Set 12 - Gerontology Flashcards
Gerontological psychosocial changes nursing consideration
Older adults should be regularly screened for depression and suicidal ideation
Gerontological respiratory changes
- decreased lung capacity
- decreased lung tissue elasticity
- weaker respiratory muscles
Respiratory changes associated with aging are more likely to place older adults at risk for
Infections, pneumonia, abnormal breathing patters (ex: sleep apnea)
Gerontological cardiovascular changes
decreased heart muscle efficacy and strength (decreased cardiac output)
Cardiovascular aging can result in incomplete valve closure placing older adults at risk for
Heart murmurs
Cardiovascular aging may result in stiffening and calcification of heart vessels placing older adults at risk for
Atherosclerosis
Older adults may experience a decrease in the size and number of neurons. This is referred to as
Cerebral atrophy
Decreased cerebral blood flow in older adults can result in a decrease in
Cognitive function (NOTE: a slight change in cognitive function, like forgetfulness, is normal! However, if the change is significant, dementia may be suspected. This is NOT normal)
General nervous system changes associated with aging
Delayed reflexes/reaction time, decreased senses, altered sleep-wake cycle, increased risk for chronic pain
What are some ways the nurse can assess pain levels in an older adult?
Facial expressions, appetite, sleep disturbances, mood/behavior
Decreased bone density places older adults at risk for
Osteoporosis, bone fractures, falls
General musculoskeletal changes associated with aging
- muscle atrophy (muscle decreases in size, strength, endurance)
- joint stiffening (risk for arthritis)
- kyphosis (forward curvature of thoracic spine —> decrease in height)
Factors that may contribute to risk for falls in the elderly population
Previous falls, impaired vision, impaired balance, polypharmacy, incontinence, cognitive decline, pain, orthostatic hypotension
A decrease in thyroid function leads to a decrease in _________ in older adults
Basal metabolic rate (BMR)
A decrease in insulin release and tissue sensitivity to insulin places older adults at risk for
Diabetes
Factors that contribute to the risk for Dysphagia and aspiration in older adults
- increased fatty tissue deposit in abdomen
- decrease in saliva production and mastication
- weaker gag reflex
A decrease in appetite and taste sensation places older adults at risk for
Malnutrition and dehydration
Slower gastric emptying rates and bowel motility places older adults at risk for
Constipation
Renal changes in the older adult include
Decrease in nephrons, renal blood flow, and kidney function
Older adults may experience stiffening and weakening of bladder muscles which places this population at risk for
Urinary incontinence/retention and UTIs
Reproductive changes in aging females
Decreased hormone production (estrogen, progesterone), cessation of ovulation, thinner and dryer vaginal walls, menopause (cessation of menstruation)
S/S of menopause
Hot flashes, mood swings, sleeping difficulties
Reproductive changes in aging males
Prostatic enlargement, decrease in hormones like testosterone (decreased sex drive, risk for erectile dysfunction)
What unique symptom might older adults experience if they have a UTI?
Confusion/agitation
A decrease in subcutaneous tissue can increase an older adults risk for
Pressure injuries; hypothermia
Integumentary changes in older adults
Thinner and dryer skin, easier bruising, senile lentigines (aging/liver spots), delayed wound healing
Difficulty focusing on close objects
Presbyopia
Opacity of the lens
Cataracts
An increase in fluid pressure inside the eye
Glaucoma
Loss of central vision
Macular degeneration
Age-related bilateral hearing loss
Presbycusis
Older adults with presbycusis are more likely to lose the ability to hear _____-pitches frequencies first
Higher
A progressive neurodegenerative disease categorized by muscle rigidity, akinesia, and involuntary tremors
Parkinson’s disease
TRAP symptoms of Parkinson’s disease
Tremors, rigidity, akinesia/bradykinesia, postural instability
A gradual, nonreversible dementia in which a person experiences memory problems, judgement issues, and personality changes
Alzheimer’s disease
Stage 1 symptoms of Alzheimer’s disease
Mild: forgetfulness, short-term memory loss
Stage 2 symptoms of Alzheimer’s disease
Moderate: disorientation, agitation, require more assistance w/ ADLs, incontinence, wandering
Stage 3 symptoms of Alzheimer’s disease
Severe: bedridden, loss of motor and verbal skills, impaired swallowing
Nursing interventions for patient’s with Alzheimer’s
- maintain a structure environment and routine
- provide short, simple directions
- repetition and reorientation may be necessary
- avoid overstimulation: use a single-day calendar
- secure environment: lock doors/exits
- implement fall precautions
Term used to describe increase confusion and agitation in the evening in patients with Alzheimer’s disease
Sundowning
Interventions for patients with Dysphagia
- monitor intake and swallowing
- thicken liquids/food as appropriate
- sit upright when eating
- ensure suction equipment at bedside
Chronic, irreversible memory loss that occurs gradually
Dementia
T or F: Dementia results in changes in LOC
False
Describe the onset of delirium
Acute and sudden
T or F: unlike dementia, delirium is reversible
True
Causes of delirium
Metabolic imbalances/disorders, infections, toxins
Effects of delirium in older adults
- change in LOC
- behavioral changes
- hallucinations
Mood changes that last more than two weeks
Depression
Using five or more medications concurrently
Polypharmacy
Polypharmacy risk factors
- use of multiple OTC medications
- chronic conditions/multiple chronic conditions
- highest risk during transition of care
The _____ criteria allows for identification of medications that have an increased harmful effect in older adults
Beer’s
In prevent polypharmacy, the nurse can encourage patients to
Carry a list of all their medications (including OTC), bring medications in their original containers for doctor visits, encourage the use of a single pharmacy
Anticholinergics included in the Beer’s list
Atropine, oxybutynin, Benztropine
Antidepressants included in the Beer’s list
SSRIs, SNRIs: amitriptyline, sertraline, duloxetine
First-generation antihistamines included in the Beer’s list
Diphenhydramine, hydroxyzine
Antipsychotics included in the Beer’s list
Chlorpromazine, olanzapine
Benzodiazepines included in the Beer’s list
Lorazepam, alprazolam
NSAIDs included in the Beer’s list
Ibuprofen, naproxen, ketorolac
PPIs included in the Beer’s list
Omeprazole, pantoprazole
Drug classes included in the Beer’s list for prevention of polypharmacy/adverse effects in older adults
Anticholinergics, antidepressants, antipsychotics, first generation antihistamines, Benzodiazepines, NSAIDs, and proton pump inhibitors (PPIs)
Elder mistreatment risk factors
Dementia, physical dependency on others for care, social isolation
Risk factors for becoming the perpetrator of elder abuse
Caregiver strain, substance abuse, mental health disorders
S/S of elder mistreatment
Bruises/injuries in multiple stages of healing, treatment delay, dehydration, pressure injuries, poor hygiene incompatibility between the injury and how it was explained to have happened, incompatibility with what caregiver and patient say
Short-term relief of duties for caregivers
Respite care
