N10 Test 3

Phases of Chronic Illness Trajectory: 5. acute

active illness or complications that require hospitalization for management

Phases of Chronic Illness Trajectory: 1. Pre-trajectory

Before the illness course occurs, the preventive phase, no signs or symptoms present

Denture care

). Dentures are very personal and expensive possessions and the utmost care should be taken when handling, cleaning, and storing dentures, especially in hospitals and long-term care facilities. It is not uncommon to hear that dentures were lost, broken, or mixed up with those of others, or not removed and cleaned during a hospital or nursing home stay. Dentures should be marked, and many states require all newly made dentures to contain the client's identification. A commercial denture marking system called Identure, produced by the 3M Company, provides a simple, efficient, and permanent means of marking dentures. Broken or damaged dentures and dentures that no longer fit because of weight loss or changes in the oral cavity are a common problem for older adults. Many elders believe that there is no longer a need for oral care once they have dentures, but regular professional attention is important

Exercise Recommended amount-

30 minutes of moderate-intensity physical activity for 5 or more days of the week. Need at least: • 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (e.g., brisk walking, swimming, bicycling) every week and • Muscle-strengthening activities on 2 or more days

Hearing aids - challenges to wearing hearing aids

A hearing aid is a personal amplifying system that includes a microphone, an amplifier, and a loudspeaker. Nearly 50% of people who purchase hearing aids either never begin wearing them or stop wearing them after a short period of time. **Some of the challenges of wearing hearing aids include: Difficulty manipulating the device Annoying loud noises Being exposed to sensory overload Developing headaches The perceived stigma

Detached Retina

A retinal detachment can occur at any age but is more common after the age of 40 years. Emergency medical treatment is required or permanent visual loss can result. There may be small areas of the retina that are torn (retinal tears or breaks) and will lead to retinal detachment. This condition can develop in persons with cataracts or recent cataract surgery or trauma, or it can occur spontaneously. Symptoms o Symptoms include a gradual increase in the number of floaters and/or light flashes in the eye. It also manifests as a curtain coming down over the person's field of vision. · Treatment o Small holes or tears are treated with laser surgery or a freeze treatment called cryopexy. Retinal detachments are treated with surgery

Recommended daily fluid intake for older adults

A significant number of older adults drink less than 1 L of fluid/day, less than the recommended amount of 1500 mL/day

Age-Related Macular Degeneration

AMD is a degenerative eye disease that affects the macula, the central part of the eye responsible for clear central vision. The disease causes the progressive loss of central vision, leaving only peripheral vision intact. AMD is the most common cause of new visual impairment among people age 50 years and older, although it is most likely to occur after age 60. Symptoms o The early and intermediate stages usually start without symptoms and only a comprehensive dilated eye exam can detect AMD. Objects may not appear to be as bright as they used to be and individuals may attribute their vision problems to normal aging or cataracts. As AMD progresses, a blurred area near the center of vision is a common symptom. Over time, the blurred areas may grow larger and blank spots can develop in the central vision. AMD does not lead to complete blindness, but the loss of central vision interferes with everyday activities such as the ability to see faces, read, drive, or do close work, and can lead to impaired mobility, increased risk of falls, depression, and decreased quality of life.

Metabolic changes related to age: Regulation of Appetite

Appetite depends on physical activity, functional limitations, smell, taste, mood, socialization, comfort, medications, chronic illness, oral/dental problems May be less hungry, fuller before meals, consume smaller meals, become more satiated following meals Gastrointestinal hormones such as CCK regulate satiety, with age CCK is increased basally and following a meal may have a more potent satiating effect. Increase in CCK may occur in malnutrition which decreases appetite Decreased stomach fundal compliance, decrease testosterone, increases leptin and amylin also thought to contribute to decreased appetite Mealtime ambience may affect appetite

Exercise Types recommended for older adults-

Biking, swimming, brisk walking, pushing a lawn mower, climbing stairs, Lifting weights, calisthenics, resistance bands, Pilates, pushups, sit-ups, heavy gardening (digging, shoveling), rake, golf, dancing, washing windows/floors, washing car, Tai chi, yoga Exercises such as standing on one foot, walking heel to toe or backwards or sideways, leg raises, hip extensions, standing up from a sitting position without using your hands From Ch 18 PP How much time should be devoted to moderate activity in order to improve health? 30 minutes daily 5 times a week

Know the different changes to vision related to aging and how the symptoms

Cataracts Glaucoma Angle-closure Glaucoma Diabetic Retinopathy Diabetic Macular Edema Detached Retina Age-Related Macular Degeneration

Metabolic changes related to age: Digestive system

Changes do not significantly affect function, digestive system remains adequate throughout life Decrease gastric motility and volume Reductions in secretion of bicarbonate and gastric mucus caused by age related gastric atrophy which results in hypochlorhydria Decreased production of intrinsic factor can lead to pernicious anemia if stomach is unable to ingest B12 vitamins Protective alkaline viscous mucus of stomach lost because of increase in stomach pH More susceptible to H. Pylori and peptic ulcer disease Presbyesophagus (decrease in intensity of propulsive waves) forcing the lower end to dilate and may lead to digestive discomfort Pathological processes seen with increasing frequency include GERD and hiatal hernia Loss of SM in stomach delayed emptying time which may lead to anorexia, weight loss, meal-induced fullness and premature satiety

Types of incontinence

Classified as either transient (acute) or established (chronic) Transient has a sudden onset, present 6 months or less, and is usually caused by treatable factors: urinary tract infection (UTI), delirium, constipation, stool impaction, or increased urine production Established UI may have sudden or gradual onset and is categorized as: (1) stress, (2) urge, (3) overflow, (4) functional, (5) mixed

Age changes that result in hearing loss: Changes in structure and fuction

Cochlear hair cell degeneration; loss of auditory neurons in spinal ganglia or organ of corti - (change in function) inability to hear high-frequency sounds, interferes with understanding speech; hearing may be lost in both ears at different times Degeneration of basilar (cochlear) conductive membrane of cochlea -(change in function) Inability to hear all frequencies, but more pronounced at higher frequencies (cochlear conductive loss) Decreased vascularity of cochlea; loss of cortical auditory neurons -(change in function) equal loss of hearing at all frequencies (strial loss); inability to disseminate localization of sound

Phases of Chronic Illness Trajectory: 3. Stable

Controlled illness course/symptoms

Diabetic Retinopathy

Diabetes has become an epidemic in the United States, and DR occurs in both type 1 and type 2 diabetes mellitus. Risk increases the longer an individual has diabetes. Almost all people with type 1 diabetes will eventually develop retinopathy. People with type 2 diabetes are less likely to develop more advanced retinopathy than those with type 1. Chronically high blood sugar from diabetes is associated with damage to the tiny blood vessels in the retina, leading to DR. Blood and lipid leakage leads to macular edema and hard exudates (composed of lipids). Symptoms o Early detection and treatment of diabetic DR is essential. There are no symptoms in the early stages of DR. The disease often progresses unnoticed until it affects vision. Bleeding from abnormal retinal blood vessels can cause the appearance of "floating" spots that sometimes clear on their own. Treatment o Constant, strict control of blood glucose levels, cholesterol levels, and blood pressure measurement

Heat and cold issues related to aging

Environmental temperature extremes impose a serious risk to older persons with declining physical health Preventative measures require attentiveness to impending climate changes, as well as protective alternatives

Age-related external eye changes

Extraocular Changes Ocular Changes intraocular Changes

Hospital - fall prevention

Fall prevention is a major nursing priority -complete a fall risk assessment for each client at admission and at regular intervals -respond to lights in a timely manner -use fall risk alerts -provide adequate lighting -place clients at risk for falls near the nurses station -provide hourly rounding -keep the bed in the low position and lock the breaks -report and document all incidents

GERD

Gastroesophageal reflux disease defined as mucosal damage from the movement of gastric contents backwards from the stomach and into the esophagus most common GI disorder affecting older adults Etiology caused by abnormalities of the lower esophageal sphincter when this muscle relaxes and allows reflux or generally week GERD may occur risk factors include hiatal hernia, obesity, pregnancy, cigarette smoking, or inhaling second-hand smoke Signs and Symptoms heartburn + regurgitation, a sensation of burning in doctor wrote as partially digested food and stomach acid inappropriately returned to the posterior oropharynx abdominal pain may occur within 1 hour of eating and symptoms are worse when lying down added with the pressure of gravity on the lower esophageal sphincter consumption of alcohol before or during eating exacerbates the reflux Complications maybe two esophagitis, peptic strictures, esophageal ulcers with bleeding, and most importantly Barrett's esophagus, a precursor to cancer. The most serious complications develop pneumonia from the aspiration of stomach contents

Shingles

Herpes zoster (HZ), or shingles, is a viral infection frequently seen in adults older than age 50, those who have medical conditions that compromise the immune system, or people who receive immunosuppressive drugs. More than 90% of the world's population is infected with this virus, and by the age of 85, about 50% of the population has reactivated the virus as manifested by a rash . HZ is caused by reactivation of latent varicella-zoster virus (VZV) within the sensory neurons of the dorsal root ganglion decades after initial VZV infection is established Herpes simplex (chickenpox) does not occur in a dermatome pattern and is recurrent. During the healing process, clusters of papulovesicles develop along a nerve pathway. The lesions themselves eventually rupture, crust over, and resolve. Scarring may result, especially if scratching or poor hygiene leads to a secondary bacterial infection. HZ (Shingles) is infectious until it becomes crusty. HZ may be very painful and pruritic. Prompt treatment with the oral antiviral agents acyclovir, valacyclovir, and famciclovir may shorten the length and severity of the illness; however, to be effective, the medications must be started as soon as possible after the rash appears. Analgesics may help relieve pain. Wet compresses, calamine lotion, and colloidal oatmeal baths may help relieve itching.

Obesity

In the United States, more than two-thirds of all adults are overweight (body mass index [BMI] = 25 to 29.9) or obese (BM! ~30). There has been some slowing in the rapid increase in obesity, but prevalence has not changed in the past decade and remains very high . In what has been termed the obesity paradox, some research has found that for people who have survived to 70 years of age, mortality risk is lowest in those with a BMI classified as overweight Weight loss recommendations should be carefully considered on an individualized basis with attention to the weight history and medical conditions. The most effective weight loss program combines nutrition education, diet, and exercise with behavioral strategies. Maintaining a healthy weight throughout life can prevent many illnesses and functional limitations as a person grows older.

Metabolic changes related to age: Body composition

Increase in body fat, including visceral fat stores Decrease in muscle mass Body weight peaks 5th or 6th decade of life and remains unstable until age 65 or 70, after there is a slow decrease in body weight for remainder of life

Home - fall prevention

Infants/toddlers are also at risk for falls (keep crib rails up, keep bed low, etc) Olders adults are at great risk for falls prevention is important because elderly clients can have longer recovery times from injuries and the risk of complications risk factors include: -physical, cognitive, and sensory changes -changes in musculoskeletal and neurologic systems--impaired vision or hearing - frequent trips to the bathroom at night because of nocturia and incontinence Modifications to improve home safety -Remove items that could cause the client to trip (aka rugs) -Place electrical cords against wall behind furniture -monitor gait and balance -make sure that steps and sidewalks are in good repair -use nonskid mat in the tub or shower -place a shower chair in shower -ensure that lighting is adequate inside

Age-related external eye changes: Extraocular changes

Like the skin elsewhere, the eyelids lose elasticity and drooping (senile ptosis) may result. In most cases, this is only a cosmetic concern. In some cases, it can interfere with vision if the lids sag far enough over the lower lid margin. Spasms of the orbicular muscle may cause the lower lid to turn inward. If it stays this way, it is called entropion. With the curling of the lid, the lower lashes also turn inward, causing irritation and scratching of the cornea. Surgery may be needed to prevent permanent injury. Decreases in orbicular muscle strength may result in ectropion, or an out-turning of the lower lid (Fig. 11.1). Without the integrity of the trough of the lower lid, tears run down the cheek instead of bathing the cornea. This, along with an inability to close the lid completely, leads to excessively dry eyes (xerophthalmia) and the need for use of artificial tears. The individual also may need to tape the eyes shut during sleep. A reduction of goblet cells in the conjunctiva is another cause for drying of the eyes in the older adult. Goblet cells produce mucin, which slows the evaporation of tear film and is essential for eye lubrication and movement.

Oral care - daily and dental visits

Nearly one-third of individuals older than age 65 have untreated tooth decay. Nearly one in five adults 65 years and older have lost all of their teeth (edentulous), primarily as a result of periodontitis, which occurs in about 68% of those in this age group Access to dental care for older adults may be limited and cost prohibitive. In the existing health care system, dental care is a low priority. Medicare does not provide any coverage for oral health care services, and few Americans 75 years of age or older have private dental insurance

Thermoregulation

Neurosensory changes in thermoregulation delay or diminish the individual's awareness of t temperature changes and may impair behavioral and thermoregulatory response to dangerously high or low temperatures Drugs can affect thermoregulation Economic, behavioral, and environmental factors may combine to create a dangerous thermal environment affecting the older person

Nursing interventions for incontinence (UI)

No cure but can be treated, assess continence, containment strategies- pads & briefs (absorbent products differ from menstrual products)-Behavioral techniques, such as biofeedback are recommended as first-line treatment of UI (as well as the ones listed below) - Scheduled (timed) voiding-Based on the person's bladder diary or common voiding patterns (voiding on arising, before and after meals, midmorning, midafternoon, and bedtime). The person is encouraged to NOT void at an unscheduled time, thus achieving "mind over bladder." -Bladder training-frequent voluntary voiding to keep bladder volume low and suppression of the urge to void using pelvic muscle contractions, distraction, or relaxation techniques. When the individual feels the urge to urinate, the person uses the urge control techniques. After the urge subsides, the person walks at a normal pace to the toilet. -Prompted voiding- person is assisted to the toilet at predetermined times during waking hours if he or she requests it and receives positive feedback if he or she voids successfully -Pelvic floor muscle exercises aka KEGEL-repeated voluntary pelvic floor muscle contraction with goal of strengthening muscle and reducing UI. To check if you are doing them right (feel tightened muscles) Men: put finger in rectum, Women: put finger in vagina For stress UI- Males- foam penile clamps. Women-intravaginal support devices, external occlusive devices, and urethral plugs -Goal: promote and restore continence and to prevent incontinence related complications, such as skin breakdown -UI increases the risk for depression, anxiety, loss of dignity and autonomy, social isolation, falls, skin breakdown, and avoidance of sexual activity

Constipation - preventatives

Nonpharmacological interventions Physical activity Positioning Toileting regimen Pharmacological interventions Enemas Alternative treatments

Metabolic changes related to age: Taste

Number of taste cells decrease and remaining cells atrophy as individual ages (beginning @ 40 to 60) but they can regenerate Mouth produces less saliva (can affect taste) Usually salty and sweet taste lost first, followed by bitter and sour taste Dentures, smoking, medications can affect taste

Balanced diet

Older adults need fewer calories because they may not be as active and metabolic rates decline Still require the same or high levels of nutrients for optimal health outcomes The Dietary Approaches to Stop Hypertension (DASH) eating plan is recommended and consists of fruits, vegetables, whole grains, low-fat dairy products, poultry, and fish as well as restriction of salt intake Mediteranean diet is also associated with lower instances of chronic illness, weight gain, impaired physical function, and improved cognition in recent studies Dietary recommendations: Fat -Limit saturated fats and trans fatty acids (associated with heart disease and cancer) Protein -Higher protein consumption particularly animal protein is associated with the decline in risk of frailty in older adults Fiber -a daily intake of 25 grams of fiber is recommended combined with adequate amounts of fluid Vitamins and minerals -older people who consume 5 servings of fruits and vegetables daily will obtain adequate intake of vitamin A, C, and E, and potassium

Natural disaster preparedness

Older people are at a great risk during and after disasters and have the highest casualty rate during disaster events when compared to all other groups Older adults at most risk include those: that depend on others for daily functioning. with limited mobility. socially isolated, cognitively impaired, or institutionalized. Nursing home residents are particularly vulnerable due to frailty, and nursing homes need to be prepared for disasters

Hypothermia

Produced by exposure to a cold environment and defined as a core temperature of less than 35° C (95° F) Hypothermia is a medical emergency requiring comprehensive assessment of neurological activity, oxygenation, renal function, and fluid and electrolyte balance Factors increasing the risk for hypothermia -Thermoregulatory impairment -Conditions that decrease heat production -Conditions that increase heat loss -Conditions that impair central or peripheral control of thermoregulation -Drugs that interfere with thermoregulation Prevention of hypothermia in frail elders -maintain a comfortably warm ambient temperature no lower than 68 F -provide generous generous quantities of clothing and bed covers -provide as much exercise as possible to generate heat from muscle activity -provide hot- high proteins means and bedtime snacks to add heat production throughout the day and as far into the night as possible

Metabolic changes related to age: Buccal Cavity

Teeth become worn, darker in color, prone to longitudinal cracks Dentin becomes brittle and thick, pulp space decreases Osteopenia (losing bone mass) of the facial bones and subtle changes in the CT of skin, sinuses, and oral cavity Xerostomia (dry mouth) occurs in 30% of older individuals and can affect eating, swallowing, and speaking leading to dental decay Artificial saliva preparations and adequate fluid intake can help

Changes to bladder and bowel related to aging

The body must remove waste products of metabolism to sustain healthy function, but bladder and bowel activity are fraught with social implications. Bladder and bowel function in later life, although normally only slightly altered by the physiological changes of age , can contribute to problems severe enough to interfere with the ability to continue independent living and can seriously threaten the body's capacity to function and to survive. The effects of uncontrolled bladder and bowel action are a threat to the person's independence and well-being. Elimination is a private matter, not publicized socially. In most cultures children are taught early to deal with their own body waste. Deviations from this may be socially unacceptable and can lead to chastisement, ostracism, and social withdrawal. Nurses are in a key position to implement evidence-based assessment and interventions to enhance continence and improve function, independence, and quality of life. The renal system is responsible for excreting toxins, regulating water and salts, and maintaining the acid-base balance in the blood. The kidneys, the primary organs in the renal system, are highly vascular. They produce the hormone erythropoietin, which stimulates the bone marrow to produce red blood cells, and the enzyme renin, which helps regulate blood pressure. In aging there are both anatomical and functional changes. The age-related loss of nephrons, kidney mass, and ability to concentrate urine ordinarily leads to little change in the body's ability to regulate its body fluids and the ability to maintain adequate fluid homeostasis under usual circumstances. Renal disease or urinary tract obstruction can amplify age-related declines in function

Preventative Care impact on chronic illness

The chronic disease burden in the United States largely results from a short list of risk factors: tobacco use, poor diet and physical inactivity, excessive alcohol consumption, uncontrolled high blood pressure, and hyperlipidemia. To help to meet the chronic disease burden, the CDC uses four cross-cutting strategies: (1) epidemiology and surveillance to monitor trends and inform programs; (2) environmental approaches that promote health and support healthy behaviors; (3) health system interventions to improve the effective use of clinical and other preventive services; and (4) community resources linked to clinical services that sustain improved management of chronic conditions. This approach is based on the assumption that establishment of community conditions to support healthy behaviors and promote effective management of chronic conditions will deliver healthier students to schools, healthier workers to employers and businesses, and a healthier population to the health care system

Age-related external eye changes: ocular changes

The cornea is the avascular transparent outer surface of the eye globe that refracts (bends) light rays entering the eye through the pupil. With aging, the cornea becomes flatter, less smooth, and thicker, with the changes noticeable by its lackluster appearance or loss of sparkling transparency. The result is the increased incidence of astigmatism. The anterior chamber is the space between the cornea and the lens The iris is a ring of muscles inside the anterior chamber. The iris surrounds the opening into the eye (the pupil), gives the eye color, and regulates the amount of light that reaches the retina. With age the iris becomes paler in color as a result of pigment loss and increases in the density of collagen fibers. A normal age-related change in the iris is related to other neurological changes—that is, slowed response to sensory stimuli, in this case, to light and dark The lens, a small, flexible, biconvex, crystal-like structure just behind the iris, is responsible for visual acuity as it adjusts the light entering the pupil and focuses it on the retina. Age-related changes in the lens are probably universal, but many of the changes are thought to result from exposure to ultraviolet light. Changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves also contribute to the decreased accommodation. Finally, light scattering increases and color perception decreases.

Age-related external eye changes: Intraocular Changes

The vitreous humor, which gives the eye globe its shape and support, loses some of its water and fibrous skeletal support with age. The retina, which lines the inside of the eye, has less distinct margins and is duller in appearance than in younger adults. Drusen (yellow-white) spots may appear in the area of the macula. As long as these changes are not accompanied by distortion of objects or a decrease in vision, they are not clinically significant. Finally, the number of rods and associated nerves at the periphery of the retina is reduced, resulting in peripheral vision that is not as discrete or is absent. Arteries in the back of the eye may show atherosclerosis and slight narrowing. Veins may show indentations (nicking) at the arteriovenous crossings if the person has a long history of hypertension.

Braden Scale - subscales

This scale assesses the risk of pressure ulcers on the basis of a numerical scoring system of six risk factors: sensory perception, moisture, activity, mobility, nutrition, and friction/shear Because the Braden Scale does not include all of the risk factors for pressure ulcers, it is recommended that it be used as an adjunct rather than in place of clinical judgment. A score of 23 means there is no risk for developing a pressure ulcer while the lowest possible score of 6 points represents the severest risk for developing a pressure ulcer. The Braden Scale assessment score scale: Very High Risk: 9 or less. High Risk: 10-12. High risk - lower than 11 Mod - 12-14 Low -15-16 No risk - over 17

Tinnitus

Tinnitus is defined as the perception of sound in one or both ears or in the head when no external sound is present. It is often referred to as "ringing in the ears" but may also manifest as buzzing, hissing, whistling, cricket chirping, belJs, roaring, clicking, pulsating, humming, or swishing sounds. The sounds may be constant or intermittent and are more acute at night or in quiet surroundings. The most common type is high-pitched tinnitus with sensorineural loss; less common is low-pitched tinnitus with conduction Joss such as is seen in Meniere's disease. Tinnitus generally increases over time. It is a condition that afflicts many older people and can interfere with hearing, as well as become extremely irritating The exact physiological cause or causes of tinnitus are not known , but there are several likely factors that are known to trigger or worsen tinnitus. Exposure to loud noises is the leading cause of tinnitus, and the exposure can damage and destroy cilia in the inner ear. Once damaged, the cilia cannot be renewed or replaced. Interventions- Some persons with tinnitus will never find the cause; for others the problem may arbitrarily disappear. Hearing aids can be prescribed to amplify environmental sounds to obscure tinnitus, and there is a device that combines the features of a masker and a hearing aid, which emits a competitive but pleasant sound that distracts from head noise.

Other considerations in oral hygiene provision

Tube feeding is associated with significant pathologic colonization of the mouth, greater than that observed in people who received oral feeding. Individuals with dysphagia often receive inadequate mouth care and experience poor oral health. Recommendations are that individuals receiving tube feeding should have their teeth brushed twice a day but techniques and safety have not been determined

Endocrine Diabetes - how is it different in older adults

Type 2 DM is the most common type of DM seen in older adults Genetics, epigenetics, lifestyle, and aging are all significant contributing factors Variants of TCF7L2 gene increase one's likelihood to develop type 2 DM Worldwide 422 million people have DM, 90% have type 2, attributed to obesity and physical inactivity Signs and symptoms The classic signs of DM are: polyuria. polyphagia. polydipsia. hese are rarely presenting symptoms later in life due to increased renal threshold for glucose, reduced thirst reflex, and age-related decreased appetite May have weight loss and urinary incontinence Women may present with candidiasis, as first sign Complications of DM Why would an older person not necessarily present with the classic signs and symptoms (polyuria, polyphagia, and polydipsia) of DM? a.Age-related decrease in appetite b.Reduced thirst reflex c.Increased renal threshold for glucose d.All of the above

Temperature monitoring in older adults

Up to one-third of older people with acute infections may present without a robust febrile response, leading to delays in diagnosis and appropriate treatment, as well as increased morbidity and mortality A temperature of 98.6°F may indicate fever in frail older people

Hyperthermia

When body temperature increases above normal ranges because of environmental or metabolic heat loads Heat syndromes Hyperthermia is a temperature-related illness and is classified as a medical emergency Preventing hyperthermia -Drink 2 to 3L of cool fluid daily -stay in air conditioned places, or use fans when possible -apply cold wet compresses or immerse the hands and feet in cool water -Evaluate medications for risk of hyperthermia -Avoid alcohol

Rolland's Conceptual Framework for Chronic Illness

alternating periods of family closeness and family disengagement Crisis, chronic, and terminal phases timeline: (Crisis) Pre-diagnosis with symptoms, Diagnosis, initial adjustment period (Chronic) chronic "long haul" (terminal) Pre-terminal, death, mourning and resolution of loss

Phases of Chronic Illness Trajectory

he trajectory model aids health care providers to understand the realities of chronic illness and its effect on individuals 9 phases: 1. Pre-trajectory 2. Trajectory onset 3. stable 4.Unstable 5.Acute 6. Crisis 7. comeback 8.Downward 9.Dying

Safety Fires and older adults

home fires continue to be a major cause of death and injury for people of all ages. educate clients about the importance of a home safety plan

Phases of Chronic Illness Trajectory: 4. Unstable

illness course/symptoms not controlled by regimen but not requiring or desiring hospitalization

Phases of Chronic Illness Trajectory: 9. Dying

immediate weeks, day, hours preceding death

Glaucoma

is a group of diseases that can damage the optic nerve. Glaucoma is the second leading cause of blindness in the United States. Individuals at higher risk for glaucoma include African Americans over age 40 years; people with a family history of glaucoma; and everyone over 60 years, especially Mexican Americans. The damage to the optic nerve in glaucoma is irreversible and regenerative attempts have been unsuccessful, so early diagnosis is essential. If detected early, glaucoma can usually be controlled and serious vision loss prevented Symptoms o include headaches, poor vision in dim lighting, increased sensitivity to glare, "tired eyes," impaired peripheral vision, a fixed and dilated pupil, and frequent changes in prescriptions for corrective lenses. Treatment o Management of glaucoma involves medications (oral or topical eye drops) to decrease IOP and/or laser trabeculoplasty and filtration surgery. Medications lower eye pressure either by decreasing the amount of aqueous fluid produced within the eye or by improving the flow through the drainage angle.

Cataracts

is an opacification (cloudiness) in the eye's normally clear crystalline lens, causing the lens to lose transparency or scatter light. Cataracts can occur at any age (babies can be born with them), but they are most common later in life. In the United States, about 70% of people older than age 75 have cataracts. Symptoms o Cataracts form painlessly over time. The most common symptom is cloudy or blurred vision. Everything becomes dimmer, as if seen through glasses that need cleaning. Treatment o The treatment of cataracts is surgical, and cataract surgery is the most common surgical procedure performed in the United States. The surgery involves removal of the lens and placement of a plastic intraocular lens (IOL).

Phases of Chronic Illness Trajectory: 6. Crisis

life-threatening situation; acute threat to self-identify

Oral hygiene in hospitals and long-term care

oral care is an often neglected part of daily nursing care and should receive the same priority as other kinds of care. Illness, acute care situations, and functional and cognitive impairments make the provision of oral care difficult. Factors contributing to less than adequate oral care include inadequate knowledge of how to provide care, lack of appropriate supplies, inadequate training and staffing, and lack of oral care protocols. When the person is unable to carry out his or her dental/oral regimen, it is the responsibility of the caregiver to provide oral care.

Phases of Chronic Illness Trajectory: 8. Downward

progressive decline in physical/mental status characterized by increasing disability/symptoms

Metabolic changes related to age: Smell

radual decrease in number of sensor cells that detect aroma and in nerves that carry signals to the brain and in olfactory bulb that process them Less mucus is produced in the nose Increase in odor threshold, decline in odor identification Many factors affect smell Nasal sinus disease, injury to olfactory receptors through viral infections, damage from industrial work before proper safety standards/ equipment are in place, smoking, medications, periodontal disease/ dental problems Change in smell associated with alzheimers and parkinsons Smelling food while cooking and participation can stimulate appetite

Phases of Chronic Illness Trajectory: 2. Trajectory onset

signs and symptoms are present to some extent, includes diagnostic period 1`

Phases of Chronic Illness Trajectory: 7. comback

while this is much less likley to occur along the trajectory of those who are frail, this is a period of temporary remission from the crisis