Exam Study Flashcards
What is wellness?
A state of being in good health both physically and emotionally
Estimated percentage of adults aged 65+ by 2051
26%
What does CALD stand for?
Culturally and linguistically diverse
Top 5 countries older adults have migrated from to Australia?
- Italy
- Greece
- Germany
- Netherlands
- China
Estimated percentage of adults aged 65+
2.6 million (13%)
Life expectancy of females
83 years
Life expectancy of males
78.1 years
Estimated percentage of adults aged 85+
- 5% in 1971
1. 8% in 2011
Leading causes of death in older adults
Circulatory disease - large cause of death in 75+
Increase in number of death due to falls (males more likely)
Ethnicity of older adults
36% of older Australians born overseas
Aboriginal and TSI contribute 3% of 0-64 years and 0.7% 65+
Risk factors affecting older adults
48% of population overweight
10% of 85+ underweight
Exercise reduces with age: 53% over 75 years sedentary
8% of smokers are 64-74 : reduces with age (26% 18-64)
Common conditions affecting 65-74 year olds
Long sightedness 64%
Arthritis 49%
Hypertension 38%
Short sightedness 36%
Common conditions affecting 75+ year olds
Long sightedness 59%
Arthritis 50%
Deafness 42%
Hypertension 41%
Older adult relationships
Primarily care = spouses
Secondary care = adult children (esp. daughters and unmarried children)
Responsible for raising grandchildren in skipped-generation households
What has lead to an ageing population worldwide
Decline in fertility rates and improvements in health and life expectancy
What is the ‘Living longer living better’ initiative
10 year aged care reform package
Provides more choice and control
Easier access to services
Meets social and economic challenges of the ageing population
Name four packages of care available for older adults?
4 Levels of the LLLB initiative
Lvl 1 - support basic care needs
Lvl 2 - support low level care needs
Lvl 3 - intermediate care needs
Lvl 4 - high care needs
Financial breakdown of the ‘Living longer living better’ initiative
$955m – help people stay at home
$55m – help carers
$1.2b – strengthen aged care workforce
$268m – tackle to nations dementia epidemic
$194m – support for older adults from diverse backgrounds
$256m – future planning
Explain Miller’s functional consequences theory?
Effects of actions in relation to risk factors and age related changes that influence their quality of life
role of nurse: use health education interventions to promote optimal health
effects relate to all levels of functioning: mind, body, spirit
Why is Health Promotion important for older adults?
Improve quality of life Increase optimal health and functioning Lower co-morbidities Increase awareness Essential for preventing chronic conditions.
Explain the Transtheoretical Model of Health Promotion?
Addresses disease prevention and health promotion interventions that require a change in health-related behaviours
Pre-contemplation: unaware of the problem, denial of change, no intent to change for next 6 months.
Contemplation: intent to change in foreseeable future. Likely to ask questions.
Preparation: ambivalence regarding unhealthy behaviour, strong desire to change to healthier habits. Change within the next month.
Action: Changes made, less than 6 months. May not see changes yet, likely to revert to unhealthy behaviours.
Maintenance: Continued over 6 months, started experiencing positive effects.
Stages of the Transtheoretical Model of Health Promotion?
Pre-contemplation Contemplation Preparation Action Maintenance
What happens in the Pre-contemplation stage?
Unaware of the problem, denial of change, no intent to change for next 6 months.
What happens in the Contemplation stage?
Intent to change in foreseeable future. Likely to ask questions.
What happens in the Preparation stage?
Ambivalence regarding unhealthy behaviour, strong desire to change to healthier habits. Change within the next month.
What happens in the Action stage?
Changes made, less than 6 months. May not see changes yet, likely to revert to unhealthy behaviours
What happens in the Maintenance stage?
Continued change over 6 months, started experiencing positive effects.
Name the 12 Activities of Living
Maintaining safe environment Communication Breathing Eating Elimination Wash/dress Temperature control Mobilisation Work/play Sexuality Sleep Death
Name 2 tools used to assess function ability in older adults
Cognitive Assessment (MMSE) FRAMPS (falls risk assessment and management plan)
What primary prevention education would the nurse give to prevent cancer
Stop smoking Wear sunscreen and avoid excessive periods in sun Avoid red meat Exercise Monitor diet Don’t drink alcohol in excessive amounts
What are functional consequences
Observable effects of actions, risk factors, and age related changes that influence quality of life or day-to-day activities. The effects relate to all levels of functioning, including body, mind and spirit.
What are negative functional consequences
Those that interfere with functioning or quality of life
What are positive functional consequences
Those that facilitate the highest level of functioning, the least dependency, and the best quality of life
What are age related changes
Inevitable, progressive, and irreversible changes that occur and are independent of extrinsic or pathological conditions
What are risk factors
Conditions that increase the vulnerability to negative functional consequences
What is health promotion
Essential for preventing chronic conditions, reducing mortality and improving quality of life
Major initiatives focus on health promotion
- Screening programs
- Risk reduction interventions
- Environmental modifications
- Health education
What age related changes affect hearing in older adults?
External Ear
Pinna: no change in conduction of sound
External auditory canal (buildup of cerumen, canal prolapse or collapse)
Middle Ear
Tympanic membrane - less elastic, thinner and stiffer
Calcification of ossicular bones
Muscles and ligaments - thicker and stiffer
Acoustic Reflex
Inner Ear
Changes cause various types of presbycusis (Sensory, Neural, Metabolic or stria, Mechanical)
Auditory Nervous System
Degenerative changes in organ of Corti, auditory meatus and degeneration of arteries to the auditory nerve
5 risk factors that affect hearing in older adults?
Male gender Increased age Genetic predisposition Exposure to noise Impacted cerumen Smoking
What percentage of older adults suffer from impacted cerumen?
2% to 6% of the general population
19% to 65% of patients over 65 years
What is presbycusis?
Age-related hearing loss with gradually progressive inability to hear, especially high frequency sounds
What is depth perception and how might it affect an older adult?
Ability to judge the distance of objects and the spatial relationship of objects at different distances.
Declines with age, can cause falls, difficulty driving, using stairs, pouring drinks, etc
What is the difference in nursing care between an arterial leg ulcer and a venous leg ulcer and why?
Arterial: inadequate blood supply, dangle legs over bed, allows gravity to aid blood flow to the ulcer
Venous: superficial with irregular edges. Compression
What age related changes to the External Ear affect hearing in older adults?
Pinna: no change in conduction of sound
External auditory canal: buildup of cerumen, canal prolapse or collapse
What age related changes to the Middle Ear affect hearing in older adults?
Tympanic membrane - less elastic, thinner and stiffer
Calcification of ossicular bones
Muscles and ligaments - thicker and stiffer
Acoustic Reflex
What age related changes to the Inner Ear affect hearing in older adults?
Changes cause various types of presbycusis (Sensory, Neural, Metabolic or stria, Mechanical)
What age related changes to the Auditory Nervous System affect hearing in older adults?
Degenerative changes in organ of Corti, auditory meatus and degeneration of arteries to the auditory nerve
What should you assess for hearing loss?
Lifestyle and Environmental Factors
- Exposure to noise due to lifestyle, environment or occupation
Impacted Cerumen
- Leading cause of hearing loss, preventable and treatable
Intervention for hearing loss?
Interventions to prevent noise-induced hearing loss
Education related to ototoxic medications
Smoking cessation
Audiology screening
Prevention of impacted cerumen
Age related changes in the Eye
Arcus senilis - lipids accumulate in outer area of cornea
Endophthalmos - posterior displacement of eyeball within orbit due to changes in the volume relative to contents or loss of function of the orbitalis muscle
Blepharochalasis - inflammation of eyelid resulting in stretching, leading to formation of folds
Ectropion - lower lid droops and tears can’t drain away
Endotropion - lower lid folds inwards
Dry eyes Excessive tearing Visual processing slows Greater size & density of lens Iris sclerotic Atrophy of ciliary body Less aqueous humour Vitreous shrinks, proportion of liquid increases Cones lost in peripheral retina Rods in central retina decrease Cones lost from central retina
What is Arcus senilis
Lipids accumulate in outer area of cornea
What is Endophthalmos
Posterior displacement of eyeball within orbit due to changes in the volume relative to contents or loss of function of the orbitalis muscle
What is Blepharochalasis
Inflammation of eyelid resulting in stretching, leading to formation of folds
What is Ectropion
Lower eyelid droops and tears can’t drain away
What is Endotropion
Lower eyelid folds inwards
Consequences of age related changes to the eye
Presbyopia (loss of near vision) Increase in near point of vision Lower acuity Delayed dark/light adaptation Increased glare sensitivity Visual field narrows Decline - depth perception Altered colour perception Diminished critical flicker fusion Visual image processing slower
Common conditions affecing the eye
Cataracts - lens changes progress to opacity, 25% of 70+
Age Related Macular Degeneration - drusen develops in macula, 18% of 70+, 47% of 85+, more likely in women
- Dry type: death of photoreceptors, slow, not total, 80-90%
- Wet type: new blood vessels in choroid that bled into sub-retinal space, rapid and severe loss of vision
Glaucoma - ganglion cells of optic nerve damaged by excess aqueous humor, 8% affected,
- Chronic: drainage of aqueous humour gradually blocked
- Acute: sudden blockage
- Normal tension: pressure remains ok but nerve damaged
Age-related changes that affect the skin
Decreased rate of epidermal proliferation
Thinner dermis, flattened dermal–epidermal junction
Diminished moisture content
Decreased dermal blood supply
Fewer sweat and sebaceous glands
Decreased number of melanocytes and Langerhans cells
Changes in patterns of hair distribution
Risks to older adult skin integrity
Genetic influence – hair colour and distribution, skin colour
Exposure to ultraviolet radiation – sunlight, tanning light
Adverse medication effects
Personal hygiene practices
Factors that increase the risk for skin breakdown
Assessment of skin
Abnormal skin conditions Personal care practices Skin lesions common in older adults Risk of skin tears, pressure ulcers and chronic wounds Skin Tear classification Chronic wound assessment Risks for development Presence of pressure ulcers Status of current pressure ulcers Braden scale / Waterlow / Norton Frequency of assessment Staging
Nurse recommendations to promote cognitive wellness
Exercise
Diet - Omega-3 fatty acids, turmeric
Socially and cognitively stimulating and meaningful activities
Define dementia
An umbrella term for several diseases characterised by progressive cognitive impairment and brain dysfunction not caused by impaired LOC
Define delirium
An acute transient confusional state of altered LOC, hallucinations and restlessness
2 tools used to assess for dementia in older adults?
MMSE
ADL’s
5 most common types of dementia
- Mixed dementia
- Vascular dementia
- Alzheimer’s dementia
- Lewy body dementia
- Frontotemporal dementia
7 stages of Alzheimer’s Disease
Stage 1: No cognitive decline. Stage 2: Very mild cognitive decline. Stage 3: Mild cognitive decline. Stage 4: Moderate cognitive decline. Stage 5: Moderately Severe Decline Stage 6: Severe cognitive decline. Stage 7: Very severe cognitive decline.
What is BPSD?
Behavioural and Psychological Symptoms of Dementia
- Agitation
- Psychiatric symptoms
- Personality changes
- Mood disturbances
Explain the PLST Model of Care?
Progressively Lowered Stress Threshold
Reference to understand and reduce the challenging behaviours associated with Alzheimer’s disease and related dementias
2 tools used to assess for depression in older adults?
Geriatric Depression Scale
MMSE
Age related changes in brain
Loss of neurotransmitters and their binding sites (especially dopamine)
Widening of the sulci
Enlarging of the ventricles (15ml in teens - 55ml age 60)
Accumulation of lipofuscin in nerve cell bodies
Large neurons shrink, may be some neuronal loss in frontal and temporal lobes
Some memory functions decline in healthy older adults
Fluid intelligence declines
- Inductive reasoning
- Abstract thinking
Crystallised intelligence improves
- Wisdom
- Judgement
Risk factors affecting older adult cognition
Physical and Mental Health Factors
- Chronic conditions
- Nutritional status
Medication Effects
- Medications can interfere with cognitive function
- Anticholinergic medications
Four types altered cognition older adults may experience
Cognitive Decline (minor changes in healthy older adults)
Dementia
Delirium
Depression
Dx dementia
Diagnosis based on clinical observations, history and available diagnostic data
How many people have dementia
Within Australia: 245,000 in 2009, 1.1 million in 2050 (4x)
Within WA: 24,000 affected, 125,000 in 2050,138 new cases every week
Percentage of people with dementia based on age
1-2% at 65 years
5-10% at 75 years
20-30% at 85 years or 50% at 85
40% + at 95 years
Types of dementia
Alzheimer’s disease
Vascular dementia
Lewy body dementia
Frontotemporal dementia
Factors protecting against dementia
Exercise
Diet: Omega-3 fatty acids, turmeric
Socially and cognitively stimulating and meaningful activities
Global deterioration scale
Stage 1: No cognitive decline. Experiences no problems in daily living.
Stage 2: Very mild cognitive decline. Forgets names and locations of objects, may have trouble finding words.
Stage 3: Mild cognitive decline. Has difficulty travelling to new locations, has difficulty handling problems at work
Stage 4: Moderate cognitive decline. Has difficulty with complex tasks.
Stage 5: Moderately severe cognitive decline. Needs help to choose clothing and prompting to bathe.
Stage 6: Severe cognitive decline. Needs help putting on clothing, requires assistance bathing, decreased ability to use the toilet
Stage 7: Very severe cognitive decline. Vocabulary becomes limited, eventually declining to single words, loses ability to walk and sit, becomes unable to smile.
Risk factors of delirium
Advanced age Pain Dementia Surgery Medications Physiological disturbances Pathological conditions
Types of depression
Major depression
Subclinical depression
Late-life depression
Depression with cognitive impairment
Risk factors of depression
Demographic factors Psychosocial influences Medical conditions Functional impairments Effects of medications and alcohol
Issues associated with depression
Willingness for enhanced coping Ineffective coping Hopelessness Caregiver role strain Risk for imbalanced nutrition Risk for compromised resilience
Parkinsons disease onset
Average age of onset is between 55 and 60 years
Parkinsons disease symptoms
Asymmetric onset of bradykinesia and rigidity
Tremor (75% of cases)
Characteristic muscle weakness and postural instability
Impaired mobility, speech, swallowing, sleep, and bladder and bowel function
Cognitive dysfunction
Pain and fatigue
Depression
Parkinsons disease prevalence
Affects 1 in 100 000 but 2% of people aged over 65
Parkinsons disease stages
Stage 1 - Initial Stage 2 - Bilateral & Balance Stage 3 - Slowing Stage 4 - Severe Stage 5 – Final
Parkinsons disease issues
Family coping Caregiver role strain Anticipatory grieving Willingness for enhanced coping as conditions progress Complications
Characteristics of the victim of elder abuse?
Mental illness Codependent Not financially independent Burden of care Weakness or frailty
What action would you take if you suspected older adult abuse?
Alert facility
Alert family
Alert appropriate authorities
5 types of elder abuse?
Emotional or psychosocial Neglect Physical Financial Sexual
Characteristics of the perpetrator of elder abuse?
Hostile Stressed Shared accommodation Financial dependence Mental illness
When are people vulnerable to abuse
Where people are frail, dependent or under the control of others
Factors influencing abuse
Functional status and behaviour of residents Characteristics and attitudes of staff Philosophy and policies of the agency Increased dependency Abuser psychopathology Family dynamics Carer stress
Signs of Possible Abuse
Unexplained injuries
Fearfulness, lack of eye contact, nervousness when caregiver is near
Lost money or sudden inability to pay bills
Over-sedation, evidence of neglected physical needs
Six Step Approach to abuse
- Identify Abuse
- Provide emotional support
- Assess risk
- Plan safety
- Refer
- Document
How to determine pain in patients with cognitive impairment?
Reactions to stimulus Ask Touch Facial expressions Observation
Explain the WHO Pain ladder?
Pain is present
- Pain persisting or increasing –> Non opioid +/- adjuvant
- Pain persisting or increasing –> Opioid for mild to moderate pain +/- non opioid / adjuvant
- Freedom from pain –> +/- non-opioid and adjuvant
What is nociceptive pain
Damage to body tissue, usually described as a sharp, aching or throbbing pain.
Two types of nociceptive pain
Somatic pain: pain receptors in skin, tissues activated.
Visceral pain: internal organs injured or inflamed.
What factors worsen pain in older adults?
Lack of exercise
Mental status
Chronic conditions
What is osteoporosis and why is it a problem in older adults?
Condition which makes bones weak and brittle
Increased chance of fractures and falls
What are the risk factors for falls in older adults?
Pathological conditions
Medications
Environmental factors
Functional impairment
What is osteoarthritis?
Type of arthritis that occurs when flexible tissue at the ends of bones wears down.
What factors affect behaviours related to taking medications in older adults?
Motivation
Cultural and psychosocial influences
Knowledge
Physical capabilities
What age related changes affect musculoskeletal wellness in older adults?
Decrease size and number of muscle fibres
Fibres deteriorate and replaced by connective tissue and fat
Muscle membrane fails and cells loose fluid and K
Bone thins
Minerals leave bone quicker
Nursing assessment when promoting safe use of medication?
Cognitive capacity
Barrier to compliance
Side effects
Cultural considerations
What age related changes affect medication use in older adults?
Altered Absorption Altered Distribution Altered Metabolism Changes to pharmacokinetics and pharmacodynamics Changes to physiology and cognition Social factors Compliance issues Increased vulnerability to adverse effects Impaired ability to swallow medications
Age related changes to muscles
Decrease in size and number of muscle fibres
Fibres deteriorate and eventually replaced by connective tissue and then fat
Muscle membrane starts to fail and cells loose fluid and K
Age related changes to joints
Thinning of synovial fluid
Collagen and elastin degenerate
Cartilage outgrowths and fragmentation of fibrous structures
Scar tissue and calcification
Fraying and cracking of cartilage – pitting of the surface
Mobility limitations
People who are active and healthy have less adverse consequences
Those whose mobility is restricted suffer more
Experience muscle fatigue after little exercise
Decreased movement affecting ADLs
Increased dependency and social isolation
Diminished pleasure in leisure activities
Falls, pressure sores and malnutrition
Prevalence of osteoporosis
Affects 3.4% of Australian population
82% are women
84% are over 55 years
Prevalence of osteoarthritis
Affects 15% of the overall population
Prevalence increases with age
Radiographic changes indicating OA in over 80% of 55+
What is the leading cause of disability in older adults
osteoarthritis
Pathology of osteoarthritis
Articular cartilage thins and tears Lack of protection leads to ulceration Bony deformity results (including spurs) Synovitis Capsule hypertrophy Periarticular muscle wasting
Prevalence of pain in older adults
Back pain 21%-49.5% Joint pain, 20.5% - 71% Substantial pain 45% to 80% Cancer pain Neuropathic pain
Categories of pain
Nociceptive Neuropathic Mixed Psychological pain disorders Chronic pain (3-6 months)
What are the pain scales
Multi-dimensional
Uni-dimensional - also reliable for those with mild-moderate cognitive impairment
Effect of Unresolved Pain
Depression Anxiety Decreased socialisation Sleep disturbance Impaired mobility
What is medication absorption altered by
Increased gastric acidity
Altered gastric emptying
Decrease in hepatic first pass metabolism of some drugs
What is medication distribution altered by
Less lean body mass and more fat
Less water in the body
Less plasma albumin
What is medication metabolism altered by
Decreased oxidative metabolism
Decreased hepatic blood flow
What does altered medication absorption cause
Unpredictable timing and extent of drug effects
Increased risk of stomach irritation
What does altered medication distribution cause
Fat soluble medications have less intense immediate effects and an erratic but prolonged action
Greater proportion of unbound (active) drugs in the bloodstream
Increase in time taken for drug to reach target
What does altered medication metabolism cause
Significant changes in half life with serious implications
Issues with medication due to changes in physiology and cognition
Sight and hearing – distinguishing which medications are due when
Problems understanding requirements
Problems remembering requirements and if medications have been taken
Problems removing packaging
What age related changes affect digestive, nutrition and hydration wellness in older adults?
Less effective chewing Low sense of smell and taste Low daily intake Tooth loss Absorption of some nutrients is impaired
What factors increase the risk of dehydration in older adults?
Health conditions
Intake behaviours
Medications
What 6 areas are assessed when using Mini Nutritional Assessment Tool?
- Food intake
- Weight loss
- Mobility
- Psychological stress
- Neuropsychological problems
- BMI
5 age related changes that affect urinary wellness in older adults?
- Cognitive ability
- Functional status
- Mobility
- Postural sway
- Medications
How much urine can older adults store in their bladder?
Usually 300-450ml, maximum 500
What environmental factors contribute to incontinence in older adults?
Cognition Accessibility Ability to voluntarily control Urge to void Accessibility to toilets
5 categories of urinary incontinence?
Overflow - urethral blockage, bladder unable to empty properly
Stress - relaxed pelvic floor, increased abdominal pressure
Urge - bladder oversensitivity from infection, neurological disorders
Detrusor over - activity incontinence
Functional incontinence
Prevalence of Type II diabetes in older adults in Australia?
1/6 over 65 are diabetics. Of diabetics 43% are 65+
What may lead you to suspect an older adult may have developed type II diabetes?
Blurred vision Itching Skin infections Cuts that heal slowly Tired and lethargic
6 interventions in a health promotion plan for an older adult with type II diabetes?
Quit smoking Exercise Nutrition Medication No alcohol Education
Changes to Taste & Smell
Sense of smell declines from 30
Sense of taste less intense in older adults
Taste discrimination decreases (sweetness unchanged)
Changes to Mouth & Oesophagus
Teeth cusps flatten Tooth fracture and loss more likely 30% have diminished saliva Oral mucosa more likely to ulcerate Swallowing ability slower and more feeble Oesophageal transit time slows
Changes to Stomach & Intestine
Gastric emptying slows
Muscle fibres and mucosa of small intestine atrophy, lymphatic follicles decrease, villi shorten and widen.
Absorption of some nutrients is impaired and immune function diminished
Changes to Liver
Shrinkage
Fibrosis occurs
Lipofuscin is deposited
Blood flow diminishes
Changes to Pancreas
Shrinkage
Ductal hyperplasia
Lobal fibrosis
Decreased responsiveness of beta cells to glucose (reduced insulin secretion > glucose intolerance > T2 diabetes)
Changes to Gall Bladder
Increased cholecystokinin
Decreased bile acid synthesis
Widened common bile duct
Leads to biliary stasis, increased flora, increased likelihood of cholelithiasis and poorer appetite
Changes to Large Bowel
Reduced mucous
Decreased elasticity
Poorer perception of rectal distension
Constipation more likely
Risk Factors affecting digestion and nutrition
Medication effects
- Digestion, eating patterns, and utilisation of nutrients
Lifestyle factors
- Alcohol intake and smoking
Psychosocial factors
- Companionship, support resources, anxiety and stress
Risk factors for diabetes
Obesity Hypertension Family history Physical inactivity High cholesterol levels
Diabetes leads to
Renal failurer Retinopathy Neuropathy Stroke Sypertension MI
Issues assiciated with diabetes
Causing changes to BGL: Infections, arthritis, medications (steroids)
Challenging ability to self care diabetes: Finance, cognitive changes, nutritional changes
Dx of diabetes
Any one of the following 3:
Fasting BG > or = 7.0mmol/L (after an 8 hour fast)
Symptoms of hyperglycaemia (polyuria, polydipsia, weight loss and a random BGL of > 11.1mmol/L during the day
2 hour blood glucose value during oral GTT > 11.1mmol/L with glucose load of 75g
Changes to Bladder
Storage capacity decreases
Connective tissue replaces some bladder & urethral muscle
Diminished sphincter tone
Changes due to cerebral cortex
- Sensation of bladder fullness occurs late
- Bladder emptying incomplete
Changes due to oestrogen
- Loss of tone and strength in bladder and urethra -> decreased urethral closure pressure
- Bladder more irritable
Changes to Urinary function
Functioning nephrons decline from early adulthood
Glomeruli deteriorate
Decline in renal function likely to be disease related
What causes changes in urine concentration
Renal tubules less efficient in:
Substance exchange
Water retention
Suppression of ADH secretion in hypo-osmolality
Ability to conserve sodium when salt depleted
Causes of urinary incontinence
Delirium and dementia Gastrointestinal conditions Diabetes mellitus Obesity Alcoholism COPD Metabolic disturbances Hip fractures
Nursing interventions for urinary incontinence
Urinalysis Pelvic floor muscle training Pelvic floor electrical stimulation Pessaries Continence training Environmental modifications Medications Surgical and minimally invasive procedures Management of incontinence
What percentage of older adults over the age of 85 years do not have coronary heart disease?
12.6%
7 risk factors for cardiovascular disease in older adults?
- Race
- Diet/nutrition
- Depression
- Hypertension
- Increased age
- Gender
- Physical inactivity
What is post prandial hypotension?
Hypotension that occurs within 75 mins of eating a meal. Often meal high in carbs.
Prevalence of post prandial hypotension?
Affects 20-40%
What is orthostatic hypotension?
Postural hypotension. A reduction of 20mmHg (S) and 10mmHg (D) within 1-4 mins on standing after lying for 5 minutes
Negative functional consequences of the respiratory age related changes?
Hypoxia
Hypercapnia
Top 3 actions included in a health promotion plan for an older adult with COPD?
Smoking cessation
Elimination exposure to environmental pollutions
Subtle exercise
What activities of daily living would be affected by an older adult with severe COPD?
Breathing Sleep Eating Work Sex
Changes affecting the nose
Tip rotates down
Septum deviates (contributes to mouth breathing, snoring and obstructive apnoea)
Blood flow decreases
Turbinates decrease in size
Changes affecting the tracheal cartilage
Calcifies
Trachea becomes stiffer
Changes to cough reflex
Diminishes
Changes to gag reflex
Less efficient
Changes to chest wall
Ribs and vertebrae subject to osteoporosis
Costal cartilage calcifies
Respiratory muscles weaken
Increase dependence in accessory muscles especially diaphragm
Sensitivity to intra-abdominal pressure changes
Changes to lungs
Decrease in size and weight and become flabbier
Mucosal bed thickens
Blood supply to lungs diminishes
Elastic recoil diminishes -> early airway closure
Age 20-30 alveoli enlarge and walls become thinner
4% loss in SA every 10 years
Response to Hypoxia and Hypercapnia
When mechanisms work properly the response to either is increased respiratory rate and depth
This response is reduced by 40%-50% between 30 and 80
Risk factors that affect respiratory wellness
Smoking Second hand smoking Occupational exposure Environmental factors Additional Risk Factors
Nursing Assessment for respiratory function
Identifying opportunities for health promotion
- Assess for risk factors
- Vaccinations
Detecting and preventing lower respiratory infections
Physical assessment findings
Promoting health for respiratory wellness
- Smoking cessation
- Disease prevention
- Eliminate exposure to environmental pollutants
Eliminating the risk from smoking
Prevalence of CHD
36% of men
39% of women
Disease related changes in the heart
Amyloid deposits
Liopofuscin accumulation
Degeneration of basophils
Age related changes in the heart
Slight increase in left ventricular wall thickness
Enlargement of left atrium
Thickening of atrial endocardium
Thickening of atrioventricular valves
Calcification in the aortic valve
Decrease in pacemaker cells and irregularity in their shape
Increased deposits of fat, collagen, and elastic fibres at sinoatrial node
Consequences of Changes in the Heart
Changes results in:
Heart less able to fully contract
Longer diastolic filling and systolic emptying
Myocardium more irritable and less responsive to SNS
Stress adaptation less efficient
Changes in arteries
Tunica intima - thicken, endothelial cells become irregular, elongate
Tunica media - increase in collagen, thinning and calcification of elastin (stiffening)
Changes in veins
Become thicker
More dilated
Less elastic
Valves in leg veins become less efficient in returning blood
Consequences of Changes in Blood vessels
Arteries more vulnerable to atherosclerosis
Aorta dilates to compensate for stiffness
Increased peripheral resistance
Slight increase in systolic BP
Impaired baroreceptor function in large arteries – especially during postural changes
Diminished ability to increase blood flow to vital organs
Left ventricle forced to work harder
Arteries stiffen and responsiveness to adrenaline stimulation diminishes -> HR fails to increase or decrease as efficiently
Risks for Cardiovascular Disease
Race Increased age Diabetes mellitus Heredity Hypertension Social Class Gender Depression Diet / nutrition Alcohol / smoking Hypertension Obesity Physical inactivity Hyperlipidemia Anxiety Stress Isolation Post menopausal
Explain Palliative Care?
An approach that improves the quality of life of patients and their families facing the problem associated with life threatening illness, through the prevention and relief of suffering by means of early identifications and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual.
What to say to patients and families during final stages of life?
Tell me more about …
What questions do you have?
What are you most concerned about?
How are you today?
Name 9 medications commonly use during end of life care and their purpose?
- Morphine - pain relief, respiratory depression
- Hydromorphine - pain relief
- Haloperidol - antipsychotic, calming, reduce restlessness
- Midazolam - produce drowsiness, alleviate anxiety
- Metoclopramide - alleviate nausea
- Hyoscine - reduces spasms
- Clonazepam - antiepileptic, treat panic attacks
- Hyosine butylbromide - relievesmooth muscle spasms
- Fentayle - pain relief
Name common symptoms that often need to be managed during Palliative Care?
- Pain
- Breathlessness
- Anxiety
- Agitation/restlessness
- Hallucinations
- Dysphagia
- Nausea
- Vomiting
- Respiratory symptoms
What physiological changes would lead you to believe death was imminent?
- Changes in respiration (cheyne stoking)
- Hypotension and tachycardia
- Change in responsiveness
- Uncharacteristic restlessness
- Peripheral shutdown and cyanosis
- Retained airway secretions - suction, positioning
Name 7 supportive interventions for relationship building during end of life care?
- Presence
- Touch
- Recognition of autonomy
- Compassion
- Honesty
- Expert communication
- Assisting in transcendence
What is the Liverpool Care Pathway? What benefits does it offer?
Pathway covering palliative care options for patients in the final days or hours of life
Supporting quality care in the last hours or days of life
Benefits of palliative care
Provides relief from distressing symptoms
Affirms life and supports active living for as long as possible
Enhances quality of life
Regards dying as a normal process
Intends neither to hasten nor delay death
Includes psychological and spiritual care
Supports the family, during the trajectory and after the death
Uses a team approach
What is the palliative care approach
Should be on a needs basis
Should involve discussion with the older person, family, and health care team
Should involve the consideration of advance care directives
A palliative approach:
- May be relevant over a long period of time
- May be concurrent with active treatment
What is end of life
An umbrella term to denote that part of life, where a person is living with, and impaired by, an eventually fatal or terminal condition, even if the prognosis is ambiguous or unknown
Often focuses on final days or weeks of life
What are advance health directives
Legal statements that say what sort of medical treatment you want to have or not have after you are no longer able to make these decisions for yourself
What is important for people who are dying
To know what to expect To maintain control and choice To maintain dignity and privacy To avoid symptom distress To have access to information and to spiritual and emotional support To have time to say goodbye To have excellent care
Signs used to anticipate death
Peripheral shutdown and cyanosis
Changes in respiration - cheyne stoking (laboured)
A change in responsiveness
Uncharacteristic restlessness
Retained airway secretions - suction, positioning
Hypotension and tachycardia
Recognition of approaching death should prompt …
Review of medications
Review of comfort care strategies
Communication with the family
Rituals
Bereavement care
Regards family
May want time to say goodbye
Need to know what happens next
Need to know that the person is still respected
Need to know that cultural and family wishes will be respected
West Australian End of Life and Palliative Care Learning Continuum
Provides structure and guidance in education and training for all health care professionals delivering end-of-life care in health and aged care settings in Western Australia
The goal is to support health care professionals to deliver safe, effective quality care for patients, their families and carers throughout the end-of-life continuum
Core Principles of palliative care
- Person, carer and family centred care
- Safety, quality and risk management
- Effective communication
- Building capacity
Symptoms in the terminal phase
Pain Breathlessness Anxiety Agitation and restlessness Hallucinations Dysphagia Nausea Vomiting Respiratory secretions
How long for constipation symptoms to develop
7-10 days
Bristol stool chart
1-3 Constipation
4 Aim
5-7 Diarrhoea (or constipation, overflow)
Rome III classification for constipation
2+ symptoms
Staining Lumpy or hard stool Sensation of incomplete evacuation Sensation of anorectal obstruction Manual maneuvers <3 bowel movements per week
Primary causes of constipation
Slow transit
Difficult defication
Secondary causes of constipation
Lifestyle
Medical conditions
Meds
Mechanical abnormalities
Risk factors for constipation
Female
Dementia
Low privacy
Increase length of stay
Types of laxative agents
Bulking agents
Softening agents
Osmotic agents
Stimulant agents
