CH 23 Saunders Care of Older Client

The nurse is providing medication instructions to an older client who is taking digoxin daily. The nurse explains to the client that decreased lean body mass and decreased glomerular filtration rate, which are age-related body changes, could place the client at risk for which complication with medication therapy? 1. decreased absorption of digoxin 2. increased risk for digoxin toxicity 3. decreased therapeutic effect of digoxin 4. increased risk for side effects related to digoxin

2. increased risk for digoxin toxicity

The long-term care nurse is performing assessments on several of the residents. Which are normal age-related physiological changes the nurse should expect to note? Select all that apply 1. Increased heart rate 2. Decline in visual acuity 3. Decreased respiratory rate 4. Decline in long-term memory 5. Increased susceptibility to urinary tract infections 6. Increased incidence of awakening after sleep onset

2.Decline in visual acuity 5.Increased susceptibility to urinary tract infections 6. Increased incidence of awakening after sleep onset

The nurse is providing instructions to the unlicensed assistive personnel(UAP) regarding care of an older client with hearing loss. What should the nurse tell the UAP about older clients with hearing loss? 1. They are often distracted 2. They have middle ear changes 3. They respond to low-pitched tones 4. they develop moist cerumen production

3. They respond to low-pitched tones

The home care nurse is visiting an older client whose spouse died 6 months ago. Which behaviors by the client indicates effective coping. Select all that apply 1. neglecting personal grooming 2. looking at old snapshots of family 3. participating in a senior citizens program 4. visiting the spouse's grave once a month 5. decorating a wall with the spouse's pictures and awards received

2. looking at old snapshots of family 3. participating in a senior citizens program 4. visiting the spouse's grave once a month 5. decorating a wall with the spouse's pictures and awards received.

The nurse is performing and assessment on an older adult client. Which assessment data would indicate a potential complication associated with the skin? 1. Crusting 2. Wrinkling 3. Deepening of expression lines 4. Thinning and loss of elasticity in the skin

1. Crusting

The home health nurse is visiting a client for the first time. While assessing the client's medication history, it is noted that there are 19 prescriptions and several OTC medications that the client has been taking. Which intervention should the nurse take first? 1. Check for medication interactions 2. Determine whether there are medication duplications 3. Call the prescribing health care provider (HCP) and report polypharmacy 4. Determine whether a family member supervises medication administration

2. Determine whether there are medication duplications

Cardiovascular system

Decreased compensatory response, so less able to respond to increased demands on the cardiovascular system Decreased resting heart rate

Hematological system

Decreased protein available for protein-bound medications

Immune system

Decreased resistance to infection and disease

Respiratory system

Decreased strength and function of the respiratory muscles respiratory rate usually unchanged

Special Senses

Decreased visual acuity Possible loss of hearing ability; low-pitched tones are heard more easily Decreased pain awareness

Physiological changes

Integument Neurologic Musculoskeletal Cardiovascular Respiratory Hematological Immune Gastrointestinal Endocrine Reproductive Special senses

Neurological system

Slowed reflexes Loss of balance

Interventions

monitor the client identify the pattern identify precipitating factors monitor the impact of pain on ADLs Provide pain relief - nonRx administer pain medication as prescribed evaluate the effects of relief measures

Pain Assessment (5 things)

restlessness verbal reporting agitation moaning crying

A common sign of an adverse reaction to a medication in the older client is a ___________________

sudden change in mental status

Aging

the biophysical process of change between birth and death

Self-neglect

the choice by a mentally competent person to avoid medical care or other services that could improve function. Unless declared legally incompetent, an individual has the right to refuse

Gerontology

the study of aging

institutional mistreatment

when abuse occurs when hospitalized or living somewhere other than home- SNF

The nurse is providing an educational session to new employees, and the topic is abuse of the older client. The nurse helps the employees to identify which client as most typically a victim of abuse? 1. a man who has moderate hypertension 2. a man who has newly diagnosed cataracts 3. a woman who has advanced Parkinson's disease 4. a woman who has early diagnosed Lyme disease

3. a woman who has advanced Parkinson's disease

Gastrointestinal system

Increased tendency toward constipation

Renal system

Increased residual urine and increased incidence of infection and possibly incontinence Impaired medication excretion

domestic mistreatment

carried out by a family member or significant other can be physical, neglect or abandonment

A nurse is performing an assessment on an older client who is having difficulty sleeping at night. Which statement by the client indicates the need for further teaching regarding measures to improve sleep? 1. "I swim 3 times a week" 2. "I have stopped smoking cigars" 3. "I drink hot chocolate before bedtime" 4. "I read for 40 minutes before bedtime"

3. "I drink hot chocolate before bedtime"

The visiting nurse observes that the older male lient is confined by his daughter-in-law to his room. When the nurse suggests that he walk to the den and join the family, he says "I'm in evreyone's way; my daughter-in-law needs me to stay here." Which is the most important action for the nurse to take? 1. Say to the daughter-in-law, "confining your father-in-law to his room is inhumane." 2. Suggest to the client and daughter-in-law that they consider a nursing home for the client. 3. Say nothing, because it is best for the nurse to remain neutral and wait to be asked for help 4. Suggest appropriate resources to the client and daughter-in-law, such as respite care and a senior citizens center.

4. Suggest appropriate resources to the client and daughter-in-law, such as respite care and a senior citizens center.

The nurse is caring for an older client in a long-term care facility. Which action contributes to encouraging autonomy in the client? 1. planning meals 2. decorating the room 3. scheduling haircut appointments 4. allowing the client to choose social activities

4. allowing the client to choose social activities

Reproductive system

Impotence or sexual dysfunction for both sexes; sexual function varies and depends on general physical condition, mental health status and medications

Integumentary system

Thinning of the epidermis and easy bruising and tearing of skin

Pain

can occur from numerous causes and most often from degenerative changes in the musculoskeletal system

Musculoskeletal system

decreased mobility, range of motion, flexibility, coordination and stability

Medications

determine the use of OTC medications be aware of Polypharmacy

NonRx pain relief measures

distraction relaxation massage biofeedback

Abuse of the older adult

domestic mistreatment institutional mistreatment self-neglect

Why does the nurse need to monitor the older client closely for signs of pain?

failure to alleviate pain in the older client can lead to functional limitations affecting their ability to function independently

The older client is at risk for ____ because of the changes that occur in the neurological and musculoskeletal systems

falls