Module 12: Development, Aging, Elderly Flashcards
Eriksons Stage for Infants
Trust v Mistrust
Attachment issues, separation and stranger anxiety
Eriksons Stage for Toddlers
Autonomy versus Shame and Doubt
Separation, disruption of routine, loss of control
Eriksons Stage for Preschoolers
Initiative v Guilt
Separation anxiety, fear of abandonment, unable to understand hospitalization (think its punishment), regression issues
Eriksons Stage for School Age Children
Industry v Inferiority
loss of control/privacy, fear of pain, bodily injury, death
Eriksons Stage for Adolescents
Identity v Role confusion
concerned with appearance, body image, loss of control/privacy, peer group
Is pediatrics just another 1 on 1?
no it involves the parents greatly and we need to educate to prevent and be an anticipatory guide for them and the Childs changes
Tips for Infant/Early Toddler Approach and Exam
Infants can be examined on bed but its better to have toddlers in the parents lap
Use comfort tools like a pacifier or bottle
talk softly and with positive encouragement
ask about any maternal health issues in pregnancy or delivery
know their birth weight
Consider the head: fontanels, trauma from birth process
consider the face: any unusual characteristics, eye coord, etc
consider feeding: type, frequency, etc
consider reflexes: rooting, sucking, palmar, moro, stepping, babinski
An infant gains how much weight a week
5-7 ounces
An infant grows how much a month
about .5 to 1 inch a month
Birth weight should be what by 6 months, and what by 1 year
double by 6 months and triple by one year
Tips for Toddler Exam
exam on lap if uncooperative
approach adult first, then acknowledge the child
call the child by name and get down on their level
they may have feeding or discipline issues
check speech development
distract them with toys, stories, let them play with equipment
reinforce what will be done and how it will feel - in simple terms
use a soft voice
praise frequently
be quick, but you may have to stop and talk to the parent and then return
minimize stress and preserve the security of the parent child relationship
Tips for Preschool and School Age Exam
gently approach but many times child open to “fun start”
allow child to verbalize
accept regressive behavior as it is normal, and reinforce to the parent that it’ll end eventually
provide play activities
provide honest and simple explanations and directions
In school age: may have some times of loneliness/boredom, isolation from peers - encourage them to make friends and participate in group/peer activities
encourage their participations
be kind yet firm
Tips for Adolescent Exam
be more forward with good eye contact and questions directed more at them as compared to the parent
be sensitive to their “awkward” stages, their anxiety and fear of changes in body image
can be searching for identity at this time
peers are the most influential group on this groups decision making
encourage verbalization of feelings - help develop coping skills
explain information honestly
maintain privacy
try to learn what they like to do, do not assume they do sports for example
be non judgmental and maybe ask questions when parents are not around
In what order should you do things for the physical exam in children?
- Count respirations before disturbing child
- Count apical heartrate
- measure BP
- measure temp (since it may need to be rectal)
* remember you may need to revisit areas and cannot go cephalocaudal
* be prepared to use pain scales like FACES FLACC or numeric
FLACC Pain Scale
you score the child based on things the infant is doing objectively that you view because the child is unable to tell you
Expected BPR for Neonates
B - 60/30 mmHg
P - 80-180 per minute
R - 30-50 per minute
Expected BPR for Infants
B - 96/60 mmHg
P - 80-160 per minute
R - 20-40 per minute
Expected BPR for Toddlers
B - 98/64 mmHg
P - 80 - 150 per minute
R - 20-30 per minute
Expected BPR School Aged Children
B - 106/68 mmHg
P - 75-110 per minute
R- 16-24 per minute
Expected BPR for Adolescents
B - 114/74 mmHg
P - 50-100 per minute
R - 12-20 per minute
Potential stress responses from children when they are unsure how to deal with articulate illness or hospitalization
Loss of appetite
disinterest in environment
Regressive behavior (thumb sucking, bed wetting, temper tantrum, clinging, irritability, demanding and possessive behavior)
The main thing to do with a pediatric assessment is …
help parents, and eventually the child, as they go through the developmental steps
Anticipate and Teach!!! so the parent is ready when the event occurs
Anticipatory guidance!!! is PRIMARY PREVENTION MEASURES
important information for SIDS
back to sleep
no smoking around
no sharing bed
formula/breast feeding
cereal
Important anticipatory guidance for parents
SIDS information
childproofing
getting ready for the NOs of toddlerhood
teenage rebellion/experimenting/puberty
*these are all primary prevention measures via education
What is Old?
It is an individual term per person that could mean a variety of things (not young, experiences, worn out, etc)
Myths about aging
Most elderly are sick
elderly people dont pull their weight on society
elderly people are set in their ways (you cant teach an old do new tricks)
elderly people arent mentally or physically sharp and alert
ailments caused by poor lifestyle choices such as smoking, cant be improved upon or undone
physical aging is primarily
elders dont have sex
Dementia is what relative to normal aging
not a normal part of aging
What is the “new Old”
65 to 74 is young old
75 to 84 is old
85+ is oldest old
2060 may be the first time in history when …
old people outnumber children
What % of elderly are in nursing homes
only 5%
What is the highest risk factor for dementia
Age (especially over 85)
What is the largest type of dementia
Alzheimer’s
Does the growth of the US population age 65 exceed that of total population under 65?
yes
greater than ___% of elderly have at least one chronic illness and __% have 2
80 and 77
Leading causes of death in the elderly are …
heart related diseases cancer cerebral vascular disease chronic lower respiratory disease Alzheimer's disease diabetes
Chronic diseases account for ___% of the money our nation spends on health care, yet only __% of health dollars are spent on public efforts to improve overall health
75% and 1%
The primary chronic disease in late life are:
HTN
Hyperlipidemia
Arthritis
The focus of elder care is …
maintenance of function, not disease cure
Persons with chronic diseases often…
continue to work and perform their usual activities
What is the limiter of the functional ability of elders?
disability from chronic diseases
When does prevention of chronic diseases need to occur and through what me4ans?
needs to occur early in adult life through screening, lifestyle changes, and medication
Chronic diseases do not go away, so what do they do?
they slowly and consistently weaken functional ability and reduce the quality of a persons life
The best 3 ways to care for late life is…
Education
Therapy
Maintenance (not cure - dont give false hope)
2 Chronic Disease Theories
- Corbin and Strauss Chronic Illness Trajectory 8 Steps
2. Shifting Perspective Model
What is the Chronic illness trajectory
a chronic disease theory
it consists of 8 stages when a chronic illness starts that cycle through, never reaching wellness again, until death occurs
What are the 8 stages of the chronic illness trajectory
Pre trajectory
Trajectory onset
Crisis
Acute
Stable
unstable
Downward
Dying
Shifting Perspective Model
Chronic Disease theory that when wellness is in the foreground, that is the best time for education and to make things happen in relation to the disease - not when illness is in the foreground
Ageism
term used to describe prejudice against the older adult (incorrectly stereotyped as being different from society)
Widespread
This attitude leads to marginalization
Overtime, it will affect us all since people will make assumptions related to age and function
How to avoid Ageism
Avoid “Elder Speak” (honey, dear: similar to baby talk)
Avoid patronizing/conveying messages of dependence
Incompetence control
Important Types of Theories of Aging
Biological Theories of Aging
Sociological theories of aging
Psychological theories of aging
What do biological, sociological, and psychological theories of aging focus on?
Biological - focus on the physiological process
Sociological - focus on role changes and relationships
Psychological - focus on the developmental aspects
What are Error (Stochastic) Theories
Theories of aging related to accumulated biological errors leading to aging and death
3 Most common Error Theories
Wear and Tear Theory
Cross Linking Theory
Free Radical Theory
Wear and Tear Theory
cell errors are the result of “wearing out”
internal and external stressors lead to these cell errors
Cross Linking Theory
aging as accumulation of errors by cross linking or stiffening
Free Radical Theory
Most understood and accepted error theory
Random damage from molecules in cells called free radicals
What are Programmed Aging (Non-stochastic) Theories
Theories that contribute the changes of aging to being “programmed” at the cellular level
Biological Clock Theory
Non Stochastic Theory
Idea that each cell is born with a limited number of replications
How does using aging theories help nursing?
helps us understand the difference between aging and disease
gives a proper teaching and gives guidance for conditions and diseases
Important Sociological theories of aging
- disengagement theory
- activity theory
- continuity theory
Disengagement Theory
withdrawl from ones society and community is natural and acceptable
sociological theory of aging
Activity Theory
sociological theory of aging
individuals need to stay active if they are to age successfully
promotes satisfaction and positive self concept
physical or intellectual activity
Continuity Theory
sociological theory of aging
with aging, personality traits remain stable
as a person ages, they try to maintain previous habits, preferences, commitments, and beliefs
Important Psychological Theories of Aging
Developmental Theories (like Erikson and Piaget)
Theory of Gerotranscendence
Theory of Gerotranscendence
psychological theory of aging
as we age we tend to forget about materialistic things and start to value individuals and relationships more
Gerontological Nursing Goals
We want to get them as much control back as possible (What do you want to wear today, have patience, give short directions, etc) - But do not help TOO much
It is the responsibility of the nurse to assist elders to achieve the highest level of wellness
*HELP THE OLDER ADULT FUNCTION AT THEIR HIGHEST CAPCITY
A gerontological nursing goal is, to care and comfort ___, to cure ____, and prevent __ __ __ __ ___
comfort always, cure sometimes, prevent that which can be prevented
Important ways to act when dealing with older adults
Have Consistency (find their normal procedure)
Be Professional (Mr, Mrs, Etc)
Be Supportive
Have Therapeutics (let them vent)
With older adults, focus on …
abilities not disabilities
What should be maximized with older adults
their strengths
What should be maintained with older adults as a part of restorative nursing
maintain:
safe environment
COMFORT REST ACTIVITY AND MOBILITY (prevent falls and skin breakdown)
adequate nutrition
resp and circ function
skin integrity
bowel and bladder function
sensory perception
What other things should restorative nursing do to help older adults
Promote social well being and psychosocial health
Enhance their self esteem
avoid elder talk and ignorance
ensure access to assistive devices
give them time
adapt environment for their function
give them some control with privacy, you asking for permission, and include them in decision making
Tips for Communicating for Hearing & Vision Loss
Never assume hearing loss is because of age
face the individual, stand and sit at the same level
Gain the individuals attention
speak distinctly
pause between sentence sand phrases
remove background noises
when repeating, say things exactly the same way
How to aid when dealing with hearing loss patients
do not raise the volume of your voice, speak in a lower tone
keep instructions simple
assess understanding by asking for feedback
use large print written communication
one person should speak at a time
eyeglasses should be clean and on
avoid glaring light
How to aid when dealing with vision loss patients
use contrasting colors
use low vision assistive devices
use orientation strategies
have the persons attention prior to talking
speak promptly and clearly
speak normally
use appropriate lighting
Hazards of Hospitalization (especially in older populations)
Decline in muscle strength
vasomotor instability
reduced bone density
diminished pulmonary ventilation
sensory deprivation
tendency for urinary incontinence
Modifications to make for Hospitalized Elderly (since we want them to be able to leave)
de emphasize bed rest - they need to move
psychological considerations
actively facilitate ambulation
socialization
medication review
dietary review
interdisciplinary care and shared objectives
toileting
What are the 3 Ds
Depression
Delirium
Dementia
having more or one of these can make it challenging to find what problems are with elderly patients
3Ds: Depression
most often found, characterized by low mood, difficulty thinking, and somatic changes
can also be a precursor to Dementia
3Ds: Delirium
an acute and sudden impairment of cognition that MAY be considered temporary
often confused with dementia
3Ds: Dementia
chronic, progressive, insidious, and permanent states of cognitive impairment
T or F: Delirium is temporary and dementia is permanent
True
What do Hyperactive versus Hypoactive delirium look likie
Hyperactive - they got your attn (pulling tubes, etc)
Hypoactive - looks like depression (sad, withdrawn)
Interventions to Prevent Delirium
Know baseline mental status
Assess any underlying mental status or sensory deficits
Attention to basic needs
medication review
understand behavior
maintain safety
minimize use of invasive equipment
environmental modifications
What is a major thing that can cause delirium?
Medications! (even something like benedryl)
How to assist Alazheimers Patients?
Give one direction at a time
speak slowly and with simple directions
do not force them
avoid restraints
repeat yourself as often as needed
give encouragement
praise accomplishments as activity progresses
be patient
Sundowning
change in personality later in the day leading to angst and anxiety in alzheimers patients
What sort of body contour changes occur in the elderly?
bony prominences show
weight distributes to waist and hips
subcutaneous tissue leave the face and arms to move to abdomen/hips
height decreases
Important Elder changes that lead to decreases in physical endurance and activity
wide base gait
weight decreases from loss of lean muscle and mass sarcopenia
Older adults differ how in total body water?
total body water decreases
this is unintentional weight loss NOT part of aging
What happens to older adult temperature regulation with age?
Less likely to have a fever
More likely to have hypothermia
Slower metabolism
Produce less body heat
Thermoregulatory Impairment
Median body temp 96.8 (36 C)
Sweat gland diminishes in size and function
Reduced sensory input
Causes of hypothermia in older adults
Decreased Activity
Hypothyroidism
Hypoglycemia
Malnutrition
(Stroke, paralysis, parkinson’s, dementia & Arthritis)
Acute Illness
Medications
What happens to the different layers of integument in older adults
Epidermis
Regeneration slows
Reduced barrier protection
Dermis
A supportive layer, a 20% loss causes older skin to look more transparent and fragile.
Hypodermis
Contains connective tissues, blood vessels, & adipose tissue
XEROSIS: DRY SKIN- Accompanied by pruritus
What sort of things can be seen in skin and nails in older adults?
Skin Tags
Seborrheic Keratosis
onychomycotic nails
What happens to hair with age
Loss of melanin leading to potential alopecia
What happens to nails with age
thicken
brittle and flat
they can get brittle ridges (onycholysis/onychorrhexis)
What sort of head and neck changes occur with age?
bones and orbits are more prevalent
great vessels may have bruits
neck shortens related to osteoporotic changes
thyroid not palpable
loss of subcutaneous tissues
Eye changes with age
Decreased eyelid elasticity
conjunctiva thinner and yellow with increased infection rate
Pinguecula may develop
lacrimal gland and ducts loose fatty tissues and tears decrease
eyeballs sit deeper in sockets
cornea flattens and iris fades
increased connective tissue may cause sclerosis of sphincter muscles
pupils become smaller, sclera becomes thick and rigid
Presbyopia
decrease ability to adjust near/far vision in older adults
What sort of vision impairment occurs in the elderly
Presbyopia
decreased visual acuity (especially near vision) and narrowing of visual field
difficulty gazing upward and maintaining convergence, adapting to lighting changes
glaucoma
cataract
What factors affect hearing
cerumen buildup and hardening
corti and the auditory nerve atrophy\
tympanic membrane thickening
tinnitus
What sort of hearing impairments occur with age
decrease tone discrimination
presbycusis
decrease ability to discern consonants
decrease equilibrium due to vestibular changes
S/S of Hearing Loss
need increased volume
tilting head toward person speaking
cupping hand around one ear
watching speakers lips
speaking loudly
not responding when spoken to
tips for communicating with the hearing or vision impaired
Stand or sit directly in front and close to the person
Talk toward the better ear, but make sure your lips can be seen
Make sure the person pays attention and looks at your face
Speak distinctly, slowly and directly to the person
Avoid or eliminate background noise
Smell Perception changes with age
decline after 60
rapid decline at age 80
cell loss from olfactory bulb and sensory cells
decrease in appetite and smell
Changes in Mouth and teeth with age
Teeth Loose Enamel & Dentin
Become More Vulnerable to Caries
Incidence of Periodontal Disease increases
How does taste perception change with age
very gradual decline
decreased taste from taste bud atrophy, amylase decreased amount in saliva, and accelerated with dental problems/meds/or smoking
Decrease Taste with Age
Taste changes are modest
Desire increase concentration of flavor over time
have a decreased appetite from it
Musculoskeletal system changes with age
Structure
Disks become thin and shortening
Slight forward bent posture
Bones
Decrease in bone density b/c resorption is more rapid than deposition
Joints, Tendons & Ligaments
Cartilage changes
Tendons may shorten
Muscles
Atrophy of muscle mass tissue
Cardiovascular System changes with age
Heart: Valves & Conductivity
Blood Vessels: Arteries & Veins
Heart changes with age
ATRIAL FIBRILLATION can occur from fibrosis of SA Node - Can occur from Hyperthyroidism
Pulse Pressure Widens
Blood Vessels of lower Extremities More likely to show s/s of cardiovascular Changes r/t dependent and distal position.
How to promote heart health early in life (when you should)
Engage in regular exercise
Eat a low-fat, low-cholesterol, balanced diet
Maintain control of diabetes
Do not smoke; avoid exposure to smoke
Avoid environmental pollutants
Practice stress management
Minimize sodium intake
Maintain ideal body weight
What determines respiratory system changes with age
musculoskeletal and nervous system (loss of elastic recoil, stiffening chest wall, gas exchange changes, resistance to flow)
Why does risk of infection of the resp system increase with age?
less responsive cilia
diminished cough reflex
If you have trouble auscultating an older patient you should ..
start at the bases and move up
Respiratory Changes seen with age
Airways:
Nose
Trachea & Larynx
Chest Wall and Lung:
Limited Chest Expansion
“Senile Emphysema”
Alveolar Duct Ectasia
Oxygen Exchange:
Chemoreceptors Altered
↓ PO²
How to promote lung capacity
Obtain pneumonia immunization
Obtain annual influenza immunization
Avoid exposure to smoke and pollutants
Do not smoke
Avoid persons with respiratory illnesses
Seek prompt treatment of respiratory
infections
Wash hands frequently
Eat meals in relaxed atmosphere
Practice thorough oral hygiene
Exercise Deep Breathing/Laughing
Renal and Urological System changes with age
Kidneys:
Loss of Nephrons
↓Kidney Mass
Renal Vessels:
↓ Renal Blood Flow
Ureters, Bladder & Urethra: ↓Tone & Elasticity ↓Bladder Holding Capacity Urgency & Frequency Increases Nocturia
Glomerular Filtration Rate:
Linear Decline
Endocrine System changes with age
Thyroid Gland:
Incidence of Hypothyroidism
↓Serum T3 ? From increase TSH
Usually Requires Lower doses of Thyroid Replacement
Parathyroid Gland:
Changes in PTH may be cause of Alterations in Calcium Homeostasis/Bone loss
Endocrine Pancreas:
Secretion does NOT decrease/Tissues may develop ↓ sensitivity to insulin.
Digestive System changes with age
Esophagus:
Contractions Increase
Propulsion is Decreased
Stomach:
↓ Motility
GERD r/t decrease in resting pressure of esophageal sphincter-INCREASE risk for Aspiration
Reduction Secretion of Bicarbonate & Gastric Mucous
How to promote healthy digestion
Practice good oral hygiene
Wear properly fitting dentures
Yearly dental checks!
Seek prompt treatment of dental caries
and periodontal disease
Eat meals in relaxed atmosphere
Maintain adequate intake of fluids
Respond promptly to urge to defecate
Eat balanced diet
Avoid prolonged periods of immobility
Decrease occurs for what neurotransmitters with age
Decreased Catecholamines
Decrease Serotonin
Decrease Choline Acetylase
Increase Monoamine Oxidase (MAO)
Changes of the Reproductive System with age
The Female Reproductive System: ↓Estradiol ↓Estrone Breast Size Decreases Breast Lumps more evident Menopause Cessation of Menses, Atrophy of ovaries
The Male Reproductive System:
BPH (Benign Prostatic Hypertrophy)
Dribbling/Difficulty Initiating urinary stream
May see an increase in fatty tissue (Breast)
Changes of the Immune System with Age?
decrease in T cell function
decrease in response to foreign antigen
also larger system changes like skin lungs and GU
Male Gait in elderly
smaller steps
wider base
Female gait in elderly
waddling gait
bowing of legs
Changes in sleep with age
Interrupted REM Episodes
Increased Total Daily Sleep
Increased Awakening after Sleep Onset
(Wake up feeling tired)
