Geriatrics

What age-related changes are associated with the female genitalia?

An elderly female client may have dry, smooth, and thin vaginal walls due to atrophy of the vaginal tissue and secretory glands on the vaginal walls. Graying and thinning pubic hair and decreased size of the labia majora and clitoris are also normal signs of aging. The client may have increased flabbiness and fibrosis of the breasts, which hang lower on the chest wall, along with decreased erection of the nipples.

A married couple in their 80s is living independently. They have three adult children. The husband, who is alert but forgetful, has an enlarged prostate and at times is incontinent of urine. The wife has diabetes and rheumatoid arthritis and walks with difficulty. Both need assistance with bathing, dressing, and meal preparation. What does the nurse suggest as the most suitable plan for this couple?

Care provided in the home is more efficient and cost-effective; this couple can manage with assistance from community resources. There is nothing in the history to demonstrate that skilled nursing care provided by a nursing home is necessary. Because the couple appears able to function with assistance at home, it is not necessary to move them to another setting at this time.

A 70-year-old client is diagnosed with cartilaginous degeneration. Which action should the nurse take?

Clients with cartilaginous degeneration are advised to take moist heat showers because they increase blood flow to the region. Isometric exercises are indicated for clients with muscular atrophy. Sitting in a supportive armchair provides support to bony structures and prevents further deformities in a client with kyphosis. Weight-bearing exercises are indicated in clients with decreased bone density.

What can the nurse do to help an older adult successfully complete Erikson's major task of this stage?

Feeling a sense of satisfaction when considering past achievements allows the client to accept what life is or was and helps prevent feelings of despair. Investing creative energies in promoting social welfare is the major task of middle adulthood (30 to 65 years). Developing deep, lasting relationships with other people or institutions is the major task of the young adult (20 to 30 years). Feeling a need to make up for past failings is a negative resolution of the major task of the older adult.

The nurse is caring for an older client admitted to the hospital with type 2 diabetes. What is important for the nurse to remember about older adults and type 2 diabetes?

Lipolysis is not a common response to meeting the metabolic needs of those with type 2 diabetes; therefore, ketones are not present in large enough amounts to cause ketoacidosis. Adults with type 2 diabetes do secrete endogenous insulin, but secretion is slow and in smaller than adequate amounts. The incidence of chronic complications depends on the level of glucose control, not developmental level. The onset of type 2 diabetes is usually gradual, whereas in type 1 diabetes, it is sudden and dramatic.

When a nurse is admitting an older client to the mental health unit, it is important to identify any signs of dementia. What signs and symptoms denote the presence of dementia of the Alzheimer type?

Older clients who have dementia[1][2] often have short-term memory loss. Clients in whom dementia is developing often have difficulty expressing themselves (expressive aphasia) or understanding the spoken word (receptive aphasia). Clients with the diagnosis of schizophrenia or depression are often indecisive and ambivalent. A client who is experiencing a manic episode of bipolar disorder experiences flight of ideas. Loose associations between thoughts are related to schizophrenia, not dementia.

Which age-related effects on the immune system are seen in the older client?

The effects of aging on the immune system include increased autoantibodies. Expression of IL-2 receptors, delayed hypersensitivity reaction, and primary and secondary antibody responses decrease in older adults because of the effects of aging on the immune system.

The biggest problem for an older female client immediately after the sudden death of her husband will probably be her inability to cope with what?

Anger at her husband for leaving her may make the client feel guilty for having these feelings. Financial security may or may not be a problem for this client. Loneliness is something she will have to cope with later, depending on her support system; it is not an immediate problem. Estrangement may be something that she will have to cope with later; it is not an immediate problem.

An older adult client with dementia of the Alzheimer type frequently switches from being pleasant and happy to being hostile and unhappy without apparent external cause. How can the nurse best care for this client?

Because these clients experience lability of mood, it is best to attempt to establish a relationship and give care when they are feeling receptive. Although the mood swings may be pointed out to the client, the client may still have limited contact with reality. Also, repeated attempts to reorient the client may elicit agitated behavior. Encouraging the client to talk about personal feelings may be of limited help; the client may be unable to do this. Avoiding caring for the hostile client rejects the client when the client needs the nurse most.

A nurse is caring for an older adult with a hearing loss secondary to aging. What can the nurse expect to identify when assessing this client?

Cerumen (ear wax) becomes drier and harder as a person ages. Generally, female voices have a higher pitch than male voices; older adults with presbycusis (hearing loss caused by the aging process) have more difficulty hearing higher pitched sounds. There is no greater incidence of tympanic tears caused by the aging process. The hair in the auditory canal increases, not decreases. The epithelium of the lining of the ear becomes thinner and drier.

The nurse is caring for a 60-year-old client who is diagnosed with dementia. Which antipsychotic drugs would be contraindicated for the client?

First-generation antipsychotic drugs such as haloperidol and chlorpromazine are contraindicated because they may increase the risk of mortality when used to treat dementia-related psychosis in elderly clients. Quetiapine, aripiprazole, and risperidone are second-generation antipsychotic drugs that are not contraindicated in elderly adults suffering from dementia-related psychosis.

The nurse is caring for an older client who is scheduled for a bronchoscopy. Midazolam has been prescribed for the procedure. What administration guidelines will the nurse follow?

In an older client, peak effect may be delayed; increments should be smaller and rate of injection slower. When used for sedation/anxiolysis/amnesia for a procedure, the dosage must be individualized and titrated. Midazolam should always be titrated slowly; administer over at least 2 minutes and allow an additional 2 or more minutes to fully evaluate the sedative effect. Titration to effect with multiple small doses is essential for safe administration. Central nervous system depression is the most serious side effect. A sudden rise in blood pressure shortly after administration has not been evidenced. Midazolam is given for sedation/anxiolysis/amnesia for a procedure.