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40 Cards in this Set
- Front
- Back
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why study care of older adults?
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1/3 of all surgical pts > 65
chronic illness 4x > old age 40% of all elderly will spend some time in nursing home most beds in acute care filled by elderly older adults most sig. users of home health |
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common myths of the older adult
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old age begins at 65
most older adults are in nursing homes older adults are sick, mental deterioration occurs older adults are not intersted in sex bladder prob. a prob. of aging older adults don't deserve agg. treatment for illnesses |
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the number of older americans is growing
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1900: 3.1 mil
1999: 34.6 mil 2050: 82 mil |
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the proportion of older americans is growing
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yr %ppl 65+
1950 8.3 2000 12.4 2004 12.7 2050 20.6 |
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imrpoved financial security for older americans
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% on s.s %below poverty
1960s 60% 35% 1990s 93% 10% |
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changes of older adulthood
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-physical strength & health
-retirement & red. income -health of spouse -r/t one's age group -social roles -living arrangements -family & role reversal |
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development of the older adult
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-physiologic- all organ sys. undergo some degree of decline, body less eff.
cognitive: doesn't change appreciably, may take longer to resp. and react psychosocial-self-concept is relatively stable throughout adult life Erikson- ego integrity versus despair and disgust; life review |
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moral and spiritual dev. of older adults
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Kohlberg-older adults have completed their moral dev. and most are at a conventional level
spiritually, many adults demonstrate faith and trust in a greater power |
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physiologic: skin
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changes: loss of subc tissue & thinning of dermis
s/s: underlying tissue more fragile, inability to resp. to heat/cold quickly, loss of moisture; wrinkling nursing implications: frequent ass., skin care, avoid tape, monitor water temp, mild soap |
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sensory
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changes: loss of lid elasticity, ocular changes, auditory canal narrows, calcification of ossicles, lowerd olfactory cells
s/s: ptosis, visual glare, low vision, hearing loss, tinnitus, lowered odor recogtnition nursing imp:safety, ass. |
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physiologic: skin
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changes: loss of subc tissue & thinning of dermis
s/s: underlying tissue more fragile, inability to resp. to heat/cold quickly, loss of moisture; wrinkling nursing implications: frequent ass., skin care, avoid tape, monitor water temp, mild soap |
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sensory
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changes: loss of lid elasticity, ocular changes, auditory canal narrows, calcification of ossicles, lowerd olfactory cells
s/s: ptosis, visual glare, low vision, hearing loss, tinnitus, lowered odor recogtnition nursing imp:safety, ass. |
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cardiovascular
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changes: less stress resp., stiffer valves, blunted, less vascular elasticity, conduction abnormality (vessels dilate & contract-lose ability. cant reg. BP as well)
s/s: murmurs, low CO, htn, orthostatic hypotension nursing implications: teaching re:OH, assessment |
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pulmonary
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changes: enlargement & rigidity of chest wall, airway collapse
s/s: poorer expansion, lowered O2 delivery nursing implications: aggressive ambulation, pulmonary toilet |
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GI
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changes: inc. hiatal hernia, dec. abd strength, weakened intestional walls, dec. gastric acid
s/s: epigastric discomfort, constipation nursing implications: monitor for constipation |
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renal
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changes: dec. blood flow
s/s: dec. concentrating ability, nocturia (kidneys can't function as well = more urine output) nursing imp: assess for fluid volume abnormality |
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musculoskeletal
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changes: loss muscle mass, vertebral disc, dec. bone mass
s/s: fractures, weakness, dec. stamina nursing imp: fall risk, height loss, safety high risk for falls |
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endocrine
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changes: insulin insensitivity, hormone loss, BMR lowers
s/s: DM type 2, vaginal dryness nursing imp: teaching, balanced diet |
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neurologic
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changes: dec. deep sleep, dec. tactile, nerve endings less sensitive
s/s: insomnia, slower resp., dec. appetite nursing imp: assess during hospitalization |
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mental impairment in older adults
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-delirium (temporary state of confusion: can last hrs to weeks)
-dementia -Alzheimer's disease -sundowning syndrome |
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recognizing delirium
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nurses recognize and document 50% of cases
dr. recognize and document only 20% of cases |
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diagnosing delirium
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DSM-IV criteria precise but difficult to apply
confusion assessment method (CAM) -clinically more useful - >95% sensitivity and specificity |
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DSM-IV diagnostic criteria
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disturbance of consciousness w/ reduced ability to focus, sustain, or shift attention
change in cognition or a perceptual disturbance not better accounted for by existing dementia dev. over a short time (hrs to days) and fluctuation during the day evidence from history, physical, or labs that the disturbance is a direct physiologic consequence of a medical condition or a drug |
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confusion assessment method
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1. acute changes in mental status and fluctuating course
2. inattention 3. disorganized thinking 4. altered level of consciousness requires features 1&2 and either 3 or 4 |
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delirium takes various forms
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hyperactive or agitated del=25% of all cases
mixed (usually mixed version) hypoactive del=> 50% of all cases, but less recognized and appropriately treated additional features include emotional labilty, psychosis, hallucinatios |
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What is dementia?
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an acquired syn. of decline in memory and other cognitive functions suff. to affect daily life in an alert pt
progressive and disabline not an inherent aspect of aging diff. from normal cognitive lapses |
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alzheimer's disease
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-form of dementia
onset:gradual cognitive symp: primarily memory motor symp: rare early, apraxia later progression: gradual, over 8-10yr on average lab tests: normal imaging: possible global atrophy, small hippocampal volumes |
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to reduce sundowning
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form of delirium
-give adequate daytime stim. -maintain adequate levels of light in daytime -est. bedtime routine and ritual -remove environment factors that might keep pt awake -discourage drinking stim. or smoking near bedtime -give diuretics, laxatives early in day -place familar objects at bedside |
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immune
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changes: thymus mass & production
s/s: infections nursing imp: teaching |
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What can nurse do to protect the health of the elderly?
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wash hands, flu shots, good nutrition, early intervention
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special older adult problems
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falls
elder mistreatment and abuse hospitalized elderly polypharmacy |
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causes of accidental injuries in older adults
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-changes in vision and hearing
-loss of mass and strength of mucles -slower reflexes and rxn time -dec.sensory ability -combined effects of chronic illness and meds -economic factors |
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elder mistreatment
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-includes physical, psychological, financial, and sexual abuse, as well as caregive neglect and self-neglect
-elderabusecenter.org -adult protectice services -risk factors (lack of close family ties, substnace abuse, shared living arrangement) |
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polypharmacy definitions
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concurrent use of multiple prescription drugs and over-the-counter meds
concomitant use of 5 or more meds prescription, administration, or use of more meds than are clinically indicated when a medical regimen includes at least one unnecessary medicine use of a med to treat the adverse effects of another med |
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polypharmacy in the eldery Why?
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the elderly use more drugs b/c illness is more common in older persons
cardiovascular disease arthritis gastrointestinal disorders bladder dys. |
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polypharmacy in the elderly how bad can it be?
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elderly = 12% of population but 32% of prescriptions
average use for persons age >65: 2 to 6 prescription drugs + 1 to 3.4 OTC drugs |
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polypharmacy in the elderly
Whats the big deal? |
polypharmacy leads to: more adverse drug rxns
dec. adherence to drug regimens pt outcomes: -poor quality of life -high rate of symptomatology -unnecessary drug expense |
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hospitalized elderly
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risk for functional decline
risk factors: acute illness, exacerbation of chronic illness, med side effects, decreased mobility(made another problem worse) |
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goal of nursing care
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promote indep. function
supp. individual strength prevent comp. of illness secure a safe & comfortable environment promote return to health |
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basis for teaching plan for older adults
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-chronic illness limits activities in almost half of older adults
-meeting expenses of healthcare is often diff. -medication costs, hospitalization costs, and costs of special equipment and supplies family members must learn to cope w/ needs of the ill person family members must adapt to psychological stressors |
