Chapter 11: Health Care of the Older Adult
A family of a patient with Alzheimer's disease asks the nurse what causes this condition? Which response by the nurse would be most appropriate?
"Evidence shows that there are changes in nerve cells and brain chemicals."
An elderly client reports fatigue without shortness of breath with walking 30 minutes five times each week. The nurse assesses the resting heart rate as 72 beats per minute; 10 minutes after walking, the client's heart rate is 92 beats per minute. What should the nurse instruct the client to do next?
Continue to walk at his current level.
____________ have the longest life expectancy.
Caucasian women
gerontology
the combined biologic, psychological, and sociologic study of older adults within their environment
gerontologic/geriatric nursing
the field of nursing that relates to the care of older adults
depression
the most common affective mood disorder of old age
elder abuse
the physical, emotional, or financial harm to an older person by one or more of the individual's children, caregivers, or others; includes neglect
urinary incontinence
the unplanned loss of urine
polypharmacy
the use of multiple meds
Fibrosis
thickening
mental status change in older adults
using a sign that something is wrong
orientation
a person's ability to recognize who and where he or she is in a time continuum; used to evaluate one's basic cognitive status
An older adult female client tells the nurse, "I have lost an inch [2.5 cm] of height and have a hump on my back. What can I do about this?" What is the best response by the nurse?
"In order to prevent further bone loss, eat a diet high in calcium and low in phosphorus."
The nurse works on a unit with elderly clients. Which of the following clients would the nurse visit first? The client who reports:
"It feels like I have food stuck in my throat."
A client with Alzheimer's disease is prescribed donepezil hydrochloride. When teaching the client and family about this drug, which of the following would the nurse include?
"The drug helps to control the symptoms of the disease."
A nurse is caring for a client with dementia. A family member of the client asks what the most common cause of dementia is. Which response by the nurse is most appropriate?
"The most common cause of dementia in the elderly is Alzheimer's disease."
A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds:
"What precipitates the outbursts?"
Myocardial hypertrophy
-Decreased cardiac output -decreases the strength/function of the left ventricle
Which is an age-related change in the respiratory system?
-Decreased gas exchange -Increased residual lung volume
Respiratory System Changes in Older Adults
-Diminished respiratory efficiency & reduced maximal inspiratory & expiratory force -Lung mass decreases & residual volume increases -Disease manifests more subtly -Smoking most significant risk factor
The nurse is teaching about preventing pneumonia and influenza to a group of clients in a senior citizens' wellness class. The nurse includes which of the following topics in the class? Select all options that apply.
-Ensuring appropriate fluid intake -Avoiding environmental smoke -Participating in regular exercise
Cardiovascular Changes in Older Adults
-Increased fibrosis and calcified tissue -Calcium and fat deposits accumulate in arterial walls -Cardiac disease may present differently -Orthostatic hypotension
A nurse is providing a fall prevention clinic for a group of older adults. What information should the nurse include? Select all that apply.
-Place grab bars in the shower and tub -Have routine vision and hearing screenings -Wear nonslip shoes or socks when walking -Review meds routinely for side effects
Preventive Health Care Nurses Can Do:
-Provide encouragement -Refer to community based support services -Promote lifelong health behaviors
Health Promotion Activities for Cardiovascular System
-Rise slowly -Eat 5 to 6 small meals -Avoid hot showers/whirlpools -Avoid straining with bowel movements -Exercise regularly -Low fat, low salt diet -Stress reduction activities -Weight and BP control -Take your meds
Health Promotion Activities for Respiratory System Changes
-Stop smoking & avoid environmental smoke -Regular exercise -Adequate fluid intake -Get Pneumonia and Flu vaccines yearly -Hospitalized patients need to cough & take deep breaths
A nurse is providing care to a patient with delirium. Which interventions would be most appropriate to implement? Select all that apply.
-Supervising nutritional intake -Using familiar cues about the environment -Providing a calm, quiet environment
A nurse is preparing a presentation for a local senior center about the health status of older adults. What trends in health promotion and disease prevention activities would the nurse explain as contributing to declining death rates in the older adult population? Select all that apply.
-early detection of -elevated cholesterol levels -screening for hypertension -improved nutrition decreased smoking
Community-based services
-in home assistance with ADLs -Meals on Wheels
Goals of gerontologic nursing
-promoting and maintaining functional status -help older adults to identify and use their strengths to achieve optimal independence -QUALITY OF LIFE
Life expectancy in 1900
47 years old
What should the patient's daily carbohydrate intake be?
55-60%
Life expectancy in 2009
78.8 years old
The nurse is assessing the genitourinary status of an older adult female patient who is experiencing stress incontinence. What finding is a common gerontologic finding for this population?
Bladder capacity decreases with advanced age.
Which is a true statement regarding pharmacologic aspects of aging?
Absorption may be affected by changes in gastric pH.
#5 Leading Cause of Death in Older Adults
Alzheimer disease
An elderly client with heart failure reports constipation that has progressively worsened over the last several months. The client's vital signs are pulse 86 beats per minute, blood pressure 94/56, and respirations 18 breaths per minute. It would be best for the nurse to instruct the client to...
Avoid straining when having a bowel movement.
A client reports to the nurse that over the past few months the elderly mother has become increasingly angry, responds inappropriately to conversations, and does not respond to calls if her back is turned away. What is the nurse's best response?
Ask if the mother could come in for a hearing evaluation.
The nurse is preparing an elderly hospitalized client for discharge to home within the hour. What should be the priority for the nurse?
Assess the need for pneumococcal and influenza vaccinations.
A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes?
Decreased acetylcholine level
Which action by the nurse demonstrates ageism?
Directing all health decisions to the older adult's child
ageism
Discrimination based on age
A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate?
Distract the client with a familiar object or music.
A nurse is teaching nursing assistants in an extended-care facility measures to protect the skin of elderly clients. Which of the following measures is the nurse likely to recommend?
Encouraging clients to avoid cigarette smoking
A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to...
Ensure that the mother does not have access to car keys or drive an automobile.
_______ population is projected to have the highest rate of growth by 2030.
Hispanic
_______ is harder to maintain as you age.
Homeostasis
A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching?
How old you feel will be determined by your physical and cognitive abilities.
Adequate fluid intake association with the respiratory system...
Increases viscosity of respiratory secretions (thins out secretions)
An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to:
Ingest five or six small meals each day.
An elderly client is hospitalized for treatment related to leukemia. Family members want to visit with a toddler who has a cold. It would be best for the nurse to...
Instruct the family to remove the toddler from the room for the protection of the client.
An older adult male patient tells the nurse that he wakes several times a night to pass his urine but never feels as though he fully empties his bladder. What suggestion can the nurse make to help control this in the evening?
Limit drinking a lot of fluid in the evening, especially caffeinated beverages.
An elderly client reports that he feels like he voids frequently during the day and at night but cannot empty his bladder. The nurse instructs the client to...
Limit ingestion of caffeinated beverages.
An elderly female client has been taking prednisone for breathing problems for many years. The nurse notes that the client's current height is 64 inches. Two years ago, her height was 66 inches. The nurse assesses this loss in height is most likely the result of:
Loss of bone density
Lung mass decreases & residual volume increases leads to...
More CO2 is being left in blood and less O2 is being brought in. Having to work harder to bring in the new O2 and get rid of the excess CO2
The reason that governments carefully regulate treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement?
Older adult clients are vulnerable.
Why are IV solutions usually given at a slower rate to older adults?
Older adults may have cardiac or renal disorders.
Which is an age-related change associated with the nervous system?
Postural hypotension
Hospitalized patients need to cough & take deep breaths association with the respiratory system...
Prevent atelectasis and respiratory infections, like pneumonia
Which action is included in a nurse's role when providing home care for a client with Alzheimer disease?
Provide emotional and physical support
Increased fibrosis and calcified tissue leads to...
Reduced stroke volume, stenosis of the valves, decreased pacemaker cells
Which is a factor that contributes to urinary incontinence in older female adults?
Relaxed perineal muscle
Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse?
Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore."
Calcium and fat deposits accumulate in arterial walls leads to...
Stiff/tortuous arteries resulting in hypertension and increased workload
__________ generally live longer than _________.
Women; men
senile dementia
a decrease in mental ability that sometimes occurs after the age of 65
geriatrics
a field of practice that focuses on the physiology, pathology, diagnosis, and management of the disorders and diseases of older adults
durable power of attorney
a formal, legally endorsed document that identifies a proxy decision maker who can make decisions if the signer becomes incapacitated
ADLs
activities of daily living
presbycusis
age related hearing loss
delirium
an acute, confused state that begins with disorientation and if not recognized and treated early can progress to changes in level of consciousness, irreversible brain damage, and sometimes death
Most older adults have ____________.
at least 1 chronic illness, if not multiple
Dementia
broad term for a syndrome characterized by a general decline in higher brain functioning, such as reasoning, with a pattern of eventual decline in the ability to perform even basic ADLs
Diminished respiratory efficiency leads to...
calcification (hardening) and weakening of chest wall muscles
#2 Leading Cause of Death in Older Adults
cancer/malignant neoplasms
depression results from...
changes in reuptake of the neurochemical serotonin in response to chronic illness and emotional stresses
cataract
clouding of the lens of the eye
atelectasis
collapsed lung
geriatric syndromes
common conditions found in older adults that tend to be multifactorial and do not fall under discrete disease categories; these conditions include falls, delirium, frailty, dizziness, and urinary incontinence
instrumental activities of daily living
complex skills needed for independent living, such as shopping, cooking, housework, using the telephone, managing medications and finances, and being able to travel by car or public transportation
Reduced stoke volume
the amount of blood pumped with each contraction, decreased pumping ability
Age-related changes reduce the heart's _______________.
efficiency and compliance/ability to stretch and distend
uLife expectancy varies by what?
gender and race
comorbidity example
having diabetes and congestive heart failure at the same time
comorbidity
having more than one illness at the same time
#1 Leading Cause of Death in Older Adults
heart diseases
The plan of care for a patient with advanced Alzheimer's disease includes the nursing diagnosis of risk for injury. The nurse has identified this nursing diagnosis most likely as related to which of the following?
impaired memory
presbyopia
impairment of vision as a result of old age
glaucoma
increased intraocular pressure results in damage to the retina and optic nerve with loss of vision
Orthostatic Hypotension can lead to...
increased risk for falling, may be caused by meds
IADLs
instrumental activities of daily living
#3 Leading Cause of Death in Older Adults
lung diseases like COPD, bronchitis, and emphysema
Many ________ show very little decline in respiratory function.
non-smokers
The body is __________ as it used to when aging.
not running as efficiently
activities of daily living
personal care activities such as bathing, dressing, grooming, eating, toileting, and transferring
Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away?
presbyopia
Improvements in ___________________has improved health and longevity.
prevention, early detection, & treatment of disease
The nurse is attempting to take vital signs of an older adult hospitalized following knee surgery. The client continuously yells, "It's 1999 and you are going to hurt me!" What action should the nurse do first?
reorient the patient
To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should:
stay with the client and encourage him to eat
#4 Leading Cause of Death in Older Adults
stroke