Neurologic changes associated with aging Ch 41

A nurse assesses an older client. Which assessment findings should the nurse identify as normal changes in the nervous system related to aging? (Select all that apply.) a. Long-term memory loss b. Slower processing time c. Increased sensory perception d. Decreased risk for infection e. Change in sleep patterns

ANS: B, E Normal changes in the nervous system related to aging include recent memory loss, slower processing time, decreased sensory perception, an increased risk for infection, changes in sleep patterns, changes in perception of pain, and altered balance and/or decreased coordination. DIF: Remembering/Knowledge REF: 846 KEY: Aging| older adult - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 351 MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Health Promotion and Maintenance

3. A nurse teaches an 80-year-old client with diminished touch sensation. Which statement should the nurse include in this clients teaching? a. Place soft rugs in your bathroom to decrease pain in your feet. b. Bathe in warm water to increase your circulation. c. Look at the placement of your feet when walking. d. Walk barefoot to decrease pressure ulcers from your shoes.

ANS: C Older clients with decreased sensation are at risk of injury from the inability to sense changes in terrain when walking. To compensate for this loss, the client is instructed to look at the placement of her or his feet when walking. Throw rugs can slip and increase fall risk. Bath water that is too warm places the client at risk for thermal injury. The client should wear sturdy shoes for ambulation. DIF: Applying/Application REF: 846 KEY: Patient safety| motor/sensory impairment MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

Change in sleep patterns

Ascertain sleep patterns and preferences. Ask if sleep pattern interferes with ADLs. Adjust the patient's daily schedule to his or her sleep pattern and preference as much as possible (e.g., evening versus morning bath). Older adults require as much sleep as younger adults. It is more common for older adults to fall asleep early and arise early.

Change in perception of pain

Ask the patient to describe the nature and specific characteristics of pain. Monitor additional assessment variables to detect possible health problems. Accurate and complete nursing assessment ensures that the interventions will be appropriate for the older adult (see Chapter 4).

Changes in sleep patterns

Assess sleep habits. Provide usual bedtime routines. Decrease noise and light at night. Age-related changes include more time in bed spent awake before falling asleep, reduced sleep time, daytime napping, and changes in circadian rhythm leading to "early to bed and early to rise." (Rebar 844)

Altered balance and/or decreased coordination

Instruct the patient to move slowly when changing positions. If needed, advise the patient to hold on to handrails when ambulating. Assess the need for an ambulatory aid, such as a cane. The patient may fall if moving too quickly. Assistive and adaptive aids provide support and prevent falls.

Increased risk for infection

Monitor carefully for infection. Older adults often have structural deterioration of microglia, the cells responsible for cell-mediated immune response in the central nervous system (CNS).

PHYSIOLOGIC CHANGES Slower processing time

NURSING IMPLICATIONS Provide sufficient time for the affected older adult to respond to questions and/or direction. RATIONALES Allowing adequate time for processing helps differentiate normal findings from neurologic deterioration.

PHYSIOLOGIC CHANGES Recent memory loss

NURSING IMPLICATIONS Reinforce teaching by repetition, using written teaching and memory aids such as electronic alarms or applications for electronic devices that provide recurrent alerts. RATIONALES Greatest loss of brain weight is in the white matter of the frontal lobe. Intellect is not impaired, but the learning process is slowed. Repetition helps the patient learn new information and recall it when needed.

Decreased sensory perception of touch

Remind the patient to look where his or her feet are placed when walking. Instruct the patient to wear shoes that provide good support when walking. If the patient is unable, change his or her position frequently (every hour) while he or she is in the bed or chair. Decreased sensory perception may cause the patient to fall.