UNIT 8- Older adult (Ch 14, Concept 2)

Major dimensions of concern relative to an individual's functional ability

(1) risk recognition (2) functional assessment (3) planning and delivery of individualized care appropriate to level of functional ability

Developmental tasks of older adults

(1)Adjusting to decreasing health and physical strength (2)Adjusting to retirement and reduced or fixed income (3)Adjusting to death of a spouse, children, siblings, friends (4)Accepting self as aging person (5)Maintaining satisfactory living arrangements (6)Redefining relationships with adult children and siblings (7)Finding ways to maintain quality of life

Actual performance circumstances

(1)Amount of assistance needed (2)Amount of time needed (3)Level of performance

Psychosocial changes that affect the older adult

(1)Changes in roles & relationships (2)Retirement (3)Social isolation (4)Housing and environment (5)Sexuality (6)Death

Risks associated with acute care settings and older adults

(1)Confusion/Delirium (2)Dehydration (3)Malnutrition (4)Healthcare-acquired infections (5)Urinary incontinence (6)Falls

Common respiratory changes with aging

(1)Decreased cough reflex (2)Decreased cilia (3)Fewer alveoli (4)Increased risk of respiratory infections

Common reproductive changes with aging

(1)Decreased hormones (2)Erectile dysfunction (3)Degeneration of sex organs

Common musculoskeletal changes with aging

(1)Decreased muscle mass (2)Bone breakdown (3)Joint changes (4)Disk degenerative

Common gastrointestinal changes with aging

(1)Decreased saliva, gastric secretions, pancreatic enzymes (2)Decreased esophageal/intestinal motility (3)Increased gastric pH (4)Hemorrhoids (5)Decreased rectal sensation

Common neurological changes with aging

(1)Decreased sensation

Common endocrine changes with aging

(1)Decreased thyroid function (2)Increased anti-inflammatory hormone (3)Decreased pancreatic hormones (4)Decreased ability to respond to stress

Common sensory changes with aging

(1)Decreased vision (2)Loss of hearing (3)Diminished taste (4)Diminished smell (5)Decreased skin receptors (6)Decreased awareness of body position

Risk factors for impaired functional ability

(1)Developmental abnormalities (2)Advanced age (3)Cognitive function (4)Mental health issues (especially depression) (5)Trauma (physical or psychological) (6)Illness (acute or chronic)

Extrinsic risk factors for falls

(1)Environmental hazards outside and within the home (2)Inappropriate footwear (3)Unfamiliar environment (4)Improper use of assistive devices

Common genitourinary changes with aging

(1)Fewer nephrons (2)Decrease in renal blood flow (3)Decreased bladder capacity (4)Prostate enlargement (5)Reduced sphincter tone in women

Intrinsic risk factors for falls

(1)History of a previous fall (2)Impaired vision (3)Postural hypotension or syncope (4)Conditions affecting mobility (5)Conditions affecting balance and gait (6)Alterations in bladder function (7)Cognitive impairment (8)Adverse medication reactions (9)Slowed reaction times (10)Deconditioning

Common myths and stereotypes about older adults

(1)Ill, disabled, and unattractive (2)Forgetful, confused, rigid, boring, unfriendly (3)Unable to learn and understand new information (4)Not interested in sex or sexual activities

Common integumentary changes with aging

(1)Loss of skin elasticity (2)Thinning hair (3)Slow nail growth (4)Turning gray (5)Atrophy of epidermal arterioles

Risk factors for the older adult not taking medication/adverse drug effects

(1)Managing multiple medications is confusing and complex (Polypharmacy) (2)Medication cost

Categories of functional ability

(1)Physical domain (2)Psychological domain (3)Cognitive domain (4)Social domain

Nursing interventions related to the older adult

(1)Recovery from acute illness or surgery (2)Support of chronic conditions that affect day-to-day functioning (3)Health promotion (4)Promotion of ADLs and IADLs (5)Fall prevention (6)Exercise therapy (7)Teaching safe use of assistive devices

Key elements of reality orientation

(1)Reminders of person, time, and place (2)The use of environmental aids such as clocks, calendars, and personal belongings (3)Stability of environment, routine, and staff. DO NOT CONTINUE TO REORIENT OLDER ADULTS WITH CHRONIC COGNITIVE IMPAIRMENT

Exmples of common nursing diagnoses for older adults

(1)Risk for falls (2)Acute pain, chronic pain (3)Activity intolerance (4)Risk for infection (5)Impaired skin integrity (6)Impaired ability to complete ADL's

Common nursing interventions for older adults

(1)Self-care assistance for BADLs and IADLs (3)Fall prevention (4)Exercise therapy (5)Teaching safe use of assistive devices

Techniques of assessment of the visual impaired

(1)Sit or stand at eye level, in front of the patient in full view. (2)Face the older adult while speaking; do not cover your mouth. (3)Provide diffuse, bright, nonglare lighting. (4)Encourage the older adult to use his or her familiar assistive devices such as glasses or magnifiers.

Assessment of older adults

(1)Takes more time...you cannot rush the older patient! (2)Allow rest periods (3)Consider vision and hearing changes (4)Consider memory deficits (5)Consider aging versus disease (6)Interpret S&S/lab data in context of older adult (7)Pay attention to minor complaints

Psychosocial techniques for the older adult

(1)Therapeutic communication (2)Touch (3)Reality orientation (4)Validation therapy (5)Reminiscence (6)Body image interventions

Common cardio changes with aging

(1)Thickening of blood vessels (2)Narrowing of vessels (3)Loss of vessels/valve elasticity (4)Increased systolic blood pressure (5)Decreased peripheral circulation

Common immune changes with aging

(1)Thymus shrinkage (2)Decrease in T-cell function

Functional changes of the older adult

(1)Usually linked to illness/disease & degree of chronicity (2)Performance of ADLs & IADLs is a sensitive indicator of health or illness.

Functional assessment components

(1)Vision (2)Hearing (3)Mobility (4)Falls (5)Continence (6)Nutrition (7)Cognition (8)Affect (9)Home environment (10)Social participation (11)BADLs & IADLs

Health promotion and maintenance

(1)Well-balanced nutrition (2)Regular physical activity (3)Routine health checkups (4)Stress management (5)Regular participation in meaningful activity (6)Fall prevention measures (7)Avoidance of tobacco and other substances associated with abuse

Which of the following interventions should be included in a plan of care for a patient who had a stroke 30 days ago and is now in home care rehabilitation? (Select all that apply). A. Promoting independence and encouraging patient participation in activities of daily living (ADLs). B. Promoting rest and sleep. C. Promoting a diet rich in protein. D. Promoting exercise and ambulation. E. Assisting the patient with ADLs. F. Limiting visitors and social contacts.

A,B,D It is important to promote independence in ADLs early in the plan of care to increase independence in general. Promoting rest and sleep will promote well-being. Ambulation and exercise promote well-being and increase healing by circulating oxygen to the brain. Protein promotes healing in post-surgical patients but is not a main focus in stroke patients. Assisting the patient does not promote independence. Limiting visitors will isolate the patient, which can lead to depression.

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,D 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.

The nurse is assessing a patient's ability to perform basic activities of daily living (BADLs). Which of the following activities are considered in the BADLs assessment? (Select all that apply): A. Feeding oneself. B. Preparing a meal. C. Balancing a checkbook. D. Walking. E. Toileting. F. Grocery shopping.

A,D,E BADLs include feeding oneself, ambulation, and toileting. Instrumental activities of daily living (IADLs) include shopping, meal preparation, housekeeping, doing laundry, managing finances, taking medications, and using transportation

Nonstochastic theories

Aging as the result of genetically programmed physiological mechanisms within the body that control the process of aging

Stochastic theories

Aging as the result of random cellular damage that occurs over time

Disengagement theory

Aging individuals withdraw from customary roles and engage in more introspective, self-focused activities

Instruments such as the Functional Activities Questionnaire (FAQ) for postoperative patients who are at home, the Minimum Data Set for Nursing Facility Resident Assessment and Care Screening (MDS) for nursing home patients, the Functional Status Scale (FSS) for children, and the Edmonton Functional Assessment Tool for cancer patients are used to assess activities of daily living (ADLs). The nurse needs to remember that a disadvantage of these instruments includes A. The efficacy and reliability of the instruments. B. The variations in assessments and responses may be subjective because of self-reporting of functional activities. C. The instruments do not show a true measure of ability because of a lack of interactivity during the assessments. D. The information contained in the instruments is insufficient to make a determination about functional status in these populations.

B A disadvantage of many of the ADLs and instrumental activities of daily living (IADLs) scales is the self-reporting of functional activities. Efficacy and reliability are not measured when assessing ADLs and IADLs. Interaction with the patient is necessary to complete the ADL and IADL assessments. The FAQ and FSS are comprehensive tools that can help the nurse determine functional status

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 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.

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 Often an older adult uses "heavy" spices because of his or her inability to taste the food.

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 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.

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

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 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.

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 This can also affect the ability of the patient to deep breath and cough effectively.

The nurse is caring for an 85-year-old woman 6 weeks following a hysterectomy secondary to ovarian cancer. The patient will need chemotherapy and irradiation on an outpatient basis. Which of the following priorities would be seen as a barrier to healing and need to be considered when planning care for this patient? (Select all that apply): A. Can feed herself and prepare meals but cannot drive to the store. B. Lives on a fixed income and can balance her checkbook. C. Has stress incontinence. D. Was active at the senior center and now cannot participate in activities. E. Lives alone and has no nearby relatives. F. Has no transportation to the oncology clinic.

C,E,F The patient will not be able to get treatment if she has no transportation or no relatives that live nearby who can help her with recovery. Stress incontinence increases the risk of falls because of urgency and rushing to get to the bathroom. Income and social abilities are lower priorities during this phase of recovery.

Reminiscence

Recalling the past to assign new meaning to past experiences

Depression

Reduction in happiness and well-being ONSET- Happens with major life changes; often abrupt but can be gradual DURATION- At least 6 weeks; sometimes several months to years

Gerontology

Study of all aspects of the aging process and its consequences

Activity theory

The continuation of activities performed during middle age as necessary for successful aging

Functional ability

The individual's ability to perform the normal daily activities required to meet basic needs; fulfill usual roles in the family, workplace, and community; and maintain health and well-being

What is the problem that arises with functional ability questionnaires?

The information is subjective and based on the patients perceptions and might not be as accurate as objective data

Gerotranscendence

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

Reality orientation

Therapeutic modality for restoring an individual's sense of the present

Expected outcome

Maintain optimal independent function and prevent functional decline for health-related quality of life

Gerontological nursing

Nursing care for the older adult

What does a SUDDEN change in function mean?

Often a sign of the onset of an acute illness.

Continuity theory

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

Developmental theories

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

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 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.

Dementia

A group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily functioning ONSET- Insidious/slow and often unrecognized DURATION- Months to years, can be permenant

Capacity

Ability to perform a task

Validation therapy

Accepts the description of time and place as stated by the confused older adult

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,C,E 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.

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,C,E 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.

The nurse is assessing a patient's ability to perform instrumental activities of daily living (IADLs). Which of the following activities are considered in the IADLs assessment? (Select all that apply): A. Feeding oneself. B. Preparing a meal. C. Balancing a checkbook. D. Walking. E. Toileting. F. Grocery shopping.

B,C,F IADLs include shopping, meal preparation, housekeeping, doing laundry, managing finances, taking medications, and using transportation. The other activities listed are activities of daily living (ADLs) related to self-care

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,D 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 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,E,F 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

Kyphosis

Changes in the configuration of the spine that affect the lungs and thorax.

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 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.

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

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 Sexuality is normal throughout the life span, and older adults need to be able to express their sexual feelings.

Ageism

Discrimination against people because of increasing age

Delirium

Disturbance in a person's mental abilities. ONSET- Sudden, often within hours or a few days DURATION- Hours to less than 1 month; longer if unrecognized and untreated