Module 1 Lesson 2: Early Adulthood, Middle Adulthood, and Later Adulthood

A nurse checking the vital signs of an older client notes that the client's resting heart rate is 60 beats per minute. Which action should the nurse take on the basis of this finding? 1. Document the finding. 2. Recheck the heart rate in 30 minutes. 3. Assess the client for signs of infection. 4. Contact the health care provider to report the heart rate.

1. Document the finding.

A nurse is developing a plan of care for an older client that addresses interventions to prevent cold discomfort and the development of accidental hypothermia. Which outcomes are desired and should be selected by the nurse for the plan of care? Select all that apply. 1. The client is not shivering. 2. The client's body temperature is 98° F (36.7°C). 3. The client's fingers and toes are cool to touch. 4. The client remains in a fetal position when in bed. 5. The client complains of coolness in the hands and feet only.

1. The client is not shivering. 2. The client's body temperature is 98° F (36.7°C).

4 mental health concerns in older adults:

1. Isolation 2. Grief 3. Depression 4. Suicide

Which findings are normal age-related physiological changes? Select all that apply. 1. Increased heart rate 2. Diminished visual acuity 3. Decline in long-term memory 4. Increased susceptibility to urinary tract infections 5. Increased incidence of awakening after onset of sleep

2. Diminished visual acuity 4. Increased susceptibility to urinary tract infections 5. Increased incidence of awakening after onset of sleep

A home-care nurse is providing information to an older client about measures to prevent constipation. Which action should the nurse tell the client to take? 1. Take an oral laxative daily. 2. Include bran in the daily diet. 3. Eat less fresh fruit each day. 4. Keep fluid intake to 1000 mL per day.

2. Include bran in the daily diet.

A nurse is conducting a psychosocial assessment of a 40-year-old client. Which findings would the nurse recognize as a sign of emotional health in a person in middle adulthood? 1. The client is establishing intimate bonds of love and friendship. 2. The client provides guidance during interactions with his children. 3. The client verbalizes readiness to assume parental responsibilities. 4. The client is making decisions concerning career, marriage, and parenthood.

2. The client provides guidance during interactions with his children.

By what age is physical growth usually complete?

20 years old

During a conversation with a nurse, an older client states, "I'm so dissatisfied with my life — it's just been one disappointment after another." Using Erik Erikson's theory of psychosocial development, which interpretation of the client's statement does the nurse make? 1. The client has fulfilled his life's goals. 2. The client is looking back over his life and accepting what has occurred. 3. The client is demonstrating unsuccessful resolution of the crisis associated with this developmental stage. 4. The client is demonstrating successful resolution of the crisis associated with the developmental stage by verbalizing what has occurred during his life.

3. The client is demonstrating unsuccessful resolution of the crisis associated with this developmental stage.

A nurse is performing an ophthalmoscopic examination of an older client. Which age-related change would the nurse expect to note while viewing the retina? 1. Clear fundus 2. Red blood vessels 3. Yellow-orange optic disc 4. Yellow spots near the macula

4. Yellow spots near the macula

What time period is considered late adulthood?

65 years to death

Psychosocial concerns in older adults:

Adjustment to deterioration in physical and mental health and well-being Threat to independent function and fear of becoming a burden to loved ones Adjustment to retirement and loss of income Loss of skills and competencies developed early in life Coping with changes in role function and social life Diminished quantity and quality of relationships and coping with loss Dependence on governmental and social systems Access to social-support systems Costs of health care and medications

What is a common sign of infection in older adults?

Confusion

Reproductive changes in older adults:

Decrease in testosterone production and size of testes Changes in the prostate gland, sometimes leading to urinary problems Decreased secretion of hormones with the cessation of menses Vaginal changes, including decreased muscle tone and lubrication Impotence or sexual dysfunction in both sexes; variation in sexual function with general physical condition, mental health status, and medications

Renal changes in older adults:

Decreased kidney size, function, and ability to concentrate urine Decreased glomerular filtration rate Decreased bladder capacity Increased residual urine and increased incidence of urinary tract infection Impaired excretion of medication

Gastrointestinal changes in older adults:

Decreased need for calories Diminished appetite and thirst and reduced oral intake Reduced lean body weight Digestive disturbances Shortened stomach-emptying time Reduced absorption of carbohydrates, proteins, fats, and vitamins Increased tendency to constipation Increased susceptibility to dehydration Tooth loss Difficulty chewing and swallowing food

Endocrine changes in older adults:

Decreased secretion of hormones, with specific physiological changes related to each hormone's function Decreased metabolic rate Decreased glucose tolerance, with resistance to insulin in peripheral tissues

What changes are seen in the senses in older adults?

Decreased visual acuity Decreased accommodation in eyes, requiring increased time for adjustment to changes in light Decreased peripheral vision and increased sensitivity to glare Presbyopia and cataract formation Narrowed and straightened optic blood vessels, opaque gray arteries, and gray or yellow spots of hyaline degeneration, called drusen, near the macula Possible loss of hearing Inability to discern taste of food Diminished smell acuity

Cardiovascular changes in older adults:

Diminished energy and endurance, resulting in decreased tolerance for exercise Decreased compliance of the heart muscle Thickening, and increased rigidity of heart valves Decreased cardiac output, resulting in decreased efficiency of blood return to the heart Decreased resting heart rate Weak peripheral pulses Increased blood pressure but susceptibility to postural hypotension

Musculoskeletal changes in older adults:

Diminished muscle mass and strength and muscle atrophy Decreased mobility, range of motion, flexibility, coordination, and stability Change of gait to a shortened step and wider base Changes in posture and stature resulting in a decrease in height Increased brittleness of the bones Deterioration of joint capsule components Kyphosis of the dorsal spine

Hematological changes in older adults:

Hemoglobin and hematocrit levels at the low end of the normal range Tendency to increased blood clotting

What time period is considered early adulthood?

Late teens to the middle to late thirties

Integumentary changes in older adults:

Loss of pigment in hair and skin Wrinkling of the skin Thinning of the epidermis and easy bruising and tearing of the skin Decreased skin turgor, elasticity, and subcutaneous fat Increased nail thickness and slowed nail growth Decreased perspiration Dry, itchy, scaly skin Seborrheic dermatitis and keratosis formation

Immune changes in older adults:

Lymphocyte counts tend to be low. Resistance to infection and disease is decreased. Confusion is a common sign of infection in the older adult, especially infection of the urinary tract.

Concerning prescriptions and medications, what are older adults commonly at risk for?

Medication toxicity and adverse effects

What time period is considered middle adulthood?

Middle to late thirties to middle sixties

What are interventions for pain in older adults?

Monitor for signs of pain and identify precipitating factor(s) and the pattern of pain. Monitor the impact of the pain on activities of daily living. Provide pain relief through measures such as distraction, relaxation, massage, and biofeedback. Administer pain medication as prescribed, and instruct the client in its use. Evaluate the effects of pain-reducing measures.

Respiratory changes in older adults:

Reduced stretch and compliance of the chest wall Reduced strength and function of respiratory muscles Decreased size and number of alveoli Decreased depth of respirations and oxygen intake Diminished ability to cough and expectorate sputum

What are signs and symptoms of pain in older adults?

Restlessness, verbalization, agitation, moaning, crying

Neurological changes in older adults:

Slowed reflexes Slight tremors and difficulty with fine motor movement Loss of balance Increased incidence of awakening after onset of sleep Increased susceptibility to hypothermia and hyperthermia Short-term memory may decline (although long-term memory is usually maintained)