder irritants

A

Caffeinated beverages, alcohol, & artificial sweeteners

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26
Q

GI System Changes in Older Adults

A

Decreased sense of thirst, smell, taste

Decreased salivation

Difficulty chewing and swallowing food

Delayed esophageal, gastric emptying

Diminished secretion of gastric acid and pepsin

-Due more to pathologic conditions rather than aging

(Reduces absorption of iron, calcium, and vitamin B12)

Reduced gastrointestinal motility-> Delayed emptying and early satiety

Increased incidence of gallstones and common bile duct stones

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27
Q

Practices that Promote GI Health

A

Regular brushing and flossing and regular dental care

Drinking adequate fluids

Eating small, frequent meals high in fiber and low in fat Avoiding heavy activity or lying flat after eating

Avoid use of laxatives and antacids

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28
Q

Nutritional Health Considerations for Older Adults

A

Require fewer calories

Require more nutrient-rich, healthy diet

Unintentional weight loss may affect ability to maintain health and fight illness

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29
Q

Factors that Contribute to Malnutrition in Older Adults

A

Apathy

Immobility

Depression

Loneliness

Poverty

Inadequate knowledge

Poor oral health

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30
Q

Nutritional Health Nursing Actions

A

Consider budgetary constraints and physical limitations

Identify nutritional problems

Work within patient’s own framework of knowledge of their health status

Recommend a reduced fat diet, sufficient protein, vitamins, minerals, and dietary fiber for health and prevention of disease

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31
Q

Factors that Affect Sleep Quality

A

Respiratory problems during sleep

Restless leg syndrome

Nocturia

Pain

Osteoarthritis

Heart Failure

Incontinence

Prostatic hyperplasia

Menopause-related problems

Alzheimer’s disease or Dementia

Depression or Social Isolation

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32
Q

Restless Leg Syndrome

A

A condition characterized by a nearly irresistible urge to move the legs, typically in the evenings

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33
Q

Consequences of Poor Sleep

A

Cognitive decline

Increase risk for falls

Daytime fatigue

Reduced physical and mental health

Reduced quality of life

Poor ICU outcomes

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34
Q

Nursing Interventions for Sleep

A

Assess and identify sleep problems

Provide health education on sleep hygiene behaviors (sleep schedule)

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35
Q

Alterations in Bone Remodeling Lead To:

A

Loss of bone density

Loss of muscle strength, size

Deterioration of muscle fibers and cell membranes Degenerated joint cartilage

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36
Q

Musculoskeletal Changes in Older Adults

A

Height loss

Prone to fractures

Kyphosis

Back pain

Loss of strength, flexibility, & endurance

Joint pain

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37
Q

When does progressive bone loss occur?

A

Before age 40 w/out exercise

38
Q

How often should older adults exercise?

A

3x a week (weight-bearing exercises)

39
Q

Nursing Actions for Musculoskeletal Systems

A

Encourage participation in a regular exercise program

Recommend bone density screenings

Take calcium & vitamin D supplements as prescribed

40
Q

Benefits of Regular Exercise Program Participation

A

Increased strength, aerobic capacity, flexibility, and balance

-Hospitalized patients benefit from getting OOBas soon as possible and in-hospital activity

41
Q

Nervous System Changes in Older Adults

A

Difficult to maintain homeostasis

Decreased nerve cells

Nerve impulses conducted slower (takes longer to respond-> falls, injuries, & driving errors)

Reduced cerebral circulation (gait and balance affected)

Sudden onset on confusion may be 1st symptom of an infection/change in physical condition (pneumonia, UTI, med interactions)

42
Q

Nursing Actions for Nervous System Changes

A

Advise older adults to allow longer time to respond to stimulus and to move more deliberately

Encourage adequate nutrition and absorption of B12, especially those following a vegetarian diet

43
Q

Sensory Deprivation

A

Absence of stimuli in the environment/ inability to interpret existing stimuli

44
Q

Vision Changes in Older Adults

A

Diminished ability to focus on close objects; inability to tolerate glare, difficulty adjusting to changes of light intensity; decreased ability to distinguish colors

Poor night vision & “dry eye”

Most common eye diseases are cataracts, glaucoma, diabetic retinopathy, and age-related macular degeneration

45
Q

What is the primary cause of vision loss in adults 65 years or older?

A

Macular degeneration (MD)

46
Q

Presbyopia

A

Diminished ability to focus on close objects

47
Q

Cataracts

A

Clouding of the eye lens

48
Q

Glaucoma

A

Vision loss due to increased pressure on the optic nerve

49
Q

Macular degeneration

A

Loss of central vision

50
Q

Nursing Actions for Vision Changes in the Older Adults

A

Wear eyeglasses & use sunglasses outdoors

Avoid abrupt changes from dark to light

Use adequate indoor lighting

Avoid nighttime driving

Use contrasting colors for color coding

51
Q

Hearing Changes in Older Adults

A

Presbycusis

Tympanic membrane thinning & loss of resiliency

Difficulty w/sound discrimination especially w/ noisy environment

52
Q

Presbycusis

A

Decreased ability to hear high-pitched sounds

53
Q

Nursing Actions for Hearing Changes in Older Adults

A

Recommend hearing screenings

Reduce background noise

Directly face client

Enunciate clearly

Speak w/low-pitched voice, use nonverbal cues, rephrasing

54
Q

Taste & Smell Changes in Older Adults

A

Decreased ability to taste & smell
-Excess use of sugar & salt

55
Q

Nursing Actions for Taste & Smell Changes in Older Adults

A

Encourage use of lemon, spices, & herbs

Encourage smoking cessation

56
Q

Ageism

A

Prejudice/discrimination on the basis of someone’s age

57
Q

Coping

A

Patterns and ability to adapt to stress develop over course of lifetime and remain consistent later in life

58
Q

Nursing Strategies to Promote Cognitive Function

A

Supply Mnemonics

Encourage ongoing learning

Link new information with familiar information

Use visual, auditory, and other sensory cues

Encourage use of prescription glasses &hearing aids

Provide glare-free lighting and quiet, nondistracting environment

Set short-term goals

Prioritize the most important information

Keep education period short

Pace learning tasks

Encourage verbal participation

Reinforce successful learning in a positive manner

59
Q

Polypharmacy

A

The use of multiple medications on a regular basis

60
Q

Med Absorption Changes in Older Adults

A

May be affected by changes in gastric pH & decrease in GI motility

61
Q

Med Distribution Changes in Older Adults

A

May be altered due to decrease in body water & increase in body fat

62
Q

“Start low, go slow”

A

Need adjustment of med dosage based on age

63
Q

Nursing Implications for Pharmacologic Aspects

A

Assess knowledge of medications and use

Identify patient’s beliefs and concerns about the medication

Review need for medication, coordination of prescriber

Keep medication regimen as simple as possible

64
Q

Factors that Affect Compliance

A

Number of medications prescribed

Complexity of the regimen

Difficulty opening containers

Inadequate patient education

Financial cost

Disease or medication interfering with patient’s life

65
Q

Nursing Actions for Mental Health Issues in Older Adults

A

Recognize, assess, refer, collaborative, treat, & support older adults who exhibit s/s of depression, substance, abuse, delirium, or dementia

66
Q

Delirium

A

Acute, confused state that begins w/disorientation

67
Q

Alzheimer’s Disease (AD)

A

A progressive, irreversible, degenerative neurologic disease that begins insidiously & is characterized by gradual loss of cognitive func & disturbances in behavior & affect

68
Q

Causes of Alzheimer’s Disease

A

Genetics

NT changes

Vasc abnormalities

Stress hormones

Circadian changes

Head trauma

Presence of seizure disorders

69
Q

Clinical Manifestations of Alzheimer’s Disease

A

Progressive dementia

Memory failure

Personality disturbance

Loss of intellectual func assoc w/ cerebral cortical atrophy

Beta-amyloid plaque formation

Intraneuronal neurofibrillary tangles

70
Q

Early-Stage Alzheimer’s Disease

A

Lasts 1-3 years

Memory loss

Poor judgement & poor problem-solving

Difficulty adapting to new environments & challenges

Agitation/apathy

71
Q

Middle-Stage Alzheimer’s Disease

A

Lasts 2-10

Difficult w/recent & remote memory

Apraxia

Irritability

Depression

Restlessness

Difficulty swallowing

Occasional incontinence

Communication difficulties

Motor disturbances

Forgetfulness

Psychosis

72
Q

Late-stage Alzheimer’s Disease

A

Loss of all mental abilities & ability to care for self

73
Q

End-stage Alzheimer’s Disease

A

Loss of all voluntary activity

74
Q

What is the most common mood disorder among older adults?

A

Depression

75
Q

Subtle Signs & Symptoms of Depression

A

Fatigue

Diminished memory & concentration

Feelings of worthlessness

Sleep disturbances

Appetite disturbances with excessive weight loss or gain

Restlessness

Impaired attention span

Suicidal ideations

76
Q

Non-pharmacological Nursing Measures for Depression

A

Exercise, bright lighting, increasing interpersonal interactions, cognitive therapy, and reminiscence therapy

77
Q

Nursing Interventions for Depression

A

Monitor closely to avoid med toxicity, hypotensive events, and falls

Monitor for side effects

Provide adequate patient education

Offer support and encouragement

Provide strategies to maintain safety, such as changing positions slowly and maintaining adequate hydration

78
Q

Geriatric Syndromes

A

Common conditions that tend to be multifactorial and do not fall under discrete disease categories

79
Q

Examples of Geriatric Syndromes

A

Falls

Delirium

Frailty

Dizziness

Urinary incontinence

80
Q

Geriatric Triad

A

Includes changes in cog status, falls, & incontinence

81
Q

Causes for Impaired Mobility

A

Strokes

Parkinson’s disease

Diabetic neuropathy

Cardiovascular compromise

Osteoarthritis

Osteoporosis

Sensory deficits

82
Q

Nursing Actions for Impaired Mobility

A

Encourage older adult to stay as active as possible

Active ROM and strengthening exercises with unaffected extremities

Passive ROM exercises on the affected extremities

83
Q

Active ROM (Range-of-Motion)

A

Pt moves a part of their body w/out outside assistance

84
Q

Passive ROM (Range-of- Motion)

A

An outside force causes mvmnt of the joint

85
Q

Nursing Actions for Falls

A

Implement fall prevention measures for hospitalized patients

Encourage patient/family to make lifestyle and environmental changes to prevent falls:

-Adequate lighting
- Grab bars in bathtub, shower or near toilet
- Properly fitted clothing and shoes
-Identify trip hazards: rugs, small objects, or pets
86
Q

Geriatric Syndromes: Increased Susceptibility to Infection

A

Altered pain & febrile responses (mental confusion, increased respirations, tachycardia, and a change in skin color)

Altered emotional impact

Altered systemic response

87
Q

What is the most common form of abuse against older adults?

A

Neglect

88
Q

Nursing Actions for Elder Abuse

A

Be alert to possible elder neglect abuse

Assess during health history

Implement preventative action when caregiver strain is evident

Provide resources to family or patient for early detection and intervention

Interdisciplinary approach to help caregiver develop self-awareness, increased insight, and understanding of disease and aging process

89
Q

Medicare

A

Federally funded health insurance for those 65 yrs or older

90
Q

Medicaid

A

Joint federal & state program that gives health coverage to some people w/limited income & resources

91
Q

Advance Directives

A

Legal document providing instructions for care (living will) or names a proxy decision maker

NURS3313 Adult Health (27 decks)

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