Older Adults-2
Obstructive Sleep Apnea:
A disorder characterizes by repetitive cessation of respiration during sleep. Symptoms: daytime fatigue, loud periodic snoring, broken sleep with frequent awakenings, gasping and choking on awakenings, unusual nighttime activity such as sitting upright or falling out of bed, morning headache, poor memory and intellectual functioning, irritability and personality change.
Restless Leg Syndrome:
A sensorimotor neurologic disorder; characterized by the uncontrollable need to move the legs; Often accompanied by discomfort in the legs. Symptoms: parethesias, creeping sensations, crawling sensations, tingling, cramping, burning sensations, pain.
Normal Bladder Functions Requires:
An intact brain and spinal cord, competent lower urinary tract function, motivation to maintain continence, functional ability to recognize voiding signals and use a toilet. Environment that facilitates the process.
The nurse employed in a long term care facility is caring for an older male client. What nursing action contributes to encouraging autonomy in the client? -Planning meals -Scheduling appts -Decorating his room -He chooses activities
Client choosing own activities. Autonomy is the personal freedom to direct one's own life as long as it does not impinge on the rights of others. An autonomous person is capable of rational thought.
Risk Factors for Urinary Incontinence:
Cognitive impairment, limitations in daily activities, institutionalization, stroke, diabetes, obesity, poor general health, comorbidities
Define Mixed Dementia
Combination of Alzheimer's disease, vascular brain changes, prior alcoholism
Complications of Diabetes Mellitus
Complications occur over the long course of the disease and are microvascular, macrovascular, or both. Macro: MI, stroke, peripheral vascular disease, and neuropathy. Micro: loss of vision, end stage renal failure, neuropathy. Problems with feet: warning signs of foot problems derive from different body systems and include cold feet and intermittent plan from claudication; burning, tingling, hypersensitivity, numbness; gradual change in shape or sudden, painless change without trauma; infections, skin color, and texture changes.
Effect of Diabetic Retinopathy on Vision:
Considered a disease of the retinal microvasculature; characterized by increased vessel permeability; blood and lipid leakage leads to macular edema and hard exudates. TX: constant, strict control of glucose, laser photocoagulation tx can halt progression of disease, annual dilated fundoscopic exam
Acute Grief:
Crisis; often difficult for persons who are acutely grieving to accomplish their usual activities of daily living; Signs and symptoms of acute grief do not last forever, or else none of us could survive; most intense in first 3 months
The nurse is performing an assessment on an older adult client. What assessment data would indicate a potential complication associated with the skin of this client?- Crusting, Wrinkling, or thinning/loss of elasticity of skin
Crusting- indicates a potential complication
Stage 4 Pressure Ulcer
Deep tissue destruction extending through subcutaneous tissue to fascia, possibly involving muscle layers, joint and/or bone. Presents as a deep crater. May include necrotic tissue, undermining, sinus tract formation, exudate, and/or infection. Wound base is usually not painful.
The home health nurse is visiting a client for the first time. While assessing the client's medication, it is noted that there are 19 prescription and several over the counter medications that the client is taking. What intervention should the nurse take first?
Determine whether there are medication duplications. Polypharamacy is a concern in the geriatric population.
Western/Biomedical System
Disease is thought to be the result of abnormalities in the structure and function of body organs.
Interventions for Bowel Incontinence:
Environmental manipulation, diet alterations, habit training schedules, improving transfer and ambulation ability, sphincter training exercises, biofeedback, medications and/or surgery to correct underlying defects.
Risks for Diabetes Mellitus:
Ethnicity, increasing age, blood pressure of 140/90 or higher, first degree relative with DM, history of impaired glucose tolerance or impaired fasting plasma glucose, obesity, previous gestational GM or having a child with a birth weight of over 9 lbs, undesirable lipid levels: high density lipoproteins (HDLs) of over 35 or triglyercides over 250.
Continuity Theory:
Explains that life satisfaction with engagement or disengagement depends on personality traits.
Xerosis
Extremely dry, cracked, and itchy skin; Occurs primarily in the extremities; exposure to environmental elements contributes to skin dryness and dehydration; dry skin may be just dry skin, but it may also be a symptom of more serious systemic disease.
Wellness behavior:
Involves one's whole being- physical, emotional, mental, and spiritual; a state of being and feeding that one strives to achieve through effective health practices; wellness involves achieving a balance between one's internal and external environment
Power of Attorney
Legal document in which one person designates another person to act on his/her behalf; General POA has the right to make financial decisions; Durable POA has additional rights and responsibilites to make health related decisions.
Define Pressure Ulcers:
Localized injury to the skin and/or underlying tissue over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. Heels are particularly apt to develop pressure ulcers, since they are small surfaces that receive a high degree of pressure. 4 stages.
Natural Aging of Dermis:
Loses about 20% of thickness with aging. Dermal blood vessels are reduced. Collagen synthesis decreases.
Natural Aging of the Respiratory System:
Loss of elastic recoil, stiffening of chest wall, inefficiency in gas exchange, increased resistance to air flow.
Natural Aging of Cardiovascular System:
Maximum coronary artery blood flow, stroke volumes, and cardiac output are decreased. It takes longer for the heart to accelerate and then return to a resting state. Heart disease is the number one cause of nonaccidental death worldwide. Decreased elasticity and recoil of blood vessels. Blood supply to various organs decreases, and peripheral resistance increases. Decreased perfusion of the liver and kidneys.
Dysphagia:
May occur as a result of neurologic diseases such as stroke, Parkinson's disease, multiple sclerosis, and dementia. Negative consequences include weight loss, malnutrition, dehydration, and aspirations. Increased risk of aspiration pneumonia. Classified as oropharyngeal or esophageal
Promoting Healthy Lungs:
Obtain pneumonia immunization, obtain annual influenza immunization, avoid exposure to smoke and pollutants, do not smoke, avoid persons with respiratory illnesses, seek prompt tx of respiratory infections, wash hands frequently, eat meals in relaxed atmosphere, and practice thorough oral hygiene.
Age Related Wet Macular Degeneration
Occurs when abnormal blood vessels behind the retina start to grow under the macula; new blood vessels are fragile and often leak blood and fluid which raise the macula from its normal place at the back of the eye; severe loss of central vision can be rapid
Prelingual Deafness
Often learn audible speech and/or sign language and lip reading well. Reading and writing skills may be impaired, communication can also be comprised for those dependent on visual cues when vision changes occur.
Health Conditions Affecting Nutrition:
Osteoporosis, GI disorders, Obesity, Diabetes, Cardiovascular and respiratory diseases, cancer, dysphagia, and dementia.
Tinnitus
Perception of sound in the absence of acoustic stimulus. ringing, buzzing, hissing, whistling, crickets, bells, roaring, clicking, pulsating, humming, swishing. Tx: iontophoersis, biofeedback, dental tx, cochlear implants, hearing aids
Considerations in planning Rehabilitation Care
Person in crisis when admitted to hospital; multidisciplinary discharge planning begins upon admission; anxiety impairs learning during hospitalization; quick discharge to home or nursing home will occur whenever possible
Define Secondary Dementia
Produce pathological conditions of the brain as a result of other conditions
Define Primary Dementia
Progressive disorders caused by pathological conditions of the brain
Symbolic Interaction Theories:
Propose that the kind of aging process people experience is a result of interactions between the environment, the individual, and the meaning the person attributes to his or her activities.
Respite Care:
Provision of temporary relief to the caregiver and is perhaps the most significant intervention to family caregivers. May be in many forms, including temporary stay of the elder in a care facility, participation in an adult day program, or in home relief by an informal or formal relief caregiver. Nurses should encourage caregivers to use this resource to provide needed relief from care giving and to restore their energy and well-being.
Anticipatory Grief:
Response to a real or perceived loss before it actually occurs, a dress rehearsal, so to speak.
Sensorineural hearing loss:
Results from damage to any part of the inner ear or the neural pathways to the brain
Interventions for Urinary Incontinence
Scheduling voiding, promoted voiding, bladder training, biofeedback, pelvic floor muscle exercises, intermittent catheterization, continuous indwelling catheter, external catheter, absorbent product. Pharmacological: Anticolinergic agents, alpha adrenergic blockers and the 5-alpha-reductase inhibitors. Surgical: suspension of the bladder neck, prostatectomy, sphincter implantation, periurethral bulking.
Natural Aging of Immune System:
Skin thinner and less resistant to bacterial invasion, reduced number of cilia in lungs leads to increased risk for pneumonia, friability of urethra increases risk for urinary tract infection, reduced immunity at cellular level.
Natural Aging of Hypodermis:
Some areas atrophy, far decreases.
Define Fluent Aphasia:
Speaks easily with many long runs of words, but the content does not make sense. Difficulty understanding spoken language and may be unaware of their speech difficulties.
Disengagement Theory:
States that aging is an inevitable, mutual withdrawal or disengagement, resulting in decreased interaction between the aging person and others in the social system he/she belongs to.
Chronic Grief:
The intermittent pain of grief is often exacerbated on anniversary dates; "Shadow Grief" or that which resurfaces from time to time; Some chronic grief is more than that of shadow grief and crosses the boundary to what we call impaired, pathological, abnormal, or maladaptive grief.
Age Related Dry Macular Regeneration
The light sensitive cells in the macula slowly break down, blurring central vision in the affected eye, one of the most common early signs is drusen, yellow deposits under retina
Define Verbal Apraxia:
When thinking about what to say, the person may be unable to speak at all or may struggle to say words
Define Cataracts:
caused by oxidative damage to lens protein and fatty deposits in ocular lens. Clouding of the ordinary clear ocular lens; appearance of halos around objects as light is diffused; blurring, decreased perception of light and color (yellow tinting), and sensitivity to glare
Promoting healthy digestion:
practice good oral hygiene, wear properly fitting dentures, seek prompt tx of dental caries and periodontal disease, eat meals in relaxed atmosphere, maintain adequate intake of fluids, provide time for response to gastrocolic reflex, respond promptly to urge to defecate, eat a balanced diet, avoid prolonged periods of immobility, avoid tobacco products.
Promoting healthy eyes:
protect eyes from UV light, avoid eye strain, use bright light when needed, see health care provider promptly for changes in vision, heave yearly dilated eye examination.
Conductive hearing loss:
usually involves abnormalities of the external and middle ear that reduce the ability of sound to be transmitted to or through the middle ear.
Interventions of Sleep Apnea:
Weight loss, avoidance of alcohol and sedatives, cessation of smoking, avoiding supine sleep positions
Dry Eye
Changes in mucin-secreting cells necessary for surface wetting, in lacrimal glands, or in meibomian glands that secrete surface oil
Serious Consequences of Malnutrition:
Infections, pressure ulcers, anemia, hypotension, impaired cognition, hip fractures, and increased mortality and morbidity.
Hyponatremia
A decrease in sodium plasma concentration. Caused by an excess of water relative to solute.
The nurse is performing an assessment on an older client who is having difficulty sleeping at night. What statement by the client indicates education is needed on improving sleep? -"I swim 3 times a week" -"I have stopped smoking cigars." -"I drink hot chocolate before bed" -"I read for 40 min at bedtime."
"I drink hot chocolate before bed" Many nonpharmacological sleep aids can be used to influence sleep. The client should avoid caffeinated beverages and stimulants such as tea, cola, and chocolate. The client should exercise regularly, because exercise promotes sleep by burning off tension that accumulates during the day. The client should sleep on a firm mattress. Smoking and alcohol should be avoided. The client should also avoid large meals, peanuts, beans, fruit and raw veggies that produce gas, and snacks high in fat that are difficult to digest.
Young-Old
65-74 years of age.
Middle-Old
75-84 years of age.
Gerotranscendence:
A shift in perspective from the material world to the cosmic and concurrent with that an increasing life satisfaction. Thought to be gradual and ongoing shift that is generated by the normal processes of living, sometimes hastened by serious personal disruptions. Characteristics include: high degree of life satisfaction; midlife patterns and ideals are no longer prime motivators; complex and active coping patterns; a greater need for solitary philosophizing, medication, and solitude; social activities are not essential for well being; satisfaction with self selected social activities; less concern with body image and material possessions; decreased fear of death; affinity with past and future generations; decreased self centeredness and increased altruism
Dysarthia
A speech disorder caused by a weakness or incoordination of the speech muscles. Occurs as a result of central or peripheral neuromuscular disorders that interfere with the clarity of speech and pronunciation. Characterized by weakness, slow movement, and a lack of coordination of the muscles associated with speech.
Giant Cell Arteritis
An autoimmune disease that causes inflammation of the temporal artery; symptoms include: malaise, scalp tenderness, unilateral temporal headache, jaw claudication, throat pain, and sudden vision loss. Considered a medical emergency because of the possibility of ensuing blindness
Disenfranchised Grief:
An experience of the person whose loss cannot be openly acknowledged or publicly mourned.
Family APGAR
Addresses 5 specific family functions: Adaptation, Partnership, Growth, Affection, and Resolution. A score of fewer than 3 out of a possible 10 points indicates a highly dysfunctional family. Useful for: interviewing a new patient, interviewing a person who will be caring for a chronically ill family member, following adverse events, when the patient history suggests family dysfunction
Effective communication strategies for patients with aphasia:
Affects a person's ability to communicate in one or more ways: speaking, understanding, reading, writing, and gesturing. Many types.
Define Dementia
Affects memory, speech, and communication; affects both receptive and expressive communication components; an irreversible state that progresses over years; disturbances in executive functioning; 3 types
Risk factors for Sleep Apnea:
increasing age, increased neck circumference, male sex, anatomical abnormalities of the upper airway, upper airway resistance and/or obstruction, family history, excess weight, use of alcohol, sedatives, or tranquilizers, smoking, HTN
Sociological Theories of Aging
Attempt to explain and predict the changes in roles and relationships in middle and late life, with an emphasis on adjustment.
Modernization Theory:
Attempts to explain the social changes that have resulted in the devaluing of both the contributions of elders and the elders themselves.
Promoting Healthy Skin While Aging:
Avoid excessive exposure to ultraviolet light, keep skin moisturized, avoid use of drying soaps, always use sun screens, keep well hydrated.
Personalistic/Magicoreligious System
Believe that illness is caused by the actions of the supernatural. Illness is a punishment.
Natural Aging of the Renal System:
Blood flow through the kidneys decreases, loss of as many as 50% of the nephrons, decrease in size and function in the kidney cortex.
Pain Cues in a person with communication difficulties:
Changes in behavior (restlessness, repetitive movements), activities of daily living (decreased appetite, decreased sleep), vocalizations ( person groans, moans, or cries), physical changes (pleading expression, grimacing, pallor or flushing).
Activity Theory:
Based on belief that remaining as active as possible in the pursuits of middle age is the ideal in later life. Because of improved general health and wealth, this is more possible than it was 40 years ago when Maddox proposed this theory.
Naturalistic/Holistic Health
Based on the concept of balance and stems from ancient civilizations. View health as a sign of balance.
Natural Aging of Nails:
Become harder and thicker, and more brittle, dull, and opaque. Changes shape, becoming at times flat or concave instead of convex.
Detached Retina
Can develop in persons with cataracts or recent cataract surgery, trauma, or can occur spontaneously. Presents as a curtain coming down over the person's line of vision. Requires immediate emergency treatment.
S/SX of Coronary Heart Disease
Caused by a blockage of these vessels and may be referred to as ateriosclerosis. Develops when cholesterol and other fats are deposited in the layers of the arteries, narrowing the channel through which blood flows and therefore limiting the amount of oxygen reaching the tissue, which is known as ischemia. Direct consequence of untreated HTN. Symptoms: gripping chest pain, radiation to the shoulder. Discomfort in back, abdomen, shoulders, arms. Nausea and vomiting.
Interventions for Wandering or Exiting Behaviors:
Face the person, and make direct eye contact; gently touch the person's arm, shoulders, back, or waist if he/she does not move away; call the person by his/her formal name (i.e Mr. Jones); listen to what the person is communicating verbally and nonverbally, listen to the feelings being expressed; identify the agenda, the plan of action, and the emotional needs the agenda is expressing; respond to the feelings expressed, staying calm; repeat specific words or phrases, or state the need or emotion; If such repetitions fails to distract the person, accompany him/her and continue talking calmly, provide orienting information only if it calms the person'; at intervals, redirect the person toward the facility or home; make sure you have a back up person; have someone call for help if you cannot redirect.
Rehabilitation and Restorative Care
Focus of rehabilitation and restorative care is to capitalize on the individual;s needs and strengths in a manner that will help him/her achieve highest practicable level of functions. Restorative care follows the same principles of rehabilitative care, with the focus of the former on maintenance and the latter on improvement.
Stressors in late life:
Incompetency proceedings, inheritance conflicts, hospitalization, abandonment, institutionalization, separation from personal physician, housing and home maintenance, lack of protection when frail and vulnerable, limited mobility, pain, illness, relocation, loss of children/friends/siblings
Pharmacological Interventions for Pain:
Medication is aimed at altering sensory transmission to the cerebral cortex. Nonnarcotic (acetaminohpen, ibprofen) and narcotic (morphine) as well as adjuvant medications (antidepressants, anticonvulsants) are currently available for use. Older adults experience more adverse reactions that the younger person. It is essential that pain medications are stated at the lowest dose possible. It is equally important that the dosage is titrated to the point that pain is relieved and relief is continuous. Acetaminophen: mild-moderate pain 4000mg is the max in 24 hours Opiates: greater analgesic effect, a higher peak, longer duration of effect. Side Effects- gait disturbance, dizziness, sedation, falls, nausea, pruritus, and constipation.
Age Related Sleep Changes:
More time spent in bed awake before falling asleep, total sleep time reduced, awakenings are frequent, daytime napping, REM stage is short, frequency of abnormal breathing events is increased, frequency of leg movements during sleep is increased
Define Macular Degeneration:
Most common cause of legal blindness in older adult and most common visual impairment of individuals over the age of 50; degenerative eye disease that affects the macula; causes progressive loss of central vision, leaving only peripheral vision intact; Early signs: difficulty reading and driving, increased need for bright light, colors appear dim or gray, awareness of blurry spots; Two types: Wet, Dry
Protein Calorie Malnutrition:
Most common form of malnutrition in older adults, characterized by the presence of clinical signs and biomedical indicators indicative of insufficient intake
Case and Care Management
Must be experts regarding community resources and understand how these can best be used to meet the client's needs; A resource person who the client can seek for advice and counsel and for brokering the flow of services; both of these roles include that of an advocate, broker, leader, manager, counselor, negotiator, administrator, and communicator; Works to optimize the resources and outcome for the client and the agency or community in which the person resides.
Instructions for Persons with COPD
Nutrition: eat small, frequent meals with high protein, select foods that do not require a lot of chewing or cut in bite size pieces, drink 2-3L of fluid daily, Activity Pacing: plan exertion during best periods of day, arrange regular rest periods, allow plenty of time to complete activities, schedule sex around best breathing times of day. General: participate in regular exercise, select and wear clothing and shoes that are easy to put on/remove.
Function of Water Intake:
Thermoregulation, dilution of water-soluble medications, facilitation of renal and bowel function, creating and maintaining metabolic processes.
Intervention for Fatigue:
Types of fatigue from chronic illness affects every aspect of the person's life and may interfere with performing ADLs as well as performing in family and societal roles. Most important intervention is to validate the reality and debilitating effects of the disorder if and when it occurs. Encourage patient to keep a health diary- may assist in self awareness regarding perception and management of a chronic illness. Give patient strategies for energy conservation, appropriate balance of exercise and rest, and adequate nutrition.
The nurse is teaching an older client about measures to prevent constipation. What statement made by the client indicates further teaching is needed? -"I'll walk 1-2 miles everyday" -"I need to decrease fiber in my diet" -"I have a bowel movement everyday" -"I drink 6-8 glasses of water everyday"
"I need to decrease fiber in my diet" -Adequate dietary fiber is an important factor in aiding bowel function. Dietary fiber increases fecal weight and water content and accelerates the transit of fecal mass through the GI tract.
EBP Fall Risk Assessment Tools:
-Hendrich II Fall Risk Model: instrument has been validated with skilled nursing and rehabilitation populations -Morse Fall Scale: widely used in hospitals/inpatient settings -Minimum Data Set (MDS): info about a history of falls and hip fractures in the last 180 days, and the fall-related resident assessment protocol provides an excellent overview of fall risk and fall assessment. -Get Up and Go Test- assessment tool for older client who is asked to rise from a straight-backed chair, stand, walk forward, turn around and walk back to the chair, then sit down.
The nurse is providing an educational session to new employees, and the topic is abuse of the older adult. The nurse helps the employees identify that which client is most typical of a victim of abuse? - 75 y.o man with moderate hypertension - 68 y.o man with newly dx cataracts - 90 y.o woman with advanced Parkinson's dz -70 y.o woman with early dx Lyme dz
90 y.o woman with advanced Parkinson's dz. Elder abuse is widespread and occurs among all subgroups of the population. Elder abuse includes physical and psychological abuse, misuse of property, and violation of rights. The typical abuse victim is a woman of advanced age with few social contacts and at least one physical or mental impairment that limits her ability to perform activities of daily living.
Seborrheic Keratosis
A benign growth that appears mainly on the trunk, face, neck, and scalp as single or multiple lesions found especially in men. A waxy, raised, verrucous lesion, flesh-colored or pigmented in varying sizes.
Hearing Aids:
A personal amplifying system that includes a microphone, an amplifier, and a loud speaker. The goal is to improve communication and quality of life, not to restore normal hearing.
Pruritus
A symptom, not a diagnosis or disease; a threat to skin integrity because of the attempts to relieve it by scratching; aggravated by perfumed detergents, fabric softeners, heat, sudden temperature changes, gentle touch, pressure, vibration, electrical stimuli, sweating, restrictive clothing, fatigue, exercise, and anxiety.
Herpes Zoster
A viral infection frequently seen in older adults; peak incidence occurs between 50-70; immunosuppressed elders and those with histories of chicken pox are at greatest risk; always occurs along a nerve pathway or dermatome; during the healing process, clusters of papulovesicles develop along a nerve pathway.
Define Ageism.
Ageism is a form of prejudice in which older adults are stereotyped by characteristics found in only a few members of their group. Fundamental to ageism is the view that older persons are different from "me" and will remain different from "me." Therefore, they are portrayed as not experiencing the same desires, needs, and concerns.
Define Holistic Nursing with Older Adult client
An integrated method of functioning which is oriented toward maximizing the potential of which an individual is capable within the environment where he is functioning.
Social Exchange Theory:
Based on the consideration of the cost benefit model of social participation. Explains that withdrawal or social isolation is the result of an imbalance in the exchange between older persons and younger members of society and that the balance is what determines one's personal satisfaction and social support at any other point in time.
Define the Neuroendocrine Theory.
Based on the integration of the neuroendocrine and immune systems; emphasis is on the programmed deaths of the immune cells from damage caused by the increase of free radicals as aging progresses; the reduced T cells are thought to be responsible for hastening the age-related changes caused by autoimmune reaction as the body battles itself; healthy cells are mistaken for foreign substances and are attacked.
Define Global Aphasia:
Cannot understand words or speak intelligibly.
Wound Healing
Cells die from ischemia or anoxia. Tissue tolerance is inversely affected by moisture, amount of pressure, friction, shearing, and age is directly related to malnutrition, anemia, and low arterial pressure. Lab Values- look for anemia and poor nutritional status.
Natural aging of the Neurological System:
Central Nervous System: dendrites appear to be "wearing out", number of neurons found decreases, decrease in brain weight and size. Peripheral Nervous System: tactile sensitivity decreases in connection with the loss of a large number of nerve endings in the skin.
The nurse is providing medication instructions to an older client who is taking digoxin (Lanoxin) daily. What age related body changes could place the client at risk for digoxin toxicity?
Decreased lean body mass and decreased glomerular filtration rate.
Simple Screen for Dehydration:
Drugs e.g diuretics End of life High fever Yellow urine turns dark Dizziness (orthostasis) Reduced oral intake Axilla dry Tachycardia Incontinence Oral problems/sippers Neurological impairment Sunken Eyes
Natural sensory changes:
Ear/Hearing: auricle, pinna loses flexibility and becomes longer and wider, auditory canal narrows causing inward collapsing, stiffer and coarser hair lines the ear canal, cerumen glands atrophy, ossivle hoints between the malleus and the stapes develop calcification, decrease in vestibular sensitivity, conductive and sensorineural hearing loss.
Established Urinary Incontinence:
Either a sudden or gradual onset. Categorized into: Urge UI, Stress, Overflow, Functional, Mixed, Reflex, and Total.
Stage 1 Pressure Ulcer
Erythema not resolving within 30 minutes of pressure relief. Epidermis remains intact. Reversible with intervention.
Mixed Incontinence:
Established UI. Combination of more than one urinary incontinence problem, usually stress and urge. Most prevalent type of incontinence in older women.
Total Incontinence
Established UI. Continuous and unpredictable loss of urine as a result of anatomical abnormalities. Usually results from surgery, trauma, or malformation.
Overflow Incontinence:
Established UI. Defined as the involuntary loss of urine associated with overdistention of the bladder. Causes include obstruction of the urethra by fecal impaction or an enlarged prostate, smooth muscle relaxants that relax that bladder muscle and increase bladder capacity, tumors, structures, impaired ability to contact the bladder.
Reflex Incontinence:
Established UI. Occurs when bladder empties autonomically without the sensation to void. Reflex UI occurs with spinal cord injuries.
Stress Incontinence:
Established UI. Outlet Incompetence. Defined as an involuntary loss of less than 50 ml of urine associated with activities that increase intraabdominal pressure (i.e coughing, sneezing, exercise, lifting.)
Urge Incontinence:
Established UI. Overactive bladder. Defined as involuntary urine loss that occurs soon after feeling an urgent need to void.
Functional Incontinence:
Established UI. Refers to situation in which lower urinary tract is intact but the individual is unable to reach the toilet because of environmental barriers, physical limitations, or severe cognitive impairment.
Effects of activity on glucose metabolism:
Exercise is an important aspect of therapy for Type 2 DM because it increases insulin production and decreases insulin resistance. Exercise in conjunction with an appropriate diet may be sufficient to maintain blood glucose levels within normal levels in some cases. A more intensive exercise program shouldn't be started until the older adult has had a physical examination, including a stress test and ECG. Exercise decreases blood sugar. In a person using insulin,exercise must be done on a regular basis rather than an erratic basis. Blood glucose should be tested before/after exercise to avoid hypoglycemia.
Natural Aging of Reproductive System:
Female: menopause, breasts are smaller and less firm, labia majora and minora become less prominent and pubic hair thins, ovaries, cervix, and uterus slowly atrophy. Male: Decreased fertility, erectile changes, prostatic enlargement.
Presbycusis
Form of sensorineural hearing loss that is related to aging. Most common form of hearing loss in the U.S.
Stage 3 Pressure Ulcer
Full-thickness tissue loss extending through dermis to involve subcutaneous tissue. Presents as shallow crater unless covered by eschar. May include necrotic tissue, undermining, sinus tract formation, exudate, and/or infection. Wound base is usually not painful.
The nurse is working with older clients in a long term care facility. Which activities performed by the nurse fosters reminiscence among these clients?
Having storytelling hours- clients who like to retell stories or past events need to be provided time to do so. It is a way for the older adult to relive and restructure life experiences and is a part of achieving ego identity.
The home care nurse is visiting an older female client whose husband died 6 months ago. What behavior by the client indicates ineffective coping? - Neglect personal grooming -Looking at old pictures -Participating in senior citizens' program -Visiting her husband's grave
Neglecting personal grooming. Coping mechanisms are behaviors used to decrease anxiety and stress. In response to death, ineffective coping is manifested by an extreme behavior that in some cases may be harmful to the individual.
Natural Aging of Hair:
Men and women in all racial groups have less hair as they grow older, the amount of hair in the ears, nose and eyebrows of older men increases, older women develop chin and facial hair.
Cerumen Impaction:
Most common an easily corrected of all interferences in the hearing of older people. Cerumen interferes with the conduction of sound through air in the ear drum. Individuals at risk: blacks, wears hearing aids, older men with large amounts of ear canal tragi
Natural Aging of Gastrointestinal System:
Mouth: Teeth eventually lose enamel and dentin, and become vulnerable to caries, the roots become more brittle and break more easily, gums more susceptible to periodontal disease, taste buds decline in number, salivary secretion lessens. Esophagus: contractions increase in frequency but are more disordered, and propulsion is less effective. GERD and hiatal hernias. Stomach: decreased gastric motility and volume, reductions in secretion of bicarbonate and gastric mucus. Decreased production of intrinsic factor, more susceptible to peptic ulcer disease, anorexia or weight loss. Intestines: villi become broader, shorter, and less functional, nutrient absorption affected, and peristalsis slowed. Accessory Organs: liver decreases in volume/weight, impaired drug metabolism by the liver, incidence of gallstones increases
Age-Stratification Theory:
Newer approach to understanding the role, the reactions, and the adaptations of older adults. Goes beyond the individual to the age structure of society. Elders can be understood as members of cohorts along with others who have shared similar historical periods in their lives, with age graded systems of expectations and rewards.
Old-Old
Over 85 years of age.
Natural Aging of Endocrine System:
Pancreas: tissues of they body often develop decreased sensitivity to insulin. Thyroid Gland: some atrophy, fibrosis, and inflammation. Diminished secretion of TSH and T4. Decreased plasma T3.
Stage 2 Pressure Ulcer
Partial-thickness loss of skin layers involving epidermis and possibly penetrating into but not through dermis. May present as blistering with erythema and/or induration; wound base moist and pink; painful; free of necrotic tissue.
Factors which make an older client susceptible to dehydration
Physical/emotional illness, surgery, trauma, conditions of higher physiologic demands, diminished thirst sensation, medications,functional deficit, communication and comprehension problems, dysphagia, depression, dementia, hospitalization, low body weight, diagnostic procedures necessitating fasting, inadequate assistance with fluid intake, diarrhea, fever, vomiting, infections, bleeding, draining wounds, artificial ventilation, fluid restrictions, high environmental temperature
Proper use of assistive devices to prevent falls
Put all your weight on unaffected leg, wear low heeled, nonskid shows, when using a cane on stairs, step up with strong leg and down with weaker leg, when using a walker, stand upright and lift or roll the walker with both hands, lean slightly forward and hold the arms of the walker for support.
Maslow's Hierarchy of Human Needs
Ranks needs from the most basic to the most complex. The needs of higher levels cannot be met without first meeting. As basic level needs are met, the satisfaction of higher level needs is possible. Basic: Biological and Physiological Integrity (Ex: air) Safety and Security (Ex: Protections) Belonging and Attachment (Ex: love, empathy) Self-Esteem and Self-Efficacy (Ex: image, identity) Complex: Self Actualization and Transcendence (Ex: seeking, expanding, spirituality).
The nurse is providing instructions to a nursing assistant regarding care of an older client with hearing loss. The nurse tells the assistant that clients with a hear loss:
Respond to low pitched tones. Prebycusis refers to the age related irreversible degenerative changes of the inner eat that lead to decreased hearing ability. As a result of these changes, the older client has a decreased response to high frequency sounds. Low pitched voice tones are heard more easily and can be interpreted by the older client.
The visiting nurse observes that the older male client is confined by his daughter to his room. When the nurse suggests that he walk into the den and join everyone, he says "I'm in everyone's way, my daughter needs me to stay here." The most important action for the nurse is to:
Suggest appropriate resources to the client and daughter-in-law, such as respite care and a senior citizens' center. Assisting clients and families to become aware of available community support systems is a role and responsibility of the nurse.
Natural Aging of Digestion/Eating Habits
Taste- sour, salty, and bitter tastes become diminished. Smell- remains the same Regulation of appetite- activity level and motor skills. Changes in neurotransmitter regulators of appetite have been implicated in impaired appetite and decreased intake associated with aging. Disease states also increase cytokine levels as a result of its release by diseased tissues. increase in cholecystokinin levels also occurs in malnourished individuals, which may further decrease appetite.
Health Disparities:
The barriers to quality care were found to be wide, ranging from those related to geographical location to age, sex, race, ethnicity, and sexual orientation. Before change can occur, health care providers must become more culturally competent. Moving toward culturally proficient gerontological nursing care is one of the major strategies to reduce health disparities.
Define Nonfluent Aphasia:
Usually understands others but speaks very slowly and uses minimal numbers of words.
Natural Aging of Musculoskeletal System:
Vertebral disks become thin, causing shortening of trunk. Stooped, slightly forward-bent posture is common. Alternation in body shape and weight occurs as lean body mass declines and body water is lost. Reduced bone mineral density.
Gerontologic Specialty Certification
The number of older people continues to increase; the need for specialized knowledge becomes even more critical in every specialty and every health care setting; In 1974, geriatric nursing was the first certification program offered by the ANA and nursing was the first professional group to develop standards of care and certification in the field of gerontology
Natural Aging of Epidermis:
Thins, making blood vessels and bruises much more visible. Cell-renewal time increases.
Transient Urinary Incontinence:
UTI, irritable bladder. Sudden onset (acute), present for six months or less, usually caused by treatable factors.
Define Anomic Aphasia:
Understand and speak readily but may have severe word finding difficulty.
The home care nurse is performing an environmental assessment in the home of an older adult. Which of the following requires immediate nursing action? Unsecured scattered rugs, operable smoke detector, or prefilled medication cassette?
Unsecured scattered rugs- trauma to the older client in the home may be caused by a variety of factors. These include unsteady gait, the presence of unsecured scatter rugs, clattered passageways, and inoperable smoke detectors.
The nurse who volunteers at a senior citizens' center is planning activities for the members. What activity would best promote health and maintenance?
Walking 3-5 times per week for 30 minutes. Exercise and activity are essential for health promotion and maintenance.
Examples of moderate intensity exercises:
Washing/Waxing car for 45-60 minutes; Washing windows/floors for 45-60 minutes; Gardening for 35-40 minutes; Wheeling one's self in a wheelchair for 30-40 minutes; Walking 2 miles in 30 minutes; swimming laps/water aerobics for 20 minutes.
Promoting healthy ears:
avoid exposure to excessively loud noises, avoid injury with cotton tipped applicators, use assistive devices as appropriate, see health care provider promptly for sudden changes in hearing.
Cochlear implants:
used if adult is profoundly deaf as a result of sensorineural hearing loss. Surgically implanted in the mastoid bone behind the ear. Electrically stimulates the cochlea, setting the cilia in motion and transmitting impulses along the auditory nerve to the brain's hearing center.
Promote a healthy heart:
engage in regular exercise, eat a low fat, low cholesterol, balanced diet, maintain tight control of diabetes, do not smoke, avoid environmental pollutants, practice stress management, minimize sodium intake, maintain ideal body weight.
