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63 Cards in this Set

  • Front
  • Back
is the scientific study of the effects of time on human development
Holistic view of aging
a realization of potential for health, wellness, quality of life, and contribution to society
Organizations Devoted to Gerontology Research and Practice
Gerontological Society of America (GSA)
American Society on Aging (ASA)
Association for Gerontology in Higher Education (AGHE)
National Council on Aging (NCOA)
Gerontological Nursing
Mission is to preserve function, enhance health, and enhance quality of life and dying
Research and Aging
Research and gerontological knowledge strongly influenced by federal bulletins distributed nationwide to indicate research most likely to receive federal funding
Global Challenges
Policies needed to meet income, health, and long-term care needs for men and women throughout world
The greatest increase in aging by group percentage is occurring among those:
85 and older
The Institute of Medicine reports that the need for the number of geriatricians by 2030 will be which of the following:
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
A strong holistic health movement
expands the definition of health as multi-factorial; realizing the potential of the individual and how they function within the context of their environment .
Successful healthy aging
social, biological, psychological, spiritual, cultural, environmental
The Wellness Model
suggests that every person has an optimum level of functioning for each position on the wellness continuum to achieve a good and satisfactory existence
Leading causes of death in older adults
Heart disease
Prevention and Health Promotion for Older Adults
Physical (healthy lifestyle)
Psychosocial (stress management)
Cognitive (cognitive stimulation)
Interpersonal (active social life)
Primary prevention of disease
before it occurs
Secondary prevention of disease
detection of disease (early state)
Medicare coverage for preventative services
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
Implications for Gerontological Nursing
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
What percentage of Older Americans does not receive routine preventive screening?
Keratinocytes become smaller and regeneration slows
Loses about 20% of thickness with aging
Lean muscle replaced by fat; subcutaneous fat reduced
Becomes gray as melanin production in hair bulb decreases
Diffuse alopecia occurs in both genders with aging
Become more brittle, flat, concave
Cuticle becomes less thick and wide
Alterations in body weight
Body Composition
Alteration in body weight occurs as lean body mass declines and body water is lost
Increased risk for dehydration
Temperature Regulation
Lower body temperature
Risk for hypothermia and hyperthermia because of reduced responsiveness to environmental changes of temperature
Musculoskeletal System
Structure and Posture

Vertebral disks become thin, causing shortening of trunk

Stooped, slightly forward-bent posture common

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
Muscle tissue mass decreases (atrophies) while adipose tissue increases
Cardiovascular System
May be thicker and stiffer as result of lipid deposits, collagen degeneration, fibrosis
SA node cells decrease in number as myocardial fat, collagen, and elastin fibers increase
AV node and bundle of His lose conductive cells
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
Reduced cardiac reserve evidenced by decreased
Maximum heart rate
Stroke volume
Cardiac output
Ejection fraction
Myocardial oxygen uptake
Respiratory System
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
Promoting Healthy Lungs
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
Renal and Urological Systems
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
Endocrine System
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
Digestive System
Mouth and Teeth
Teeth eventually lose enamel and dentin, and become more vulnerable to caries
Gums more susceptible to periodontal disease
Contractions increase in frequency but are more disordered and propulsion are less effective
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
Promoting Healthy Digestion
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
Nervous System
Central Nervous System
Peripheral Nervous System
Reticular formation
Autonomic Nervous System
Basal ganglia
Reproductive System
Decreased fertility
Erectile changes
Prostatic enlargement
Immune System
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
Menopause occurs at approximately what age for most women?
Reducing Health Disparities
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
LEARN model
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.
Two major types of hearing loss
Reduced ability of sound to be transmitted to inner ear
Cerumen impaction most common cause
Hearing loss from damage to inner ear or neural pathways to the brain
Presbycusis most common form of hearing loss in the United States
The Power of Touch
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
Tactile Sensitivity
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
Communication and Neurological disorders
Affected by anxiety, disease process, hearing deficits, and altered level of consciousness
Affected by stroke, dementia, delirium
Caused most commonly by cerebral infarction with neuromuscular effects
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
Health Literacy in Older Adults
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.
Physical Assessment
Socialization and social skills
Integrated Assessment
Sleep disorders
Problems with eating or feeding
Evidence of falls
Skin breakdown
Physical Assessment
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
Unable to perform
Function and Cognition
Blessed Dementia Score
Clinical Dementia Rating Scale
Global Deterioration Scale
Mental Status Assessment
Cognitive Measures

Mini-Mental State Examination

Clock Drawing Test
Integrated Assessment
Older American’s Resources and Service (OARS)

Social resources
Economic resources
Mental health
Physical health
Activities of daily living
Red Blood Count
Normal value: 4.2 to 6.1 million/mm3

Normal value: 12 to 18 g/dL

Normal value: 37% to 52%
White Blood Cells
Normal value: 5000 to 10,000/mm3
Normal value: 55% to 70%
Normal value: 20% to 40%
Normal value: 2% to 8%
Normal value: 1% to 4%
Normal value: 0.5% to 1%
Functions of White Blood Cells
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
Normal value: 150,000 to 400,000/mm3
Common Diagnostics for Hematological Testing
Erythrocyte sedimentation rate (ESR)
C-Reactive Protein (CRP)
Iron studies
B vitamins
Vitamin D

Triiodothyronine (T3)
Thyroxine (T4)
Thyroid-stimulating hormone (TSH)
Sodium and chloride
Calcium and phosphorus
Generalized muscle weakness
Fatigue, muscle cramps
Flaccid paralysis
ECG changes
QT interval prolonged
T wave flattened or depressed
ST segment depressed
Impaired muscle activity
Muscle pain/cramps
Increased GI motility
Cardiac arrest
ECG changes
P wave flattened
T wave large, peaked
QRS broad
Biphasic QRS-T complex
Diagnostic Criteria for Diagnosing Diabetes
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
New Additional Diagnostic Test for Diabetes
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
Acute Cardiac Events
Creatnine kinase

Testing and Monitoring Risk and Health
C-reactive protein
Brain natriuretic peptide
Testing for Body Proteins
Total Protein
Serum Albumin
Measures nutritional status
Most useful as indicator of severity of illness and risk of mortality
Lab tests for renal health
Blood Urea Nitrogen
Measurement of nitrogen portion of urea; used as gross measurement for renal functioning
More accurate refection of renal health
Monitoring for Therapeutic Blood Levels
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

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
Urine Studies
Specific gravity