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78 Cards in this Set
- Front
- Back
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concerned with the assessment of the health and functional status of older adults
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GERIATRICS (65 & older)
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Emphasizes nurturing, caring, and comforting more than Treatment of disease?
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-GERONTOLOGICAL NURSING
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Focuses on the dx and tx of diseases in older adults?
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-GERONTIC NURSING
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AGEISM:
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-discrimination against people b/c of increasing age
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How does a nurse recongize and address ageism?
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-by questioning, prevailing negative attitudes & sterotypes & emphasizing what really happend during the aging process
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What changes in older adults can result in Cognitive disorders?
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-slowed neurotransmission
-impaired vascular circulation -disease states -poor nutrition -structural brain changes |
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What are 3 congnitive d/o?
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-delirium
-dementia -depression |
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DELIRIUM:
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-acute, temporary and sudden -
-depends on the cause -< 1 mth - acute confusional state |
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What are 4 myths/sterotypes regarding older adults?
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-ill, disabled, unattractive
-forgetful, confused, rigid, boring, unfriendly -unable to learn & understand new info -not interested in sex |
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Convalescence:
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-recovery
ie. recovery from hospital |
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S/S of UTI in older adults:
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-confusion
-incontinence -Falls instead of fever, dysuria, frequency |
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S/S of Pneumonia in older adults?
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-tachycardia
-tachypnea -confusion w/ decreased appetite & functions show No s/s of fever & cough |
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S/S of MI in older adults
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-sudden onset of dyspnea along w/ anxiety and confusion
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What are the early indicators of an acute illness in older adults:
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-change in mental status
-falls -dehydration -decrease in appetite -loss of function -dizziness -incontinence |
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Examples of Altered presentation of illnesses in older adults occurring in the HOSPITAL?
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-suffer from chronic dehydration accelerated by acute illness
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S/S of INFECTION in older adults:
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-respiratory rate
-falls -incontinence -confusion |
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Residents w/ less muscle mass (frail & obese) are at a High risk for?
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-toxicity from protein-binding drugs
ie. phenytoin (Dilantin) & warfarin (Coumadin) |
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Fatigue of decreased ability to do usual activities are S/S of?
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-anemia
-thyroid problems -depression -neurologic problems -cardiac problems |
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If an older adult w/ a cardiac hx reports, increase dyspnea and confusion, what should the caregiver do?
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-take them to the hospital
-common s/s w/ MI |
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What is an early symptom in an older adults w/ late-stage heart that should be monitored?
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-Appetite (it's an early symptom of impending failure)
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Decrease in APPETITE in older adults is a common symptom w/ the onset of, what?
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-pnemonia
-heart failure -UTI |
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DIZZINESS is a commonly occurring sign in older adults of what acute illnesses?
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-anemia
-arrhythmia -infection -MI -stroke -brain tumor |
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A new onset of urinary incontinence in older adults is associated w/ ?
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-adverse drug event
-electrolyte abnormality -UTI |
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PRESBYCUSIS:
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-affects the ability to hear high-pitched sounds and sibilant consonants, such s, sh and ch
*inspect ear for impacted cerumen, before assumes presbycusis* |
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PRESBYOPIA
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-progressive decline in the ability of the eyes to accommodate for close, detailed work
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Color vision changes in older adults?
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-difficult to distinguish b/w blues and greens & pastel shades
-no changes in Dark colors |
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Dorsal kyphosis:
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-curvature of the thoracic spin
--"dowager's hump" --due to osteoporosis |
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Gynecomastia:
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-enlarged breast in men
-often due to med side effects, hormonal changes or obesity |
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3 common causes of death in older adults:
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-heart disease
-cancer -cerebrovascular disease |
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stress incontinence:
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-involuntary release of urine that occurs when women (w/ children)cough, sneeze or lift an object
-results of a weakening perineal and bladder muscles |
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What are the risk factors for urinary incontinence:
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-age
-menopause -diabetes -hysterectomy -stroke -obesity |
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Physiological changes with Aging associated w/ INTEGUMENTARY:
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-loss of skin elasticity (wrinkles, sagging, dryness, easily tears)
-pigmentation changes -glandular atrophy (oil, moisture, sweat glands) -facial hair(increase in women, decrease in men) -decrease subcut fat |
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Physiological changes with Aging associated w/ RESPIRATORY
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-decreased cough reflex
-decreased removal of mucus, dust, irritants from airways -increase risk for respiratory infections |
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Physiological changes with Aging associated w/ CARDIOVASCULAR
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-thickening of bld vessels
-narrowing of vessel lumen -lower cardiac output -increased B/P (systolic) -decreased peripheral circulation |
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Physiological changes with Aging associated w/ GI
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-decrease in saliva, gastric, secretions & pancreatic enzymes
-decrease small intestinal motility -decrease in taste & smell |
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Physiological changes with Aging associated w/ EYES
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-presbyopia (far)
-altered color perception -smaller pupils -yellowing of the lens -difficulty adjusting from light to dark (lead to night blindness) |
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Sensory changes r/t aging?
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-Eyes
-Ears (presbycusis, cerumen) -Taste-diminished -Smell-diminished -Touch-decreased skin receptors -proprioception- decreased awareness of body positioning in space |
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DELILRIUM:
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--Progression: abrupt
-Consciousness: reduced -Alertness: lethargic -Attention: impaired -Memory: recent & immediate impaired -Thinking: Disorganized, incoherent speech (slow or accelerated), fragmented -Perception: distorted, illusion, delusions & hallucinations, difficulty in distinguishing b/w reality & misperceptions -Psychomotor: hypo or hyperkinetic -Sleep/wake: distubed, cycle reversed -Assessment: distracted from task, numerous errors |
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a condition of abnormally diminished muscular movement
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-Hypokinetic
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a neurological disorder characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements.
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-Apraxia
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APHASIA
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disorder caused by damage to the parts of the brain that control language.
-can make it hard to read/write & understand what you mean -most common in stroke pt. -brain tumors, infections, injuries and dementia can also cause it. The type of problem you have & how bad it is depends on which part of your brain is damaged & how much damage there is. -dementia pt |
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Agnosia
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the inability to recognize people or objects even when basic sensory modalities, such as vision, are intact
-The patient can perceive the object but has no meaningful associations to it. In agnosia, while perception itself, feeling an objects shape, normal, recognition of objects is not. -dementia pt |
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Distorted perception/thinking
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Distorted thinking is screening reality through a negative filter so that most events can seem negative.
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perception, as of visual stimuli (optical illusion), that represents what is perceived in a way different from the way it is in reality
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-Illusions
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false belief strongly held in spite of invalidating evidence, especially as a symptom of mental illness
-A false belief or opinion |
Delusion
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Hallucinations
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-apparent perception of sights, sounds,. that are not actually present
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Command Hallucinations:
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A type of auditory hallucination in which the person hears voices ordering him or her to perform a specific act.
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What are the symptoms for Cognitive impairment in older adults?
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-disorientation
-loss of language skills -loss of the ability to calculate -poor judgement (these are NOT normal aging changes) |
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What are some physiological causes of DELIRIUM?
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-electrolyte imbalances
-cerebral anoxia (lack of O2 to the brain) -hypoglycemia -meds -drug effects -tumors -subdural hematomas -cerebrovascular infections -infarction -hemorrhage |
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ALZHEIMER'S DISEASE:
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Alzheimer’s disease (AD) is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks. In most people with AD, symptoms first appear after age 60.
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Dementia:
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Leads to decline in the ability to perform basic and instrumental ADL
-interferes w/ social and occupational functioning |
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What are some psychosocial changes older adults face?
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-retirement
-social isolation -sexuality -housing & retirement -death |
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What are the easiest colors for older adults to see?
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-red
-orange -yellow |
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*POLY-PHARMACY:
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-concurrent use of many meds,
-increase the risk for an Adverse Drug Effect, which is an unintended response to a drug -reflects inappropriate prescribing, but the concurrent use of multiple meds is necessary in situations where olders adults has multiple acute & chronic conditions |
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a communication technique that makes an older adult more aware of time, place and person?
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-REALITY ORIENTATION:
Purpose: restoring a sense of reality, improving the level of awareness, promoting socialization, elevating independent functioning & minimizing confusion, disorientation & physical regression |
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What older adults are at high risk for becoming disoriented?
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-experiencing a change in environment (bright lights, unfamiliar noises, lack of windows
-surgery -illness -emotional stress Increases disorientation: -absence of familiar caregivers -anesthesia, sedatives, tranquilizers, analgesics -physical restraints |
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VALIDATION THERAPY:
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-alternative approach to communication w/ a confused older adult
-accepts the description of time & place as stated by the confused older adult -dementia pt are less likely to benefit, become agitated -you don't challenge of argue w/ statements & behaviors -does not involve reinforcing the confused older adult's misperceptions, but reflects a sensitivity to hidden meanings in statements & behaviors |
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Nursing Interventions using validation therapy include:
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-recognize and address that inner need or feeling
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REMINISCENCE:
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-recalling the past
---As a therapy---: -uses the recollection of the past to bring meaning & understanding to the present & to resolve current conflicts -looking back reminds older adults of coping strategies -way of expressing personal identity -reflection an past achievements supports self-esteem --Assessment: - self-esteem, cognitive function, emotional stability, unresolved conflicts, coping ability, & expectations of future -used as a group therapy for cognitively impaired or depressed older adults |
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Acute care setting poses increased risk for adverse events such as:
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-delirium
-dehydration -malnutrition -health care agency-acquired infections -urinary incontinence -falls |
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What experiences increase the risk for delirium when older adults are hospitalized:
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-immobilization
-sleep deprivation -infection -dehydration -pain -sensory impairment -hypoxia |
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Name 2 meds that are a significant risk factors for delirium:
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-psychoactive
-anticholinergic properties |
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What are non-medical causes of Delirium:
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-placement in unfamiliar surroundings
-bed rest -separation from family & stress |
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What impairments interfer w/ the attempts to reorient the older adult:
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-impaired vision and hearing
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Supportive Interventions for Delirium in an acute care setting:
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-encouraging family visits
-providing memory cues (clock, calendars, name tags) -compensating for sensory deficits -reality orientation techniques |
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Health care agency-acquired infections in older adults include:
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-urinary- catheter- related bacteriuria
-surgical site infections -pneumonia -bloodstream infections *Prevention: hand hygiene, measures to minimize the risk of infection from procedures, measures to increase the olders adults resistance to infection |
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Transient incontinence:
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-incontinent of urine
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Causes of Transient incontinence:
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-delirium
-untreated UTI's -excessive urine production, meds, depression, restricted mobility & constipation or stool impaction |
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What are causes of FALLS in older adults in an acute care setting?
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-intrinsic factors (gait/balance problems, weakness, cognitive impairment)
-extrinsic (polypharmacy, poor lighting, cluttered environment -sedating meds -orthostatic hypotension -increase urinary output -physically restrained -equipment (IV tubing, monitors) -impaired vision -confused (benefit from reality orientation or presence of family/friends) - |
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What areas are affected by Psychosocial changes in older adults?
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-retirement
-social isolation -change in housing -death -sexuality |
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Nursing Interventions for psychosocial concern include:
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-therapeutic communication
-touch -reality orientation -validation therapy -reminiscence -interventions to improve body image |
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Restorative nursing interventions include:
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long-term care or home
-stabilize chronic conditions -promote health -promote independence of ADL's(basic & instrumental) |
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3 common conditions affection cognition in older adults:
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-delirium
-depression -dementia |
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Receptive aphasia
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– you hear the voice or see the print, but you can't make sense of the words
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Global aphasia
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-you can't speak, understand speech, read or write
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Anomic aphasia
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– you have trouble using the correct word for objects, places or events
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DEPRESSION:
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-Onset: pt w/ major life changes, abrupt, can be gradual
-Course: diurnal effects, worse in am, situational fluctuation -Progression:Variable: rapid or slow but even -Duration: at least 6 wks, sometimes several months or years -consciousness- clear -Alertness- normal -Attention: minimal impairment, but easily distractible -Disorientation: selective -Memory: selective or "patchy", "islands" of memory, evaluation often difficult due to low motivation -Thinking: intact but w/ themes of hopelessness, helplessness, or self-deprecation -Perception: intack, delusion & hallucination present in severe cases -Psychomotor behavior: variable, psychomotor retardation or agitation -Sleep/wake cycle: disturbed, usually early morning awakening -Associated Features: dysphoric mood, exaggerated & detailed complaints, preoccupied w/ personal thoughts, insight present, verbal elaboration, somatic complaints, poor hygiene & neglect of self -Assessment: failings highlighted by freq "don't knows", little effort, frequently gives up, indiff toward test: dont care or attempt to find answers |
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DEMENTIA:
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Onset: insidious/slow, often unrecognized, Course: long, no diurnal effects,
Progression: slow but uneven -Duration: months to years Consciousness: clear -Alertness: generally normal -Attention: generally normal -Memory: recent & remote impaired -Thinking:difficulty w/ abstraction, thoughts diminished, judgement impaired, words difficult to find -Perception:misperceptions usually absent -Psychomotor behavior: normal, some have apraxia -Sleep/wake cycle: fragmented -Associated Features: superficial, inappropriate, labile (changing), hides deficits in intellect, personality changes, aphasia, agnosia Assessment: failings highlighted by family, frequent "near miss" answers, struggles w/ test, freq requests for feedback on performance |
