X Gerentology Flashcards
Young Old
55 - 74
Old-Old
75 - and up
Frail Elderly
75 yrs w health concern
Is Chronological age an indicator of old age?
NO
Wellness is
based on belief that each person has optimal level of function, and even in chronic illness and dying some level of well being is attainable.
Traits of Healthy Person
Self-Responsibility Nutritional Awareness Physical Fitness Stress Management Evnt. Sensitivity (social)
Primary prevention
exercise for prevention of cardio vascular disease, falls and depression
Secondary Prevention
early detection and treatment of disease
Suggested Screening for Elders (Table 33-1)
MEN
Prostate Exam (2yrs)
Testicular Self Exam (monthly)
WOMEN
Pelvic Exam, Pap, Breast Exam (annual)
Mammo (2yrs)
Breast Self Exam (monthly)
BOTH Physical (annual) BP (p/visit) Rectal Exam (2yrs) Stool for occult blood (annual) Eye exam (2yrs) Glaucoma (annual) Dental (annual, 2/dentures) Hearing (2-5yrs)
Common Theories of Aging (Box 33-4)
BIOLOGICAL .Programmed aging .Genetic .Immunological .Free Radical .Wear and Tear
PSYCHO SOCIAL .Erickson's Dev Stages (acceptance of one own lifestyle/inability to achieve level of acceptance results in anger/despair) .Disengagement Theory .Exchange Theory .Activity Theory .Continuity Theory
Ageism
term that describes prejudice in America against older adults
End of Life care
nurse works with older adult and entire family to meet the physical, spiritual and psycho-social needs of dying patient
1991 PSDA (Patient Self-Determination Act)
relates to advance directives, living wills, durable powers of attorney, DNRs
Physiological Changes of Aging
DOWN Immune response
DOWN compensatory reserve
DOWN ability to efficiently repair damaged tisue
Integumentary Changes
.Dry and thin, loses tone and elasticity
.less adipose causes wrinkles
.less melanin, grey, thin hair
.Nails grow slow developing horizontal ridges
.thinner skin causes changes in touch sensation
.response to meds or disease
.susceptabe to infection, ecchymosis, tears
.slow would healing
.age spots (lentigo)
Table 33-3
Integumentary Changes
PHYSIOLOGIC CHANGE RESULTS
-DOWN vascularity of dermis ,decreased melanin / UP pallor in white skin
-DOWN sebaceous gland / UP skin dryness
-DOWN sweat gland function / DOWN perspiration
-DOWN subcutaneous fat /
UP wrinkling
-DOWN thickness of epidermis / UP susceptibility to trauma
-UP localized pigmentation / UP incidence of brown spots (senile lentigo)
-UP capillary fragility / UP purple patches (senile purpura)
-DOWN density of hair growth / DOWN amount and thickness of hair on head and body
-DOWN melanin production in the hair bulb / Graying hair
-DOWN hormone production / DOWN vaginal secretions, breast tissue mass/DOWN erection and ability to maintain erection
/ UP brittleness of nails
-Decreased peripheral circulation / UP thickening yellowing nails
-DOWN nail growth / UP longitudinal ridges on nails
-UP androgen-to-estrogen ratio /UP facial hair in women
ASSESSMENT: Integumentary
- observe for signs of excessive dryness, openings, tears, lesions.
- Examine for lesions that have changed in size, shape, raised, crusty, pitted etc.
- Observe hair loss, dryness, oiliness
- Observe nails for color, length, shape, symmetry, cleanliness
Pruritis
dryness and itching, reduced glandular secretions
NURSING INTERVENTIONS
- use soap sparingly
- rinse completely
- NO antibac soap, extra drying
- showers only 2 p/week
- water based lotion, oil residue uncomfortable for some
Nail Abnormalities
- BILATERAL CLUBBING could indicate possible pulmonary or cardiac issue
- YELLOWING, possible fungal infection
- SPLINTERING, possible malnutrition
- PITTING, signals peripheral vascular disease, psoriasis, diabetes mellitus or syphilis
Pressure Ulcers
Nursig Interventions prevent shearing forces -reposition every 2 hrs -use padding to reduce friction on skin to bedding -gentle handling
Gastrointestinal Changes
- Decreased secretion of saliva,
- DOWN gag response,
- UP risk for aspiration/choking
- DOWN gastric motility
- DOWN production bicarbonate, gastric mucous, Intrinsic factor (leads to pernicious anemia)
- DOWN gastric enzymes
- less firm abdominal wall, muscle weakness
- DOWN peristalsis, UP constipation
- DOWN liver function
- DOWN drug metabolism
Table 33-4 Gastro Changes w Aging
- UP dental caries
and tooth loss = DOWN ability to chew, DOWN nutrition - DOWN gag reflex = UP choking/aspiration
-DOWN muscle tone at
sphincters = UP pyrosis (heartburn); esophageal reflux
-DOWN gastric
secretions = DOWN digestion
-DOWN peristalsis = UP constipation/bowel impaction
Gastro ASSESSMENT
- ASSESS oral cavity for lesions, loose/missing teeth, ill fitting dentures, edematous gums, halitosis
- ASSESS chewing/swallow ability, heartburn? Nausea?
- ASSESS dietary intake, fiber, fat, Na, fluid
- ASSESS appetite
- ASSESS weight. compare w norms, asses sudden change
- ASSESS elimination, amount, odor, consistency. bowel tenderness, sounds
- ASSESS ability to control BMs
- Annual fecal occult blood
Obesity
need to reduce calories as age.
1800 - 2400 daily (varies)
NURSING IMPLICATIONS
-more quality nutricious foods (grain, vege, fruit for vit/mis/roughage/fiber
reduce sugar, fats
-respect individual food preferences
Fluids/Dehydration
minimum 1500 ml/day fluids
- due to difficulty holding cups
- purposely reduce intake due to difficulty getting to bathroom, incontinence
NURSING INTERVENTION
- make fluids readily available and within reach
- accessible toilet
- rearrange room if necessary
- start bathroom schedule, every 2 hrs/waking, 4 hrs/sleep
- double handed cups easier to hold
- prompt disoriented to drink
Loss of Appetite
- DOWN saliva
- DOWN taste buds
- DOWN gastric motility, loss of smooth muscle in stomach
- Physiologic (anorexia)
NURSING INTERVENTION
- prepare food using color, garnish, make attractive
- more seasoning if no restrictions
- homemade frozen dinners
- extra portions of favorite foods
- eat with company, social
Gastric Reflux
due to less efficient esophageal spincter, heartburn, sour stomach
NURSING INTERVENTION
- eat small meals
- avoid eating before bed
- elevate bed head
- achieve/maintain body weight
Dysphagia
Difficulty swallowing, stroke, neuro disfunction, local trauma, tumor obstruction
ASSSES
-Dysphasia with liquid, solid, or both
Constipation
abnormally infrequent or difficult passage of hard, dry feces.
Risk for fecal impaction
ASSESSMENT
dietary intake of fiber, fluid, med (antacid, iron, anticholinergics, laxatives), mechanical obstruction (fecal impaction, volvulus, adhesions, strangulated hernia cancer)
NURSING INTERVENTION
ensure adequate fluid, exercise, diet containing fiber.
up to 10g bran per day
Fecal incontinence
appearance of diarrhea, soft stool ooze around impaction.
most common cause of invontinence, associated w immobility and DOWN Fiber DOWN Fluid
Genitourinary System
DOWN Kidney function decreases w age.
DOWN Bladder capacity (50%, 150ml)
Urinary Incontinence
not normal part of aging
due to weak bladder, cancer, UTI, female perennial estrogen changes, male prostate
TYPES (SOUF)
Stress, Overflow, Urge, Functional
ASSESSMENT
- frequency, amount, odor, color, constancy
- ability to control urination
- satisfaction with dexualtiy and affectionate relationships
NURSE INTERVENTIONS Nocturia (excessive urination at night): -limiting fluids in pm, -diuretics in am, -Bladder retraining -Kegels -easy access to comode
Stress Incontinence
involuntary loss of small amount with increased abdominal pressure (coughing, sneezing) vaginal births, weak muscles
Overflow Incontinence
chonically full bladder increases bladder pressue to higher level than rethral resistance is able to ounter. weak uring stream difficulty starting to passs, interrutped voiding, incomplete emptying
(can be caused by
anticholinergics, spinal cord injury, mechanical obstruction)
Urge Incontinence
Involuntary urine loss ater a sudden urge to void.
cystitis, urethritis, tumors, stones, CNS disorders (stoke, dementia, Parkinsons)
Functional Incontinence
inability or unwillingness to toilet resulting from physical limitations, depression, confinement to bed or restraints.
Cardiovascular Changes
- DOWN structural elasticity (heart takes longer to contract and chambers to fill) heart valves thicker, more rigid = DOWN venus return, UP dependent edema, UP orthostatic hypotension, UP varicosities, hemmroids
- DOWN Cardiac output = UP heart failure, DOWN peripheral circulation
- DOWN elasitity
- DOWN pacemaker cells
- DOWN electrical conduction (dysrythmias)
- UP Arteriosclerosis = UP BP, UP Myocardial infarction
ASSESSMENT Difficulty breathing Signs of pallor, Rubor, cyanosis Chest pain Apical / peripheral pulse Capillary refill time Vertigo, syncope, fatigue Assess BP lying, sitting, standing Assess for edema
INTERVENTIONS
- promote circulation
- ambulating
- avoid standing for long periods
- no crossing legs
- TED stockings
- pneumatic compression pump
- wide shoes giving support but not bind or rub
Respiratory System
Tissue of lungs and bronchi less elastic and more rigid.
Ribs less mobile, osteoporosis and calcification of rib cage, affect breathing
DOWN Hemoglobin
DOWN Cillia reduce clearing of secretions
DOWN gas exchange w alveoli
HTH contributes to coronary artery disease and stroke and…
CHF, renal failure, peripheral vascular disease
Musculoskeletal
DOWN bone calcium = osteoporosis, kyphosis
DOWN fluid in invertebrates discs = DOWN height
DOWN blood supply = DOWN muscle strength
DOWN joint mobility = DOWN mobility, flexibility
DOWN muscle mass = DOWN strength, UP risk of falls
INTERVENTIONS
am warm bath and shower to reduce stiffness
Walking devices
ROM exercises
Major risk factor for Coronary Artery Disease
Elevated Serum cholesterol
INTERVENTIONS
low saturate fat diet
30 min excercise 4/5 x pweek
Walking
