Exam 3: Care of older adults Flashcards
variability among older adults
Physiological, cognitive, and psychosocial health
Wide range of functional ability
Functionality
Chronic conditions add to the complexity of assessment and care
Do not assume that all older adults have signs, symptoms, or behaviors representing disease
Identify an older adult’s strengths and abilities
Statements that demonstrate ageism
Ill, disabled, and unattractive
Forgetful, confused, rigid, boring, and unfriendly
Unable to learn and understand new information
Not interested in sex or sexual activities
Nurses must assess their own attitude toward older adults and their own aging.
Come from personal experiences with older adults, education, employment experiences, and attitudes of co-workers and employing institutions
Forming positive attitudes toward them and gaining specialized knowledge about aging and the health care needs of older adults are priorities for all nurses
Nurses need to gain knowledge about aging and health care needs of older adults
Respect
Dignity
Involvement in care decision and activities
Gerontology
Study of aging process
Gerontological nursing
caring for the aging adult
Current fastest growing subgroup is
85-99 years old
Ego integrity vs. despair
older adult need to look back on life and feel a sense of fulfillment, success at this stage leads to wisdom, failure results in regret and despair.
Developmental tasks for older adults
Adjustment
Maintaining quality of life
functional status includes
- ADL’s: sensitive indicator of health or illness.
- Instrumental ADLs
older adults and acute cared
Delirium Dehydration Malnutrition Health care–associated infections Urinary incontinence Skin breakdown Falls ------Medications, increased urine output, orthostatic BP
Risk of acute care go up with
sleep deprivation, infections, dehydration, pain, sensory impairment, drug interactions, anesthesia, hypoxia.
Delirium
Acute confusion state
Reversible
Underlying medical condition (UTI, anesthesia, electrolytes, sleep deprivation, pain, etc….)
Dementia
Irreversible
Gradual/chronic confusion/impaired cognitive functioning
Depression
Most common, yet most undetected and untreated, impairment in older adulthood
Mood disturbance: sadness and despair
Nursing management of dementia and delirium
Safety! Meet physical & psychosocial needs Correct underlying physical problem Maintain routine Modify the environment for safety Compensate for sensory deficits Encourage fluids Individualize nursing care to enhance quality of life Maximize functional performance by improving cognition, mood, and behavior.
Illness in older adults
Confusion:
–Infection
–Acute illness
–Medications
Chronic dehydration esp. with illness
ADL decline can signal underlying illness
Depression common w/chronic illness
Monitor for drug to drug interactions and toxicity
Classic S/S of disease are sometimes absent/atypical in older adults. EX:
–UTI presents w/confusion and incontinence, maybe no fever, but increased RR
–MI: dyspnea and anxiety rather than crushing pain
–Change in mental status, falls, dehydration, decreased appetite, loss of function.
Pain often undertreated: look for non-verbal cues (inspection/observation)
Decreases nutrition and hydration
Increased need for Calcium, Vit’s D, C, A
Decreased metabolism: need for fewer calories
Decreased sense of smell/taste and dental care/dentures
Reduced income; starvation or fast foods
At risk for Geriatric failure to thrive: under nutrition, physical impairment, depression and cognitive impairment
Limit fluid consumption r/t immobility, diuretics, incontinence
Advantages of physical activity in the elderly
Decreased --risk for falls --Depression symptoms --Risk of diabetes, CAD and dementia --Body weight/BMI Increased --Muscle strength and balance --Sleep --Sense of well being and self esteem --Longevity
what is the most common accident in elderly
Falls!
what is the second most common accident in elderly
motor vehicle accident
fall prevention
- Handrails, Slip proof pads for rugs, adequate lighting, avoid scatter rugs, slippery floors, and clutter.
- Grab bars in bathrooms, raised toilet seats, caution with icy and wet surfaces
- Concentrate on one activity at a time
Poly pharmacy
use of multiple drugs, duplicative drugs, excessive dosages and drugs prescribed for a long period of time.
Age-related changes affect drug absorption/excretion/metabolism
Decreased GI blood flow/motility, renal excretion, water distribution, metabolism
Increased fat storage
Altered liver metabolism of drugs
Elderly are at risk for _____ with self administration of medication
toxicity
Nursing care of elderly
See a list of all medications (including OTC)
Educate on each med and use (duplicative drugs)
Collaborate with Pharmacists suggest once a day dosing if possible
Verbal and written information
Organizing administration with medication containers
Physical restraints
Straight jackets/Posey’s Limb restraints Torso restraints Bed rails Household items: pillows, sheets, wheelchair brakes while at the table; ANYTHING that prevents free mobility
Chemical restraints
medications, alcohol, illicit drugs
Psychological restraints
Alarms
Alternative use to restraint s
Meet underlying physical needs: food, water, toileting Reorientation Validation of feelings Check often, at least every hour Hide tubes and lines with gauze or clothing Keep patient busy Calm music Place in common area for supervision Turn off TV if agitated Visitors/“Sitters”
Psychosocial changes
Occur with transitions and loss Coping and adjustments Retirement Finances, role and function Personal identity Social isolation Social network, transportation Sexuality Love, warmth, sharing, touching Housing and environment Promote independence and functioning Death Spouse, alone, suffering burden
Sources of stress and loss
Changes in lifestyle: retirement/illness
Loss of significant others
Financial hardships
Relocation
Nursing Care: Stress and Loss
Establish trusting relationship Encourage participation in decisions Explain relocation before it happens Validation therapy Special keepsakes at bedside/in apartment Reminiscence Reorient to new environment Encourage family and friends to visit often Therapeutic touch
Neglect and abuse can be
Verbal, physical, sexual, emotional and financial
Abuser is often family member
Under reported and under investigated
Neglect
Failure to provide basic needs: Food, clothing, shelter, meds, ADL’s
Abuse
use of force/power that results in injury: Hitting, burning, pushing, raping, molesting, stealing, humiliating, intimidating, isolating.
Depression
Most common undetected in elderly
15% of elderly are depressed (NIH)
Increases with hospitalizations
Classification: Mild/severe/major
Primary depression
Lack of neurotransmitters norepinephrine and serotonin
Secondary depression
situational–sudden change in life such as illness or loss
