383 old peeps

Lung expansion in the elderly may be reduced because of decreased 1. tissue elasticity. 2. rib mobility. 3. control by the respiratory center. 4. skeletal muscle strength.

1,3

A client is on bed rest after sustaining injuries in a car accident. Which nursing action helps prevent complications of immobility? Select one: a.turning the client every 2 hours and providing a low-air-loss mattress b.bathing and feeding the client to decrease energy expenditure c.decreasing fluid intake to ease dependent edema d.raising the head of the bed to maximize the client's lung inflation à make sure to change this on test to lower HOB so students are not confused about prioritization of ABCs

A

Which statement is true regarding stress on the body? Select one: a.Stress may result in temporary vasodilation and improve cardiac blood flow b.Stress may cause infection, such as chronic herpes simplex, to become temporarily dormant c.Stress may result in temporary improvement of a pre-existing cardiac condition d.Stress may cause an exacerbation of a chronic disease, such as hypertension

D

According to the General Adaptation Syndrome model, which are the stages of the stress response? Select one or more: a.Resistance stage b.Reaction stage c.Denial stage d.Exhaustion stage e.Alarm stage

E A D

Other Changes in Sensation

Hearing loss Usually caused by degenerative changes in inner ear Sense of taste may be less Decreased sense of smell may become safety issue Ability to discriminate among odors is reduced Diminished taste and smell sensation may impair appetite and nutrition.

Recommendations to reduce the risk factors and the progression of osteoporosis with aging include

a.maintaining glucocorticoid therapy. b.maintaining walking and weight-bearing exercise. c.reducing vitamin D intake. d.increasing bone resorption.

•SELECT ALL THAT APPLY: Which of the following contribute to the increasing life span of the general population? • •A. improved living conditions •B. Reduced cognitive and social activities •C. Better nutrition D. Advancements in health care

acd

Which client is most at risk for potential infections from a surgical experience? Select one: a.an 38-year-old client b.an 75-year-old client c.an 18-year-old client d.an 61-year-old client

b why? Delayed tissue healing

An older adult reports being cold in the room even though the thermostat is set at 75°F (24°C). The nurse can tell the client that older adults may feel cold for which reason? Older adults have: Select one: a.increased cellular cohesion. b.increased moisture content of the stratum corneum. c.decreased ability to thermoregulate. d.slower cellular renewal time.

c

Dependence Habit Psychological dependence Addiction Physiological dependence

physiological and psychological craving for substance practice of using substances at regular and frequent intervals continuing desire to take substance to function used for the most serious form of substance abuse discontinuance of substance leads to withdrawal

Respiratory changes AND EFFECTS

ventilation is limited, expiration is reduced, vascular changes •Decreased metabolism •Respirations slow and shallow •Deep breathing and coughing more difficult •Drugs •Sedatives and analgesics •Depress neuromuscular activity and respiratory control center •Increased secreations in the lungs •Pneumonia Atelectasis

Stress Response

•A generalized or systemic response to a change •Internal or external •Homeostasis •Body's compensation to minor changes in needs or environment •Stressor •Factor that creates significant change in body function •Severe or prolonged stress can cause dysfunction •Increased wear and tear on tissues •Exhaustion of resources •Exacerbation of chronic conditions

General Adaptation Syndrome (GAS) Model

•Alarm Stage •Mobilization of defenses •Hypothalamus •Sympathetic nervous system •Adrenal glands •Resistance Stage •Elevation of hormone levels •Body systems operate at peak performance levels •Exhaustion Stage •Resolution or death

GI Effects(•Decreased dietary intake,•Constipation,•Obesity)

•Appetite reduced •Negative nitrogen imbalance = protein deficit •Caused by muscle inactivity and body position Reduced food, fiBer, and fluid intake •When prolonged immobility occurs, and caloric intake exceeds energy needs

Cardiovascular Effects/(•Full immobilization—initially,•Patient becomes mobile after long bed rest,•Prolong immobility)

•Blood pools in trunk •Venous return may increase •May take weeks for cardiovascular reflex controls to return to normal •Venous return and cardiac output reduced •Orthostatic hypotension—at change of position •Short periods of dizziness •Fainting •Pallor and sweating •Rapid pulse

Neural and Psychological Effects

•Conitnuous pressure on skin and unerlying tissue will stimulate mechanoreceptors, pain receptors, and others •Spasms may occur because of nerve damage, and therefor muscle innervation may ensue •Effects of pain and lack of control over the environment •May cause depression and health related problems

Osteoarthritis

•Degeneration of cartilage in joints •Articular cartilage thins •Usually in larger weight-bearing joints •Pain and stiffness Joint replacement may be necessary Will have pain in the joints Pain with trauma or injuries might be delayed (ex: played a sport in highschool or college and don't have issues until later in adulthood)

Other Factors(•Infections,cancer,autoimmune disorders)

•Delayed healing •Less rapid immune responses •Higher cumulative exposure to carcinogens

Changes in skin and mucosa

•Dermis thinner—subcutaneous tissue diminished •Number of specializes structures declines: •Sweat glands •receptors •Skin dries because of reduced sebum •Lesions include skin tags, keratoses, and lentigines. •Hair becomes gray •Melanocytes are reduced in number •Thinning of hair Number of hair follicles decreases

Significant Effects of Stress Response

•Elevated blood pressure and increased heart rate •Bronchodilation and increased ventilation •Increased blood glucose levels •Arousal of the central nervous system •Decreased inflammatory and immune responses

Stress and Disease: Specific Problems

•Headache •May develop during or after stress response •Stomatitis (ulcers in the mouth) and necrotizing periodontal disease •Prolonged vasoconstriction •Can impair function or necrosis in GI tract or kidneys •Precipitating factor •Chronic infections •Physical and/or emotional distress

Hormonal Changes

•Hormone secretion remains relatively constant •Number of tissue receptors decreases •Speed of hormonal response may diminish

EFFECTS CARIO

•Increased capillary pressure and edema •Promotes thrombus formation in veings •Blood clotting in patients with dehydration or cancer •May be encouraged by increased venous pressure or damage to blood vessels •Thrombi break away with movement or massage •Pulmonary embolus •Venous stasis, hypercoagulability, and blood vessel damage increase the chance of deep vein thrombosis

Urinary System Changes

•Kidney function reduced •Loss of nephrons •Diminished ability to adapt to changes in electrolyte and acid levels •Reduced capacity to excrete drugs •Weakened urinary sphincter and bladder •Nocturia- urination Incontinence-involuntary voiding of urine

Polypharmacy

•Large number of medications common •Prescription, herbal, and over-the-counter medications •Increased risk of undesirable drug interactions •Compliance may be a problem •Often necessary to adjust dosage and drug combinations •Unpredictable absorption, distribution and elimination of drugs

Visual Changes

•Lens become less flexible •Reduced accommodation •Lens tends to become yellow, less transparent •Cataracts develop •Night vision reduced •Color vision may be reduced Vascular degeneration may affect retina

Osteoporosis

•Loss of calcium and bone mass •Higher incidence in postemenopausal women •Fractures of spine, pelvis and limbs common •Risk Factors: •Hereditary predisposition •Decreased estrogen levels •Decreased weight-bearing activity or stress on bone •Decreased intake of calcium, vitamins C and D at all ages •Decreased intestinal absorption of calcium Decreased osteoblastic activity

effects •Inactive Muscle and loss of bone mass tendon

•Loss of strength, endurance, and mass •Muscle atrophy •Prolonged bed rest may lead to loss of half of the muscle strength •Correct positioning •Essential for inactive muscles and joints •Lack of weight-bearing activity and muscle action •Reduces osteoblastic activity •Osteoclastic activity continues *immobility huge contributing factor •Tendon and ligaments •Require movement to maintain structure and function •Days of immobility will shorten these connective tissue structures and density increases •Results in limited felxibility and range of motion

Digestive changes and nutrition

•Maintenance of good nutrition may be a problem. •Decreased sense of smell and taste may lead to anorexia •Older individual may lack money for adequate nutrition •Muscle weakness and fatigue •Obesity in older individuals •Atrophy of mucosa and glands •Constipation common in older adults

Nervous system changes

•Natural reduction of brain mass •Some degenerative changes •Decreased response to neurotransmitters •Slower response time •Decreased reflexes •Short-term memory lapses •Less adequate adaptation by the ANS

•Menopause (average age around 50

•Ovaries do not respond to FSH and LH •Lack of ovulation •Declining estrogen and progesterone levels •Cessation of menstrual cycle •Hot flashes •Social expectations •Fatigue •Decreased glandular secretions

•Quadriplegia

•Paralysis of trunk and all 4 limbs

•Paraplegia

•Paralysis on lower body half

•Hemiplegia

•Paralysis on one side of the body

•Factors that promote skin breakdown

•Poor general circulation or anemia •Edema •Inadequate subq tissue in older adults or disabled persons •Loss of sensation •Mechanical irritation or friction •Excessive moisture from perspiration or urine •Inadequate personal hygiene •Inadequate nutrition or hydration •Trauma to the skin

Potential Effects of Prolonged or Severe Stress

•Renal failure •Prolonged severe vasoconstriction •Ischemia causes cell damage •Stress ulcers •Vasconstriction and glucorticoids •Decrease in mucosal regeneration and mucus production •Infection •Depression of the inflammatory and immune responses Exacerbation •Slowed healing •Following trauma or surgery •Increased secretion of glucocorticoid—reduction in protein synthesis and tissue regeneration •Increased catecholamine levels—vasoconstriction, reduced nutrients and oxygen to the tissue •PTSD •Serious consequence of major disaster or personal threat •Usually occurs within 3 months of event •may cause symptoms years later •High risk of developing dependence on drugs and/or alcohol

Cardiovascular Changes

•Size and number of cardiac muscle fibers decrease. •Fatty tissue and collagen fibers accumulate. •Reduced strength of contraction. •Heart valves thicken, become less flexible. •Vascular changes may cause a decrease in oxygen supply to heart. •Cardiac reserve is diminished. can be due to years of abuse

Other musculoskeletal changes

•Skeletal muscle mass declines with aging •Dependent on level of fitness •Strength of muscle contractins may decrease •Flexibility is reduced •Stiffnes becomes evident •Coordination and balance are reduced.

Urinary Effects

•Stasis of urine •In kidneys or bladder •Normal drainage by gravity impeded •Infection •Stasis of urine and calculi are predisposing factors •Renal calculi (stones) •More likely in people with hypercalcemia •Bladder infection •Common if catheters are used •Increase in diuresis, resulting in dehydration

Diplegia

•Symmetrical paralysis in any area of the body

Reproductive system changes: males

•Testosterone levels decline gradually •Muscle mass decreases •Testes decrease in size •Sperm production somewhat reduced •Glandular secretions of prostate decrease •Benign prostatic hypertrophy (BPD) common