Gero HESI Flashcards
Young old
65-74
Middle Old
75-84
Old-Old
Over 85
Elite old
Over 90
Centenarian
100+
Disengagement Theory
Progressive social disengagement occurs naturally with aging and is accepted by the older adult.
Activity Theory
Successful again requires a high level of activity and involvement to maintain life satisfaction and positive self-esteem.
Pacemaker Theory
A programmed decline or cessation of many components occurs in the nervous and endocrine systems.
Immunity Theory
A programmed accumulation of damage and decline of the immune system’s function takes place due to oxidative stress.
Wear-and-tear theory
After repeated use, damaged cells in the body structures wear out from the harmful effects of internal and external stressors, now known as free radicals.
HESI HINT: What is a more accurate measure of age than chronologic age?
The ability to perform ADL’s
What stage of Erikson’s theory are older adults in?
Integrity vs despair
Maslow’s Theory
- Ranks an individuals needs from the most basic to most complex.
- These terms include safety and security, physiologic, belonging, self-esteem and self-actualization needs to describe the process that generally motivates individuals to move through life..
What are three physiologic changes that are significant in making older adults vulnerable to injury and disease?
- Loss in compensatory reserve
- Progressive loss in efficiency of the body to repair damaged tissue
- Decreased functioning of the immune system processes
Physiologic Changes in Older Adults
- Diseases in older adults do not always present with classic signs and symptoms.
- Physiologic changes increase more rapidly with increasing age.
- Aging changes are influenced by genetic makeup and environment.
HESI HINT: Changes in the heart and lungs result in less efficient utilization of O2, which reduces an individual’s capacity to maintain physical activity for long periods. What can be done to help increase this?
Physical training for older people can significantly reduce blood pressure and increase aerobic capacity. Exercise and nutrition.
HESI HINT: Why are older people often unable to get sleep at night and do not sleep soundly after they fall asleep?
- This is because they have shorter stages of sleep, particularly shorter cycles between stages 1 and 4 and REM sleep (stage 4 is deep sleep).
- They are easily awakened by environmental stimuli.
- They often compensate by napping during the day, which leads to further disruptions of night sleep.
- A common response is the use of prescription sleeping pills, which can create still further problems of disorientation, etc.
Physiologic Changes to the Integumentary System as one ages
- Thin Skin
- Keratinocytes become smaller and regeneration slows -> wound healing is slower.
- Hair loss occurs; woman have increased facial hair
- Vascular hyperplasia causes more viscosities. (Brown or blue discoloration)
- Increased appearance of “age spot” and or “liver spots” and raised lesions (Seborrheic keratosis)
- Nails become brittle and thick.
Thinner skin in older adults can lead to
- Increased risk for dehydration due to decline in lean mass and loss of body water
- Decreased ability of the skin to detect and regulate temperature
- Dry skin resulting from a decrease in endocrine secretion
- Loss of elastin and increased vascular fragility
HESI HINT: Why is regular assessment of the feet important in older adults?
- Because peripheral circulation decreases as one ages.
- Regular assessment increases the opportunities to treat skin care problems early.
Physiological Changes to the Musculoskeletal System as one ages
- Bone loss
- Shortening of the trunk d/t thinning of vertebral disks.
- Loss of bone calcium, atrophic cartilage and muscle occurs.
- Bone mineral density decreases (results in osteoporosis and osteopenia)
- ROM of joints decreases
- Progressive loss of cartilage occurs, resulting in osteoarthritis
- Muscle cells are lost and not replaced.
- Lean body mass decreases with increased body fat.
Physiological Changes to the Cardiovascular System as one ages
- Decreased CO d/t decrease in HR and stroke volume
- Decreased contractility of the heart in response to increased demands.
- Diastolic murmurs are present in more than one half of older adults (d/t mitral and aortic valves becoming thick and rigid)
- Dysrhythmias become more common.
- Significant increases in systolic BP
- Arteriosclerosis increases
Why are dysrhythmias in older adults particularly serious?
Because older people cannot tolerate increased cardiac output which can result in syncope, falls, and TIAs.
Angina in older adults
May be absent, or may be confused with GI symptoms
Physiological Changes to the Respiratory System as one ages
- Breathing Mechanics
- Oxygenation
- Ventilation control
- Immune response
- Exercise Capability
- Breathing Ability
Respiratory Changes to Aging: Breathing Mechanics
- Decreased lung elasticity
- Muscles become rigid and lose muscle mass and strength (decreases ability to cough efficiently)
Respiratory Changes to Aging: Oxygenation
- Increased ventilation and perfusion are imbalanced
- Increased dead space in the lungs
- Decrease of alveolar surface area
- Decreased Vital Capacity (amount of air brought into the lungs at one time)
Respiratory Changes to Aging: Ventilation Control
Decreased reaction of peripheral and central chemoreceptors to hypoxia and hypercapnia.
Respiratory Changes to Aging: Immune Response
- Decrease of Cilia
- Decreased ability to clear mucous secretions
- Decreased ability to cough and deep-breathe
- Decreased immune response
Respiratory Changes to Aging: Exercise Capability
-Decrease of strength and muscle mass in the body
Respiratory Changes to Aging: Breathing ability
Decreased reaction to hypoxemia and hypercapnia
Hypoxia in older adults can manifest as
Confusion
Physiological Changes to the Gastrointestinal System as one ages
- Xerostomia (dry mouth) and decreased saliva
- Dental caries (tooth decay) and loss of teeth (decreased ability to chew food)
- Hunger sensations decrease d/t diminishing taste buds.
- Increased risk for GERD and aspiration
- Pepsin and hydrochloric acid production decreases.
- Delayed gastric emptying
- Decreased peristalsis and decreased absorption in the small intestines (can cause constipation)
- Decreased enzyme production in the liver
HESI HINT: What are the following changes that contribute to chronic constipation with age?
- The number of enzymes in the small intestine is reduced, and simple sugars are absorbed more slowly, resulting in decreased efficiency of the digestive process.
- The smooth-muscle content and the muscle tone of the wall of the colon decrease. Anatomic changes in the large intestine result in decreased intestinal motility.
- Psychological factors, as well as abuse of over-the-counter laxatives, are factors.
- Decreases in fluid intake and mobility contribute to constipation.
HESI HINT: Tooth loss
Is not a normal aging process.
HESI HINT: Why do older people appear to eat small quantities of food at mealtimes?
This is because the digestive system of older people features a decrease in the contraction time of the muscles, and more time is needed for the cardiac sphincter to open. Therefore it takes more time for the food to be transmitted to the stomach. Thus the sensation of fullness may occur before the entire meal is consumed.
An early sign of malnutrition may be
Changes in weight.
Physiological Changes to the Genitourinary System as one ages: Kidney
- Decrease in size and weight (d/t reduced renal tissue growth)
- GFR decreases (d/t decrease in renal BF from lower CO)
- Tubular function diminishes
- Increased risk for reflux of urine into the ureters.
Physiological Changes to the Genitourinary System as one ages: Bladder
- Decreased capacity of the bladder by one half (increased urinary frequency and nocturia)
- Decreased sensation of the urge to void
- Weakened bladder and perineal muscles
- Increased frequency and dribbling may occur in men (d/t weakened bladder and enlarged prostate)
Prostatic enlargement may cause
Urinary retention and bladder infection in men.
Age related changes to the reproductive system: Women
- Ovarian function decreases
- Breast tissues involutes
- Ovaries and uterus slowly atrophy
- Perineal muscle weakness and atrophy of the vulva occur
- Vaginal mucous membranes becomes dry, elasticity of tissue decreased, surface becomes smooth and secretions become reduced and more alkaline.
- Libido may or may not decline.
Age-related changes to the Reproductive System: Men
- Testes atrophy, lose weight, and soften.
- Erection changes are seen.
- Prostate enlargement due to changes in testosterone levels
- Libido may or may not decline.
For older men, the most common physiologic changes in response to orgasmic pleasure include
- An erection that is less firm
- Shorter duration of erection
- Diminished force of ejaculation
Physiological Changes to the Neurologic System as one ages
- Decrease in neurons and neurotransmitters in the brain.
- Decrease in both CNS and PNS functioning
- Central processing decreases; performance of tasks is slower.
Intelligence in healthy older adults
Remains constant
PNS changes in aging people may include the following:
- Significantly lower or nonexistent vibratory senses in the lower extremities
- Decrease of tactile sensitivity
- Loss of connection in nerve endings in the skin
- Loss of proprioception, affecting balance
Physiological Changes to the Endocrine System as one ages
- Thyroid activity decreases.
- Decreased metabolic rate
- Estrogen production ceases with menopause (ovaries, uterus and vaginal tissue atrophy)
- Gonadal secretion of progesterone and testosterone decreases.
- Insulin production decreases or insulin resistance increases.
- Production of parathyroid hormone decreases (made evident by osteoporosis)
Physiological Changes to the Sensory System as one ages
- Decrease in sensory cells in the nasal lining occur.
- Sensitivity to smell declines
- Taste perception decreases due to loss of taste buds on tongue.
- Tear production decreases.
- Cataracts
- Arcus senilis
- Increased IOP -> glaucoma
- Hearing of high pitches diminishes first (presbycusis)
Arcus senilis
A partial or complete white ring encircles the periphery of the cornea
The Four A’s of Cognitive Impairment
- Agnosia
- Amnesia
- Apraxia
- Aphasia
Vascular or multi focal dementia
Ischemic brain lesions develop as a result of a history of hyperlipidemia, HTN, smoking or obesity
Dementia with Lewy bodies
Microscopic deposits develop in the brain and damage nerve cells
Frontotemporal Dementia (Pick disease)
The frontal and temporal lobes of the brain degenerate
Interventions for Dementia
- Keep client oriented to time, place and person (repeatedly)
- Keep a calendar and clock within sight at all times.
- Keep familiar objects in the older adults environment to promote a sense of continuity and security.
- Administer prescribed drugs to reduce emotional lability, agitation and irritability or prescribed antidepressant as needed.
- Speak in a slow, calm voice; avoid excitement.
Alzheimer Medications
Acetylcholinesterase Inhibitors: Rivastigmine Galantamine Donepezil HCl Tacrine HCl NMDA Antagonist: Memantine
Alzheimer Medications: Acetylcholinesterase Inhibitors Nursing Implications
- Teach clients that they should take no Anticholinergics medications.
- Medications should not be used in cases of severe liver impairment.
- Take with meals to avoid GI upset.
- Do not discontinue abruptly.
End of Life Care
- Pain management
- Alleviating dyspnea
- Listening, reassuring and reinforcing nonpharmacologic interventions to help manage anxiety.
- Managing GI symptoms
- Assessing for psychiatric symptoms of depression and delirium.
- Recognizing the spiritual needs can help them come to term with their illness and the end of their life.
Delirium
- Acute confused state with rapid onset, usually the result of systemic illness or medication.
- Decreased LOC.
Delirium: Nursing Implications
- Establish a meaningful environment.
- Help maintain body awareness.
- Help client cope with confusion, delusions, and illusions.
- Review medications for syngestic effects
Dementia
- Slow onset of symptoms.
- LOC may be intact.
Macular degeneration
Principal cause of blindness
Hypothyroidism increases the risk for development of
Myxedema coma which is life threatening
Graves Disease (Thyrotoxicosis)
Weight loss and HF may be predominant symptoms.
COPD
- Most people exhibit both chronic bronchitis and chronic emphysema.
- Fatigues is a common result because of the increased work required to breathe.
