Chapter 15 - Nursing Care of Older Adult Patients

Which statement from the caregiver of an Alzheimer's client would concern you the most 1. I get tired, but my daughter comes to relieve me each day 2. I can't sleep because I am afraid he will get out of the house 3. This illness has affected the entire family, not just him 4. The disease is progressing about the way we were told to expect that it would

2. I can't sleep because I am afraid he will get out of the house

When the nurse is collecting data from the older adult, which findings should be considered normal physiological changes? Select all that apply. 1. decreased heart rate 2. decline in visual acuity 3. decreased respiratory rate 4. decline in long-term memory 5. increased susceptibility to urinary tract infection 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

Which client is most likely at risk to become a victim of elder abuse? 1. A 75 year old man with moderate hypertension 2. A 68 year old man with newly diagnosed cataracts 3. A 90 year old woman with advanced Alzheimer's disease 4. A 70 year old women with early diagnosed Lyme disease

3. A 90 year old woman with advanced Alzheimer's disease.

An older client has been prescribed digoxin. The nurse determines that which age-related change would place the client at risk for digoxin toxicity. 1. Decreased salivation and gastrointestinal motility. 2. Decreased muscle strength and loss of bone density. 3. Decreased lean body mass and glomerular filtration rate. 4. Decreased cardiac output and decreased efficiency of blood return to the heart.

3. Decreased lean body mass and glomerular filtration rate

Which intervention should be implemented for the older client with presbycusis who has hearing loss? 1. Speak louder 2. Speak more slowly 3. Use low-pitched tones 4. Use high-pitched tones

3. Use low pitched tones

The nurse should plan which to encourage autonomy in the client who is a resident in a long term care facility? 1. Choosing 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.

The nurse is assessing an old-old client. Which assessment finding should the nurse consider as highest priority? 1. Slowing peristalsis 2. Decrease sense of smell 3. Loss of skin elasticity 4. Temp of 94 degrees

4. Temp of 94 degrees

The nurse is providing an education class to healthy older adults. Which exercise will best promote health maintenance. 1. Gardening every day for an hour 2. Sculpting once a week for 40 minutes 3. Cycling three times a week for 20 minutes 4. Walking three to five times a week for 30 minutes

4. Walking three to five times a week for 30 minutes

Depression

A psychological impact of change is too hard to cope with. Loneliness, grief, or sadness can occur while having this. This does not allow an older person to cognitively focus on health.

ABCs of nursing care of focus and safety for an older patient

A) Abilities B) body alignment and mechanics C) comfort D) deliberate movements E) environment F) falls G) giving your time H) hand hygiene

Pressure Injury

An older person with limited mobility is at risk for developing these types of injuries. The older adult skin takes longer to heal. Healing times are affected by presence of multiple chronic diseases.

Aspiration

Decreases lung recoil strength, or gag reflex, producing a weaker cough and pulmonary risk.

Extrinsic factors

Focus on environmental influences such as pollutants, free radical theory, and stress adaptation theory.

Intrinsic factors

Focus on genetic and physiological theories of aging. Genetic theories include the biological clock theory or programmed against theory. Physiological theories include aspects of the wear and tear theory or stress adaptation theory.

Nocturia

Having to urinate at night occurs with older adults most times.

Dementia

Involves a more permanent progressive deterioration of mental functioning. Various types of this including Alzheimer's disease being the main type.

Optimum level of functioning

Patients with dementia are helped to maintain this level of functioning.

Reality orientation

Provide an environment with physical and emotional safety. To help a confused patient you use this type of orientation.

Homeostasis

Remaining balanced with Something the body works hard to maintain, it is often unable to fully adapt to many of the declines that result from aging. Similar standing.

Sensory deprivation

Several eye disorders can affect the aging eye. Disorientation, withdrawal, or social isolation occurs from this.

Edema

Swelling of a body part where present.

Sensory changes in elderly

Visual acuity hearing loss smell decreased taste decreased touch decreasing cataracts/ glaucoma/ macular degeneration

Immunological

decreased immune response increasing autoimmune diseases increased risk of infection and cancer

physical assessment tips

extra attention to safety plan assessment to avoid tiring pt ask family to help with health history questions avoid rushing accommodate

influencing factors

heredity/ genetics illness/ disease stress environment

Define aging

Universal, normal process Conception to death Unique, individualized Older adult (65 yrs old and older) Frailest (85 yrs and older)

Identify nursing practices that promote safety for the older adult

Balance (ambulatory and transfer). Burns (electric warming devices and hot water).

Describe the psychological and cognitive changes associated with advancing age

Brain cells lost, decreased blood flow, endorphins decrease, equilibrium and motor coordination decreases, hypothalamus function decreases, reaction times increase, and sensitivity decreases.

Range of motion

Can be limited in arms, legs, and neck of the older patient. Because muscle response is slower, movement takes longer.

Contractures

Can limit the persons ability to perform self care tasks with the development of these.

Sensory overload

This can create psychological and physical strain on the individual. This strain is difficult for an older adult to cope with. This also should be minimized by speaking slowly and calmly and providing a non threatening therapeutic touch.

Perception

Through this filter, a person identifies, defines, and adapts to the changes in body structure and function over time.

Activities of daily living

The ability to perform self care tasks with your fingers and hands.

Expectorate

The act of coughing up. This is decreased in older adults because lung recoil strength is decreased and mucus is more difficult to expel.

Health promotion

A: ability B: body mechanics C: comfort D: deliberate movement E: environment F: falls G: giving your time H: hand hygiene

urinary incontinence

Loss of bladder control, varying from a slight loss of urine after sneezing, coughing, or laughing to complete inability to control urination. (Not a normal condition of aging. One of the main reasons older people enter a long term care facility.)

Changes in sexuality as aging occurs

Men: altered ability to obtain/maintain erection Women: decreased vaginal lubrication & changes in estrogen production

Plan nursing care for the physiological and psychological changes associated with advancing age

Nursing implications include ADL's, altered temp regulation. Other nursing implications include Glasses, hearing aids, anorexia, and safety. Cognition nursing implications Include gathering data to assess and identify needs as well as using memory aids.

Constipation

The difficulty to have a bowler movement increases with medications and an older patients ability to eat.

Holistic

The part of care where the older patients sexual life is an important aspect of the plan of care.

Osteoporosis

Thinning (decrease in density) and softening of the bone. A passage bone condition.

What does cognition focus on

information: intake storage processing retrieval

Long term care goal

maintain dignity; facility becomes their home

Potential changes of aging

parental role social cultural economic status

other concerns related to elderly population

polypharmacy (lots of meds) safety from scams elder abuse caretaker fatigue financial concerns

acute care goal

rehabilitate pt back to baseline

Factors affecting cognition

sensory changes diseases medications sleep

Which data indicate to the nurse that a client is experiencing effective coping following the loss of a spouse. Select all that apply. 1. Looks at old snapshots of family 2. Constantly neglects personal grooming 3. Visit the spouse's grave once a month 4. Visits the senior citizens' center once a month 5. Prefers to spend time alone and avoids contact with others

1. Looks at old snapshots of family 3. Visit the spouse's grave once a month 4. Visits the senior citizens' center once a month

The nurse is preparing to communicate with an older client who is hearing impaired. Which intervention should be implemented initially. 1. Stand in front of the client 2. Exaggerate lip movements 3. Obtain a sign-language interpreter 4. Pantomime and write the client notes.

1. Stand in front of the client

Which physiological change is of the highest concern? 1. urinary retention 2. slowing of metabolism 3. impaired visual acuity 4. development of age spots on the skin

1. urinary retention

The nurse should implement which activity to promote reminiscence among older clients 1. Having storytelling hours 2. Setting up pet therapy sessions 3. Displaying calendars and clocks 4. Encouraging client participation in a pottery class

1. Having storytelling hours

The nurse is planning to feed an older client who is at risk for aspiration of food. During the meal how should the nurse position the client? 1. Upright in a chair 2. On the left side of the bed 3. On the right side of the bed 4. In a low-Fowler's position, with the legs elevated

1. Sitting upright in a chair

Delirium

Having this reflects the patients level of alertness and psychomotor activity

Describe basic physiological and cognitive changes associated with advancing age

Cellular decline, altered structures. Storage, processing, retrieval of information. Affected by sensory changes, disease, pain, drugs, lack of sleep. Short term memory impaired.