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Gerontology
Test 2
| Question | Answer |
|---|---|
| Respiratory Age-Related Changes | -Nasal septal deviation (snoring,apnea) -Thicker nasal mucous(stuffiness) -Calc of neck cartilage (choking) -Diminished cough reflex,gag reflex,pneumonia,aspiration -Kyphosis,calcification of costal cartilage, rib osteo(less efficient chest expansion |
| Changes in Lung Structure | -Smaller,flabbier lungs,poor elastic recoil=less air exchange & poor exhalation -Larger,thinner wall alveoli, pul.art thickening,fewer cap=diminished gas exchange -Less ventilation & perfusion=poor gas exchange,Use more accessory musc. -Poor rate com |
| Risk Factors for Respiratory Wellness | -Smoking-Leads to: -COPD -Lung Cancer -Cardiovascular Disease -Mouth Cancer -Stomach Cancer -Bladder Cancer -Pancreatic Cancer -Smokeless tobacco has same risk |
| Other effects on Lung Function | -Poor air quality, second-hand smoke-cumulative affects -Obesity-poor inhalation and aeration of bases of lungs -Increasing susceptibility to pneumonia, influenza,TB -Sedatives and anti-cholingergics-dry mucous -ACE inhibitors-dry cough |
| Diseases Affecting Lung Function | -TB-often no symptoms and PPD is neg; often reactivation of dormant disease -COPD-chronic airway obstruction (emphysema,chronic bronchitis, asthma) Symptoms: cough,dyspnea,wheezing,increased sputum production |
| Nursing Assessment: Respiratory | -Thorough Interview -Ask about environmental exposures -Smoking-ready to quit? May be all they have left of former life, never too late to quit |
| Nursing Assessment: Pneumonia | -Lower Resp. Disease -Not usual symptoms of cough,fever,chills -Present w/ delirium, incontinence falls,agitation,not eating -Dyspnea,fever late |
| Physical Assessment: Respiratory | -Respiratory rate increase up to 24/min (normal 16-20) -Increased chest diameter -Diminished intensity of lung sounds-quieter -More adventitious sounds in lower lungs |
| Promoting Lung Wellness | -Stop smoking-Never too old to quit -Bring up stopping smoking, programs to help -Reducing cigs can help too - neg effects of smoking is directly related to # of cigs smoked -Prevent pneumonia and influenza -Vaccines for all 65 and over&healthcare wor |
| Promoting Lung Wellness 2 | -Encourage coughing and deep breathing exercises,especially with COPD and smoking -Changing positions frequently and some form or exercise should be encouraged |
| Cardiovascular Age-Related Changes | -Myocardial (hypertrophy,valve thickening,amyloid deposits) -Blood vessels (Tunica intima=artherosclerosis;Tunica media=hypertension) -Baroreflex mechanism-physiologic process regulate BP by D HR,peripheral vascular resistance |
| Risk Factors for Cardiovascular Disease | -Physical deconditioning (lack of exercise)-cause of most CV changes -Causes less O2 to tissues and decrease CO -Obesity,diabetes,smoking,dyslipidemia -Socioeconomic factors-college grad w/income of $50,000 has 1/2 the risk of HS grads making $10,000 |
| Risk Factors for Cardiovascular Disease 2 | -Smoking-2nd hand smoke leads to atheroscleorsis, >systolic BP, > LDL, <HDL -Hypertension 140/90 and needs a treatment (risks:obesity,inactivity,high NA diet) -Dyslipidemia-abnormal lipoprotein levels >LDL,<HDL;Heart disease, stroke,diabetes,PVD |
| Cardio Vascular: Gender Issues | -Most CV research on men -Women get CV disease 10yrs later than men -Postmenopausal women: atherogenic lipid profile, increase ab fat, increase diabetes and insulin resistance, increase activity and decrease intake |
| Orthostatic Hypotension | -Decreased baroreflex sensitivity -Hypertension treatment -Parkinson's disease -Diabetes -Anemia -Arrhythmias -Dehydration -Meds-Antihypertensives,antidepressants, diuretics,alcohol |
| Functional Consequences:Cardiovascular | -HR decreases gradually -Atrial fibrillation-top part of heart can't empty, common in older adults but caused by pathologic conditions like hypertension, CAD -Cardiac Output-Most older adults experience no change in their cardiac output |
| Effect on Exercise: CV | -Blunted adaptive response to exercise -Exercise increased demands on CV system by 4-5 times the basal level -Adaptive response involves lungs,heart, muscles, nervous system |
| Effects on BP | -Systolic increases more widening PP -Systolic stays higher longer after exercise -Postparandial hypotension-drop of BP of 20 mmHg w/in 75 mins of eating -Pseudohypertension-false high BP due to incomplete compression of artery due to athersclerosis |
| Orthostatic Hypotension | -Lightheadedness,weakness,blurred vision, pallor -Drop of systolic by 20mm or diastolic by 10mm w/in 1-4 mins of standing,after being recumbent for 5 mins or longer |
| BP has more variable | -Lower=Postural changes, meals, hot weather -Diurnal-lowest at night, highest 1st thing in am -Caffeine and smoking (30 min bf BP) -Should be seated for 5m, arm at heart level |
| Nursing Assessment for CV problems | -Get baseline assessment -Know guidelines for assessing BP -Watch for atypical presentations |
| Nursing Interventions: CV | -Focus is on smoking,obesity, sedentary lifestyle, dyslipidemia, hypertension -Nutrition: Eat more fruits and veggies, esp green and leafy; eat more fiber and Ca; Green tea; Avoid high salt foods |
| Lifestyle Changes: CV | -Physical activity-weight bearing best, aerobic important -No smoking -Maintain ideal body weight |
| Medications:CV | -Antihypertensives, diuretics (watch for orthostatic hypotension) |
| Treating dyslipidemia | -Increase fiber (whole grains) -Add soy (milk,tofu) -Minimize fatty fish (1-2 a wk) -Use nonfat dairy and desserts -Limit butter,margarine -Lean meat-trim fat, skin poultry -Avoid processes meats, gravies, organ meats |
| Treating Orthostatic hypotension | -8 glasses of non-caffeine fluids/day -Avoid alcohol -Avoid sitting/standing long periods -Avoid heat sources (sun,electric blankets,heating pads,hot tubs-vasodilation) -Change position slowly -Sit b/f standing -Elastic stockings-b/f getting out of |
| Treating Postprandial Hypotension | -Antihypertensives 1 hour after meals -Eat small,low carb meals -Avoid alcohol -Avoid strenuous activity for 2 hours after meals |
| Age-related Changes Affecting Eating | -Decreased smell-affect food enjoyment -Xerostomia-from meds,disease;lead to dysphagia,aspiration -Early satiety,presbyphagia-changes in swallowing -Atrophy of musc in intestine-affects absorption of nutrients -Liver-atrophy little affect on digestion |
| Changed Nutritional Requirements | -ADA doesn't give recommendations -Cals:should reduce by 40, more carbs less fats -Protein-<lean body mass, musc tissue -Carbs-good source of fiber-soluble (oats,fruits); improve glucose tolerance, lower cholesterol, insoluble help bowel func. |
| Changed Nutritional Requirements 2 | -Water- temp regulation, maintains metabolism; elders should have 1500-2000 ml, noncaffeine; have decrease thirst drive -Fats-help w/ temp regulation, provide energy source,provides feeling of satiety; saturated: animals and unsaturated: vegetables |
| Risk Factors Affecting Nutrition | -Poor oral care (ability,$,confusion) -Functional Impairment(get/ prepare food) -Meds(anorexia,xerostomia,impaired smell/taste) -Lifestyle(alcohol w/Vit B&C, smoking w/smell/taste) -Psychosocial-prepare smaller meals,eating alone -Socioeconomic-$,cul |
| Cultural Issues | -AA-fried,barbecued,pork;High salt,fat,car,lack Ca -Asian-rice,pork,chicken,soy,lard& oil;High salt,fat,low carb -Hispanic-chicken,corn,bread, frying/lard;high salt,fat,carb -NA-fish,fruit,game;good nutrition,lack refrig. lack Ca |
| Nursing Interventions:Nutrition | -Find dental care or oral care supplies -Mobile meals, shoppers -Monitor med effects -Programs for smoke stopping and alcohol -Identify food preferences -Help find meaningful ways to socialize during meals |
| Constipation | -Myths:BM daily,raw fruits&veggies are detrimental to elderly -Function of large intestine -Not an age-related issue, but due to risk factors -Increase fluid intake,increase fiber intake, increase activity |
| Getting food for preparation | -Driving -Cognitive skills-what to buy -Balance-pushing cart,reaching on high shelf -Vision-reading labels,prices,glare of bright lights (frozen foods) -Pain&stiffness -arthritis -Manual dexterity-holding purse,pushing cart,coupons, shopping list |
| Preparing Food | -Slicing and chopping -Opening containers -Measuring ingredients -Carrying foods/liquids from frig to counter w/out spilling -Standing for long periods of time -Items on high shelves, basement -Safely using stove,temp controls-cognitive issue |
| Xerostomia | -Gingivitis, and other gum disease -Dry lips -Caries -Plaque -Difficulty swallowing -Dentures that don't fit -Candidiasis & other oral infections -Speech dysfunction |
| Common Nutritional Deficits | -Proportion of body fat to lean tissue increases -Marasmus-protein-energy undernutrition (wt.loss, decrease musc mass, decrease sub-q fat, poor reserve, recovery from surgery or illness) -Kawshiokor-severe (above symptoms,edema,loss of protein from orga |
| Nursing Assessment of Nutrition | -Assess mouth -Assess Ab (inspection,auscultation,percussion,palpation) -General decrease indicators (wt, decrease strength, edema, dry dull hair,dry eyes, dry lips&mouth) -Lab data(hemoglobin/hematocrit-anemia;albumin-protein loss,edema;cholesterol) |
| Nursing Assessment Questions:Nutrition | -Where do you eat? -With whom? -Do you prepare with any assistance? -Who purchases your food? -Recent changes to eating pattern? -Enjoy what you eat? -Difficulty eating? |
| Promoting Oral Health | -Brush w/child toothbrush -Floruidated toothpaste, floss daily (aids) -Mouth rinse (not to replace brushing), no alcohol -Hard candy, gum should be sugar free -Denture care -Assisstive devices available |
| Promoting Nutrition | -Exercise daily -8 or more glasses of water each day -Supplements of Ca,vitamin D&B12 -Food pyramid-Water,Whole grains, veggies & fruits, Dairy & meat, Fats |
| Pancreas Function | -Secrete digestive enzymes (exocrine) -Secrete Insulin and glycogen (endocrine), necessary for glucose metabolism and storage -Age-related changes (Decrease response to glucose,fibrous changes,atrophy) |
| Metabolic Disorder | -Vascular (most damaging and dangerous,diabetes makes blood vessels smaller) -Renal -Neurological (blood supply decrease) -Vision (more trouble w/blindness than any other disease process) |
| Normal Age Related Changes: Diabetes Mellitus | -Normal FBS are higher -Change in nutritional status: fat to muscle increases; metabolism decreases;altered endocrine function;decreases glucose tolerance -FBS=8 hrs w/out eating |
| Initial Symptoms:DM | -Polyuria (excessive urine) -Polydypsia (excessive thirst) -Polyphagia (excessive hunger) -Weight loss - Type 1 -Fatigue -Susceptibility to yeast infections -Blurred Vision |
| Management of DM: Primary Prevention | -Healthy eating habits -Normal weight -Exercise |
| Management of DM: Secondary Prevention | -Detection (BS) -Prompt treatment -Assessment of changes in health -Health care regimen -Nutrition -Exercise |
| Chronic Complications: DM | -Athersclerosis of large blood vessels (macrovascular, Cardiovascular effects) -Microvascular Disease (retinopathy, nephropathy) -Neuropathies (parasthesia-feeling in hands and feet altered, feel like needles) |
| Macrovascular Disease | -Coronary Artery Disease -Cerebrovascular Disease -Hypertension -Peripheral Vascular Disease (mostly legs, take months to heal wounds) -Infection |
| Microvascular Complications | -Diabetic Retinopathy (blindness) -Nephropathy (protein in urine) -Neuropathy (sensory, autonomic) |
| Nurse's Role: DM | -Teaching: Diet; Medications; Exercise: Prevention of Complications; Knowledge of the disease -Never walk without shoes or with flip flops |
| Nursing Diagnosis: DM | -Alt Tissue Perfusion -Alt Nutrition -Sensory/Perceptual Alt -Risk for impaired skin integrity -Risk for inf -Risk for acute complications -Sexual dysf -Ineffective individual coping -Ineffective management of the therapeutic regimen -Knowledge |
| Goals: DM | -Understanding: disease process, medications,diet -Monitoring for side effects -Blood glucose monitoring -Exercise -Personal hygiene -Follow up appointments -Medic Alert Bracelet -Community Resources |
| Age Related Changes: GI system | -Atrophy gastric mucosa -Thinning stomach lining -Slowing of stomach emptying -Little effect on SI -Change in intestinal villa of SI: Decrease in mucosal surface area -Lining of LI becomes thinner&less mucus is secreted -Diminished motility of col |
| Factors Affecting Bowel Elimination | -Developmental Considerations (what they expect) -Daily patterns -Food&Fluid Intake -Activity and Muscle Tone (exercise) -Lifestyle -Psychologic Variables (stress) -Pathologic Conditions -Medications: Narcotics (C); Antibiotics (D) |
| Assessment of Bowel Status: Subjective | -Usual Pattern -Recent Changes -Problems: Seven Variables -Aids to elimination -Diet/Fluid intake -Presence of Artificial Orifices |
| Assessment of Bowel Status: Objective | -Hydration status -Abdomen (IPPA) Inspect,Auscultate, Percuss,Palpate -Skin integrity-Skin turgor test -Stool -Diagnostic tests: stool specimens,upper GI series,lower GI series, barrier enema |
| Promoting Regular Bowel Habits | -Timing -Positioning -Privacy -Nutrition -Exercise |
| Constipation | -Dry,hard stool-water absorbed from stool -Symptom, not a disease -Reasons: Dehydration,meds, ignoring the urge,and mobility, change in diet,overuse of laxatives -Interventions-individualized (diet,fluid,exercise,meds,enemas); focus on identified probl |
| Causes of Constipation in the Elderly | -Decreased levels of activity -Decreased physical mobility -Inadequate intake of fluids -Improper diet -Chronic use of enemas and laxatives -Anal fissures/hemorrhoids -Decreased intestinal motility |
| Impaction | -Build up feces that becomes so large it can't be passed through rectum -Why: ignoring urge and unrelieved constipation, bed ridden -Assess: Hx of C -S&S: Ab discomfort,involuntary liquid stools,cramping,N,no appetite -Interventions:Digital removal/me |
| Bowel Incontinence | -Incontinent of stool -D/T-spinal cord trauma, dementia, stroke, delirium, MS -Problems-affect body image, socially isolated -Interventions-Briefs, frequent assessing, good skin care, bowel training |
| Diarrhea | -Increase # of stools, contents that pass through GI so quickly, not enough time to absorb water -Symptom -Assess-Look, how many, type -Problems-Dehydration,lose electrolytes,skin breakdown -Interventions-Maintain hydration, w/hold food to rest bowel |
| Hemorrhoids | -Tissue extends to anal canal; internal or external -Causes-Increase venous pressure, pregnancy -S&S: pain, itching, burning, blood -Interventions: creams, pads, or hemorrhoidectomy |
| Bowel Obstruction | -Hard stool stuck in bowel -Why: slow motility after surgery, tumors -S&S: No bowel movement, pain, distention, vomit stool -Test: GI series, xray flat plate of AB -More stool if not w/meds could have perforation |
| Gastroesophageal Reflux Disease (GERD) | -Too much acid being regurgitated from stomach -Dx-Test for H. Pylori -Medical Management-Antacids/ Histamine receptor antagonists: Zantac; Proton Pump Inhibitors: Prevacid; GI stimulants: Reglan -Surgical Management: Nissen fundoplication (last resort |
| Hiatal Hernia | -Cause symptoms like Heart attack -Two Types: Type I (sliding); Type II (rolling) |
| Nursing Diagnosis: GERD and Hiatal Hernia | -Pain may be acute or chronic -Potential for injury -Knowledge Deficit |
| Nursing Management: GERD and Hiatal Hernia | -Obese ppl have problems w/both -Head of bed elevated after meals -Patient Teaching (lifestyle changes) Decrease intraabdominal pressure, measures to aid digestion, foods, meals (don't overeat), medications, weight loss |
| Diverticular Disease | -Pouches in the intestine where debri gets trapped and inflamed -L ab pain & discomfort, D blood -Dx- Flat late of ab -Medical Management-diet modification, bowel rest, surgical management -Nursing Dx-Asst. habits, patterns, bowel -Diet -Teaching |
| Diverticular Disease: Nursing Dx | -Anxiety -Knowledge Deficit -Altered Nutrition (less than) -Altered Bowel Elimination -Altered Comfort (pain) |
| Diverticulitis vs. Diverticulosis | -Diverticulitis: Acute infection and inflamed -Diverticulosis: Chronic Pouching, high fiber diets, caused by foods w/ seeds in pouches and become infected |
| Normal Age-Related Changes: Genitourinary System | -Kidneys d size d/t d bf, d#nephrons -GFR d elimination of waste impaired -D in renin decreases ability of the kidney to maintain homeostasis -Bladder capacity decreases -Residual volume increases -More involuntary bladder contractions of detrussor |
| Urinary Incontinence | -Involuntary loss of urine -Symptom, not a disease -People deny being incontinent-they think it's a normal change of aging -People are labeled by HCP, so they get no treatment |
| Urinary Incontinence: Consequences | -Skin breakdown -Cost and potential pain from dressing changes -Falls -Psychological/psychosocial problems -Caregiver stress thus potential nursing home placement -Can be reversed if assessed and treated |
| Urinary Incontinence: Nursing Assessment | -Onset -Duration -Frequency -Volume of urine -Pattern -Time b/w voiding -Intake of fluids |
| Urinary Incontinence: More assessment | -Symptoms:Nocturia,hematuria,pain, vaginal discharge,straining to void -Meds-consider side effects -Medical conditions/Dx-Have an impact on function? -Environment and functional status: consider ability to dress/ambulate or get to BR -Mental Status |
| Acute Incontinence | -Brief periods of incontinence -Potential Causes: Delirium/Acute confusion, Hosp, restricted mobility, urinary retention, UTI, fecal impaction, pharmaceutical causes |
| Chronic Incontinence | -Persists after an illness -Persists after a drug is discontinues -Important to assess the difference |
| Urge Incontinence | -Most common -Invol bladder contract -Uncontrol loss of urine -Cause:Unstable bladder,UTI,Atrophic vaginitis, Kidney stones -Asst:Uncontrol loss of urine,nocturia,frequent voiding -Tx:anticholinergic drugs, bladder retraining,tx UTI/vaginitis |
| Stress Incontinence | -Incompetent bladder outlet -I in ab pressure -Weak pelvic musc -Cause:childbirth,estrogen deficiency, sphincter damage -A: small amts, during day, infrequent @ night -Tx: kegal exercises, estrogen replacement, surgery |
| Overflow Incontinence | -Cause by obstruction -Urine can't get out,bladder distends w/retention&pressure overcomes sphincter control -C:enlarge prostrate,urethral stricture,noncontract bladder -A:small amts,freq occurence,day/night -Tx:surg,foley,intermittent cath,meds for |
| Reflex/Neurogenic Incontinence | -Spinal Cord insufficiency-messages aren't sent to cerebral cortex -C: spinal cord or other neurogenic injury -A: moderate to large amts of urine, day/night, no sensation -Tx: Foley, Bladder retraining |
| Functional Incontinence | -When a person can't get to the BR -C: Environmental barriers, Decreased mobility, decrease mental, depression -A: moderate to large amts, day/night, sensation evident -Tx: scheduled toileting, incontinence pads, manipulation of the environment |
| Benign Prostatic Hypertrophy | -Prostate gland enlarges, no relation to prostate cancer -Urine outflow is obstructed -Unknown etiology, possibly r/t aging/hormones -Most often asymptotic |
| Signs and Symptoms of BPH | -Urinary Frequency, some incontinence -Nocturia r/t decrease in bladder capacity -Hesitancy-difficult start flow -Decreased force of stream -Dribbling after urinate -Urinary retention (UTI)potential for infection -Ab Pain |
| Dx and Tx BPH | -Dx: Urine analysis/C&S, check for bladder distention, rectal exam, cystoscopy,biopsy -Tx: dilation of bladder neck, stent placement, Meds: Proscar and Flomax |
| Surgery for BPH | Dependent on: size of gland, severity of obstruction, age of patient, condition (general health), presence of other medical conditions |
| Home teaching after prostate surgery | -Don't sit for long periods -No valsalva maneuvers (gagging or straining=reduce HR) -Exercise to regain bladder control -Avoid strenuous activity -Increase fluid intake -Monitor Urinary output -Asst. of impotence |
| Prostate Cancer | -Slow growing tumor -S&S: similar to BPH, obstruction, hematuria, backache, perineal/rectal pain -Metastases: bone, brain, lungs |
| Normal Age Related Changes: Epidermis | -Protective outer skin layer has less regeneration with age, causes delayed wound healing and increased susceptibility to infection -Decrease in number of melanocytes which protect the skin from sun damage |
| Normal age related changes: Dermis | -Less collagen which helps prevent tearing and overstretched skin -Elastin levels increased but quality decreases -Causes atrophy and fibrosis of hair bulbs, sweat and sebaceous glands |
| Normal Age Related Changes: Subcutaneous Tissue | -Atrophy/ hypertrophy of tissue leading to changes in sensation of pressure, vibration, and touch |
| Normal Age Related Changes: Sweat and Sebaceous glands | -Sweat glands decrease in number and function increases susceptibility to hypo/hyperthermia -Sebaceous glands increase in size but produce less sebum which helps to prevent water loss |
| Normal Age Related Changes: Hair | -Hair color and distribution changes leading to graying and balding |
| Normal Age Related Changes: Nails | -Growth slows -Become more fragile with splitting and possible discoloration |
| Skin Conditions | -Xerosis-dry skin -Photoaging-coarse,leathery appearing skin, wrinkled, loss of collagen, elasticity -Dermatitis-rash -Pruitis-itching -Viral,fungal,bacterial inf. -Skin cancers -Pressure ulcers |
| Viral,Fungal,Bacterial Infection | -Long term onychomycosis (nails become opaque, no pink) or onnychogryposis (thickened nail) |
| Skin Cancer | -Squamous cell -Basal cell -Melanoma: related to the effects of chronic sun exposure, early detection and treatment important |
| Pressure ulcers | -A localized area of cellular necrosis that occurs over boney prominences exposed to pressure over a sufficient period of time to cause tissue ischemia |
| Pressure Ulcers: Prevalence and Incidence | Prevalence (likelihood of it occurring) Mostly Acute care setting then long term care setting and last home health setting -Incidence (# of cases) Mostly long term care setting |
| Cost of Pressure Ulcers | -Increased health care costs -Pain -Infection |
| Stages of pressure ulcer development | 1)Define area of persistent redness 2)involving epidermis, dermis or both superficial abrasion, blister or shallow crater 3)Damage to subcu tissue may extend to but not thru fascia 4) extensive damage to musc,bone, supporting structures |
| Assessment: Skin | -Inspect hair,skin,nails: redness, swelling, rashes, pain, problems with fingers/toe nails, lesions ,skin turgor,bruises,color and texture of hair and nails |
| Braden Scale | -Asst tool to determine the risk of developing pressure ulcers -Assess: sensory perception, moisture, activity, mobility, nutrition, friction and shear -Patients w/ lower score=higher risk |
| Skin: Interventions | -Prevent wrinkles (sunscreen, avoid sun) -Prevent dry skin (moisturizers) -Detect harmful lesions (screening) -Eliminate excess moisture -Avoid massage over bony prominence -Good personal hygiene -Optimal nutrition/hydration |
| Prevent Pressure Ulcers | -Reduction of external pressure -Frequent position changes -Pressure reducing mattresses |
| Mobility and the Older Adult | -Mobility is necessary for the maintenance of independence -Mobility is affected by age-related changes -Risk factors=hazardous for the older adult -Safety concerns are of utmost importance |
| Normal Aging Changes: Mobility | -Decreased Height -Redistribution of lean body ass and subcu fat -Increased porosity of bones -Muscle Atrophy -Slowed movement -Decreased strength -Joints stiffen |
| Muscle Age Related Changes | -Decreased size -Loss of motor neurons -Replacement of muscle by connective tissue and fat -Decreased protein synthesis (trouble healing) |
| Results of muscle Changes | -Decline in motor function -Loss of muscle strength -Decreased endurance |
| Joint Age Related Changes | -Thinning synovial fluid -Collagen breakdown -Scar tissue replaces connective tissue -Articular surfaces fray,shred |
| Results of Joint Changes | -Wear and tear (heavier the person=the more wear and tear) -Impaired flexion -Decreased flexibility -Diminished protection -Bone erosion |
| Nervous System Age Related Changes | -Lead to changes in the older adult's ability to maintain balance -Postural control-Body Sway (predisposition to falls) -Slowed reaction time |
| Internal Factors of Immobility | -Decreased musculoskeletal function -Altered neurological function -Altered cellular function -Pain -Perceptual deficits-less sensation -Falls -Diminished cognitive ability -Altered Social relationships -Psychological aspects |
| External Factors of Immobility | -Therapeutic regimens (PT,exercise,yoga) -Medical regimens -Characteristics of the staff -Nursing care delivery system -Institutional policies |
| Assessment of Immobility | -Ease of movement -Gait -Body Alignment (laying in bed) -Joint structure -Muscle Mass -Muscle Tone -Muscle Strength -Endurance |
| Cardiovascular System: Immobility | -Increased Cardiac Workload -Orthostatic Hypotension -Venous Thrombosis (blood clots, slower less pressure, potential to get sludgey, mostly in lower extremities) |
| Respiratory System: Immobility | -Decreased ventilatory effort (inhale) -Increased Respiratory secretions -Take shallow breaths |
| Musculoskeletal System: Immobility | -Atrophy of muscles (flexor always stronger) -Contractures -Bone demineralization |
| Metabolic System: Immobility | -Decreased Metabolic rate (eat same amount of food but moving through body slower) -Cause C, Heart burn, indigestion |
| GI System: Immobility | -Decreased appetite -Constipation |
| Urinary System: Immobility | -Urinary stasis (some urine stays in bladder after urinating) *Use cude method-take hands and push on pelvic region to push out extra urine -Renal Calculi (Kidney stones) |
| Other: Immobility | -Skin breakdown -Self-concept/ Body Image -Decreased self esteem -Decreased ability to cope -Confusion/Disorientation |
| Osteoporosis | -Gradual loss of bone mass, associated w/fractures in the elderly,dimineralization -Patho:Estrogen deficiency,BMD, peak bone mass in 30s RF:Women>Men, Men-<testosterone, smoking, lifestyle, family hx Dx: BMD, x-ray Meds:Drugs to prevent&Treat |
| Categories of Osteoporosis | Primary: Associated with age-related changes Secondary: Caused by other disease |
| Pharmacological Treatments: Osteoporosis | -Evista: Selective estrogen receptor modulator,no risk of Ca,Increase uterine Ca -Fosamax:biophosphonate, nursing considerations -Actonel: biophosphonate, daily or weekly -Boniva: biophosphonate, 1x a month |
| Nursing Intervention to Prevent Osteoporosis | -Ca&Vit D elderly >70, 1200mg/day -Dairy -Salmon, wall-eye pike -Take Ca w/food, divide doses -Limit Caffeine -40mg of Ca will offset ea. cup of coffee -<Na,<Ca in urine&more available for bone resabsorption -Limit Carbonated drinks -Increase pro |
| Risk Factors: Falls | -Impaired vision -Impaired cognition -Hx of falls -Diminished physical function-gait -Smoking -Nocturia -Environment -Medication |
| Fall Prevention | -Intervention of a multidisciplinary team -Fall prevention programs -Identification of those at risk for falls -Staff education |
| Common Fractures | -Vertebral Compression Fractures (downward pressure of ribs on abdomen-kyphosis) -Colles fracture(distal radius) -Pelvic fracture -Hip fracture (can be severe/ debilitation, require surgery) |
| Benefits of Exercise | -Reduce joint paint&stiffness -Improve endurance -Decrease bone loss, resorption -Minimize fatigue -Enhance weight loss -Increase flexibility -Develop muscle strength -Help control joint swelling -Improve sleep -Keep bone&cartilage strong/healt |
| Household activities Workout | -Wash your car -Get dressed -Take a commercial break -Rock in a rocking chair -Do the dishes -Dance -Park your car a little farther away |
| Exercise: Getting Started | -Don't start w/out doctor's consent -Start w/supervision from PT or trainer -Apply heat b/f exercise and cold pack when done -Include flexibility, strengthening,aerobic conditioning -Stop if exercise hurts,get doctor's advice -Exercise regularly |
| Osteoarthritis | -Degenerative inflam. disease affect musc,joint,tendon -Wear&Tear over time on articular surface-overuse -S&S:joint pain,heberdan&boulen nodules,diff move joints, worse@night -RF:Trauma,genes,obesity, osteoporosis -P:Protect joints -Tx:exercise,pai |
| Managing Osteoarthritis | -Acetaminophen (tylenol) drug of choice, NSAIDS -Exercise:weight bearing,fluid movements,Tai Chi -Alternate heat&ice,ice after -Pain increase w/activity;Decrease w/rest -Glucosamine Chondroitin: supplements, not regulated by FDA |
| Rheumatoid Arthritis | -Chronic, systemic disease marked by inflammation of multiple synovial joints -S&S:Morning joint stiffness,rheumatoid nodules,ulnar drift,swan neck,boutonnier deformity -RF:Family Hx -Prevention: None -Tx:Support joints,surgery,gold injections |
| Managing Arthritis | -Aim to control pain -Most appropriate treatments depend on:affected joints,severity of pain,impairment of joint function,other existing health problems -Take meds as prescribed -Stay active-Osteo; Rheumatoid-need rest -Practice stress management |
| Gout | -Protein metabolism is altered so that uric acid builds up in joints, particularly the big toe, can be ankle or other parts of the foot |
| Two types of Gout | -Primary:Genetic dysfunction in purine metabolism, 80% of all cases, mostly in males -Secondary:related to other disorders, excess breakdown of nucleic acids |
| Diagnosing Gout | -Uric Acid levels:Serum, Urine -Needle Aspiration -S&S:Acute pain, red inflamed, very painful |
| Nursing Management of Gout | -Dietary changes-Purines (aged cheese,red meat&whine,pickled things) -Avoid alcohol -Increase fluid intake -Meds (Allopurinal) -Positioning (Foot elevated) -Weight loss (if overweight) -Education/Teaching |
| Activity Intolerance:Potential Causes | -Any condition that decreases the transport of oxygenated blood to the tissues -Chronic disease & disability -Pain,fatigue,confusion -Anxiety,grief,depression -Smoking,obesity,poor nutrition -Prolonged bedrest, sedentary lifestyle |
| Characteristics of Activity Intolerance | -Dyspnea on exertion -Shallow respirations/Tachypnea -Labored breathing/Use of accessory musc -Lethary,weakness,angina -Abnormal HR/BP -Possible EKG changes -Cyanosis/Diaphoresis |
| Assessing Activity Intolerance | -Assessment (baseline and after activity) -Nursing Interventions (assessment/monitoring,measures to promote rest,improve nutrition,improve respiratory status,decrease fear and anxiety) |
| Key Points: Restraints | -Asst(must have physician's order for restraint) -Least Restrictive Device -Agency Policy (Removed every 2h) -Inform the family -What needs to be charted (everything) -Nursing Interventions (2 fingers under restraint,order renewed every 24h) |
| Dangers of using restraints | -Incontinence -Constipation -Increased confusion -Increased agitation -Skin breakdown -Dehydration -Pneumonia -Suffocation -Impaired Circ -Emotional distress -Over sedation -Sensory deprivation |
| Causes of disturbances in sleeping patterns | -Illness -Meds -Hunger -Worry,Anxiety,Tension -Boredom,Inactivity -Environmental factors |
| Environmental factors:Sleep | -Sleep partners-change -Noise or lack of (less noise stimulation interrupts sleep) -No bed time routine/day time routine -Uncomfortable temp -Lack of light during the day (less melatonin produced) -Too much light @ night |
| Stages of Sleep | -NREM (4)slow wave stages -REM (1) dream stage, most important -Alternates in 90 minute cycles -Changes in older adults must be considered |
| Changes in sleep patterns of older adults | -Increased duration of Stage 1 -Increased number of shifts into stage 1 -Decreased amount of time in stage 3 & 4 sleep (most restorative) -Longer time to fall asleep -More often awakened |
| Assessment: Sleep | -Current and past sleep patterns -Any changes? -Napping? -Exercise -Medications -Disease Processes -Mental Status (Depression) |
| Functional Consequences of lack of sleep | -Insomnia -Excessive daytime sleepiness -Confusion -Psychomotor difficulties -Risk of injury (falls) |
| Nursing Interventions: Sleep | -Consider Nighttime activities -Naps? Level of activity? -Decrease anxiety/relaxation techniques -Establishment of good sleep habits -Modification of the environment to promote sleep -Careful evaluation of the potential need for medications for slee |
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prettyinpink7
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