Chapter 8: Care of the Older Adult

An older adult develops sudden onset of confusion and is hospitalized. The family expresses concern that their loved one is developing Alzheimer disease. What response by the nurse is most appropriate?

"Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion." Explanation: Delirium is associated with a sudden onset of confusion, not Alzheimer disease. The family needs to be told the correct information, which is that several underlying conditions could be causing the confusion. Once the underlying cause(s) is found and treated, the confusion should subside; however, some clients may not recover from the underlying cause, so telling the family the client will be better than ever is not appropriate. Asking the family about their concerns about Alzheimer disease and what they know about community support related to it is not appropriate because the client is exhibiting symptoms related to delirium.

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 Frequently change the furniture layout in the home Wear nonslip shoes or socks when walking Review medications routinely for side effects Use scatter rugs on hard wood surfaces.

-Wear nonslip shoes or socks when walking -Review medications routinely for side effects - Place grab bars in the shower and tub - Have routine vision and hearing screenings

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." Neglect is the most common form of elder abuse. The inability of an older adult to obtain basic care is considered neglect. If a client is not being turned or repositioned to prevent skin breakdown, then neglect is happening. A BMI of 24 is within the normal range, and the inability of the client to have his or her favorite foods would not be abuse. The client with diabetes has blood sugar within normal ranges, and the client is only expressing concern over the cost of medications; social services may need to be notified to provide help through community resources. The story provided by the older adult with the deformed arm is consistent with the injury.

The nurse is concerned that an older adult is experiencing ageism. Which client statement did the nurse use to make this clinical determination?

"My grandchildren think I should work for my Social Security payments." Explanation: Ageism, or prejudice or discrimination against older adults, predominates in society, and there are many myths about aging. This belief is based on stereotypes that reinforce society's negative image of older adults. Retirement and perceived nonproductivity are partly responsible for negative feelings because a younger working person may falsely see older people as not contributing to society and draining economic resources. The grandchildren believing that the client should work for Social Security payments demonstrates ageism. A neighbor cutting grass, placement of the daily newspaper, and help with groceries are not examples of ageism.

An older adult seeks medical attention for a new onset of epigastric distress and bilateral arm pain. Which action will the nurse complete? Recommend taking an over-the-counter antacid. Assess cardiovascular function. Encourage the client to ambulate. Review the contents of the client's most recent meal.

Assess cardiovascular function. Explanation: Careful assessment of older adults is necessary because they often present with different symptoms than those seen in younger clients. Rather than the typical substernal chest pain associated with myocardial ischemia, older adults may report burning or sharp pain or discomfort in an area of the upper body. When a client reports symptoms related to digestion and breathing and upper extremity pain, cardiac disease must be considered. Because the absence of chest pain in an older client is not a reliable indicator of the absence of heart disease, the client should not be encouraged to ambulate or recommended to take an over-the-counter antacid. Time should not be wasted reviewing the contents of the client's most recent meal.

The nurse identifies which of the following as an age-related change in the respiratory system?

Increased residual lung volume Explanation: The older adult experiences an increase in residual lung volume, decreased vital capacity, decreased diffusing capacity, and decreased cough efficiency.

A department of nursing within a health care organization is adopting the Functional Consequences Theory when caring for older adults. Which action would the nurse take to faciliate using this theory when caring for a client? Recognize that immune system changes cannot be altered. Identify reasons for changes in musculoskeletal function. Plan interventions to address consequences of age-related changes. Establish improvement of cognitive function as the overall goal of care.

Plan interventions to address consequences of age-related changes. Explanation: The Functional Consequences Theory encourages nurses to consider the effects of normal age-related changes and the damage caused by disease or environment and behavioral risk factors when planning care. This theory suggests that nurses can alter the outcome for clients through nursing interventions that address the consequences of these changes. The Functional Consequences Theory does not focus specifically on musculoskeletal function, immunity, or cognitive functioning.

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. decreased smoking improved nutrition screening for hypertension early detection of elevated cholesterol levels decreased exercise decreased community-based services

decreased smoking improved nutrition screening for hypertension early detection of elevated cholesterol levels Most deaths in the United States occur in people 65 years or older, with one-half of these caused by heart disease and cancer. Decreased smoking, improved nutrition, screening for hypertension, and early detection of elevated cholesterol levels are contributing factors to a decreased death rate in older adults. Older adults are encouraged to increase exercise and increase community-based services.

The nurse caring for residents of a long-term care facility is explaining the occurrence of elder abuse in such facilities. Which statement from the nurse indicates the need for more education? "Older adults with disabilities are at increased risk for elder abuse." "Limitations to activities of daily living contribute to risk of elder abuse." "Older adults in long-term care facilities are at low risk for elder abuse." "Most states requires nurses to report elder abuse."

"Older adults in long-term care facilities are at low risk for elder abuse." Explanation: Residence in a long-term care facility does not result in a lower risk for elder abuse. Older adults with disabilities of all types are at increased risk for elder abuse from family members, paid caregivers, and staff, whether they live in the community or a long-term care facility. Most states require caregivers, including nurses, to report elder abuse. Another factor that places older adults at higher risk of abuse is limitations to activities of daily living.

An older female client is concerned because of experiencing vaginal bleeding after having intercourse. Which response will the nurse make to this client?

"The vaginal tissues are dryer with aging." Explanation: With aging, changes that occur in the female reproductive system include thinning of the vaginal wall along with a shortening of the vagina and a loss of elasticity; decreased vaginal secretions, resulting in vaginal dryness, itching, and decreased acidity; involution of the uterus and ovaries; and decreased pubococcygeal muscle tone, resulting in a relaxed vagina and perineum. Without the use of water-soluble lubricants, these changes may contribute to vaginal bleeding and painful intercourse. Older adults report that a fairly stable and active sex life is an important quality of life issue. Although the vaginal walls become thinner as women age, this is not associated with bleeding after intercourse.

An older adult female has been widowed for several years. Which statements indicate to the nurse that the client may need to consider a change in living arrangements? Select all that apply. "My granddaughter helps me with my laundry." "I attend religious services twice a week at my church." "I don't like to cook for myself anymore." "There is no one to talk to most days of the week." "I have coffee with my neighbor every morning."

"There is no one to talk to most days of the week." "I don't like to cook for myself anymore." Many older adults have more than adequate financial resources and good health even until very late in life; therefore, they have many housing options. Many older adults relocate in response to changes in their lives such as retirement or widowhood, a significant deterioration in health, or disability. Older adults may move to retirement facilities or assisted living communities that provide some support, such as meals. These types of facilities will also provide opportunities for socialization. The client would not necessarily want to change current living arrangements if grandchildren are available to assist, or if there is a strong support system with neighbors or faith community.