Ch 19: The Aging Adult

The charge nurse in an extended-care facility knows that the new nurse understands ageism when she says which of the following? "Most older adults are lonely." "Older adults have incontinence." "Neither intelligence nor personality normally decline because of aging." "Older adults don't mind how they look."

"Neither intelligence nor personality normally decline because of aging."

Age-Related Changes for Sleep Older Adult:

- Disturbed Sleep Pattern: Initiation of Sleep Decreased physical activities Tired and fatigued throughout day Depression Polypharmacy - Disturbed Sleep Pattern: Maintaining Sleep Nocturia Sleep-related movement disturbances (e.g., restless leg syndrome)

Nursing Implications Sleep A comprehensive nursing assessment and individualized interventions may be effective in the long-term care of this age group. Emphasize concern for a safe environment because it is not uncommon for older people to be temporarily confused and disoriented when they first awake. Use sedatives with extreme caution because of declining physiologic function and concerns about polypharmacy. Encourage people to discuss sleep concerns with their physicians.

A comprehensive nursing assessment and individualized interventions may be effective in the long-term care of this age group. Emphasize concern for a safe environment because it is not uncommon for older people to be temporarily confused and disoriented when they first awake. Use sedatives with extreme caution because of declining physiologic function and concerns about polypharmacy. Encourage people to discuss sleep concerns with their physicians

Why This Is Important

Accidental injuries occur more frequently in older adults because of decreased sensory abilities, slower reflexes and reaction times, changes in hearing and vision, and loss of strength and mobility. Collaboration between family and health care providers can ensure a safe, comfortable environment and promote healthy aging.

Alterations in Renal Functioning Loss of nephrons Decreased renal blood flow

Alterations in Renal Functioning Loss of nephrons Decreased renal blood flow (Taylor 1494) Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalBook file.

NURSING STRATEGIES TO ADDRESS AGE-RELATED CHANGES AFFECTING FLUID BALANCE

Alterations in Renal Functioning Alterations in Cardiac Functioning

Developmental Patterns of Sleep Older Adults Sleep Pattern

An average of 7 to 9 hours of sleep is usually adequate for this age group. Sleep is less sound, and stage IV sleep is absent or considerably decreased. Periods of REM sleep shorten. Elderly people frequently have great difficulty falling asleep and have more complaints of problems sleeping. Decline in physical health, psychological factors, effects of drug therapy (e.g., nocturia), or environmental factors may be implicated as causes of inability to sleep

One of the greatest causes of death in the United States and Canada is colon cancer. The nurse instructs the community on which of the following factors? Annual screening after the age of 50 Endoscopic exam every year after 30 <20 g of fiber intake per day Administration of a stool softener daily

Annual screening after the age of 50

Assessment Priorities:

Assess general ease of movement and gait. Assess alignment. Check joints and their function. Assess muscle mass, tone, and strength

IMPLICATIONS FOR NURSING Later years

Assess how the older person is adjusting to effects of aging. Counsel regarding meaningful use of time. Explore resources. Assess depression, substance abuse. Recognize and value older adults' life experience

Assessing pain in the older adult population

Assessing pain in the older adult population can be challenging. Adults over the age of 65 years experience pain more frequently than do younger adults and endure moderate to severe pain for twice as long as younger adults (Eliopoulos, 2010). Approximately 80% of older adults suffer with at least one chronic illness and experience varying degrees of discomfort (Jablonski, DuPen, & Ersek, 2011). Untreated chronic pain in older adults can result in disrupted sleep patterns, altered social activities, and a decline in their ability to complete the routine activities of daily living (Brown, Kirkpatrick, Swanson, & McKenzie, 2011). However, many see pain in the elderly as part of the normal aging process. Another myth held by many is that older patients have a decreased sensitivity to pain and, therefore, a heightened pain tolerance. Because many older people have chronic disease, pain is a common occurrence. Assessment of pain in the older adult can be problematic. Vision or hearing impairments may influence the assessment format. Multiple-drug regimens that are common in older people can also affect reliable reporting of pain. Many older adults view pain as a forecast of serious illness or death, thus are reluctant to admit its occurrence or report it. Boredom, loneliness, and depression may affect an older adult's perception and report of pain. Experts agree that pain can be adequately assessed in older adults using common rating scales. The Wong-Baker FACES Pain Rating Scale (see Fig. 34-4), recommended for pain assessment in children, may also be effective for this age group because a 0-to-5 scale is easier to use. The Numeric Rating Scale, the verbal descriptor scale, and the Faces Pain Scale-Revised (FPS-R; see Table 34-4) are additional pain rating scales that are also widely used for assessing pain in older adults. Some research has indicated that older adults prefer a vertical pain scale such as the Iowa Pain Thermometer shown in Figure 34-5, rather than the horizontal numeric pain scales (McGuire, 2011). Special attention and consideration of an older patient's pain can positively affect the nurse's ability to assess pain accurately.

Nursing Strategies Altered Physiologic Response to Analgesics

Be aware of dosage and frequency to avoid oversedation and toxicity. Monitor carefully for oversedation and respiratory depression. Explain side effects of analgesics to patient. Use memory aid if necessary to avoid overdosing. Discourage self-medication. Caution about use of alcohol with analgesics. Caution about driving or operating machinery when taking analgesics

OLDER ADULTS Nutrition

Because of the decreases in BMR and physical activity and loss of lean body mass, energy expenditure decreases. Loss of teeth and periodontal disease may make chewing more difficult. A decrease in peristalsis can result in constipation. Loss of taste between sweet and salty begins between 55 and 59 years of age, but discrimination between bitter and sour remains intact. The sensation of thirst also decreases. Degenerative diseases and the use of medications are more common with aging. It is not uncommon for social isolation, poor self-esteem, or loss of independence to affect nutritional intake negatively. Because of the changes related to aging, the caloric needs of the body decrease. The need for nutrients, however, stays the same or increases (Dudek, 2014). Foods that are difficult to chew may need to be eliminated, whereas an increase in fiber and fluid intake can relieve constipation. Older adults are also prone to dehydration, and lack of interest in eating is common. Nutrient intake, digestion, absorption, metabolism, or excretion may be altered because of the physiologic changes common to this age. Dietary restrictions related to chronic illness, limited income, isolation, and age-related physiologic changes place persons in this age group at risk for malnutrition

An older adult client's daughter asks if the doctor can prescribe an antipsychotic medication for her father because he is so confused and agitated much of the time. The nurse is aware that the client should only be prescribed this medication when which strategy has failed? Select all that apply. Behavioral Environmental Physical Chemical Social

Behavioral Environmental Social

The nurse is evaluating a 42-year-old client who says that he is feeling stressed. Which of the following does the nurse know that could be a cause of stress for this age group? Being caught in the sandwich generation Retirement Losing driving privileges Social isolation

Being caught in the sandwich generation

Nutritional Assessment Considerations for Older Adults* Biochemical Data Anthropometric Data Dietary Data

Biochemical Data Low serum albumin level (<3.5 mg/dL) may be a reflection of the aging process rather than a nutritional risk factor. Albumin synthesis declines with age. Hemoglobin levels that are lower than normal may only reflect anemia observed in older people as part of the aging process. Anthropometric Data Because of age-related changes in body composition, skin-fold measurements, if used, should be taken from several body sites. Dietary Data Dietary recall may be inaccurate because of vision and memory problems. Question use of vitamin and mineral supplements. Gather information concerning medication regimen (prescribed and over-the-counter) to assess for food-drug interactions and adverse effects of medications

Diseases that Alter Smell and Taste Seen More Frequently as People Age

Burning Mouth Syndrome: This is a sensation that one's tongue is tingling or burning. There may be several contributing factors: Vitamin B deficiencies, local trauma, gastrointestinal disorders causing reflux, allergies, salivary dysfunction and diabetes.

Diseases that Alter Vision Seen More Frequently as People Age (Taylor 1638)

Cataracts: Macular Degeneration: Glaucoma: Diabetic Retinopathy: Hypertensive Retinopathy: Temporal Arteritis: Detached Retina:

Diseases that Alter Hearing Seen More Frequently as People Age (Taylor 1638) Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalBook file.

Central Auditory Processing Disorder: Tinnitus: Ménière's Disease:

Nursing Strategies Denial of Pain

Clarify terms used to describe pain or discomfort. Emphasize importance of reporting pain to caregivers. Express concern about pain and a willingness to help. Explain that pain is not a normal consequence of aging

The nurse is providing care to an older adult client. Which assessment finding would necessitate the inclusion of interventions in the nursing plan of care to decrease the risk for disability? Client is prescribed calcium and vitamin D to prevent the development of osteoporosis. Client's current body mass index (BMI) is 40. Client is prescribed nitroglycerin to treat angina. Client's current pain rating is a 3 on a 1-10 scale.

Client's current body mass index (BMI) is 40.

In regard to lifespan considerations, the most important functional health pattern to assess in the elderly client is Values-belief Sexuality-reproduction Cognition-perception Coping-stress tolerance

Cognition-perception

Changes in Smell and Taste Common to Older Adults

Common changes in smell include a decline in the sensitivity to airborne chemical stimuli with aging. Common changes in taste include a decreased ability to detect foods that are sweet. Most changes in taste are thought to occur due to decreased sense of smell, medications, diseases and tobacco use.

FOCUS ON THE OLDER ADULT Pain Age-Related Changes

Communication Difficulties Denial of Pain Altered Physiologic Response to Analgesics

Developmental Changes Affecting Self-Concept Later years

Declining physical and possibly mental abilities Multiple losses Increasing dependency Impending death Diminished choices/options

Nursing Strategies Disturbed Sleep Pattern: Maintaining Sleep

Decrease fluids during the evening. Take diuretics in the morning or early evening. Discuss problems with health care provider.

FOCUS ON THE OLDER ADULT NURSING STRATEGIES TO ADDRESS AGE-RELATED CHANGES IN OXYGENATION

Decreased Gas Exchange and Increased Work of Breathing Decreased Ventilation and Ineffective Cough Decreased Cardiac Output and Ability to Respond to Stress

Alterations in Cardiac Functioning

Decreased efficiency as a pump Volume intolerance

Decreased Gas Exchange and Increased Work of Breathing

Decreased elastic recoil of the lungs Expiration requiring use of accessory muscles Fewer functional capillaries and more fibrous tissue in alveoli Decreased skeletal muscle strength in thorax Reduction in vital capacity and increase in residual volume

Age-Related Changes

Decreased gastric motility; increased gastric pH Increased adipose tissue Decreased number of protein-binding sites Decreased liver function; decreased enzyme production for drug metabolism; decreased hepatic perfusion Decreased kidney function, renal mass, and blood flow Alterations in normal homeostatic responses; altered peripheral venous tone Alterations in blood-brain barrier Decreased central nervous system efficiency Decreased production of oral secretions; dry mouth Decreased lipid content in skin (Taylor 758) Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalBook file.

Age-Related Changes

Decreased sense of thirst Medical conditions, e.g., heart failure or hypertension, requiring medications such as diuretics

What term is used to describe various disorders that progressively affect cognitive function? Dementia Ageism Reminiscence Delirium

Dementia

Nursing Strategies Weakening of intestinal walls with greater incidence of diverticulitis

Encourage a high-fiber diet and adequate fluid intake. Teach patients not to ignore the urge to have a bowel movement. Encourage regular exercise.

Decreased Ventilation and Ineffective Cough Nursing Strategies

Encourage increased fluid intake, especially water, as allowed. Use cool-mist humidifier (teach proper cleaning technique). Encourage attendance at pulmonary exercise rehabilitation program. Discourage use of over-the-counter medications. Teach how to splint thorax and cough effectively. Instruct in use of supplemental oxygen. Teach avoidance of milk products if they are troublesome.

Nursing Strategies Disturbed Sleep Pattern: Initiation of Sleep

Encourage patient to engage in some type of physical activity, such as walking or water aerobics. Discourage napping throughout day. Arrange for assessment for depression and treatment. Review medications that patient is taking and assess for any side effects of sleep pattern disturbances. (Taylor 1137) Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalBook file.

Decreased Gas Exchange and Increased Work of Breathing Nursing Strategies

Encourage rest periods, as necessary. Encourage cessation or moderation of smoking and second-hand smoke exposure. Teach breathing exercises. Remind about avoiding air pollutants. Caution about effect of extreme weather conditions. Instruct to avoid narcotics and sleeping pills. Discuss home management with patient and family. Teach avoidance of infection and preventive measures (i.e., pneumococcal and flu vaccination). Use pillows as necessary to sleep.

Nursing Strategies Slowing of gastrointestinal motility with increased stomach-emptying time

Encourage small, frequent meals. Discourage heavy activity after eating. Encourage a high-fiber, low-fat diet. Encourage adequate fluid intake. Discourage regular use of laxatives. Evaluate medication regimen for possible adverse effects

Decreased Cardiac Output and Ability to Respond to Stress Nursing Strategies

Encourage the inclusion of physical activity in the daily routine; pace activities. Encourage a healthy low-fat, low-salt diet, including plenty of fruits, vegetables and whole grains. Assist with smoking cessation and/or avoid the use of tobacco. Teach the importance of regular check-ups Assist with weight control. Teach the importance of medication compliance. Teach stress-reduction activities.

Gould viewed the middle years as a time when adults increase their feelings of self-satisfaction, value their spouse as a companion, and become more concerned with health. Which nursing action best facilitates this process? Counseling a patient who complains of being depressed Providing entertainment for a patient on bedrest Arranging for social services to assist with meals for a homebound patient Encouraging a patient to have regular checkups

Encouraging a patient to have regular checkups

Nursing Strategies

Ensure that oral intake is at least 1,500 mL for 24 hours. Be aware of schedule for diagnostic tests (and associated dietary and fluid restrictions). Offer fluids at regular intervals. Replace fluids as necessary, either orally or intravenously. Investigate individual fluid preferences. Provide assistance or assistive devices for encouraging fluid intake

An elderly client is becoming progressively confused due to Alzheimer's disease. The family can no longer manage the client at home due to wandering. Which of the following living arrangements could the nurse recommend? Respite care Naturally occurring retirement communities (NORCs) Extended-care facility Accessory apartment

Extended-care facility

Impaired Oral Mucous Membrane Nursing strategies

Floss and brush teeth with fluoride toothpaste twice a day; rinse after meals. Brush dentures twice a day and rinse with cool water; remove and rinse dentures and mouth after meals. Avoid mouthwashes with alcohol content. Inspect mouth daily for lesions and inflammation. Use lubricant on lips. Suck on sugar-free candies, chew sugarless gum, use salivary substitutes. Continue with dental exams at the dentist every 6 months.

A 78-year-old woman is on a nurse's rehabilitation unit status post a cerebrovascular accident (CVA). As the nurse assess her gait, the nurse notices that the client's left foot is dragging and she is not bending her left knee nor swinging her left arm. How would the nurse best describe the client's gait? Spastic Festinating Hemiparesis Ataxic

Hemiparesis Weakness on one side

The nurse performs an assessment on a newly admitted older adult client. The client receives a score of 12 on the Braden scale. What is the risk for impaired skin integrity for this client? No risk Low risk Moderate risk High risk

High risk

A 77-year-old woman is on the nurse's unit s/p left knee replacement. The client typically stools every morning but has not had a bowel movement in 3 days. The nurse knows that which medication places the client at increased risk for constipation? Hydromorphone Psyllium Acetaminophen Furosemide

Hydromorphone

Teaching Tip

Identify safety hazards in the environment. Modify the environment as necessary. Attend defensive driving courses or courses designed for elderly drivers. Encourage regular vision and hearing tests. If prescribed, ensure that eyeglasses and hearing aids are available and functioning. Wear appropriate footwear. Have operational smoke detectors in place. Objectively document and report any signs of neglect and abuse.

NURSING STRATEGIES TO ADDRESS AGE-RELATED CHANGES IN HYGIENE (Taylor 911) Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalBook file.

Impaired Oral Mucous Membrane Impaired Physical Mobility Risk for Impaired Skin Integrity

The Effect of Healing Touch on Persistent Pain In Older Adults

It is common knowledge that pain is underassessed and undertreated, particularly in older adults residing in long-term care facilities. A majority of this population suffers from chronic pain, with estimates varying from 20% to 80%. Analgesics used to treat chronic pain can have adverse effects on older adults and their medication regimens are more complicated, leading to the potential for drug interactions. Many factors affect a person's reaction to pain including previous pain experiences and their effect on quality of life. The addition of a complementary nonpharmacologic approach to pain management, such as Healing Touch, addresses the subjective component of pain and provides an additional method to use to ease pain for people in this setting.

Decreased Ventilation and Ineffective Cough

Less air exchange; more secretions remain in lungs Drier mucous membranes Altered pain sensation Different norms for body temperature; fever may be atypical Greater risk for aspiration due to slower gastric motility Impaired mobility and inactivity, effects of medication

POTENTIAL CAUSES OF DISTURBANCES IN SELF-CONCEPT Later years

Loss of significant work (retirement); feelings of uselessness Death of spouse, significant others Diminished physical attractiveness, strength, overall health Multiple stressors Fear of dependency Change may be more difficult

Alterations in Cardiac Functioning Nursing Strategies

Monitor breath sounds Assess for shortness of breath, wet productive cough, increased respiratory rate and work of breathing. Monitor chest radiograph

Nursing Strategies Communication Difficulties Pain

Observe carefully for any behavioral manifestations or indications of pain (e.g., change in activity level or grimacing with movement). Use open-ended questions to solicit information about pain. Rely on family or caregiver to assist with information-gathering process. Monitor for any behavior changes or confusion after medication has been taken.

Developmental Stage/Safety Risks

Older Adult Falls Motor vehicle accidents Elder abuse Sensorimotor changes Fires

Bed Bath

Older Adult Considerations Check the temperature of the water carefully before bathing an older patient, because sensitivity to temperature may be impaired in older adults. An older, continent patient may not require a full bed bath with soap and water every day. If dry skin is a problem, water and skin lotion or bath oil may be used on alternate days. (Taylor 937) Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalBook file.

Activity Variations based on Developmental Level: Assessment Priorities and Nursing Interventions Developmental Level:

Older Adult: Increased convexity in the thoracic spine (kyphosis) from disk shrinkage and decreased height Flexed posture Loss of muscle tone Subcutaneous fat loss Arthritic joint changes may be present.

Older Adults Specific physical changes occur in older adults that are unrelated to any pathology. Refer to the Focus on the Older Adult Box . The tissues and airways of the respiratory tract (including the alveoli) become less elastic. The power of the respiratory and abdominal muscles is reduced, therefore the diaphragm moves less efficiently. The chest is unable to stretch as much, resulting in a decline in maximum inspiration and expiration. Airways collapse more easily. These alterations increase the risk for disease, especially pneumonia and other chest infections. (Taylor 1405) Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalBook file.

Older Adults Specific physical changes occur in older adults that are unrelated to any pathology. Refer to the Focus on the Older Adult Box . The tissues and airways of the respiratory tract (including the alveoli) become less elastic. The power of the respiratory and abdominal muscles is reduced, therefore the diaphragm moves less efficiently. The chest is unable to stretch as much, resulting in a decline in maximum inspiration and expiration. Airways collapse more easily. These alterations increase the risk for disease, especially pneumonia and other chest infections. (Taylor 1405) Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalBook file.

Older Adults and pain

Older Adults. Research on pain management in older adults has focused on pain associated with chronic illness and acute postoperative pain. Little is known about pain in well older adults living in the community. However, residents of long-term care facilities are a vulnerable population who experience a high prevalence of pain. Many health care providers, and older people as well, expect that pain is a natural outcome of the aging process. As stated previously, pain is routinely undertreated in this population. Recommendations for analgesic administration for older adults include the following (Westbrook & D'Arcy, 2012): Use acetaminophen cautiously for mild to moderate pain. NSAIDs also have the potential for renal and gastric complications; a proton pump inhibitor may be prescribed to decrease gastric side effects. Administer medications, if possible, via the oral route. Use IV analgesics cautiously because decreased circulation poses a risk for reduced absorption of opioids. The recommendation is to "start low and go slow." Opioid drugs can be used safely for older adult patients as long as appropriate precautions are taken, pain is conscientiously assessed, and potential side effects are monitored. Adjust dosage and dosing intervals for the older adult based on therapeutic response to the drug and the presence of adverse effects. The accompanying Focus on the Older Adult box describes additional strategies pertinent to this age group. (Taylor 1179) Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalBook file.

Developmental Aspects of Sexuality Through The Life Span Late adulthood: Age 55 yr and older Characteristics

Orgasms may become shorter and less intense in both men and women. Vaginal secretions decrease, and period of resolution in men lengthens. May feel need to conform to stereotypes regarding the aging process and cease sexual activity Fear of loss of sexual abilities

Diseases that Alter Peripheral Sensation Seen More Frequently as People Age

Peripheral Neuropathy: Diabetic Neuropathy: Phantom Limb Pain: Acute Sensory Loss:

Changes in Peripheral Sensation Common to Older Adults

Peripheral nerve function that controls the sense of touch declines slightly with age. Two-point discrimination and vibratory sense both decrease with age. The ability to perceive painful stimuli is preserved in aging. However, there may be a slowed reaction time for pulling away from painful stimuli with aging.

An 80-year-old client tells the nurse that he has been dizzy since starting to take an herbal remedy for arthritis in addition to prescribed medications. The nurse recognizes that the client may be experiencing the effects of which of the following? Polypharmacy Fluid volume overload Sleep disorder Cascade iatrogenesis

Polypharmacy

Hearing Changes Common in Older Adults (Taylor 1638) Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalBook file.

Presbycusis: Conductive Hearing Loss: Sensorineural Hearing Loss:

Vision Changes Common in Older Adults

Presbyopia

Nursing Strategies Decreased muscle tone/incontinence

Provide easy access to the bathroom. Use assistive devices when necessary (raised toilet seat, grab bars, walker). Ensure safety when ambulating (e.g., skid-proof slippers)

Alterations in Renal Functioning Nursing Strategies

Record accurate intake and output. Note appearance and specific gravity of urine. Check laboratory values for abnormal levels. (Taylor 1494) Taylor, Carol. Fundamentals of Nursing. Wolters Kluwer Health, 10/2014. VitalBook file.

Decreased Cardiac Output and Ability to Respond to Stress

Reduction in the elasticity of the heart's tissues Heart muscle becomes less efficient—working harder to pump the same amount of blood through the body. Progressive atherosclerosis (fatty buildup or plaques, thickening) in arterial walls and loss of elasticity Capillary walls thicken slightly, leading to a slower rate of exchange of gases, nutrients, and waste.

An client 81 years of age is in a long-term-care facility. His family could no longer cope with his progressing senile dementia, including wandering away and unpredictable behavior. Late one night the nurse finds the client wandering in the hall. He says he is looking for his wife. What should the nursing approach should be? Use a matter-of-fact attitude and gently help him back to his room. Remind him that he must not get up unassisted and should stay in his room at night. Remind him of where he is and assess why he is having difficulty sleeping. Allow him to sleep in the recliner in the day-room, so he will not disturb other clients.

Remind him of where he is and assess why he is having difficulty sleeping.

Nursing Implications and Guidelines

Sexual activity need not be hindered by age. Teach couples that adaptation to bodily changes is possible with use of comfortable positions for intercourse and increased time for stimulation. Teach alternatives to coitus, such as caressing, hugging, and stroking, when coitus is impossible because of illness or disability. Couples who have been consistently sexually active throughout their lives may continue their intimate relationship for as long as they desire.

NURSING STRATEGIES TO ADDRESS AGE-RELATED CHANGES AFFECTING BOWEL ELIMINATION

Slowing of gastrointestinal motility with increased stomach-emptying time Decreased muscle tone/incontinence Weakening of intestinal walls with greater incidence of diverticulitis

A public health nurse is participating in a health fair that is being held at a local community center. The nurse should encourage adult participants to completely eliminate which of the following from their diet and lifestyle? Smoking Alcohol Salt Cholesterol

Smoking

An older adult female client tells the nurse, "Whenever I sneeze or cough, I urinate a little bit. It's very embarrassing." The nurse interprets the client's statement as indicating which type of incontinence? Urge Stress Overflow Functional

Stress

Nursing Interventions:

Teach and counsel about: Importance of regular exercise Need to maintain proper weight Need for high protein, calcium, and vitamin D-enriched diet Pacing activities Using assistive devices safely when needed Safety-proof homes to reduce falls

Promoting Positive Self-Concept

The experience of illness, diagnostic testing, and treatment can severely threaten self-concept. Social support, positive role function, and satisfaction with health care have been demonstrated to have a positive influence on the experience of dealing with illness. As an external resource for patients, nurses can help promote a positive self-concept

Impaired Physical Mobility Nursing strategies

Use adaptive devices for hygiene such as toothbrush with a large handle or extended handle, long-handled body sponge, shower chair, and grab bars. Provide for safety in the bathroom: use nonslip mats, grab bars.

Risk for Impaired Skin Integrity Nursing strategies

Use safe water temperatures to bathe; warm water, not hot. Avoid soap; use pH-balanced skin cleansers. Shower instead of tub bath. Use skin moisturizers and emollients at least daily. Bath regularly, but less often (not every day).

9. A nurse is caring for an 80-year-old female patient who is living in a long-term care facility. To help this patient adapt to her present circumstances, the nurse is using reminiscence as therapy. Which question would encourage reminiscence? a. "Tell me about how you celebrated Christmas when you were young." b. "Tell me how you plan to spend your time this weekend." c. "Did you enjoy the choral group that performed here yesterday? d. "Why don't you want to talk about your feelings?"

a Asking questions about events in the past can encourage the older adult to relive and restructure life experiences.

2. A nurse caring for older adults in a long-term care facility knows that several physical changes occur in the aging adult. Which characteristics best describe these changes? Select all that apply. a. Fatty tissue is redistributed. b. The skin is drier and wrinkles appear. c. Cardiac output increases. d. Muscle mass increases. e. Hormone production increases. f. Visual and hearing acuity diminishes.

a, b, f Physical changes occurring with aging include these: fatty tissue is redistributed, the skin is drier and wrinkles appear, and visual and hearing acuity diminishes. Cardiac output decreases, muscle mass decreases, and hormone production decreases, causing menopause or andropause

A nurse arrives at the home of an older adult client. The agency was called because a neighbor noticed that the client was home alone. The nurse finds the client alone in the living room. When asked about the client's daughter who lives there and has been caring for her, the client says, "She went on vacation for about a month. She'll be back soon." Further assessment reveals that there are no other family members or services currently involved. The nurse would identify this situation as: abandonment. exploitation. neglect. emotional abuse.

abandonment.

3. Based on Erikson's theory, middle adults who do not achieve their developmental tasks may be considered to be in stagnation. Which statement is one example of this finding? a. "I am helping my parents move into an assisted-living facility." b. "I spend all of my time going to the doctor to be sure I am not sick." c. "I have enough money to help my son and his wife when they need it." d. "I earned this gray hair and I like it!"

b Middle adults who do not reach generativity tend to become overly concerned about their own physical and emotional health needs

6. A nurse who is caring for older adults in a senior daycare center documents findings as related to which normal aging process? Select all that apply. a. A patient's increased skin elasticity causes wrinkles on the face and arms. b. Exposure to sun over the years causes a patient's skin to be pigmented. c. A patient's toenails have become thinner with a bluish tint to the nail beds. d. A patient experiences a hip fracture due to porous and brittle bones. e. Fragile blood vessels in the dermis allow for more easy bruising of a patient's forearm. f. Increased bladder capacity causes decreased voiding in an older patient.

b, d, e Exposure to sun over the years can cause a patient's skin to be pigmented. Bone demineralization occurs with aging, causing bones to become porous and brittle, making fractures more common. The blood vessels in the dermis become more fragile, causing an increase in bruising and purpura. Wrinkling and sagging of skin occur with decreased skin elasticity. A patient's toenails may become thicker, with a yellowish tint to the nail beds. Bladder capacity decreases by 50%, making voiding more frequent; two or three times a night is usual

10. Following a fall that left an elderly male patient temporarily bedridden, the nurse is using the SPICES assessment tool to evaluate him for cascade iatrogenesis. Which are correct aspects of this tool? Select all that apply. a. S - Senility b. P - Problems with feeding c. I - Irritableness d. C - Confusion e. E - Edema of the legs f. S - Skin breakdown

b, d, f The SPICES acronym is used to identify common problems in older adults and stands for: S - Sleep disorders P - Problems with eating or feeding I - Incontinence C - Confusion E - Evidence of falls S - Skin breakdown

7. A nursing instructor teaching classes in gerontology to nursing students discusses myths related to the aging of adults. Which statement is a myth about older adults? a. Most older adults live in their own homes. b. Healthy older adults enjoy sexual activity. c. Old age means mental deterioration. d. Older adults want to be attractive to others.

c Although response time may be longer, intelligence does not normally decrease because of aging. Most older adults own their own homes, and although sexual activity may be less frequent, the ability to perform and enjoy sexual activity lasts well into the 90s in healthy older adults. Older adults want to be attractive to others

8. What is the leading cause of cognitive impairment in old age? a. Stroke b. Malnutrition c. Alzheimer disease d. Loss of cardiac reserve

c Alzheimer disease is the most common degenerative neurologic illness and the most common cause of cognitive impairment. It is irreversible, progressing from deficits in memory and thinking skills to an inability to perform even the simplest of tasks

1. A nurse caring for adults in a physician's office notes that some patients age more rapidly that other patients of the same age. The nurse researches aging theories that attempt to describe how and why aging occurs. Which statements apply to the immunity theory of aging? Select all that apply. a. Chemical reactions in the body produce damage to the DNA. b. Free radicals have adverse effects on adjacent molecules. c. Decrease in size and function of the thymus causes infections. d. There is much interest in the role of vitamin supplementation. e. Lifespan depends on a great extent to genetic factors. f. Organisms wear out from increased metabolic functioning.

c, d The immunity theory of aging focuses on the functions of the immune system and states that the immune response declines steadily after younger adulthood as the thymus loses size and function, causing more infections. There is much interest in vitamin supplements (such as vitamin E) to improve immune function. In the cross-linkage theory, cross-linkage is a chemical reaction that produces damage to the DNA and cell death. The free radical theory states that free radicals, formed during cellular metabolism, are molecules with separated high-energy electrons, which can have adverse effects on adjacent molecules. The genetic theory of aging holds that lifespan depends to a great extent on genetic factors. According to the wear-and-tear theory, organisms wear out from increased metabolic functioning, and cells become exhausted from continual energy depletion from adapting to stressors

5. An experienced nurse tells a younger nurse who is working in a retirement home that older adults are different and do not have the same desires, needs, and concerns as other age groups. The nurse also comments that most older adults have "outlived their usefulness." What is the term for this type of prejudice? a. Harassment b. Whistle blowing c. Racism d. Ageism

d Ageism is a form of prejudice in which older adults are stereotyped by characteristics found in only a few members of their age group. Harassment occurs when a dominant person takes advantage of or overpowers a less dominant person (may involve sexual harassment or power struggles). Whistle blowing involves reporting illegal or unethical behavior in the workplace. Racism is prejudice against other races and ethnic groups

4. Which of the following nursing diagnoses would be appropriate for many middle adults? a. Risk for Imbalanced Nutrition: Less Than Body Requirements b. Delayed Growth and Development c. Self-Care Deficit d. Caregiver Role Strain

d Many middle adults help care for aging parents and have concerns about their own health and ability to continue to care for an older family member. Caregivers often face 24-hour care responsibilities for extended periods of time, which creates physical and emotional problems for the caregiver

A nurse is preparing a presentation for a group of families who are providing care to their older adult parents. One of the family members asks the nurse, "How common is Alzheimer's disease?" The nurse responds by telling the group that after age 65, the prevalence of Alzheimer's disease: doubles every 5 years. triples every year. decreases by 10 for every year. declines but the rate is unknown.

doubles every 5 years.

The nurse is assessing an older adult client who has suffered injury to his nervous system. The client has a history of chronic pain and currently reports pain on a scale of 8 out of 10. The nurse identifies this type of pain as most likely: neuropathic pain. central pain. postherpetic neuralgia. phantom limb pain.

neuropathic pain

An older adult client being cared for at home has developed a decubitus ulcer. The nurse would instruct the family caregiver to institute measures to: relieve sustained pressure. control incontinence. promote bowel elimination. improve nutrition.

relieve sustained pressure.