1. primary aging (aging well) 2. seconday aging: impacted of co-mobility/ aging faster/ often requiring assistance

- discrimination based on the age of a person - our society values attractiveness, energy youth = undervaluing older persons

Week 1 Older persons & infection control Flashcards by Selena Jeon

the definition of the older adult

the elderly are often lumped together, grouping everyone over the age of 65. A 65 year old’s experience of life is much different than a 90 year olds

the older adult poopulation can be divided into 3 life-stage subgroups:
- the young-old (app 65-74)
- the middle-old (ages 75-84)
- the old-old (over age 85)

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what is Geriatric

medical specialty focuing on the elderly

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2 steps of aging

primary aging (aging well)
seconday aging: impacted of co-mobility/ aging faster/ often requiring assistance

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What is the best way to describe the majority of older persons in canada

increased life expectancy
- medical advancements
- better treatment for chronic disease
aging baby boomers (born between 1946-1964)
life expectancy = 81.3 years
(> 80) = wealth, diet, education, health-care
(< 60) = HIV/AIDS, public health, medical care, diet

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how do physiological and psychosocial changes affects aging?

what are the factors impacting aging

changes with aging (= normal changes of aging)
- retirement (income)
- social isolation (retirement, mobility, lack of transportation, loss of friends and loved ones, loss of their purpose and roles, mental health and sense of uselessness)
- elder abuse (frustration from neglecting whether intentionally or not, financial abuse, caregiver abuse, housing; being taken benefit from)
- sexuality (loss of function, changes in relationship)
- housing & environment (changes in environment)
- death
- sense of usefulness
- body appearance and function

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what is the difference between health and healthy?

(only 23% of older adults define their own health as poor)
- health: objective
- subjective (physical, emotional, mental)

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what is quality of life

can take care of yourself
physically can move
ADL (activities of daily living); does the person being involved in community improve the ADL - very individualized

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physiological changes: nuerological

effects of aging on the brain/ misconceptions about aged people geetting cognitive impairment

effect of aging on the brain:
- decrease in brain weight and volume
- decrease in white matter
- ventricular system enlarges
- brain generates fewer neurotransmitters

(misconceptions): cognitive impairment
- disorientation
- loss of language
- inability to calculate
- poor judgement
- forgetfulness
- not able to use computers
- not able to learn
- rigid

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physiological changes: integumentary & musculoskeltal

effect and misconceptions

(integumentary)
- less amount of elastic fibre (broken)
- weaker of collagen (atrophy)
- melanin ceases to be produced in the hair root
- skin to lose moisture
- deep wrinkle
(musculoskeltal)
- bone mass starts to reduce between the age of 30 and 40 years
- osteoblast (cells that make bone) activity declines but osteoclast (a bone cell that resorbs bone tissue) activity continues at normal levels
- bone break more easily and do not repair well

misconceptions: disabled-functionally dependent & slow

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physiological changes: respiratory & cardiovascular

mostly changes happened due to smoking
- there are no changes happening jus bc of aging > there’s something abnormal situation is body impacting body to make a change

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physiological changes: gastrointestinal & genitourinary (in the gastrointestinal tract)

(in the gastrointestinal tract)
1. Nose and mouth:
- Reduction in sense of smell and taste
- Gum recession
- Difficulty in swallowing
2. Oesophagus
- Oesophageal peristalsis decreases
- Oesophageal sphincters lose tension
3. Stomach
- Reduced elasticity of stomach wall
- Decreased bicarbonate production and gastromucosal protection
- Delayed gastric emptying
4. Liver
- Shrinkage of liver occurs w/ loss of hepatocytes
- Reduced ability to detoxify substances including drugs
- Changes in bile constitution
5. Pancreas
- Decreased secreation of pancreatic protease and lipase
6. Large intestine
- Peristalsis slows down
- Decline in rate of cell division and lining repair
- Changes in microbial fauna
- Changes in DNA of epithelial cells
7. Small intestine
- Compromised gut-associated lymphoid tissue capacity
» not a normal change in elder people

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physiological changes: sensory (eyes)

Presbycusis: the tympanic membrane (eardrum) gets thicker
Tinnitus: a condition when a person hears a ringing sound or a diff variety of sound when no corresponding external sound is present and other people cannot hear it
Macular degeneration: may result in blurred or no vision in the center of the visual field
= affects the retina in the back of the eye

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physiological change: reproduction and endocrine

misconception about this change

Temperature maintaining
Thyroid gland
Insulin changes; diabetes
Misconceptions: not interested in sex or sexual activity - unattractive
More active since they have no concerns of having babies anymore

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immune system changes

Neurological
Endocrine
Respiratory
Cardiovascular
GI/GU
= normal defences are decreased as we age further increasing risk of infection

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leading health challenges in older persons

Chronical disease (S):
* Noncommunicable
* Persistent and generally slow in progression
* Cannot be cured
* COPD

Leading cause of death is cancer and heart disease
* 41.8% of death

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what is ageism

discrimination based on the age of a person
our society values attractiveness, energy youth = undervaluing older persons

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how can nurses recognize and address ageism?

by questioning prevcailing negative attitudes and stereotypes
by advocating for older persons

“nurses must treat older persons as independent, dignified persons”
* what you do as a nursing student and as a nurse: the language you use and your behaviour; can influence others
* nurses must treat older persons as independent and dignified persons; not just older persons but all persons
* you can talk slowly but no baby talking

(think twice; if we are doing something for the patients too much so that makes them to lose their functions)

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how to accommodate changes by nursing care?

= use an age-specific approach
* physical and psychosocial changes of ageing
* effects of disease and disability on function
* decreased homeostasis
* lack of standards for norms of health and wellness
* altered response and manifestations of disease
* “active listening”
* mindful about transition (e.g. recently transitioning into a long-term care or home care)

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what transition might be difficult?

be aware of atypical (not normal/ absent) signs and symptoms
examples:
- delirium (acute confusion) with an acute illness is considered a medical emergency
- depression without sadness
- infectious disease without fever or tachycardia
- myocardial infarction without chest pain
- nondyspneic pulmonary edema
- abdominal pain is absent or vague
- confusion is not inevitable. look for neurological events, new medicaiton, or the presence of risk factors for delirium
- many hospitalized older persons suffer from chronic dehydration accelerated by acute illness
- not all older persons have fevers with infection; most common are respiratory or urinary tract infections.
(symptoms may include increased respiratory rate, falls, incontinence or confusion)

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how can the symptoms of disease in older patients different from younger patients?

The classic signs and symptoms of diseases may be absent, blunted, or atypical (diff from those in younger persons)
* May be due to the age-related changes in organ systems, and homeostatic mechanisms, from progressive loss of physiological and functional reserves, or from coexisting acute or chronic conditions

(examples)
- the patients with a urinary tract infection = may present with confusion, loss of appetite, weakness, dizziness or fatigue (instead of fever, dysuria, frequency or urgency)

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what are the early indicators of acute illness in older persons?

It is important to recognize the early indicators of acute illness in older persons: change in mental status, falls, dehydration, decrease in appetite, loss of function, dizziness and incontinence

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what are the normal defenses aginst infection?

normal flora
body system defenses
* inflammation: vascular & cellular responses;
inflammatory exudate/ tissue repair damaged cells + histamine release for…

Capillary widening/ vasodilation “increased blood flow (heat)”> increased permeability “ fluid release into tissue (redness and swelling)”> attraction of leukocytes “extravasation of leukocytes to site of injury (tenderness)”> systemic response “fever and proliferation of leukocytes (pain)” )

The factors leading to be at risk for infection susceptibility

age: very young & older persons
nutritional status
stress
disease processes
(immune system/ chronic disease)
medical therapy (meds that suppress the immune system) = e.g. hemotherapy

stages of infection

incubation: pathogen enters the body, no symptoms present
prodromal (first symptom): mild or non-specific signs & symptoms are present (transmission may occur)
illness: specific signs & symptoms present
covalescence: acute symptoms disappear - homeostasis/ body replenishes (time depends on severity)

2 types of infecitons

1. localized infection: an infection that is limited to a specific part of the body and has local symptoms 2. systemic infection: fathogen is distributed throughout the body WBC = white blood cell CRP = C-reactive protein; produced by the liver that indicates inflammation in the body

signs and symptoms (local inflammation/ infection)

heat, redness, swelling, pain, immobility = others signs and symptoms can be dependent on site

signs and symptoms (systemic infection)

SEPSIS = a life-threatening condition that occurs when the body's immune system overreacts to an infection.

What S/S of infection can be present in older patients?

may not show typical signs & symptoms - mental status changes (delirium) - falls - dehydration - decreased appetite - loss of function/ incontinence - dizziness

What is HAI

healthcare-associated infection * lungs (respiratory system) * surgical/ open wounds * urinary tract * bloodstream - an infection acquired in hospital: was not incubatin gupon admission (terms) 1. ARO-MRSA 2. Prophylaxis 3. Endogenous 4. Exogenous

3 ways to protect our patients from infection

1. routine practices 2. isolation precautions 3. chain of infecitons

what are the ways to protect/ isolate the susceptible host?

1. Routine practices: apply to all HCW exposed or potentially exposed to: * Blood * Body fluid (not sweat) * Non-intact skin * Mucous membranes 2. Isolation precautions: apply to specific circumstances

what are the personal protectice equipment (PPE)

* Routine practices * Gown and gloves: contact precautions * Surgical mask/ eye protection: droplet precautions * N95 mask/ eye protection: airborne precautions * Full face protection: splash to the face

what do we wear for Flu?

droplet/ airborne

what do we wear for Cdiff

contact

What is C.Diff?

contact precaution - what is it: diarrhea from bacteria - what causes it: HAI due to abx - how bad is it: threatening

what is flu?

droplet/ contact what is it: respiratory illness what causes: virus-nose, throat, lungs how bad is it: mild to severe (can be deadly)

what are the commons of C.Diff and FLue

both contagious (aka communicable) - increased risk in the older adult - increased risk with those with co-morbidities - with both- our older adults are at a higher risk due to all the changes ; especially if they have co-morbidities (asthma, CVS disease, Stoke, DM and CKD, Ca., HIV/AIDS)

(meet myrtle) you enter into practice and are assigned to work with an 87 year-old cliet who lives in LTC - history: COPD, HTN, CVA - client care: TC, incontinent, STC diet with HT fluids-set up what are the risk factors for infection?

- risk of falls - at risk of food or fluid going into lungs and causing infection (must sit up properly to eat) - age - comorbidities * age: 87 years old * Hx: COPD: chdornic obstructive pulmonary disease HTN: hypertensin CVA: cerebral vascular accident (stroke) * care: T/C: total care and LTC: long-term care incontinence: risk fo IAD (incontinence associated dermatitis) Diet STC and HT: soft to chew and honey thick

Myrtle (goes to the hospital) Myrtle was trying to get out of her WC. this caused a fall with a #It. hip and skin tear to hear right arm. she was transferred to the hospital where a foley is inserted and IV fluids are initiated. After 2 days of waiting she had a It. THA what does this mean? 1. WC 2. # 3. Lt. 4. Skin tear 5. foley 6. IV fluids 7. THA

1. WC = wheelchair 2. # = fracture 3. Lt. = left 4. Skin tear = opening 5. foley = empty the bladder 6. IV fluids = intravenous 7. THA = total hip arthroplastysurgery

what is a foley catheter?

A tube is inserted through the urethra and into the bladder to help with drainage.

Health promotion & maintenance

focus on prevention - consider individual needs - promote independence - stabilize chronic conditions

(Multiple choice) which of the following statements reflects ageism? 1) anabling world war II veterans to visit war memorials 2) speaking slowly and loudly when talking to an 85 year-old 3) believing that older people can use computers 4) living in a culture where elders are respected

2) speaking slowly and loudly when talking to an 85 year-old

(multiple response/ select all that apply) Which of the following are common examples/causes of HAIs? SELECT ALL THAT APPLY. A)C. Diff due to post-op IV antibiotics. B)Surgical wound such as incision infection to THA. C)Community acquired influenza. D)Blood infection: Sepsis due to deep/chronic wound. E)Pneumonia due to immobility post-stroke. F)UTI due to foley catheter.

The older adult is at a higher risk of infection. This is due to increased _____(A) and decreased ________ (B). resistence/ immunity/ pathogenicity/ cortisol/ defenses/ phagocytosis/ susceptibilty/ virulence

In the exam (A) and (B) will be a drop down. a) resistance/ susceptibility/ defenses/ virulence b) immunity/ pathogenicity/ cortisol/ phagocytosis

While working with an 87-year-old client in long term care the nurse is assessing if the client potentially has a urinary tract infection. What would be assessment findings, more typical to the older adult, that may alert the nurse that there is an infection? SELECT ALL THAT APPLY 1. altered mental status 2. fever 3. falls 4. dehydration 5. redness 6. pain

1. altered mental status 3. falls 4. dehydration

While providing care of the older adult which of the following are considered normal age-related physiological changes? SELECT ALL THAT APPLY 1. increased heart rate 2. decline of visual acuity 3. decreased respiratory rate 4. decline in long-term memory 5. increased susceptibility to urinary tract infections 6. increased incidents of awakening after sleep onset

2. decline of visual acuity 5. increased susceptibility to urinary tract infections 6. increased incidents of awakening after sleep onset ## Footnote Heart rate typically decreases with age and respiratory rate stays the same. Short term memory may be impacted, but not typically long-term memory. The rest are all expected as normal changes of ageing.

A nurse is caring for an older adult with a compromised immune system due to medications. Which infection control measure is most appropriate in protecting the client from environmental sources of infection? 1. placing the client on airborne precuations 2. administering prophylactic antibiotics daily 3. limiting visitors to immediate familiy only 4. ensuring a well-balanced diet for immune support

3. limiting visitors to immediate familiy only ## Footnote Immunocompromised patients are more susceptible to infections, and restricting visitors helps minimize the risk of exposure to potentially infectious agents. There are times when prophylactic antibiotics are appropriate, however this is not one of them. A well-balanced diet will provide more support for the immune system but will not have the MOST direct impact. Placing the client on airborne precautions is not appropriate at this time.

Which of the following physiological changes of ageing increases the older adults risk of infection? 1. atypiceal signs and symptoms to infectious agents 2. altered inflammatory response 3. enhanced immune response in the elderly 4. greater efficiency of the respiratory system

Altered inflammatory response ## Footnote As we age our immune response weakens, our risk for respiratory infections increases due to normal changes of ageing causing a less efficient respiratory system and altered response to infection does not increase risk of infection itself- but it can impact timely treatment.

A nurse is caring for an older adult with decreased skin turgor. How does this age-related change impact the risk of skin infections in the elderly? 1. it enhances the skin's ability to resist microbial invasion 2. it reduces the risk of pressure ulcers and skin breakdown 3. it compromises the skin's protective barrier 4. it accelerates wound healing

3. It compromises the skin's protective barrier ## Footnote Decreased skin turgor is associated with a loss of elasticity, which compromises the skin's protective barrier and increases susceptibility to skin infections.

when caring for the older person the nurse should do which of the following? 1. offer client-centered and individualized care 2. speak in a louder voice because many older persons are hard of hearing 3. be awrae that older persons are often forgetful, always write it fown for them to review later 4. most older adults require assistance so be prepared to provide full care

1. offer client-centered and individualized care ## Footnote all patients should be treated as individuals

Nurses have the responsibility to dispel myths and replace stereotypes of older persons with accurate information. Which of the following does the nurse know is TRUE about most older persons? 1. older adults are unable to understand and learn new information especially on computers 2. most older adults have a reduced ability to maintain their independence 3. older adults are confused and forgetful 4. older adults have a reduced ability to respond physically to stress

4. older adults have a reduced ability to respond physically to stress ## Footnote As cellular function changes, older adults may have a reduced ability to respond physically to stress. For example, hormone levels can decrease, the immune system can become less effective, therefore putting the patient at risk for having a reduced ability to respond to stress.

In Canada, the leading causes of death in older persons include (1) and (2).

1. cancer 2. heart disease ## Footnote Malignant neoplasms (cancer) are the most common cause of death among older persons in Canada. p423 Heart disease is the 2nd leading cause of death among older persons in Canada

What is the best method for older adults to protect themselves against influenza? 1. routinely cleaning surfaces in their home 2. washing their hands often 3. avoiding those who are, or may be, sick with influenza 4. receiving the influenza vaccine every year

4. receiving the influenza vaccine every year ## Footnote Vaccines are the BEST method for prevention. All other options are beneficial but not considered the best! Nursing/NCLEX questions will often have answers that are not the BEST or MOST right answer.

An older adult is prescribed antibiotics for a respiratory infection. What nursing action is essential in preventing the development of antibiotic-resistant infections? 1. administering the antibiotics as prescribed 2. encouraging the patient to stop the antibiotics when symptoms improve 3. using a broad-spectum antibiotic to ensure complete coverage 4. skipping doses to reduce the risk of side effects

1. administering the antibiotics as prescribed ## Footnote Completing the full course of antibiotics as prescribed is crucial in preventing the development of antibiotic resistance. ARO (antibiotic resistant organisms) are caused by multiple factors including- taking inappropriate antibiotics, incomplete treatment (stopping too early), and inadequate medication regimen (skipping doses).