Chapter 23 - The older adult
A nursing student is studying the normal physiologic changes of older adults. The faculty member knows that the student comprehends the information when the student makes which statements? Select all that apply. "Fluids and electrolytes remain within normal ranges." "Rate of reflex responses increase." "Height may decrease 1 to 3 in (2.5 to 8 cm)." "The senses of taste and smell are decreased, sour taste diminishes first." "There is an increased sensitivity to glare."
"Height may decrease 1 to 3 in (2.5 to 8 cm)." "There is an increased sensitivity to glare." "Fluids and electrolytes remain within normal ranges." Normal physiologic changes of older adults include height may decrease 1 to 3 in (2.5 to 8 cm), there is an increased sensitivity to glare, and fluids and electrolytes remain within normal ranges. Rate of reflex responses decrease and the senses of taste and smell are decreased. Sweet and salty tastes diminish first.
An older adult client comes to the health center reporting difficulty sleeping. Which statement by the client would the nurse need to address? "I find myself napping on and off throughout the day." "I go to bed around 10:30 pm every night." "I don't drink coffee or alcohol." "I try not to be too active once I've eaten dinner."
"I find myself napping on and off throughout the day." The client's statement about napping throughout the day will need to be addressed by the nurse because this can interfere with the client's ability to sleep at night. Avoiding activity after dinner, having a routine bedtime, and avoiding caffeine and alcohol are healthy sleep habits.
A nurse is conducting an education session about appropriate measures to promote sleep with an older adult who is experiencing frequent awakenings at night and then awakening early in the morning. The nurse determines that the education was successful when the client states: "I should continue to take my sleep medication for as long as I need to." "I need to try and go to bed and get up at the same time each night." "I should avoid coffee, but tea is okay to drink before bed." "I should do some mild exercises about 2 hours before bedtime."
"I need to try and go to bed and get up at the same time each night." Sleep measures include maintaining a routine, going to bed and getting up at the same time each night, avoiding exercise 3 to 4 hours before bed, using prescribed sleep medications only for the short-term (7 to 14 days), and avoiding alcohol, nicotine, and caffeine (which tea contains).
A new graduate nurse has accepted a staff position on a geriatric unit. The preceptor determines that the new nurse understands gerontologic nursing when which statement is made? - "All older adult clients are treated the same. There are really no differences in care" - "Gerontologic nursing is not a specialty area of nurse." - "Normal changes that occur with aging result from complex interactions." - "The focus of care for the elderly with chronic disorders should be on helping them through the acute disease process."
"Normal changes that occur with aging result from complex interactions." Normal changes that occur with aging result from complex interactions among genetics, biologic systems, and physical and social environments. For an older client with chronic disorders, the focus of care should include the client's and family's goals and promote functional health and independent living to the greatest extent possible. Gerontologic nursing combines the basic knowledge and skills of nursing with a specialized knowledge of both illness and health. As of 2011, only 1% of registered nurses were certified in gerontology and only one third of bachelor of science in nursing programs included a geriatrics course in their curriculum.
A nurse is teaching an elderly client's family about the causes of mental impairment. The nurse sees that the teaching has been effective when the family says which of the following? "Alzheimer's disease (AD) is a reversible neurologic illness." "Sundowning is a common problem of dementia." "Delirium progressively affects cognitive function and is a chronic process." "Dementia is an acute process and develops suddenly."
"Sundowning is a common problem of dementia." A common problem in patients with dementia is sundowning syndrome, in which an older adult habitually becomes confused, restless, and agitated after dark. Dementia is chronic and usually develops gradually. AD is the most common degenerative illness and is irreversible. Delirium, a temporary state of confusion, is an acute illness that can last from hours to weeks and resolves with treatment.
An older adult client enjoys good overall health, but has just been diagnosed with pneumonia and has begun receiving an intravenous (IV) antibiotic. Shortly after being administered the first dose, the client pulled out his IV line and is now attempting to scale his bed rails. Which of the following phenomena most likely underlies this change in the client's cognition? Dementia Disorientation Depression Delirium
Delirium Delirium is a temporary state of confusion that is often precipitated by drug interactions or the effects of new drugs. Dementia is rooted in organic brain changes and rarely has a sudden onset. The client is not showing signs or symptoms of depression. Disorientation is a manifestation of a problem rather than a cause.
A nurse is preparing to medicate an older adult client with an opioid analgesic. Which information will the nurse obtain first to decide about administering the medication? - Taking the clients vital signs to determine if indicative of pain - Determining if the client is able to communicate pain verbally or nonverbally - Obtaining family feedback about client's pain level - Observing client behavior to determine if coincides with report of pain
Determining if the client is able to communicate pain verbally or nonverbally The nurse should ascertain the level and intensity of the client's pain. The family is not able to give adequate information about the client's pain. Taking the client's vital signs can be of value as a baseline. A client may share indication of pain other than verbally, such as a grimace or moaning. Each client may exhibit different behaviors when in pain. This is not a reliable indicator as to a client's pain level.
Gould viewed the middle years as a time when adults increase their feelings of self-satisfaction, value their spouse as a companion, and become more concerned with health. Which nursing action best facilitates this process? Arranging for social services to assist with meals for a homebound client Counseling a client who complains of being depressed Providing entertainment for a client on bedrest Encouraging a client to have regular checkups
Encouraging a client to have regular checkups Gould viewed the middle years as a time when adults look inward (ages 35 to 43); accept their lifespan as having definite boundaries, and have a special interest in spouse, friends, and community (ages 43 to 50); and increase their feelings of self-satisfaction, value spouse as a companion, and become more concerned with health (ages 50 to 60). The nursing action that best facilitates this process would be encouraging a client to have regular checkups.
An 84-year-old client has returned from the postanesthesia care unit. The client is oriented to name only. The client's family is very upset because before having surgery the client knew the family. The client is diagnosed with delirium. Which action should the nurse take to help the family with their emotions? - Explain that delirium is a state of confused thinking and usually lasts only a short time. - Introduce the family to the hospital chaplain for religious counseling. - Coordinate a family meeting to make sure everyone has the same information. - Refer the family to the health care provider for support.
Explain that delirium is a state of confused thinking and usually lasts only a short time. By explaining what delirium is and that it usually is short-term provides the family with information that can decrease the family's worry. The hospital chaplain may help to provide emotional support but not all people are interested in religious counseling. The health care provider can be a good resource for information but the nurse should provide teaching to alleviate family concerns. It is not the nurse's place to coordinate a family meeting.
When assessing a client during the middle adult years, the nurse recognizes which of the following as a normal physical change? Increased cardiac output Increased levels of energy Increased loss of calcium from the bones Increased oil levels in the skin
Increased loss of calcium from the bones Some physical changes common during the middle adult years include increased fatigue, decreased cardiac output, increased loss of calcium from the bones, and decreased oil levels (resulting in dry skin).
The nurse is reminiscing with a 72-year-old client with early onset dementia while providing care in a long-term care facility. How does the nurse implement this form of therapy to maximize the therapeutic value? - Listen to the client's stories and ask questions to facilitate ego integrity and provide companionship. - Encourage the client to talk about special life experiences so discussions regarding death and dying can be easier and can prepare the client for declining health. - Ask questions about the client's childhood and any unresolved relationship issues that may be preventing the client's peace and acceptance of the aging process. - Ask family members to participate in activities that help the client remember important aspects of life and health so he/she can move through the final stages of aging.
Listen to the client's stories and ask questions to facilitate ego integrity and provide companionship. Reminiscence is a way for an older adult to relive and restructure life experiences and is part of achieving ego integrity. Listening and asking questions also provides a sense of companionship to clients as they often experience loneliness during dementia even though they may have family members that visit. , nor does it support the client's acceptance of declining health status.
A nurse caring for older adults in a long-term care facility is teaching a novice nurse characteristic behaviors of older adults. Which statement is not considered ageism? Personality is not changed by chronologic aging. Most older adults are ill and institutionalized. Intelligence declines with age. Old age begins at age 65.
Personality is not changed by chronologic aging. Ageism is a form of prejudice, like racism, 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 people are different and will remain different; therefore, they do not experience the same desires, needs, and concerns as other adults. The statement not considered ageism would be that personality is not changed by chronologic aging. Most older adults are not ill and institutionalized. Intelligence does not decline with age. Old age does not begin at age 65.
The home care nurse is visiting an older adult client in the home to assess a leg wound and change the dressings. The nurse is aware that the client receives money monthly but there is no food in the house, no adequate heat, and the client states, "My sister takes my check and cashes it every month." What is the correct action by the nurse? Tell the client to talk with the sister and have her replace the money she has stolen. Report the incident to social service informing them the client has no food or heat. Call the police and tell them to swear a warrant for the arrest of the sister. Take the client to the local hospital Emergency Department
Report the incident to social service informing them the client has no food or heat. The client is apparently a victim of financial abuse and is being left without resources in order to live comfortably and to have basic needs cared for. The nurse should not confront the sister or have the client confront her due to the potential for violence. The incident must be reported to social service to have them involved with obtaining immediate resources for the client. Taking the client to the Emergency department would be against regulations for home health nurses and the client is not in need of immediate medical attention.
In a report, the night nurse tells the incoming nurse that one client with dementia has sundowning syndrome. Which of the following nursing diagnoses would be most appropriate for this client? Social isolation Grieving Sleep deprivation Noncompliance
Sleep deprivation A common problem in clients with dementia is sundowning syndrome in which an older adult habitually becomes confused, restless, and agitated after dark and does not sleep. Implementing the nursing diagnosis of sleep deprivation will help the client obtain adequate sleep at night and awaken refreshed. Social isolation, grieving, and noncompliance are diagnoses that could be related to dementia but not sundowning.
A nurse has attended an inservice workshop that addressed the phenomenon of ageism in the health care system. Which of the following practices is indicative of ageism? Assessing the skin turgor of an older adult differently than that of a younger adult Implementing falls prevention measures in a setting where older adults receive care Speaking to older adults with the presumption that they have mild cognitive deficits Providing slightly smaller servings of food for clients who are elderly
Speaking to older adults with the presumption that they have mild cognitive deficits Accommodation of normal, age-related changes such as decreased skin turgor and slightly decreased nutritional needs is not an indication of ageism. Similarly, safety measures are unlikely to be motivated by ageist beliefs. Assuming that all older adults have cognitively deficits, however, is an indication of ageism.
Which of the following assessment findings of a male client age 77 years should signal the nurse to a potentially pathologic finding, rather than a normal age-related change?
The client is oriented to person and place but is unsure of the month. Age-related physiologic changes include a weakening of bladder emptying, presbycusis, and a slow gait that may be accompanied by stooped posture. Disorientation to time, however, should always prompt the nurse to perform further assessment and should never be considered a normal accompaniment to the aging process.
A nurse arrives at the home of an older adult client. The agency was called because a neighbor noticed that the client was home alone. The nurse finds the client alone in the living room. When asked about the client's daughter who lives there and has been caring for her, the client says, "She went on vacation for about a month. She'll be back soon." Further assessment reveals that there are no other family members or services currently involved. The nurse would identify this situation as: exploitation. abandonment. neglect. emotional abuse.
abandonment The client is alone and without any support or caregivers. Therefore, abandonment, which is the desertion or a vulnerable older adult by anyone who has assumed responsibility for that adult's care, would apply. Exploitation involves illegally taking or misusing funds, property, or assets of a vulnerable older adult. Neglect involves refusal or failure by those responsible to provide food, shelter, protection, or health care for a vulnerable older adult. Emotional abuse involves verbally or nonverbally causing mental pain, anguish or distress on the older adult.
