NUR 255
EXAM 3 REVIEW
(Covers Units 6, 7 & 8)
Concepts of Aging, Chronic Illness & Mental Health
Nursing - Galen College of Nursing
, NUR 255 Exam 3 Review
Review the slide presentations – If a chart or table is mentioned, review it as well.
Unit 6
Special needs of the geriatric client
Increased dependence on others for ADLs, may have negative effect on morale and life
satisfaction.
Experience a number of losses that can affect a sense of control over their lives, like death of
spouse & friends or loss of social and work roles.
Nurses need to support older adult’ self-esteem and feelings of independence by encouraging
them to maintain as much control as possible over their lives, to participate in decision making,
and to perform as many tasks as possible.
Age related changes
Skin:
o Increase collagen w/age, makes skin stiffer and less flexible (nose gets bigger, ears
enlarge)
o Melanin decreases = increased r/f sunburn
o Increase in benign lesions: Age spots, liver spots
o Thinning subcu layer = increased r/f hypothermia and pressure injury
o Decreased perspiration w/decreased cooling effect = no sweating can tell hyperthermia
w/sweating
Geriatric Syndromes
Major health issues associated w/late adulthood. Linked to a combo of health problems and
chronic conditions, focus on function.
Frailty (unintentional weight loss, weakness and exhaustion, and slowed physical activity,
including walking), falls, malnutrition & dehydration, delirium & dementia, difficulty swallowing,
sleeping issues, dizziness, gait issues, polypharmacy, pressure ulcers, abuse and neglect
Decreased NURTITION and hydration, Decreased MOBILITY, Stress and loss, Accidents, Drug use
and misuse
Mental Health/COGNITION problems (including substance abuse), Elder neglect and abuse
Elder abuse
Abuser often a family member who becomes frustrated or distraught over the burden of caring
for the older adult
Neglect can occur when caregiver fails to provide for an older adult’s basic needs; food, clothing,
meds, ADL ast. Care giver refuses to let other people (NAs, home care RNs) into the home.
Intentional or unintentional ½ cases of abuse Signs: pressure ulcers, contractures, dehydration or
malnutrition, urine burns, excessive body odor, & listlessness
Physical: Physical force results in bodily injury, especially in “bathing suit” zone (abd, butt, genital
area, upper thighs). Hitting, burning, pushing, molesting, and sedating. Signs: bruises in clusters
or irregular patterns; burns commonly to buttocks or soles of the feet; unusual hair loss or
multiple injuries, especially fractures.
, Financial: Older adult’s property or resources are mismanaged or misused; more common than
physical abuse.
Emotional: Intentional use of threats, humiliation, intimidation, and isolation toward older
adults.
Depression and dementia are common in community older adults who are abused or neglected
Reporting laws: Must report abuse to Adult Protective Services agency if in community. In
hospital or nursing home, notify social worker or case manager who will report to appropriate
agency.
Nutrition and Activity
Increase fiber (35 to 50g daily) and water (at least 2L daily)
Increase calcium, vit D, vit C, and vit A b/c aging changes disrupt the ability to store, use, and
absorb them.
Decreased metabolism, need fewer calories, nutrient dense
Decreased thirst and taste sensation, loose ability to taste sugar and salt therefor the increase
them
Decreased total body water, increased risk for dehydration
Decreased GI motility, increase r/f aspiration, GERD, indigestion, constipation, feel full faster
Increased gastric pH, don’t break down nutrients as easily w/o acids in stomach (calcium, vit.
D,C,A, Iron, Folic Acid) Decreased absorbing cells in the intestines
Bone loss and lean muscle mass loss
Increase in total body fat, need nutrient dense foods lower in calories, problems result from
inactivity, increased fatigue, and less endurance.
Geriatric Failure to Thrive (GFTT): Complex syndrome, under-nutrition, impaired physical
functioning, depression, cognitive impairment, *unintended weight loss
Inadequate nutrition can be related to loneliness. Respond to loneliness, depression, and
boredom by not eating.
Benefits of regular exercise
o Decrease risk for falls, increased mobility increased sleep, reduce or maintain weight,
improved well-being and self-esteem, decreased depression sx, improved longevity,
reduce r/f DM, CAD, and dementia.
Walking one of best exercises, 30 min 3-5x weekly. Weight bearing helps build bone to help
prevent osteoporosis.
Stress and Loss
Rapid environmental changes that require immediate reaction
Changes in lifestyle resulting from retirement or physical incapacity
Acute or chronic illness
Loss of significant others
Financial hardships
Relocation
o Physical and/or mental health problems may force some to relocate to a retirement
center or assisted living facility, with family or into an apt for seniors.
, o Relocation stress syndrome: physical and emotional distress that occurs after the person
moves from one setting to another
Physiologic behaviors: Sleep disturbances, increased physical sx such as GI
distress
Emotional manifestations: Withdrawal, anxiety, anger, and depression
o Interventions for Relocation Stress Syndrome
Provide opportunities for pt to assist in decision making
Explain all procedures & routines to the pt before they occur
Keepsakes at pt bedside (family pic, favorite hairbrush, favorite clothing, valued
knickknacks)
Reorient pt frequently to his or her location
Ask pt about their expectations during their stay
Encourage family and friends to visit often
Establish trusting relationship w/pt as early as possible
Assess pt usual lifestyle & daily activities, food likes & dislikes, preferred time for
bathing
Avoid unnecessary room changes
Have family, staff, or volunteer accompany pt when leaving the unit for special
procedures
Combination of poor physical health and social problems leaves older adults susceptible to stress
overload, which can result in illness and premature death.
Those with close, intimate, stable relationships with others in whom they confide are more likely
to cope with crisis.
Medication safety (14-15)
Can’t tolerate same doses as younger adults. Age related changes cause changes in drug
metabolism and excretion
OTC drugs interact with prescription drugs (warfarin and OTC meds like ibuprofen for arthritis
and garlic for HTN can cause serious bleeding since the inhibit clotting)
Beers Criteria for Potentially Inappropriate Medication Use in Older Adults assessment tool. Lists
meds and related concerns (meperidine, cyclobenzaprine, digoxin (not exceed 0.125 except afib)
ticlopidine, fluoxetine, amitriptyline, diazepam, promethazine, ketorolac, nifedipine, ferrous
sulfate, chlorpropamide, diphenhydramine.
Mental health (16)
Changes in cognition Decreased reaction time to stimuli, impaired memory for recent events are
normal
Severe cognitive impairment, depression, hallucinations, and delusions are not common
Clinically competent: Can make rational clinical decisions and is legally competent (not declared
incompetent by court)
Alcoholism can contribute to cognitive decline and may be used as a coping mechanism for loss.
Depression: Most common mental health problem of older adults
o Primary: results from a lack of serotonin and norepinephrine
EXAM 3 REVIEW
(Covers Units 6, 7 & 8)
Concepts of Aging, Chronic Illness & Mental Health
Nursing - Galen College of Nursing
, NUR 255 Exam 3 Review
Review the slide presentations – If a chart or table is mentioned, review it as well.
Unit 6
Special needs of the geriatric client
Increased dependence on others for ADLs, may have negative effect on morale and life
satisfaction.
Experience a number of losses that can affect a sense of control over their lives, like death of
spouse & friends or loss of social and work roles.
Nurses need to support older adult’ self-esteem and feelings of independence by encouraging
them to maintain as much control as possible over their lives, to participate in decision making,
and to perform as many tasks as possible.
Age related changes
Skin:
o Increase collagen w/age, makes skin stiffer and less flexible (nose gets bigger, ears
enlarge)
o Melanin decreases = increased r/f sunburn
o Increase in benign lesions: Age spots, liver spots
o Thinning subcu layer = increased r/f hypothermia and pressure injury
o Decreased perspiration w/decreased cooling effect = no sweating can tell hyperthermia
w/sweating
Geriatric Syndromes
Major health issues associated w/late adulthood. Linked to a combo of health problems and
chronic conditions, focus on function.
Frailty (unintentional weight loss, weakness and exhaustion, and slowed physical activity,
including walking), falls, malnutrition & dehydration, delirium & dementia, difficulty swallowing,
sleeping issues, dizziness, gait issues, polypharmacy, pressure ulcers, abuse and neglect
Decreased NURTITION and hydration, Decreased MOBILITY, Stress and loss, Accidents, Drug use
and misuse
Mental Health/COGNITION problems (including substance abuse), Elder neglect and abuse
Elder abuse
Abuser often a family member who becomes frustrated or distraught over the burden of caring
for the older adult
Neglect can occur when caregiver fails to provide for an older adult’s basic needs; food, clothing,
meds, ADL ast. Care giver refuses to let other people (NAs, home care RNs) into the home.
Intentional or unintentional ½ cases of abuse Signs: pressure ulcers, contractures, dehydration or
malnutrition, urine burns, excessive body odor, & listlessness
Physical: Physical force results in bodily injury, especially in “bathing suit” zone (abd, butt, genital
area, upper thighs). Hitting, burning, pushing, molesting, and sedating. Signs: bruises in clusters
or irregular patterns; burns commonly to buttocks or soles of the feet; unusual hair loss or
multiple injuries, especially fractures.
, Financial: Older adult’s property or resources are mismanaged or misused; more common than
physical abuse.
Emotional: Intentional use of threats, humiliation, intimidation, and isolation toward older
adults.
Depression and dementia are common in community older adults who are abused or neglected
Reporting laws: Must report abuse to Adult Protective Services agency if in community. In
hospital or nursing home, notify social worker or case manager who will report to appropriate
agency.
Nutrition and Activity
Increase fiber (35 to 50g daily) and water (at least 2L daily)
Increase calcium, vit D, vit C, and vit A b/c aging changes disrupt the ability to store, use, and
absorb them.
Decreased metabolism, need fewer calories, nutrient dense
Decreased thirst and taste sensation, loose ability to taste sugar and salt therefor the increase
them
Decreased total body water, increased risk for dehydration
Decreased GI motility, increase r/f aspiration, GERD, indigestion, constipation, feel full faster
Increased gastric pH, don’t break down nutrients as easily w/o acids in stomach (calcium, vit.
D,C,A, Iron, Folic Acid) Decreased absorbing cells in the intestines
Bone loss and lean muscle mass loss
Increase in total body fat, need nutrient dense foods lower in calories, problems result from
inactivity, increased fatigue, and less endurance.
Geriatric Failure to Thrive (GFTT): Complex syndrome, under-nutrition, impaired physical
functioning, depression, cognitive impairment, *unintended weight loss
Inadequate nutrition can be related to loneliness. Respond to loneliness, depression, and
boredom by not eating.
Benefits of regular exercise
o Decrease risk for falls, increased mobility increased sleep, reduce or maintain weight,
improved well-being and self-esteem, decreased depression sx, improved longevity,
reduce r/f DM, CAD, and dementia.
Walking one of best exercises, 30 min 3-5x weekly. Weight bearing helps build bone to help
prevent osteoporosis.
Stress and Loss
Rapid environmental changes that require immediate reaction
Changes in lifestyle resulting from retirement or physical incapacity
Acute or chronic illness
Loss of significant others
Financial hardships
Relocation
o Physical and/or mental health problems may force some to relocate to a retirement
center or assisted living facility, with family or into an apt for seniors.
, o Relocation stress syndrome: physical and emotional distress that occurs after the person
moves from one setting to another
Physiologic behaviors: Sleep disturbances, increased physical sx such as GI
distress
Emotional manifestations: Withdrawal, anxiety, anger, and depression
o Interventions for Relocation Stress Syndrome
Provide opportunities for pt to assist in decision making
Explain all procedures & routines to the pt before they occur
Keepsakes at pt bedside (family pic, favorite hairbrush, favorite clothing, valued
knickknacks)
Reorient pt frequently to his or her location
Ask pt about their expectations during their stay
Encourage family and friends to visit often
Establish trusting relationship w/pt as early as possible
Assess pt usual lifestyle & daily activities, food likes & dislikes, preferred time for
bathing
Avoid unnecessary room changes
Have family, staff, or volunteer accompany pt when leaving the unit for special
procedures
Combination of poor physical health and social problems leaves older adults susceptible to stress
overload, which can result in illness and premature death.
Those with close, intimate, stable relationships with others in whom they confide are more likely
to cope with crisis.
Medication safety (14-15)
Can’t tolerate same doses as younger adults. Age related changes cause changes in drug
metabolism and excretion
OTC drugs interact with prescription drugs (warfarin and OTC meds like ibuprofen for arthritis
and garlic for HTN can cause serious bleeding since the inhibit clotting)
Beers Criteria for Potentially Inappropriate Medication Use in Older Adults assessment tool. Lists
meds and related concerns (meperidine, cyclobenzaprine, digoxin (not exceed 0.125 except afib)
ticlopidine, fluoxetine, amitriptyline, diazepam, promethazine, ketorolac, nifedipine, ferrous
sulfate, chlorpropamide, diphenhydramine.
Mental health (16)
Changes in cognition Decreased reaction time to stimuli, impaired memory for recent events are
normal
Severe cognitive impairment, depression, hallucinations, and delusions are not common
Clinically competent: Can make rational clinical decisions and is legally competent (not declared
incompetent by court)
Alcoholism can contribute to cognitive decline and may be used as a coping mechanism for loss.
Depression: Most common mental health problem of older adults
o Primary: results from a lack of serotonin and norepinephrine
