module 9 common concern of older adult 2

Question 1

vision changes associated with aging

Answer 1

dec. visual acuity: presbyopia
structural changes
floaters
reduced peripheral vision

Question 2

vision changes associated with pathology

Answer 2

cataracts
glaucoma
macular degeneratoin
retinopathy

Question 3

hearing

Answer 3

presbycusis
tinitus
ear wax 
-> social isolation
-> dec. ability to hear instructions/warnings

Question 4

touch/pain sense

Answer 4

dec. conduction speed along nerves
- loss of myelin
dec. circulation
slowed waste removal
-> dec. ability to feel injury/pressure
-> clumsy
-> difficulty with tasks

Question 5

proprioception

Answer 5

dec. conduction speed along nerves
- > difficulty with balance
- > falls,
- > dec. willingness to leave familiar places

Question 6

smell

Answer 6

dec. number of nerve endings and mucus production in nose
- > dec. enjoyment of smells and taste
- > dec. ability to smell dangerous odors

Question 7

taste

Answer 7

dec. number of taste buds 
dec sensitivity 
dec. saliva
-> dec. enjoyment of smells and tastes
-> dec. ability to taste food
-> dec. intake
-> missing bad taste of spoiled food

Question 8

cataracts risk factors

Answer 8

age
diseases
smoking
ETOH
prolonged UV exposure

Question 9

cataracts assessment

Answer 9

visual acuity
dilated eye exam
tonometry

Question 10

cataracts s/s

Answer 10

cloudy/blurry vision 
faded colors
glare/halos around lights
dec. night vision 
double vision or multiple images in one eye 
- this may improve as cataracts worsen
freq. Rx changes

Question 11

presentation of infections in elderly

Answer 11

absence of fever
sepsis w/out leukocytosis and fever
falls
dec. appetite or fluid intake
confusion 
change in functional status

Question 12

preventing falls

Answer 12

ask the 3 questions
review meds
recommend
- Vit. D
- inc. bone and muscle strength 
= improve nerve health

Question 13

polypharmacy

Answer 13

use or misuse of multiple drugs

• Rx and Non-Rx
• interactions with one another

Question 14

polypharmacy arises from

Answer 14

multiple comorbidities
multiple Rx'ers 
fear of accusation of ageism
cultural bias 
changing medical guidelines 
medication advertising 
treating AE of one med with another

Question 15

polypharmacy patho

Answer 15

abnml in the CV system
dec. gastric acid
dec. total body water
inc. total body fat
- all affect drug absorption and metabolism
Age related renal changes
-> inc. drug levels and potentially toxic effects

Question 16

consequences of polypharmacy

Answer 16

adverse drug reaction
change in mental status
sedation
falls

Question 17

cognitive impairment

Answer 17

decline in cognition

- most feared: dementia

Question 18

cognitive impairment AD s/s

Answer 18

• chronic, irreversible illness with gradual onset and steady decline.
• ST memory loss
• disorientation, disturbance in executive functioning
• dec. ADL function
• aphasia, apraxia, or agnosia
• sleep cycles reversed
• consciousness and psychomotor changes late in disease

Question 19

cognitive impairment delirium s/s

Answer 19

acute onset
fluctuations in orientation and attention
- transient waxing and waning of LOC

Question 20

Dehydration

Answer 20

state of fluid intake deprivation and/or excess fluid loss

• electrolyte imbalances may ensue
• often multifactorial

Question 21

dehydration patho

Answer 21

dec. thirst response
-> inc. solute/water ratio
dec. renal plasma flow
-> dec. ability to concentrate urine
-> prevent body from retaining enough fluid
Vasopressin release stimulated by low fluid volume is diminished

Question 22

dehydration s/s

Answer 22

often vague
confusion
lethargy
rapid wt loss
functional decline

Question 23

dehydration physical exam

Answer 23

CV: orthostatic drop in BP, inc HR
temp may be elevated
mucous membranes not noticeably dry until severe dehydration

Question 24

dehydration labs

Answer 24

electrolytes (Na > 148)
BUN/creatinine ratio (>25:1)
osmolality
hgb/hct