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N352: Practice of Nursing I > Module 3 - Age Related Changes and Vulnerability > Flashcards

Module 3 - Age Related Changes and Vulnerability Flashcards

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1
Q

Hair Changes with Age

A

Loss of melanin

alopecia may occur

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2
Q

Nail changes with age

A

thicken

brittle and flat

vertice or angular ridges

Oncholysis

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3
Q

Oncholysis

A

Nail lifting normal with age / fungal infection

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4
Q

Tactile Perception Changes with Age

A

Tactile sensation decreases due to skin and sensory neuron changes

Possible delayed pain transmission

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5
Q

Why is the origins of tactile perception changes difficult to determine?

A

it could either be d/t neuropathy of natural aging processes or an effect of disease

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6
Q

What occurs to pain transmission and perception with age?

A

possible delayed pain transmission

This does NOT mean patient has reduced pain perception, just slower

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7
Q

Integumentary conditions common with aging

A

Want for cosmetic surgeries

Rashes

Skin Cancer

Pruritis

Vascular Lesions

Pressure Injuries

Kyphosis/Hunchback from bending forward

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8
Q

Why do older people seem to get shorter?

A

their vertebral disks thin and they lose some height

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9
Q

Pruritis

A

itching

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10
Q

Elderly are at ___ risk for fracture

A

higher

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11
Q

Why is it important to do ROM with the elderly?

A

Their shortened tendons could lead to contracture so you want to prevent that

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12
Q

Why do vascular lesions occur in the elderly

A

poorer circulation

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13
Q

Why do pressure injuries occur in the elderly?

A

immobility

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14
Q

Musculoskeletal Structure changes with age?

A

Disks become thin and the person becomes shorter

Slight forward bent posture - kyphosis - hunchback

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15
Q

Bone changes with age?

A

Decrease in bone density

Higher risk for fractures

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16
Q

Joint, Tendon, and Ligament changes with age?

A

Cartilage changes

Tendons may shorten

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17
Q

Muscle changes with age?

A

atrophy of muscle mass tissues

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18
Q

Things to assess in the musculoskeletal system for the elderly

A

Feet - DM and vascular disease

Joint replacement

Osteoarthritis and osteoporosis

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19
Q

What are the two most common joint replacement needs in the elderly?

A

Hip and Knee joints

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20
Q

Osteoporosis

A

bone weakening and brittling

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21
Q

What are some reasons that Osteoporosis can occur?

A

Inadequate calcium absorption

Inactivity or Immobility

Reduction of anabolic sex hormones

Diet

Medications

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22
Q

What are the 3 general principles of caring for the elderly?

A
  1. manage pain!
  2. prevent injury!
  3. Promote Independence
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23
Q

Common Chronic Cardiovascular Disorders in the Elderly

A

HTN/Hypotension

CAD

HF

PVD (Peripheral Vascular Disease)

Cardiovascular Disease

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24
Q

What areas of the cardiovascular system are highly impacted with aging?

A

Valves

Conductivity (sclerotic potentially)

Blood vessels like arteries and veins

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25
Q

Atrial Fibrillation

A

rapid heartbeat commonly d/t bad blood flow

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26
Q

Heart Changes that occur with age?

A

Chronic Disorders

Atrial Fibrillation from fibrosis of SA node

Pulse pressure widens

Blood vessels of LE more likely to show s/s of cardiovascular changes r/t dependent position

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27
Q

S/S of Hypertension in the Elderly

A

Silent Killer!

Dull headache

confusion

epistaxis

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28
Q

Epistaxis

A

Nosebleed

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29
Q

What conditions can occur due to chronic HTN in the elderly?

A

CHD

A Fib

HF

MI

Stroke

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30
Q

Treatments for HTN

A

Medication Management

Rest

Diet

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31
Q

Why is diet so hard to work with in the elderly?

A

they will not want to change the diet they have eaten their whole life

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32
Q

When treating HTN it is important to keep what in mind?

A

Do not overtreat as it could cause hypotension, syncope or dizziness

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33
Q

S/S of CAD in the elderly

A

Mild Pain in the back, abdomen, shoulders, or arms

N/V or indigestion (nausea and vomiting)

HR > 80

Fatigue

Dizziness

Syncope or Confusion

Irritability

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34
Q

What is a big issue occurring with CAD in the elderly?

A

It is often misdiagnosed leading to a delay in treatment which could ultimately lead to death

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35
Q

Treatment for CAD

A

medications

physical and functional activity limitations - they need lots of rest as they are very unhealthy

Energy conservation -rest is needed

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36
Q

S/S of Heart Failure in the Elderly

A

General malaise

Dyspnea

Chronic Cough

Insomnia

Weight Loss

Nocturnal

Syncope

Delirium

Falls

Decreased Functional Ability

Ankle Edema (this is a major one) or Weeping Edema

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37
Q

What does Heart failure eventually lead to for the elderly?

A

Decline in physical functioning

Diminished cognition

Delirium

Alterations in skin breakdown (d/t weeping edema)

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38
Q

Treatment for Heart Failure

A

Medications

Oxygen

Comfort Measures (major one since there is not a lot that can be done)

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39
Q

S/S Of Peripheral Vascular Disease

A

Discoloration

Speckled (Hemosiderin) Edema

Ulcerations

Pain

Ulcers

DVT

Edema

Hemosiderin Deposits

Decreased Circulation

Poor Nutrition Delay Wound Healing

40
Q

Important Treatments/Considerations for PVD Elderly

A

Skin care

Diuretics

Compression Stockings

Elevation as often as possible

Assess feet - they will be colder in PVD

Compression stockings to contain edema

41
Q

Types of Cerebrovascular Disease in the Elderly

A

Ischemic Stroke
Hemorrhagic Stroke
TIA

42
Q

Reasons for Ischemic Stroke in the Elderly

A

Arterial clots

Cardio Embolism

Hematological Disorders

System Hypo Perfusion

*Blood pools and forms clots which lead to stroke

43
Q

Reasons for Hemorrhagic Stroke in the Elderly

A

Uncontrolled HTN

Malformations of Blood vessels leading to aneurysm (seen at birth, and may one day burst)

44
Q

TIA

A

Transient Ischemic Attack

It is a mild stroke that can occur

45
Q

S/S of TIA

A

sudden weakness or numbness on one side

loss of vision or dimness in one eye

slurred speech, loss of speech or inability to comprehend speech

difficulty walking, loss of balance, falling, dizziness

sudden severe headache, confusion

difficulty swallowing

N/V

46
Q

Risk Factors for Stroke in the Elderly

A

Heart Disease

Diabetes

HTN

Hypercholesterolemia

Diabetes

Smoking

Brain Tumor

Family History

Coagulopathies

47
Q

Risk Factors for Diabetes Mellitus

A

Increasing age

HTN

First degree relative with diabetes

History of impaired glucose tolerance or impaired fasting glucose

Ethnicity (AA more likely)

Previous gestational diabetes or having child greater than 9 lbs

high HDL or triglycerides

48
Q

Coagulopathy

A

coagulation factors are not being made/there (like in liver disease)

49
Q

What levels of HDL or triglycerides are leaving the elderly at higher risk for DM

A

HDL 35 mg/dL

Triglycerides - 250 mg/dL

50
Q

S/S of Diabetes mellitus type 2

A

Periodontal disease

dehydration

confusion

delirium

poor visual acuity

incontinence

weight loss

anorexia

UTI

candida infections (yeast)

wounds that wont heal

fatigue

nausea

paresthesia (trouble feeling)

orthostatic HTN

HgA1C > = 6.5%

51
Q

What issue can DM Type 2 lead to?

A

Hypoglycemia

Foot problems

ulcers

PVD

numbness of extremities (neuropathy)

amputations

recurrent non healing infections

may lead to social isolation

52
Q

Treatments and Care for DM Type 2

A

Foot care

medications

comfort care (if end stage)

diet (could be difficult)

53
Q

Risk Factors for Hypothyroidism in the Elderly

A

Age older than 60

Female

Menopausal

History of infertility or miscarriage

History of smoking

Radiation treatment to head, neck, chest, and tonsil area

54
Q

S/S of Hypothyroidism

A

Fatigue

Weakness

Depression and confusion

Slow insidious onset

55
Q

Why is Hypothyroidism often undiagnosed?

A

Because it is commonly misdiagnosed as dementia!

56
Q

Treatments for Hypothyroidism

A

TSH Measurements

Medications

57
Q

Common Digestive System changes in the elderly occur in what areas?

A

Esophagus

Stomach

58
Q

Esophagus changes in the Elderly

A

contractions increase

Propulsion is decreased

59
Q

What occurs due to the changes in the esophagus for the elderly?

A

Contraction increase leads to more hiccupping

Propulsion decreases lead to GERD

Both can lead to potential aspiration (especially GERD)

60
Q

Stomach Changes in the Elderly

A

Decreased motility

GERD r/t decrease in resting pressure of esophageal sphincter

Increased risk for aspiration (d/t GERD) - may precede swallowing issues - so it is important to raise the HOB

Reduced secretion of bicarbonate and gastric mucous

Decreased production of intrinsic factor

Increase weight loss r/t anorexia

61
Q

Risk factors for Constipation for the Elderly?

A

Decrease in fluid intake (many older people do not want to drink because of their diuretic use and do not want to keep going to the bathroom)

Immobility

Medications (can slow things down like with pain meds)

Decreased Motility

62
Q

S/S of Constipation in the Elderly

A

Confusion

Behavior Changes

Abdominal Discomfort

Loss of Appetite

Nausea

UTI

Urinary retention

63
Q

What emergency can occur from constipation in the elderly?

A

Fecal impaction leading to acute intestinal obstruction that could lead to a burst - this is an emergency!

64
Q

Treatments/Interventions for Constipation in the Elderly?

A

Medication review (remove what is unneeded)

Increase fluid intake, encourage ambulation

follow bowel protocol

Close monitoring and documentation! (do not just doc, monitor)

65
Q

Common Respiratory Disorders in the Elderly

A

COPD:

Bronchitis - inflammatory

Emphysema - oxygen dependent

Air Hunger

66
Q

Risk Factors for the Respiratory Diseases in the Elderly

A

Smoking

Alcoholism leading to Ascites

Heart Disease

Institutionalized - closed in / poor air ventilation

Normal physiologic changes

67
Q

What are some normal respiratory system physiologic changes in the elderly?

A

Decreased cough reflex

Increased residual volume (air sitting there normally)

Less responsive cilia (harder to get things out)

Musculoskeletal and nervous system changes leading to changes like loss of elastic recoil, stiffening of chest wall - kyphosis/scoliosis, inefficiency in gas exchange

Higher risk for infection d/t less responsive cilia, diminished cough, and fatigue

68
Q

How does Alcoholism lead to respiratory disease?

A

It causes ascites, fluid build up around the belt, which makes it hard to expand the lungs since it is pressing against them

69
Q

Many elderly on oxygen still ___

A

smoke!

70
Q

S/S in COPD, Bronchitis & Emphysema

A

Decreased alertness indicating decreased O2 or increased CO2

Wheezing

Prolonged Expiration

Pursed Lip Breathing

Barrel Chest

Hyper resonance

Pale lips and nail beds

clubbing of fingernails

increased use of accessory muscles

Insidious symptom onset potentially!!!

71
Q

What are some issues that can occur d/t COPD, Bronchitis and Emphysema in the elderly?

A

Pneumonia

Respiratory Failure

Tracheotomy

Ventilator Assistance

72
Q

Treatments and Nursing Intervention for COPD, Bronchitis, and Emphysema Elders

A

Good/great oral care

maintain functional status and QOL

medication

O2

activity limitations

avoid stress

breathing exercises (lean forward - very much for barrel chest, not so much kyphosis)

education and support

73
Q

Factors that increase risk for Lung Cancer

A

Ages greater than 65

Higher in men than women

Higher in smokers than non-smokers

74
Q

Symptoms of Lung Cancer

A

Dyspnea

Coughing

Chest Pain

Fatigue

Anorexia (Tumors take a lot of energy leading to weight loss)

Wheezing and Respiratory infections

75
Q

Treatments for Lung Cancer

A

Surgery

Chemo and Radiation Therapy

Sometimes it is just comfort care

76
Q

Kidney changes with age

A

loss of nephrons

decreased kidney mass volume

77
Q

Renal Vessel changes with age

A

decreased renal blood flow

78
Q

Ureter, Bladder, and Urethra changes with age

A

Decreased tone and elasticity

decreased bladder holding capacities

urgency and frequency increases

nocturia

79
Q

How does Glomerular Filtration Rate (GFR) change with age?

A

Once it begins to decline, it undergoes a linear decline

80
Q

Female Reproductive System changes with Age

A

Decreased Estradiol and Estrone

Menopause and Hot Flashes

Vaginal Dryness

Sleep Disturbances

81
Q

Male Reproductive System changes with Age

A

BPH (benign Prostatic hypertrophy)

Difficulty urinating - start/stop

May develop kidney stones

82
Q

BPH

A

Benign Prostatic Hypertrophy

Enlarged prostate which can cause urination issues leading to kidney stones

83
Q

What are the important things to do for rehabilitation for expected chronic and normal changes in the elderly?

A

Maximize QOL

Maintain individuality and autonomy

increase level of independence

increase exercise tolerance

increase self esteem and self care skills

84
Q

What are the number 1 things to do/keep in mind when caring for an older adult?

A

MAXIMIZE QOL (and Dignity)

85
Q

Types of Abuse that occur to the Elderly

A

3 Types of Abuse:
1. Abuse
2. Neglect
3. Mistreatment

Subcategories:
Physical
Emotional
Sexual
Exploitation
Neglect
Abandonment

86
Q

Risk factors Increasing the Older Adults risk for Elder Mistreatment

A

lack of resources or access to resources

low income

social isolation

low level of education

functional debility

cognitive impairment (big one since it can lead to burnout for the caregiver)

dependence on caregiver for ADLs

substance or alcohol abuse

psychological disorders

history of family violence

87
Q

Risk factors increasing the Caregivers likeliness of committing elder mistreatment

A

Mental illness

substance or alcohol use/abuse

burnout, frustration, stress, and/or resentment

dependence on the elder for financial or material support

poor relationship with the elder before caregiving

88
Q

Most Perpetrators of Elder Abuse are?

A

40% - Adult Children

15% - Spouse

9% Grandchildren

A high percentage is family!

89
Q

What group is most likely to report cases of elder abuse?

A

Health Care Providers

They are mandated reporters and need to be vigilant

90
Q

Physical Signs of Elder Abuse

A

Injury that hasnt received proper care

Injury inconsistent with explanation for its cause

Pain from touching

cuts, puncture wounds, burns, bruises, welts

Dehydration or malnutrition without illness related cause

poor coloration

excessive drugging, lack of medication

fear

sunken eyes or cheeks

inappropriate administration of medication

soiled clothing or bed (is it abuse or socioeco related)

frequent use of hospital or healthcare/doctor-shopping (caregiver gets extra meds for themselves)

lack of necessities like food, water, or utilities

lack of personal effects, pleasant living environment, personal items

force isolation - abuse

91
Q

Do physical signs of elder abuse always mean there is abuse?

A

no, but it is important to investigate carefully

if they fit a category, be suspicious and ask questions

92
Q

Signs of Sexual Abuse occurring for an elder?

A

Physical signs (bruises, pain, itching) on the genital area or breasts

Sexually transmitted disease diagnosis

Change in older adult’s behavior or mood that is unexplained

Fear of physical exam of genital area (ex: bed bath, peri care, fear of undressing)

93
Q

Elder Behavioral Signs of Abuse

A

Fear

Anxiety or Agitation

Anger

Isolation and Withdrawal

Depression

Non-responsiveness, Resignation, Ambivalence

Contradictory statements, implausible stories

Hesitation to talk openly

Confusion or Disorientation

Suicide Attempts or Thoughts

94
Q

Signs by the Caregiver of Elder Abuse

A

Prevents elder from speaking to or seeing visitors

Displays anger, indifference, aggressive behavior toward the elder

History of substance abuse, mental illness, criminal behavior or family violence

Lacks affection toward the elder

Acts flirtatious or coy, a possible indicator of inappropriate sexual relationships

Gives conflicting accounts of incidents

Talks of elder as a burden

Blames the older adult for the mistreatment

95
Q

Signs of Financial Abuse or Exploitation of an Elder

A

Frequent expensive gifts from elder to caregiver (to try and get them to stay)

Numerous unpaid bills

Elder personal belongings, papers, credit cards all missing

Recent will when elder seems incapable of writing a will (will manipulation)

Caregivers name added to bank account

elder unawareness of monthly income

Elder signs on another’s loan

Frequent checks made out to “Cash”

Unusual activity in bank account

Irregularities on tax return

Elder unaware of reason for appointment with banker
Refuses to spend money on elder even if its their money

Fraud signatures

96
Q

What is the healthcare providers responsibility regarding elder abuse?

A

PARC

Protect
Advocate
Report (Mandated)
Care

*maybe call APS hotline

N352: Practice of Nursing I (14 decks)

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