Older Adults Chapter 14 NRS 101 EXAM 4

Acute care settings pose risks for adverse events including:

- Delirium -Dehydration - Malnutrition - Health care-associated infections - Urinary incontinence - Falls

What are the goals for Healthy People 2010?

- Increasing the number with one or more chronic conditions who report confidence in maintaining their conditions. - Reducing the number with moderate to severe functional limitations. - Reducing the number of emergency department visits resulting from falls - Increasing the number who live at home but have unmet long-term services - Increasing the number with reduced physical or cognitive function who engage in leisure-term physical activities

What are different health promotion preventative measures?

- Participating in screening activities - Regular exercise - Weight reduction, if overweight - Eating a low-fat, well-balanced diet - Moderate alcohol use - Regular dental visits - Smoking cessation - Immunization

A 63-year-old patient is retiring from his job at an accounting firm where he was in a management role for the past 20 years. He has been with the same company for 42 years and was a dedicated employee. His wife is a homemaker. She raised their five children, babysits for her grandchildren as needed, and belongs to numerous church committees. What are your major concerns for this patient? (Select all that apply.) A. The loss of his work role B. The risk of social isolation C. A determination if the wife will need to start working D. How the wife expects household tasks to be divided in the home in retirement E. The age the patient chose to retire

A. The loss of his work role D. How the wife expects household tasks to be divided in the home in retirement The psychosocial stresses of retirement are usually related to role changes with a spouse or within the family and to loss of the work role. Often there are new expectations of the retired person. This patient is not likely to become socially isolated because of the size of the family. Whether the wife will have to work is not a major concern at this time, nor is the age of the patient.

At what age is it considered to be the lower boundary for "old age" in demographics and social policy within the United States?

Age 65

A nurse has conducted an assessment of a new patient who has come to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the nursing history. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing: A. Dementia. B. Depression. C. Delirium. D. Disengagement.

B. Depression. Factors that often lead to depression include presence of a chronic disease or a recent change or life event (such as loss). Patients are alert but easily distracted in conversation.

A 71-year-old patient enters the emergency department after falling down stairs in the home. The nurse is conducting a fall history with the patient and his wife. They live in a one-level ranch home. He has had diabetes for over 15 years and experiences some numbness in his feet. He wears bifocal glasses. His blood pressure is stable around 130/70. The patient does not exercise regularly and complains of weakness in his legs when climbing stairs. He is alert, oriented, and able to answer questions clearly. What are the fall risk factors for this patient? (Select all that apply.) A. Presence of a chronic disease B. Impaired vision C. Residence design D. Blood pressure E. Leg weakness F. Exercise history

B. Impaired vision E. Leg weakness F. Exercise history Risk factors for falling include sensory changes such as visual loss, musculoskeletal conditions affecting mobility (in this case weakness), and deconditioning (from lack of exercise). The mere presence of a chronic disease is not a risk factor unless it is a condition such as a neurological disorder that alters mobility or cognitive function. The patient's blood pressure is stable, and there is no report of orthostatic hypotension. A one-floor residence should not pose risks.

Taste buds atrophy and lose sensitivity, and appetite may decrease. As a result, the older adult is less able to discern: A. Spicy and bland foods. B. Salty, sour, and bitter tastes. C. Hot and cold food temperatures. D. Moist and dry food preparations.

B. Salty, sour, and bitter tastes. Often an older adult uses "heavy" spices because of his or her inability to taste the food.

A nurse is caring for a patient preparing for discharge from the hospital the next day. The patient does not read and has a hearing loss. His family caregiver will be visiting before discharge. What can you do to facilitate the patient's understanding of his discharge instructions? (Select all that apply.) A. Speak loudly so the patient can hear you. B. Sit facing the patient so he is able to watch your lip movements and facial expressions. C. Present one idea or concept at a time. D. Send a written copy of the instructions home with him and tell him to have the family review them. E. Include the family caregiver in the teaching session.

B. Sit facing the patient so he is able to watch your lip movements and facial expressions. C. Present one idea or concept at a time. E. Include the family caregiver in the teaching session. Teaching and communication are more effective with older adults when you sit and face the patient and present one idea or concept at a time. This requires planning. Speaking loudly can distort sound. Speak in a normal tone. Sending instructions is helpful but will not directly facilitate the patient's own understanding. Sharing information with a caregiver provides someone to clarify instructions.

A nurse is caring for a patient preparing for discharge from the hospital the next day. The patient does not read and has a hearing loss. His family caregiver will be visiting before discharge. What can you do to facilitate the patient's understanding of his discharge instructions? (Select all that apply.) A. Shout so the patient can hear you. B. Sit facing the patient so he is able to watch your lip movements and facial expressions. C. Present one idea or concept at a time. D. Send a written copy of the instructions home with him and tell him to have the family review them. E. Include the family caregiver in the teaching session.

B. Sit facing the patient so he is able to watch your lip movements and facial expressions. C. Present one idea or concept at a time. D. Send a written copy of the instructions home with him and tell him to have the family review them. E. Include the family caregiver in the teaching session.

During a home health visit a nurse talks with a patient and his family caregiver about the patient's medications. The patient has hypertension and renal disease. Which of the following findings places him at risk for an adverse drug event? (Select all that apply.) A. Taking two medications for hypertension B. Taking a total of eight different medications during the day C. Having one physician who reviews all medications D. Patient's health history E. Involvement of the caregiver in assisting with medication administration

B. Taking a total of eight different medications during the day D. Patient's health history The patient is at risk for an adverse drug event (ADE) because of polypharmacy and his history of renal disease, which affects drug excretion. Taking two medications for hypertension is common. Having one physician review all medications and involving a family caregiver are desirable and are safety factors for preventing ADEs.

A patient's family member is considering having her mother placed in a nursing center. You have talked with the family before and know that this is a difficult decision. Which of the following criteria would you recommend in choosing a nursing center? (Select all that apply.) A. The center should be clean, and rooms should look like a hospital room. B. There should be adequate staffing on all shifts. C. Social activities should be available for all residents. D. Three meals should be served daily with a set menu and serving schedule. E. Family involvement in care planning and assisting with physical care is necessary.

B. There should be adequate staffing on all shifts. C. Social activities should be available for all residents. E. Family involvement in care planning and assisting with physical care is necessary. Adequate staffing, provision of social activities, and active family involvement are essential. Meals should be high quality with options for what to eat and when it is served. A nursing center should be clean, but it should look like a person's home.

You see a 76-year-old woman in the outpatient clinic. Her chief complaint is vision. She states she has really noticed glare in the lights at home. Her vision is blurred; and she is unable to play cards with her friends, read, or do her needlework. You suspect that she may have: A. Presbyopia. B. Disengagement. C. Cataract(s). D. Depression.

C. Cataract(s). Cataracts normally result in blurred vision, sensitivity to glare, and gradual loss of vision. Presbyopia is a common eye condition resulting in a person having difficulty adjusting to near and far vision. The symptoms are not reflective of depression since her vision affects her ability to interact. She has not chosen to avoid her friends. Disengagement is a term referring to aging theory.

Kyphosis, a change in the musculoskeletal system, leads to: A. Decreased bone density in the vertebrae and hips. B. Increased risk for pathological stress fractures in the hips. C. Changes in the configuration of the spine that affect the lungs and thorax. D. Calcification of the bony tissues of the long bones such as in the legs and arm.

C. Changes in the configuration of the spine that affect the lungs and thorax. This can also affect the ability of the patient to deep breath and cough effectively.

A major life event such as the death of a loved one, a move to a nursing home, or a cancer diagnosis could precipitate: A. Dementia. B. Delirium. C. Depression. D. Stroke.

C. Depression. The onset of depression could be abrupt or gradual, but the usual cause is a major life-altering event in the life of the person experiencing the depression.

You are working with an older adult after an acute hospitalization. Your goal is to help this person be more in touch with time, place, and person. What might you try? A. Reminiscence B. Validation therapy C. Reality orientation D. Body image interventions

C. Reality orientation Reality orientation is a communication technique that can help restore a sense of reality, improve level of awareness, promote socialization, elevate independent functioning, and minimize confusion.

Identify common myths and stereotypes about older adults.

Common myths include: ill, disabled, unattractive, forgetful, confused, rigid, boring, unfriendly, unable to learn and understand new information, and not interested in sex or sexual activities.

Sexuality is maintained throughout our lives. Which answer below best explains sexuality in an older adult? A. When the sexual partner passes away, the survivor no longer feels sexual. B. A decrease in an older adult's libido occurs. C. Any outward expression of sexuality suggests that the older adult is having a developmental problem. D. All older adults, whether healthy or frail, need to express sexual feelings.

D. All older adults, whether healthy or frail, need to express sexual feelings. Sexuality is normal throughout the life span, and older adults need to be able to express their sexual feelings.

Older adults experience a change in sexual activity. Which best explains this change? A. The need to touch and be touched is decreased. B. The sexual preferences of older adults are not as diverse. C. Physical changes usually do not affect sexual functioning. D. Frequency and opportunities for sexual activity may decline.

D. Frequency and opportunities for sexual activity may decline. As a result of loss of a loved one or a chronic illness in themselves or their partner, opportunities for sexual activity may decline.

You are caring for an 80-year-old man who recently lost his wife. He shares with you that he has been drinking more than he ever did in the past and feels hopeless without his wife. He reports that he rarely sees his children and feels isolated and alone. This patient is at risk for: A. Dementia. B. Liver failure. C. Dehydration. D. Suicide.

D. Suicide. The patient is sharing that he is depressed. Key concepts include recent loss of his wife, excessive drinking, hopelessness, and isolation, making him at risk for suicide.

A student nurse is caring for a 78-year-old patient with multiple sclerosis. The patient has had an indwelling Foley catheter in for 3 days. Eight hours ago the patient's temperature was 37.1° C (98.8° F). The student reports her recent assessment to the registered nurse (RN): the patient's temperature is 37.2° C (99° F); the Foley catheter is still in place, draining dark urine; and the patient is uncertain what time of day it is. From what the RN knows about presentation of symptoms in older adults, what should he recommend? A. Tell the student that temporary confusion is normal and simply requires reorientation B. Tell the student to increase the patient's fluid intake since the urine is concentrated C. Tell the student that her assessment findings are normal for an older adult D. Tell the student that he will notify the physician of the findings

D. Tell the student that he will notify the physician of the findings The patient may have subtle symptoms of a urinary tract infection, as evidenced by a slight increase in body temperature, development of confusion, and the dark-colored urine. Temporary confusion is not a normal condition in older adults. Increasing the fluid intake is acceptable but not a recommendation for the set of symptoms the patient presents. The presenting set of symptoms is not normal.

What are functional changes in older adults?

Day-to-day activities of ADLs involving activities within physical, psychological, cognitive, and social domains. Changes are usually linked to illness or to disease and degree of chronicity.

Define Delirium.

Delirium - or acute confusional state, is potentially a reversible cognitive impairment that often has a physiological cause

Define Dementia.

Dementia - is a generalized impairment of intellectual functioning that interferes with social and occupational functioning, cognitive function deterioration leads to a decline in the ability to perform basic ADLs and IADLs.

Define Depression.

Depression - reduction in happiness and well being that contributes to physical and social limitations and complicates the treatment of concomitant medical conditions. It is usually reversible with treatment. Fourth stage of Kubler-Ross's stages of grief and dying, in this stage the person realizes the full impact and significant of the loss.

What are the factors that contribute to the projected increase in number of older adults?

Factors that contribute to the projected increase in number of older adults is the aging of the baby-boom generation and the growth of the population segment over age 85.

Describe health concerns of older adults.

Health concerns of adult adults include sleep disorders, problems with eating or feeding, incontinence, confusion, evidence of falls, and skin breakdown.

Discuss issues related to psychosocial changes of aging.

Issues related to psychosocial changes of aging include retirement, social isolation, sexuality, housing and environment and must be appropriate for the functional and safety needs of the older adults, and death.

List ways nurses can assess a patient's potential for social isolation.

Nurses assess a patient's potential for social isolation by identifying their social network, access to transportation, and willingness and desire to interact with others.

What should a nurses' attitude be like toward older adults?

Nurses need to recognize and address ageism by questions prevailing negative attitudes and stereotypes and reinforcing the realities of aging as they care for older adults in all care settings. It is critical for you to learn to respect older adults and actively involve them in care decisions and activities.

What are the theories that are incorporated with the psychosocial theories?

PSYCHOSOCIAL THEORIES OF AGING - developed during the 1960s, explain changes in behavior, roles, and relationships that come with aging. These theories reflect the values that the theorist and society held at the time the theory was developed. A sample of theories follows. DISENGAGEMENT THEORY - the oldest psychosocial theory, states that aging individuals withdraw from customary roles and engage in more introspective, SELF-FOCUSED activities. ACTIVITY THEORY - unlike the disengagement theory, considers the continuation of activities performed during middle age as necessary for successful aging. CONTINUITY THEORY (or developmental theories) - suggests that PERSONALITY REMAINS STABLE and BEHAVIOR BECOMES MORE PREDICTABLE. The personality and behavior patterns developed during a lifetime determine the degree of engagement and activity in older adulthood. The more recent theory of GEROTRANSCENDENCE -proposes that the older adult experiences a shift in perspective with age. The person moves from a materialistic and national view of the world to a more cosmic and transcendent one, causing an increase in overall life satisfaction. Critics suggest that theories either fail in some measure to consider the many factors that affect an individual's response to aging or address those factors in a too-simplistic fashion. Rather, each individual ages uniquely.

Describe common physiological changes of aging.

Physiological changes include: perception of well-being defines quality of life, older patients' concept of health revolves around how they perceive their ability to function, nurses need to be cognizant of normal age-related changes, not all physiological changes are pathological.

What is Polypharmacy and why is it a potential issue for older adults?

Polypharmacy is the use of a number of different drugs by a patient who may have one or several health problems. It is an important factor in causing numerous health problems for older adults, including the risk for adverse drug events (ADEs), the inappropriate use of medications, and falls.

Define Reality Orientation.

Reality Orientation is the therapeutic modality for restoring an individual's sense of the present.

Define Reminiscence.

Reminiscence is the recalling the past to assign new meaning to past experiences.

What is one of the greatest challenges for older adults?

Safe medication use

When interviewing older adults, what techniques should you keep in mind?

Sit or stand at eye level, in front of the patient in full view. Face the older adult while speaking; do not cover your mouth. Speak clearly. Provide diffuse, bright, nonglare lighting.Encourage the older adult to use his or her familiar assistive devices such as glasses or magnifiers.

Identify nursing interventions related to the physiological, cognitive, and psychosocial changes of aging.

Sleep problems - manage patient's pain by giving pain meds before bedtime, attempt to keep patient awake during the day to prevent insomnia, keep staff conversations quiet and away from patient's room, postpone treatments until waking hours or early morning. Problems with eating and feeding - preform nutritional screenings on the first day of patient admission, collaborate with the RD about patient's nutritional status, consider cultural preferences, manage symptoms such as pain, nausea, vomiting. Coordinate care for patient with speech language pathologist and dietitian if difficulty chewing or swallowing, encourage family members to bring in food that patient like. Incontinence - assess the patient to identify causes, place patient on toileting schedule or bowel/bladder training program Confusion - avoid multiple drugs and promote adequate sleep can help prevent acute confusion, reorient patient to reality as much as needed, keep patient as comfy as possible, provide interventions to control pain Falls - assess for risk, monitor activities as often as possible 30-60 min, remind patient to call for help when getting out of bed, teach to use grab bars or walker or cane, remind to wear eyeglasses or hearing aid, bathroom schedules, clear path to bathroom, bed in lowest position, place objects within reach Skin breakdown - proper nutritional support, avoid skin injury from friction or shearing forces, reposition and support surfaces, plan to increase mobility and activity level when appropriate, skin cleansing and use of moisture barriers.

What are the theories that are incorporated with the biological theories of aging?

The biological theories of aging are either stochastic or nonstochastic. STOCHASTIC THEORIES - view aging as the result of random CELLULAR DAMAGE that occurs over time. The accumulated damage leads to the physical changes that are recognized as characteristic of the aging process. NONSTOCHASTIC THEORIES - view aging as the result of GENETICALLY PROGRAMMED physiological mechanisms within the body that control the process of aging.

Identify biological and psychosocial theories of aging.

The biological theories of aging are either stochastic or nonstochastic. Stochastic theories view aging as the result of random cellular damage that occurs over time. The accumulated damage leads to the physical changes that are recognized as characteristic of the aging process. Nonstochastic theories view aging as the result of genetically programmed physiological mechanisms within the body that control the process of aging. The psychosocial theories of aging, developed during the 1960s, explain changes in behavior, roles, and relationships that come with aging. These theories reflect the values that the theorist and society held at the time the theory was developed. A sample of theories follows. Disengagement theory, the oldest psychosocial theory, states that aging individuals withdraw from customary roles and engage in more introspective, self-focused activities. The activity theory, unlike the disengagement theory, considers the continuation of activities performed during middle age as necessary for successful aging. Continuity theory, or developmental theories, suggests that personality remains stable and behavior becomes more predictable as people age. The personality and behavior patterns developed during a lifetime determine the degree of engagement and activity in older adulthood. The more recent theory of gerotranscendence proposes that the older adult experiences a shift in perspective with age. The person moves from a materialistic and national view of the world to a more cosmic and transcendent one, causing an increase in overall life satisfaction. Critics suggest that theories either fail in some measure to consider the many factors that affect an individual's response to aging or address those factors in a too-simplistic fashion. Rather, each individual ages uniquely.

What were the most frequently diagnosed chronic conditions occurring in 2005 to 2007?

The most frequently diagnosed chronic conditions occurring in 2005 to 2007 were arthritis, hypertension, and types of heart disease, and cancer, and diabetes.

_________ of ________ are closely linked to the concept of developmental tasks appropriate for distinct stages of life.

Theories of aging

Discuss common developmental tasks of older adults.

• Adjusting to decreasing health and physical strength • Adjusting to retirement and reduced or fixed income • Adjusting to death of a spouse, children, siblings, friends • Accepting self as aging person • Maintaining satisfactory living arrangements • Redefining relationships with adult children and siblings • Finding ways to maintain quality of life • Linked to the concept of developmental tasks appropriate for stages in life (deaths of friends and significant others, retirement and reduced or fixed income, changes in quality of life or living arrangements) • Structural and functional changes (failing health and physical strength) • Self-acceptance

What are some principles for promoting older-adult learning?

• Make sure that the patient is ready to learn before trying to teach • Is the patient physically well enough or are they in pain • Sit facing the patient so he or she is able to watch your lip movements and facial expressions • Speak slowly and in a normal tone of voice • Present one idea or concept at a time • Emphasize concrete rather than abstract material • Give the patient enough time in which to respond because older adults process information slower than younger persons • Keep environmental distractions to a minimum. Provide appropriate lighting and a comfortable setting • Defer teaching is the patient becomes distracted or tired or cannot concentrate for other reasons • Invite another member of the household to join the discussion • Use audio, visual, and tactile cues to enhance learning and help the patient remember information • Ask for feedback to ensure that the patient understands the information • Use past experience; connect new learning to previous knowledge