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63 Cards in this Set
- Front
- Back
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Gerontology
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is the scientific study of the effects of time on human development
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Holistic view of aging
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a realization of potential for health, wellness, quality of life, and contribution to society
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Organizations Devoted to Gerontology Research and Practice
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Gerontological Society of America (GSA)
American Society on Aging (ASA) Association for Gerontology in Higher Education (AGHE) National Council on Aging (NCOA) |
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Gerontological Nursing
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Mission is to preserve function, enhance health, and enhance quality of life and dying
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Research and Aging
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Research and gerontological knowledge strongly influenced by federal bulletins distributed nationwide to indicate research most likely to receive federal funding
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Global Challenges
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Policies needed to meet income, health, and long-term care needs for men and women throughout world
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The greatest increase in aging by group percentage is occurring among those:
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85 and older
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The Institute of Medicine reports that the need for the number of geriatricians by 2030 will be which of the following:
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36000
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Eliminate preventable disease, disability, injury, and premature death
Achieve health equity, eliminate disparities, and improve the health of all groups Create social and physical environments that promote good health for all Promote healthy development and healthy behaviors across every stage of life |
Healthy People 2020
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A strong holistic health movement
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expands the definition of health as multi-factorial; realizing the potential of the individual and how they function within the context of their environment .
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Successful healthy aging
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social, biological, psychological, spiritual, cultural, environmental
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The Wellness Model
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suggests that every person has an optimum level of functioning for each position on the wellness continuum to achieve a good and satisfactory existence
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Leading causes of death in older adults
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Heart disease
Stroke Cancer |
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Prevention and Health Promotion for Older Adults
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Physical (healthy lifestyle)
Psychosocial (stress management) Cognitive (cognitive stimulation) Interpersonal (active social life) |
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Primary prevention of disease
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before it occurs
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Secondary prevention of disease
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detection of disease (early state)
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Medicare coverage for preventative services
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One-time “Welcome to Medicare” physical examination
Adult immunizations Cardiovascular screenings Colorectal cancer screening Breast cancer screening mammograms Pap test and clinical breast exam if over 65 with a recent abnormal screening test Bone mass measurements Diabetes screening Diabetes supplies Diabetes self-management training Glaucoma tests for high risk individuals Diabetic retinopathy screening Foot exams and treatment for those with diabetes-related nerve damage and/or meet certain criteria Hearing and balance exams HIV screening for those at risk Prostate cancer screening Medical nutrition therapy (diabetic or renal disease) Smoking and tobacco-use cessation counseling |
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Implications for Gerontological Nursing
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Holistic approach to enhance wellness in all realms of being
Help to achieve the highest level of personal wellness no matter the health condition Promote healthy behaviors and healthy development at every stage of life |
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What percentage of Older Americans does not receive routine preventive screening?
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60%
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Integument
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Skin
Epidermis Keratinocytes become smaller and regeneration slows Dermis Loses about 20% of thickness with aging Hypodermis Lean muscle replaced by fat; subcutaneous fat reduced Hair Becomes gray as melanin production in hair bulb decreases Diffuse alopecia occurs in both genders with aging Nails Become more brittle, flat, concave Cuticle becomes less thick and wide |
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Alterations in body weight
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Body Composition
Alteration in body weight occurs as lean body mass declines and body water is lost Increased risk for dehydration |
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Thermoregulation
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Temperature Regulation
Lower body temperature Risk for hypothermia and hyperthermia because of reduced responsiveness to environmental changes of temperature |
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Musculoskeletal System
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Structure and Posture
Vertebral disks become thin, causing shortening of trunk Stooped, slightly forward-bent posture common Bones Disequilibrium in bone maintenance develops when resorption is more rapid than deposition of new minerals Joints, Tendons, Ligaments Age-related changes in articular cartilage result from biochemical changes Tendons may shorten and move from usual positions Muscles Muscle tissue mass decreases (atrophies) while adipose tissue increases |
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Cardiovascular System
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Heart
Valves May be thicker and stiffer as result of lipid deposits, collagen degeneration, fibrosis Conductivity SA node cells decrease in number as myocardial fat, collagen, and elastin fibers increase AV node and bundle of His lose conductive cells Contractility Contraction prolonged most likely due to slower release of calcium into the myoplasm during systole Blood Vessels Elasticity diminished because of changes in collagen, elastin, and possible cross-linking Vessel walls thicken as result of reorganization of cellular and extracellular matrix Pooling of blood increases venous pressure, diminishing effectiveness of peripheral valves Presbycardia Reduced cardiac reserve evidenced by decreased Maximum heart rate Stroke volume Cardiac output Ejection fraction Myocardial oxygen uptake |
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Respiratory System
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Airways
Nose Nose elongates downward as support of upper and lower lateral cartilage weakens Trachea and Larynx Stiffening of larynx and tracheal cartilage occurs as result of calcification Chest Wall and Lung Ossification or rigidity of costal cartilage and downward slant of ribs create less compliant, more rigid rib cage, which limits chest expansion Oxygen Exchange PO2 declines Chemoreceptor function altered or blunted |
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Promoting Healthy Lungs
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Obtain pneumonia immunization
Obtain annual influenza immunization Avoid exposure to smoke and pollutants Do not smoke Avoid persons with respiratory illnesses Seek prompt treatment of respiratory infections Wash hands frequently Eat meals in relaxed atmosphere Practice thorough oral hygiene |
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Renal and Urological Systems
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Kidneys
Size, function of kidneys decrease Glomerular sclerosis Renal Vessels Renal blood flow decreases 50% by age 80 or about 10% per decade of adult life Ureters, Bladder, Urethra Some tone and elasticity lost Capacity declines from about 500 to 600 mL of urine in younger adult to about 250 mL in older adult Weakened contractions during emptying can lead to post-void residual and increased risk for urinary tract infections Glomerular Filtration Rate May be reduced by 50% by age 75 |
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Endocrine System
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Thyroid Gland
Some atrophy, fibrosis, and inflammation occur Parathyroid Gland Slight reduction in production of parathyroid hormone Adrenal Gland Becomes more fibrous Decreases metabolic clearance rate Endocrine Pancreas Secretion does not decrease Tissues often develop decreasing sensitivity to insulin |
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Digestive System
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Mouth and Teeth
Teeth eventually lose enamel and dentin, and become more vulnerable to caries Gums more susceptible to periodontal disease Esophagus Contractions increase in frequency but are more disordered and propulsion are less effective Stomach Decreased gastric motility and volume and reductions in secretion of bicarbonate and gastric mucus Decreased production of intrinsic factor More susceptible to peptic ulcer disease Small Intestine Villi become broader, shorter, and less functional Nutrient absorption affected Large Intestine Peristalsis slowed Accessory Organs Liver and gallbladder Liver decreases in weight and mass Incidence of gallstones increases Exocrine pancreas Becomes more fibrotic, has increased fatty acid deposits, atrophies slightly |
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Promoting Healthy Digestion
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Practice good oral hygiene
Wear properly fitting dentures Seek prompt treatment of dental caries and periodontal disease Eat meals in relaxed atmosphere Maintain adequate intake of fluids Provide time for response to gastrocolic reflex Respond promptly to urge to defecate Eat balanced diet Avoid prolonged periods of immobility Avoid tobacco products |
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Nervous System
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Central Nervous System
Neurons Neurotransmitters Peripheral Nervous System Motor Sensory Reflexes Reticular formation Autonomic Nervous System Basal ganglia |
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Reproductive System
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Female
Perimenopause Menopause Male Decreased fertility Erectile changes Prostatic enlargement |
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Immune System
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Skin thinner and less resistant to bacterial invasion
Reduced number of cilia in lungs leads to increased risk for pneumonia Friability of urethra increases risk for urinary track infection Reduced immunity at cellular level |
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Menopause occurs at approximately what age for most women?
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51
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Reducing Health Disparities
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Cultural awareness
Self-level: requiring self-understanding of one’s experiences and values Ability to work with and build relationships with a member from another cultural group Recognition of factors beyond culture, such as health, safety, and poverty, that affect members of a cultural group Cultural knowledge Both what nurse brings to caring situation and what nurse learns about older adults, their families, their communities, their behaviors, and their expectations Essential knowledge includes elder’s way of life (ways of thinking, believing, acting) Cultural skills Appropriate use of communication and language is foundational skill and intimately tied to concept of self Communication is issue not only of language but also of idiom, style, jargon, voice tone, inflection, body language |
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LEARN model
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L Listen to what the patient has to say
E Explain your perception of the problem A Acknowledge the similarities and differences of perception R Recommend a plan of action that takes into account both perspectives N Negotiate a plan that is mutually acceptable. |
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Two major types of hearing loss
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Conductive
Reduced ability of sound to be transmitted to inner ear Cerumen impaction most common cause Sensorineural Hearing loss from damage to inner ear or neural pathways to the brain Presbycusis most common form of hearing loss in the United States |
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The Power of Touch
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Adaptively used for awareness and protective responses
Compensates for other sensory impairments Intensifies bonding and defines boundaries of self An important therapeutic intervention by nurses |
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Tactile Sensitivity
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Touch sensitivity diminishes with aging
Can predispose older adults to skin damage and development of pressure ulcers Loss of thermal sensitivity can lead to burns and/or frostbite injuries Adding texture to the older adult’s surroundings can enhance safety and increase interaction with environment |
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Communication and Neurological disorders
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Reception
Affected by anxiety, disease process, hearing deficits, and altered level of consciousness Perception Affected by stroke, dementia, delirium Articulation Caused most commonly by cerebral infarction with neuromuscular effects |
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Aphasia
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Most common language disorder caused by cerebral infarction
Varying types depending on area of neurologic insult Can cause profound communication difficulties and negatively impact quality of life Speech therapy an important rehabilitative aspect of care |
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Health Literacy in Older Adults
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Defined as the ability to effectively navigate and understand basic health information and make appropriate health decisions.
Older adults disproportionally affected by inadequate health literacy. Cognitive and sensory impairments can substantially affect the older adult’s ability to process basic healthcare information. |
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Physical Assessment
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FANCAPES
Fluids Aeration Nutrition Communication Activity Pain Elimination Socialization and social skills |
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Integrated Assessment
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Fulmer SPICES
Sleep disorders Problems with eating or feeding Incontinence Confusion Evidence of falls Skin breakdown |
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Physical Assessment
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Functional Assessment
Evaluation of person’s ability to carry out basic tasks for self-care and tasks needed to support independent living Numerous tools available that describe, screen, assess, monitor, and predict functional ability Activities of Daily Living Katz Index Barthel Index Functional Independence Measure Instrumental Activities of Daily Living Assesses three levels of functioning Independent Assisted Unable to perform Function and Cognition Blessed Dementia Score Clinical Dementia Rating Scale Global Deterioration Scale |
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Mental Status Assessment
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Cognitive Measures
Mini-Mental State Examination Clock Drawing Test |
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Integrated Assessment
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Older American’s Resources and Service (OARS)
Social resources Economic resources Mental health Physical health Activities of daily living |
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Red Blood Count
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Normal value: 4.2 to 6.1 million/mm3
Hemoglobin Normal value: 12 to 18 g/dL Hematocrit Normal value: 37% to 52% |
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White Blood Cells
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Normal value: 5000 to 10,000/mm3
Neutrophils Normal value: 55% to 70% Lymphocytes Normal value: 20% to 40% Monocytes Normal value: 2% to 8% Eosinophils Normal value: 1% to 4% Basophils Normal value: 0.5% to 1% |
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Functions of White Blood Cells
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Neutrophils: Stimulated by pyogenic infections, to fight bacteria
Eosinophils: Stimulated by allergic responses, to fight antigens and parasites Basophils: Stimulated by the presence of allergens, transport histamine Lymphocytes: Stimulated by the presence of viral infections Monocytes: Stimulated by severe infections, including viral, parasitic, and rickettsial |
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Platelets
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Normal value: 150,000 to 400,000/mm3
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Common Diagnostics for Hematological Testing
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Erythrocyte sedimentation rate (ESR)
C-Reactive Protein (CRP) Iron studies B vitamins Vitamin D |
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Hormones
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Thyroid
Triiodothyronine (T3) Thyroxine (T4) Thyroid-stimulating hormone (TSH) |
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Electrolytes
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Sodium and chloride
Potassium Calcium and phosphorus Glucose |
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Hypokalemia
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Generalized muscle weakness
Fatigue, muscle cramps Constipation Ileus Flaccid paralysis Hyporeflexia Hypercapnia Tetany ECG changes QT interval prolonged T wave flattened or depressed ST segment depressed |
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Hyperkalemia
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Impaired muscle activity
Weakness Muscle pain/cramps Increased GI motility Bradycardia Cardiac arrest ECG changes P wave flattened T wave large, peaked QRS broad Biphasic QRS-T complex |
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Diagnostic Criteria for Diagnosing Diabetes
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ONE random plasma glucose 200 mg/dL when exhibiting symptoms OR
TWO of any one or combination of positive tests on different days Fasting plasma glucose (FPG) 126 mg/dL Oral glucose tolerance test (OGTT) 200 mg/dL 2 hours after glucose Random plasma glucose 200 mg/dL without symptoms |
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New Additional Diagnostic Test for Diabetes
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Elevated Glycated hemoglobin A1C, repeated to confirm
<6.5%* is the general cut off for normal, however there is still discussion if this should be 4-6% for those considered in the normal range Other tests….. Alkaline Phosphates Uric Acid Prostate-specific Antigen |
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Acute Cardiac Events
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Creatnine kinase
Troponin Testing and Monitoring Risk and Health C-reactive protein Homocystine Brain natriuretic peptide Lipids Cholesterol Triglycerides |
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Testing for Body Proteins
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Total Protein
Serum Albumin Measures nutritional status Most useful as indicator of severity of illness and risk of mortality |
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Lab tests for renal health
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Blood Urea Nitrogen
Measurement of nitrogen portion of urea; used as gross measurement for renal functioning Creatinine More accurate refection of renal health |
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Monitoring for Therapeutic Blood Levels
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Coagulation Time
Prothrombin time Partial thromboplastin time International normalized ratio Cardiac Rate Control Digoxin Level Blood level is general guide; must be combined with clinical presentation (including heart rate) of person Antiseizure Phenytoin (Dilantin) Levels Breakthrough seizure activity may occur with levels below 10 mcg/mL Toxicity at levels above 20 mcg/mL Thyroid Hormone Levels Hypothyroidism most common disturbance seen in older adults Hyperthyroidism, or thyrotoxicosis, significantly less common |
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Urine Studies
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Urinalysis
Specific gravity pH Protein Glucose Ketones Blood Bilirubin Nitrates Leukocytes |
