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
ENDOCRINE
DOWN pituitary excretions = DOWN muscle mass
DOWN TSH = DOWN metabolism
DOWN parathyroid = DOWN blood calcium
DOWN insulin = UP blood glucose
DOWN testosterone, estrogen, progesterone = menauoause
INTERVENTIONS
manage medicine
Dysrythmias
heart less effective in suppying blood to body
INTERVENTIONS
- observing response to treatment,
- vital signs
- I&O
- response to meds
- keeping stress on heart down
- monitor response to activity and provide appropriate rest periods
REPRODUCTIVE
DOWN estrogen = vagina shortens, loose elasticity, DOWN vag secretions, pubic hair, uterus size, UP pain w intercourse, fragility
UP vag alkalinity = UP risk for infection
Male
DOWN testosterone = DOWN facial, pubic hair
DOWN circulation = DOWN ejaculation, rate, force, speed
Peripheral Vascular Disease
Spasms or atheosclerosis allow insufficient Oxygenated blood to circulate legs and feet
Symptoms
intermittent Claudication: Cramping in calves.
Cold feet
varicose veins
INTERVENTION techniques to promote circulation ambulating avoid standing in place for long periods of time no leg crossing compression stockings pneumatic compression pumps unna boots clean legs and feet wide fitting shoes, provide support but no rubbing, tightness teaching to be aware
Respiratory
- tissues of lungs and brochi become less elastic, more rigid.
- Ribs less mobile,
- osteoporosis and calcification of cartilage, rigidity of thoracic cage
- DOWN Vital Capacity
- DOWN cilia to clear secreations (trachea)
- UP risk for respiratory infections
- DOWN elasticity of alveoli
- UP shortness of breath
- risk for Kyphosis (chest less able to expand because of changes in skeletal system)
- COPD, Pneumonia, Lung cancer
ASSESSMENT respiration chest shape, symmetry, accessory muscles breath sounds (wheezing, cracking: Adventitious sounds) amount of activity patient can tolerate presence of cough
COPD
Chronic Obstructive Pulmonary Disease
common respirator condition, combination of chronic bronchitis, chronic asthma and emphysema
INTERVENTIONS pulmonary hygiene breathing retraining chest physiotherapy medication smoking cessation exercise programs
Pulmonary Hygiene
hydrating to liquify secretions and removing secretions by teaching dee diaphragmatic breathing and variety of coughing techniques.
Pursed lip breathing
Musculoskeletal System
-Joints less elastic, less mobility
-calcification of cartilage, rigid rib cage
-female: DOWN estrogen (increases bone resorption)
-DOWN calcium deposition = BONE LOSS, Kyphosis,
-DOWN fluid in invertebral disks = lose 1.5 - 3” height
-DOWN blood supply to muscles = DOWN muscle strength
-DOWN muscle mass = DOWN strength, UP risk for falls
changes in bone density affect long bones and vertebrae
ASSESSMENT Vital signs I&O turning, deep breathing movement ,circulation mental status use pillows avoid movements such as crossing legs, adduction of hips canes, walkers declutter
Endocrine System
DOWN Pituitary excretions ACTH = DOWN Muscle Mass
DOWN TSH = DOWN Metabolism
DOWN PTSH = UP blood calcium
DOWN production/use Insulin = UP Blood glucose
DOWN release of testosterone, estrogen, progresteone = menopause and other changes
ASSESSMENT
Lab results, ca, glucose, thyroid
INTERVENTIONS
?Diabetes: Type 1
Insulin dependent, Diabetes Mellitus
body produces NO insulin.
SIGNS not always signs thirst, Polydipsia UP appetite, Polyphasia Polyurea DOWN awareness of pain, temp DOWN circulation
INTERVENTION provide education maintain stable metabolic rate diet management weight control exercise medication motoring blood glu
?Diabetes: Type 2
Inability to produce and use insulin appropriately
SIGNS
slow healing
blurred vision
weight gain or loss
INTERVENTIONS provide education maintain stable metabolic rate diet management weight control exercise medication motoring blood glucose, hyperglycemia, sick day mgmt foot care
Reproductive
DOWN hormone
WOMEN: estrogen, progesterone
MEN: Androgen, Testosterone
changes to arousal, orgasm, post orgasm, extragenital changes
TABLE 33-10
ASSESSMENT
history of past experiences
signs of vaginal, penile ulceration, edema, discharge
presence of lumps, dimpling, drainage from breast
alternative sexual orientations
INTERVENTIONS allow verbalization of sex concerns provide private time maintain good hygiene/cosmetic needs provide distractions and alternative activities for individuals who masturbate, or provide privacy.
Sensory Perception
DOWN Vision, DOWN Hearing = DOWN social interaction, mobilization
DOWN taste, smell, touch
VIsion:
Presbyopia (farsightedness from loss of elasticity of lens)can’t focus near. pupil small, less reactive to ligh
ASSESSMENT
- eyes for dryness, tearing, signs of irritation
- ability of individual to see close up and distance.
- hearing, not use of hearing aids and effectiveness
- report changes in taste or smell
Vision: 4 main cases of visual impairment
Cataracts
Glaucoma
Macular Degeneration
Diabetic Retinopathy
INTERVENTIONS clean eyeglasses, within reach inrease light in environment reduce glare use night lights large print contrasting colors magnifying glasses
Glaucoma
2nd leading cause, blindness
occlusion in drainage of fluid in anterior chamber of eye, which produces an increase in intra-occular pressure
Pressure transfers to optic nerve, damage of blindness. Irreversible
INTERVENTION
medication
Cataracts
most common disorder found in eye
Clouding of normally clear lens
degenerative changes to lens protein and fatty deposits (lipofuscion) in lens.
SYMPTOMS
blurred, misty vision
need more light to read
INTERVENTIONS
surgery
?Hearing
extrenal ear
middle ear
inner ear
Hearing loss NOT normal part of aging
Presbycusis - sonsoneural hearing loss
eardrum loses elasicity, ossicles of middle ear become more rigid, atrophy of auditory nerve and end-organs in inner ear.
also due to loud noises throughout life
INTERVENTIONS
- provide good visual contact
- allow lip reading
- avoid rooms with glare or shadow’s in patients field of vision
- reduce/eliminate background noise
- speak at normal rate and volume
- do not over articulate
- use short sentences
- pause after each sentence
- use facial expressions/gestures
- ask how you can help listening
- be patient, stay positive
Touch
decrease in number of receptor cells througtou skin adn joints
DOWN sensing temp
DOWN maintain balance
UP risk for burns and fall
DOWN blood flow to body parts
Nervous System
DOWN brain cells, peripheral nerve cells and fibers
synaptic changes to affect transmission and sensitivity
Longer reaction time
decreased efficiency maintaining normal body temp
low perception to stimuli
Memory
short term memory may decline with age, but long term is usually maintained.
ASSESSMENT
- alertness level and consciousness including eye opening, verbal responses nad ability to follow simple commands
- behavior and responses
- mental status
- presence of pain
- sleep patterns
- lab resulsts
- CT scan, MRI
Insomnia
INTERVENTIONS
- encouraging bed time rituals
- excercise during day
- nap in morning
Delirium
NOT a disease, its the syndrome resulting from variety of causes
Rapid onset (hours to days) brief course
CAUSES
- environmental
- social isolation
- unfamiliar surroundings
- sensory overload
- immobilization
- sleep deprivation
- metabolic
- endocrine
- cardiovascular (low O to brain)
- cerebrovascular
- nutritional
- infections
- cerebral and extracranial neoplasms
- trauma
- medication/drug toxicity
- substance withdrawal
INTERNVENTIONS
- education to sign/symptoms
- orientatoin and communications
- mobilization
- environmental modicications
- education and caregivers
- pain control
- mgmt of elimination patterns
- medication mgmt
- discharge planning
- Reality orientation
Reality Orientation (used for Delirium ptns)
- call ptnts by correct names or name desired
- make eye contact
- converse about familiar subjects
- provide familiar objects in living space
- explain events and procedures in concise, simple language
- be honest
- set a routine and be consistent
- engage older adult in familiar simple activity such as ADLs.
4a) Dementia
4b) definitions
Progressive impairment of intellectual (cognitive) function that interferes with normal social and occupational activities.
SYMPTOMS
- loss of memory
- and one other function of intellectual function (i.e. orientation, attention, calculation, language, motor kills)
- difficulty abstract thinking and will (i.e. unable to define differences in objects or words)
- Aphasia (inability to understand words)
- Agnosia (can’t recognize familiar objects)
- Agraphia (difficulty writing/drawing)
- sometimes personality changes
affects SHORT TERM, INTERMEDIATE, and LONG TERM memory
4c) Alzheimers
most common cause of DEMENTIA.
(Dementia of the Alzheimer’s type)
progressive disorder where the brain atrophies
usually in patients over 60, loss of cortical neurons, ventricles enlarged, senile plaques and neurofibrillary tangles appear in cortex of brain.
STAGES:
EARLY: gradual onset of memory loss and difficulty focusing attention
MIDDLE: diff w language, object recognition and judgement
TERMINAL/FINAL: urinary/fecal incontinence, inability to ambulate or provide self-care, inability to communicate. little/no response to family or surroundings. Mute and bedridden
Duration 8-20yrs.
4d) MID
Multi-infarct Dementia
second most common cause of dementia
related to vascular disorders within brain resulting from stroke and sever HTN.
SYMPTOMS
- Abrupt onset
- remission (absence of symptoms)
- preservation of personality
- mood swings
- confusions
- problems w recent memory
- wandering, getting lost in familiar places
- moving with rapid shuffling steps
- loss of bladder/bowel control
- inappropriate display of emotions
- difficulty following instructions
CAUSES
- arteriosclerosis
- blood dyscrasias
- cardiac decompensation
- HTN
- atrial fibrillation
- cardiac calve replacements
- systemic emboli arising from other causes
- DM
- peripheral vascular disease
- obesity
- smoking
- vasospasms in brain (Transient Ischemic Attacks, TIAs)
** Stair step decline, not slow and steady like Alzheimers
TIA
4b) one def word - Ataxia
Transient Ischemic Attacks
changes in vascular system cause small spasms or occlusions in cerebral vessels of brain
SYMPTOMS (last as little as 20min)
- vary depending on location of vessel in brain
- changes in vision
- headache
- disorientation
- ATAXIA (imparied ability to coordinate movement)
- drop attack (falling without losing consciousness)
prompt treatment can prevent stroke
INTERVENTIONS provide safe environment safety devices mobility aids memory aids schedules lists neuro exam
Parkinson’s Disease
second most common disorder affecting nervous system
SYMPTOMS
- muscle rigidity
- tremors
- AKINESIA (abnormal state of -motor and psychic hypoactivity)
- mask-like appearance
- drooling
- shuffling gait
- sometimes emotional instability
Stress/Frustration increase symptoms
INTERVENTION
- observe response to medication (levodopa, amantadine HCL, anticholinergics
- maintaining mobility
- ROM exercise
- massage to relieve spasms
- de-clutter
- canes/walkers
- if intellectual function not impaired, allow time to respond to questions
- encourage efforts to communicate
- show acceptance
- non-verbal communications
Akinesia
abnormal state of -motor and psychic
Parkinson’s
Anticholinergics
Anticholinergic: Opposing the actions of the neurotransmitter acetylcholine. Anticholinergic drugs inhibit the transmission of parasympathetic nerve impulses, thereby reducing spasms of smooth muscles (for example, muscles in the bladder). Side effects of anticholinergic medications include dry mouth and related dental problems, blurred vision, tendency toward overheating (hyperpyrexia), and in some cases, dementia-like symptoms.
Stroke
brain attack.
3rd leading cause of DEATH in USA.
SYMPTOMS
- HEMIPLEGIA (paralysis one side body)
- DYSARTHRIA (difficult, poor articulated speech)
- Dysphagia (diff swallowing)
- hemianopia (defective vision or blindess in half of visual field)
- Aphasia (defective language function)
- Intellectual/emotional changes
INTERVENTIONS
- support of life functions IMMEDIATELY after stroke. symptoms usually dissapear 3-6 months w quick action.
- rehab of ADLs
- pull on/off clothing
- wheelchair/canes
- encourage excercise
- listen carefully
- lower distracting sounds
- speak slowly
- short direct statements
- no interrupting their speech
- do not rush patient
- de-clutter
- use touch to communicate
Hemiplegia
paralysis on one side of body
Dysarthria
(difficult, poorly articulated speech, resulting
from interference in the control over the muscles of
speech),
Hemianopia
(defective vision or blindness in half of the visual field),
5) Nursing Diagnoses - neuro
- Impaired verbal comm, related to memory loss and diff focusing attention
- caregiver role strain, related to diff coping w cognitive losses and progressive deterioration of self-care abilities
- wandering related to search for security
- unilateral neglect, related to neurologic involvement
etc
6) General Fall Guidelines
pg 1114
GENERAL CARE
- Wear low-heeled shoes with small wedge platforms.
- Wear leather or rubber-soled shoes.
- Leave night-lights on at night.
- Keep items within reach to prevent overreaching.
- Check the tips of canes and walkers for evenness.
- Paint the last step a different color, indoors and outdoors.
- Dangle the legs between positional changes, and rise slowly.
- Avoid the use of alcohol.
- Avoid rushing.
- Avoid risky behavior, such as standing on ladders unaided.
General Fall Guidelines
pg 1114
STEPS AND FLOOR SURFACES
• Be careful to avoid slippery floors and frayed carpets.
• Watch for the last step when descending the stairs.
• Count the number of steps as a cue while ascending and
descending the stairs.
• Install and use sturdy banisters on both sides of staircases.
• Tack down throw rugs or remove them entirely.
• Remove obstacles in the path of traffic.
• On landings, use carpeting that has color contrast.
General Fall Guidelines
pg 1114
BATHROOM
• Install grab rails in the tub and shower and near the toilet.
• Avoid throw rugs; install carpeting.
• Apply oils to skin after showering or bathing.
• Avoid using bar soaps; use liquid soap from a dispenser
mounted in the shower.
7a) Polypharmacy
Polypharmacy is the use of four or more medications by a patient, generally adults aged over 65 years. Polypharmacy is most common in the elderly, affecting about 40% of older adults living in their own homes.
7b) Polypharmacy patients at risk
(1) take 5 or more Rx meds
(2) sometimes borrow meds
(3) use OTC meds ,
including vits, supplements, or herbal preps
(4) request refills w/out seeing Dr.
5) take meds whose Rx come from more than one HCP
(6) have Rx filled at more than one pharmacy.
7c) Changes in body that alter ability to absorb, transport, eliminate meds - 33-12
- impaired circulation
- change in vessel walls
- DOWN number and efficiency of glomeruli in kidneys
- DOWN bloodflow in liver, fewer functioning liver cells
- DOWN liver enzymes that break down meds
7d) Changes, CNS
Brain receptors become more sensitive, making psychoactive drugs very potent.
7d) Changes, Circulation
Vascular nerve controls grow less stable.
Antihypertensives, for example, may drop
blood pressure too low. Digoxin, for
example may slow the heart rate too much.
7d) Changes, Metabolism
Liver mass shrinks. Hepatic blood flow and
enzyme activity decline. Metabolism drops
to 1/2 to 2/3 the rate of young adults. Enzymes lose ability to process some drugs
that reduce irregular heart rhythms or
breathing disorders.
7d) Changes, Excretion
In kidneys, renal blood flow, and number
of functional nephrons decline. Blood flow
and waste removal slow and drugs stay in
the body longer.
7d) Changes, Absorption
Absorption
Gastric enzymes and secretions decrease;
gastric pH rises. Gastric emptying rate and
gastrointestinal motility slow. Absorption
capacity of cells and active transport
mechanism declines.
7d) Changes, Distribution
Adipose stores increase. Total body water
declines, raising the concentration of
water-soluble drugs, such as digoxin, which
can cause heart dysfunction.
7e) Encourage older adults to
avoid taking any herb, supplement, or other over-thecounter products without contacting the health care provider or a pharmacist who will review the complete drug profile
.
7f) INTERVENTIONS for ability to take meds properly
- chart
- pillbox
mistaken for Old Age, but could be reaction to Meds
- Disorientation
- fatigue
- anorexia
- falls
- vertigo
7i1) Antihypertensives
- Observe for depression, anxiety, disorientation.
- Monitor for bradycardia, angina, hypotension.
7i2) Cardiovascular Agents
- Explain importance of keeping appointments for laboratory examinations.
- Observe for orthostatic hypotension.
- Monitor heart rate, rhythm, and blood pressure.
- Observe for adverse reactions—disorientation, depression, vertigo, lethargy.
7i3) Diuretics
- Observe for orthostatic hypotension, delirium, changes in mental function.
- Explain reasons for taking in the morning.
- Observe for hypokalemia.
- Weigh daily.
- Record I&O.
7i4) Oral anticoagulants
- Monitor prothrombin time (PT) and International Normalized Ratio (INR).
- Observe for bleeding.
- Explain importance of keeping appointments for laboratory examinations.
- Explain the need to avoid aspirin-containing products.
- Institute safety measures to prevent injury.
7i5) Oral hypoglycemic agents
- Observe for signs of hypoglycemia—weakness, headache, malaise.
- Monitor blood glucose levels.
8a) 5 classes of Elder abuse
1) Physical/Sexual
2) psychological
3) misuse of
assets
4) medical abuse (withholding necessary treatment or aids for ADLs)
5) neglect
8b) 2 indicators of elder abuse
1) frequent unexplained crying
2) unexplained fear of or suspicious of a particular person in the home
Type of Older Adult Abuse
Box 33-6
-Physical abuse: The use of physical force that has potential
to result in bodily injury, physical pain, or impairment.
-Sexual abuse: Nonconsensual sexual contact of any kind
with an older adult, including those persons unable to
give consent.
-Emotional or psychological abuse: The infliction of anguish, pain, or distress through verbal or nonverbal acts,
including intimidation or enforced social isolation.
-Neglect: The refusal or failure to fulfill any part of a person’s
previously agreed obligation or duties to an older adult
dependent on the person for care or assistance.
-Abandonment: The desertion of an older adult by an individual who had assumed the responsibility of providing
care or assistance.
-Medical abuse: Subjecting a person to unwanted medical
treatments or procedures; medical neglect occurs when
a medically necessary and desired treatment is withheld.
-Financial or material abuse or exploitation: The illegal or
improper use of older adult’s funds, property, or assets.
9i) Effects of Immobility on body
- stasis of secretions
- orthostatic hypotension
- digestive disorder
- perceptual disorders
9ii) INTERVENTIONS to prevent immobility
- turning, deep breathing, coughing (ventilation)
- removal of respiratory secretions (DOWN infection)
- ambulate 8-24hrs after surgery if possible
- getting up and standing, take a few steps (stimulate circulation and muscle activity)
- encourage performing self care
9iii) Types of facilities and care
- Home
- Assisted Living
- Long-Term Care
Discharge Planning
• Teach when the older adult is alert and rested. Allow for
several shorter sessions, watching for signs of fatigue.
• Involve the individual in discussion or activity.
• Focus on the person’s strengths.
• Use approaches that adapt for the presence of pain and impaired range of joint motion, impaired reception of stimuli
such as slower reaction time, muscular weakness, reduced
pain and temperature perception, reduced depth perception
and color discrimination, or reduced visual acuity.
• Consider need for adaptive devices, such as a syringe magnifier.
• As needed, enlist the help of the patient’s significant other,
and/or provide assistive personnel.
9iv) Bill of Rights for Long Term Care Residents: Box 33-7
• The right to voice grievances and have them remedied.
• The right to information about health conditions and treatments and to participate in one’s own care to the extent
possible.
• The right to choose one’s own health care providers and to
speak privately with one’s health care providers.
• The right to consent to or refuse all aspects of care and
treatments.
• The right to manage one’s own finances if capable, or
choose one’s own financial advisor.
• The right to be transferred or discharged only for appropriate reasons.
• The right to be free from all forms of abuse.
• The right to be free from all forms of restraint to the extent
compatible with safety.
• The right to privacy and confidentiality concerning one’s person, personal information, and medical information.
• The right to be treated with dignity, consideration, and respect in keeping with one’s individuality.
• The right to immediate visitation and access at any time for
family, health care providers, and legal advisors; the right
to reasonable visitation and access for others
NOTE: This list of rights is a sampling of federal and several
states’ lists of rights of residents or participants in long-term
care. Check the rules of your own state for specific rights in
law for that state.
