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121 Cards in this Set
- Front
- Back
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What is senescence?
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The progressive deterioration of body systems that increase the risk of mortality as an individual gets older.
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What are the 3 main categories of Aging Theories?
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Biological
Sociological Psychological |
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What are the 2 sub-categories under the biological theories of aging?
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Programmed Theories
Error Theories |
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Name 3 programmed theories of aging.
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(PIE)
Programmed longevity Immunological Endocrine |
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Name 3 error theories of aging.
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Cross-Link
Free radical Wear & tear |
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Name 3 sociological theories of aging.
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Continuity
Activity Disengagement |
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Name 3 psychological theories of aging.
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Jung's theory
Erickson's theory Butler's theory |
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What is the basic premise of biological theories of aging?
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Changes are natural & intrinsic or environmental
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What is the basic premise of programmed theories of aging?
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The body's genetic codes contain instructions for the regulation of cellular reproduction & death
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What is the basic premise of error theories of aging?
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Environmental assaults & the body's constant need to fuel activities cause toxic by-products to accumulate which impair function & cellular repair.
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What is the basic premise of sociological theories of aging?
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These theories focus on roles & relationships that occur later in life.
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What is the basic premise of psychological theories of aging?
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These theories stress that coping or adaptation must occur for successful aging.
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Programmed theories include programmed longevity, endocrine, & immunological. Describe each theory.
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-Programmed Longevity: results of sequential switching on & off of certain genes & eventually age-associated deficits occur
-Immunological: Immune system attacks own body cells or its function declines (focus on limiting exposure to pathogens & support immune function) -Endocrine: biological clocks act through hormones to control pace of aging (focus on growth hormones) |
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Error theories include cross-link, free radical, & wear & tear. Describe each theory.
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-Cross-Link: Error in protein synthesis (causes cataracts, wrinkling, etc.)
-Free radical: Metabolism results in excessive changes resulting in cell damage (focus on antioxidants & vitamins to slow changes) -Wear & tear: all cell wear out (allow for age, disease) |
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Sociological theories include continuity, activity, & disengagement. Describe each theory.
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-Continuity: Aging is dependent on lifestyle & personality
-Activity: result of decrease in activity -Disengagement theory: mutual withdrawal between elder & society (e.g. mandatory retirement) |
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What is Jung's Theory?
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Jung's Theory of Individualism
-A type of psychological aging theory -there is a shift from extroversion to introversion as aging occurs (1960s) -searching for answers -trying to find "true self" -accept past accomplishments & failures -introspection as age |
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What is Erickson's Theory?
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Erickson's Developmental Theory (Ego Integrity vs. Despair) (1950)
-accept life as lived & find meaning in life -accept death as part of life -accept limitations (if they can do these things, then they have ego integrity) |
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What is Butler's Theory?
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(reminiscence guru) (1970)
-adjust to infirmities of old age -develop sense of satisfaction with life as lived -prepare for death -reintegrate ego |
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What 5 areas should you consider when communicating with the older adult?
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"VENTS"
Verbal communication Empathetic listening Nonverbal communication Teaching Social communication |
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What tone of voice should you use when communicating with the older adult?
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A low tone
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Does social communication have a place when communicating with the older adult?
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yes, it shows we think of them as a real person (we may be their "family")
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When reminiscing, what areas should you focus on?
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the person's accomplishments
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Is learning altered with age?
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no
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How should you go about teaching the older adult?
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Assess learning needs
helpful if can relate new material to previously learned info repetition practice return demonstrations follow up sessions (Older adult is goal oriented) |
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When should you plan to have a detailed conversation with the older adult?
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during mid morning "peak" times
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How do you arrange a conducive environment for conversation with the older adult?
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Maximize sensory abilities (adequate lighting, glasses, hearing aids) & cognitive abilities (re-orient)
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What is Geropharmacology?
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How the elderly respond to medications
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What is Pharmacokinetics?
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What the body does to the drug: Absorption, Distribution, Metabolism, Excretion
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What is Pharmacodynamics?
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What the drug does to the body.
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What are the 6 medication risks in the elderly?
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"People Fail To Know Certain Meds"
physiological changes (pharmacokinetics/dynamics) Financial factors Testing methods (don't test drugs on elderly) Knowledge deficit Cognitive (forget) & sensory (can't see labels) changes Many meds |
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Does our risk of adverse responses to medications increase as we age?
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Yes, because the more physiological changes we have - the greater our risk of adverse reactions.
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What factors affect drug response in the elderly?
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Altered: Absorption, Distribution, Metabolism, Excretion
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What causes altered drug absorption?
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Altered GI motility
↓ gastric acidity ↓ lipid content in skin (drugs don't reach target site due to altered absorption) |
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What causes altered drug distribution?
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Increase in body fat (fat soluble drugs trapped in fatty tissue), ↓ in body water (water soluble drugs stay in blood stream which could cause toxicity), ↓ in serum proteins (leaves fewer sites for protein bound drugs).
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What is an example of a water soluble drug that could cause toxicity if it builds up in the blood?
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Gentamycin
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What are some examples of drugs that need serum proteins to bind to?
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Digoxin, Lasix
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What is a "green" way of disposing medications?
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place meds in paper bag, unlabeled, & throw away (keeps from getting into water supply)
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What causes altered metabolism of drugs?
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↓ liver blood flow
(usually b/c of cardiovascular problems/decreased cardiac output) ↓ enzyme activity in liver |
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What causes altered drug excretion?
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↓ renal blood flow & mass
↓ glomular filtration rate ↓ of functional renal tubules (↓ renal function of 50% by age 90) |
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What are some common drugs that affect renal function?
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IV antibiotics
Digoxin NSAIDS |
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What test is best at determining how well drugs are being cleared from system?
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Creatinine clearance test
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Can residents in LTC self medicate?
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yes, it is a patient right
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What is the general rule of thumb for administering medications to elderly?
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Start low & go slow
(give 1/2 usual dose & wait 2x as long before you increase dose) |
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What facts about each drug should the nurse know before administering to the elderly?
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"DRRSST"
Dose Route Reason Special precautions Side effects Therapeutic effect |
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What are the 3 ways to check NG tube placement?
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Listen for air
Look for gastric content Check pH of aspirate |
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How long should the pt remain upright after taking medication?
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1 hour
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How should you give liquid medication that is less than 10 ml?
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In a syringe
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What is the best way to identify a resident at a LTC facility?
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Ask someone to identify who knows them.
(can check ID bracelet if have one or picture in Mar) |
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If you are administering medication to a pt with dementia, what should you check for?
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Pocketing of medication
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What should you do if a pt refuses to take their medication?
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Barter with them if you can & give most important meds first. If still refuse, wait 30 minutes and offer again.
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What should you be careful of when giving a suppository medication?
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Careful not to stimulate vagus nerve. Check heart rate after.
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If a pt is on a thickened liquid diet with free water, can they use water to take their pills?
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No - only water with nothing else.
(if aspirate, only water in lungs) Must use thickened liquid to take pills. |
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What does Latrogenesis mean?
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Harm from a therapeutic regimen.
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What does ADRs stand for?
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Adverse drug reactions
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Are older adults more likely to have adverse drug reactions?
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yes
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What are some examples of adverse drug reactions the older adult may experience?
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confusion
falls cognitive changes n&v anorexia weight loss |
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What are the 7 rights of med administration?
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"DDDPTRR" (3D's Peter)
Right… drug dose documentation patient time route right to refuse |
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What is the goal with med administration to the elderly?
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Want maximum benefit with least amount of medication.
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What are some teaching suggestions concerning medications & the older adult?
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KISS: keep it simple sweetie
include family teaching aids link med times with regular events cover storage of meds instruct not to share meds instruct not to use old meds suggest 1 MD & pharm |
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What meds are the most commonly used with the elderly population?
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Cardiac medications
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What is Health Perception/health maintenance?
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The perception of personal health and related activities performed to maintain health; multidimensional pattern of self-initiated actions & perceptions that serve to maintain or enhance the level of wellness, self-actualization, and fulfillment of the individual; focus on strengths, abilities, & values of individual
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What are some common influences on Health perception/maintenance?
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"MS CHKR"
Motivation Socioeconomic status Culture Health Knowledge Religion |
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There are 4 Hematological physiologic changes associated with aging. List the changes & possible results of these changes.
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↑ platelet adhesion = ↑ risk of clots
↓ production of RBCs = ↑ incidence of anemia ↓ T-cells = ↓ immune system response ↓ intrinsic factor production = ↑ incidence of pernicious anemia |
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There are 5 Musculoskeletal physiologic changes associated with aging. List the changes & possible results of these changes.
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↓ bone calcium = ↑ osteoporosis & kyphosis
↓ fluid in spinal disks = ↓ height ↓ blood supply to muscles = ↓ muscle strength ↓ tissue elasticity = ↓ mobility, ROM, flexibility ↓ muscle mass = ↓ strength (↑ risk of falls) |
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What are 2 common hematological diseases seen in elderly?
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Anemia (iron deficient)
Infections (UTI & URI) |
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What are 2 common musculoskeletal diseases seen in elderly?
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Osteoporosis & Osteoarthritis
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What is the standard deviation for osteopenia?
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(-) 1 sd
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What is the standard deviation for osteoporosis?
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(-) 2.5 sd
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How can you detect bone loss?
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Bone mineral density test
Bone & joint x-rays & ct scan MRI Blood serum tests (regular x-rays not good for detection b/c only see loss when 30-35% or greater) |
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What 3 nutrients may the older adult need for supplementation?
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Ca, Vit D, B12
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When may a person need Ca & how much?
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1200-1500 mg daily when > 50 yo
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When may a person need Vit. D & how much?
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600 mg daily when > 60 yo (to help absorb Ca)
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What may a deficiency of Vit B12 lead to?
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pernicious anemia aka macrocytic anemia
s/s include peripheral neuropathy, irritability, depression, poor memory |
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How much B12 may an elder person need?
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1000 mcg x 1 mon
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What foods contain B12?
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liver, fish, fish liver oil
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What is the older adult's response to infection?
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Often vague symptoms: fever may be low-grade, may have adverse & allergic reactions to medications
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What is the most common infection in the elderly?
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UTI 32%, URI 15%
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Will the elder adult respond to antibiotics the same as others?
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No, it may take longer for them to respond to antibiotics
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Decreased urine output may signal what?
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Decreased kidney function
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What are some signs of an URI?
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Cough
congestion sputum ↑ in abnormal respiratory sounds |
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What are the common microorganisms seen with bacteremia?
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Gram (+): Staph
Gram (-): Ecoli, Klebcillia, proteus |
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What are some signs/symptoms of sepsis?
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Fever (low or spiked)
confusion agitation irritation decreased LOC |
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What usually causes bacteremia?
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Usually complication of pneumonia, URI, skin infections
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Who is at the greatest risk for falls?
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Women over age 80
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What is the 7th leading cause of accidental death in people age 65 or older?
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Falls
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What causes the greatest number of deaths r/t falls?
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hip fractures
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What is osteoporosis?
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Loss of bone mass that occurs through out the skeleton & predisposes clients to fractures.
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What causes osteoporosis?
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Healthy bone remodels itself. Aging causes more bone to be resorbed than laid down.
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Describe the 2 types of osteoporosis.
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Type 1: results from loss of protective effects of estrogen on bone at menopause
Type 2: bone loss occurring from aging (senile osteoporosis) |
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What are some risk factors for osteoporosis?
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over age 50
white postmenopausal thin/small framed family hx sedentary smoker excessive alcohol, caffeine or soft drink intake steroids |
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Why does excessive intake of soft drinks increase the risk factor of osteoporosis?
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Phosphorus displaces calcium.
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What are some interventions for osteoporosis?
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Ca & Vit D supplements
estrogen supplements weight bearing exercise meds as ordered (Fosimax, Evista, Boniva, Reclast) |
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How often should a woman over age 65 get a pelvic exam?
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q 3 years
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How often should a woman over age 65 get a mammography?
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yearly
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How often should a woman over age 65 get a breast exam?
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yearly
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How often should a man over age 65 get a prostate/digital rectal exam?
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yearly
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How often should someone over age 65 get a colonoscopy exam?
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q 5-7 years
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How often should a person over age 65 get a bone density exam?
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baseline at menopause (aprox. 50 yo)
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How often should a person over age 65 get a TB skin test?
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yearly (repeat in 1-3 weeks if negative: it is the 2 step method: delayed reactivity may occur b/c of decreased immune system)
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What is sarcopenia?
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Decrease of lean muscle mass with aging
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Name the 9 oral/gastrointestinal changes that occur with age & what it may result in.
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↑ dental caries/tooth loss = ↓ chewing
↓ salivary production = ↓swallowing/taste ↓ tongue papilla = ↓ taste ↓ gag reflex = ↑ aspiration/choking ↓ muscle tone at upper sphincters = ↑ GERD/heartburn ↓ gastric secretions = ↓ digestion/enzyme secretion ↑ cholecystokinin = ↑ satiety ↓ peristalsis = ↑ constipation ↓ thirst mechanism = ↑ dehydration. |
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What is xerostomia?
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decrease in salivary production
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Name the 4 endocrine changes that occur with age & what it may result in.
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↓ pituitary secretions (growth hormone) = ↓ body mass
↓ thyroid stimulating hormone = ↓ BMR ↓ parathyroid hormone = ↑ blood Ca levels ↓ insulin production = ↑ blood sugar |
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You may see a decrease in what hormone with osteoporosis?
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Parathyroid hormone (cause increased Ca to be released into blood)
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There are 13 common age-related skin changes in the elderly. Name them and what they can result in.
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↓ moisture of epidermal cells = ↑ dry, rough skin
↓ thickness of epidermis = ↑ susceptibility to trauma ↓ thickness/elasticity of dermis = ↑ pallor & wrinkling ↓ melanocytes = ↓ hair color (graying) ↓ sebaceous & sweat gland function = ↑ dry skin & ↓ perspiration ↓ subq fat after 75 yo = ↑ wrinkling, skin damage risk & c/o cold ↑ localized pigmentation = ↑ brown spots (lentigo) ↑ capillary fragility = ↑ senile purpura ↓ density of hair growth = ↓ amt. & thickness of head & body hair ↓ rate of nail growth = ↑ brittleness of nails ↓ peripheral circulation = ↑ ridges on nails, thickening & yellowing of nails ↑ androgen: estrogen ratio = ↑ facial hair in women & ↑ hair in ears/nose for men |
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What is the treatment for B12 deficiency aka pernicious anemia?
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B12 shot q month & intrinsic factor
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What is a hiatal hernia?
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The stomach protrudes into chest cavity through a hole in the diaphragm.
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What age should a person start getting screenings for colon cancer?
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Age 40, q 5-7 years after. Peak incidence 60-75.
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What are the common gastrointestinal disease processes that may be seen in elderly pts?
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Periodontal disease
Malabsorbtion B12 deficiency/Pernicious anemia Esophageal disorders (GERD, Hiatal hernia, Dysphagia) Gastritis Ulcers Diverticulosis/itis Colon cancer |
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What are common endocrine disorders seen in elderly?
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Diabetes Mellitus
Hypothyroidism |
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What are common integumentary disease processes seen in elderly?
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Pruitus, Skin tears, Skin cancer, Decubitis ulcers
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What is the most common form of skin cancer?
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Basal cell
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What is the more serious form of skin cancer?
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Squamous cell
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What is the name of precancerous skin lesions?
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Actinic keratotic lesions
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What are some risk factors for decreased nutrition/metabolism?
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Inability to obtain/prepare food
stomatitis/dysphagia depression/social isolation changes in metabolism decreased taste/smell absorptive disorders malnutrition medication side effects poorly fitting dentures |
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What diagnostic tests might you review relating to nutrition/metabolism?
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Electrolytes: Ca, Na, Cl, K
Glucose CBC: Hgb, Hct, RBCs Iron (↓ indicate anemia) Protein ttl albumin Radiology Endoscopy (Upper & Lower GI series) |
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What is the best diagnostic indicator of malnutrition?
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albumin < 3
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What are the nutritional areas to assess?
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Modified food guide pyramid
Vitamin requirements Screening tools (MDS) Assess dysphagia fluid balance (volume, electrolytes, pH, specific gravity) tissue integrity thermoregulation |
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Do caloric needs change for the elderly?
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Yes, at age 70, males need only 2000 cal/day & women need only 1600 cal/day
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How much fluid should you encourage the elder to drink daily?
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2000 ml/day
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Describe a proper meal for an elderly person.
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Meals should be high in complex carbs & fiber. They need some protein, vitamins & minerals but should not rely on carbs for balance of nutrients. < 30% of calories should come from fats.
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