Summary HESI GERONTOLOGY STUDY GUIDE

HESI GERONTOLOGY STUDY GUIDE • Healthy aging is now an achievable goal for many. • Aging and disease are separate entities. • Aging is an individual process that affects each person differently. • The chronologic age of 65 is the standard in the United States for being considered an older adult (elderly). • By 2050, one in five Americans will be over the age of 65. • The concept of aging is further defined as young-old (65 to 74), middle-old (75 to 84), old-old (over 85), elite-old (over 90), centenarian (over 100), and super-centenarian (110 and over). • Eighty percent of people over the age of 70 have at least one chronic condition, and 50% have multiple health problems. Theories of Aging 1. Psychosocial Theories: a. Disengagement Theory: Progressive social disengagement occurs naturally with aging and is accepted by the older adult. Variation in disengagement across older populations is related to cultural style and behaviors in different geographic regions. b. Activity Theory: Successful again requires a high level of activity and involvement to maintain life satisfaction and positive self – esteem. 2. Biologic Theories: a. Pacemaker Theory: A programmed decline or cessation of many concepts occurs in the nervous and endocrine systems. b. Immunity Theory: A programmed accumulation of damage and decline of the immune systems’ function (immunosenescence) takes place due to oxidative stress. c. Wear-and-Tear Theory: After repeated use, damaged cells in the body structures wear out from the harmful effects of internal and external stressors, now known as free radicals. 3. Developmental Theories: a. Erik Erikson’s Theory: Theory identifies 8 stages of developmental tasks throughout the life span; 8th stage is integrity versus despair b. Maslow’s Theory: Maslow’s hierarchy of needs ranks an individual’s needs from the most basic to the most complex. Maslow uses the terms physiologic, safety and security, belonging, self-esteem, and self-actualization needs to describe the process that generally motivates individuals to move through life. HINT: The concept of aging is shifting from viewing older adults as frail and dependent to being able to engage in healthy living. The majority of those aged 65 and older regard their health as good or excellent. The ability to perform activities of daily living (ADLs) is a more accurate measure of an older person’s age than chronologic age. Physiologic Changes • Aging effects every cell in every organ of the body, but not at the same rate • Three physiologic changes are clinically significant in making older adults vulnerable to injury & disease: o Loss in compensatory reserve (making up for a loss in physiological compensation; vital signs) o Progressive loss in efficiency of the body to repair damaged tissue o Decreased functioning of the immune system processes • Diseases in older adults do not always present with classic signs and symptoms • Physiologic changes increase more rapidly with increasing age • Aging changes are influenced by genetic makeup & environment HINT: Questions may ask about teaching and designing rehabilitation programs for older adults. The answers should contain information about exercise and nutrition. Integumentary System: Skin, hair, and nail changes occur with aging and can cause problems concerning discomfort and self-esteem. • Thin Skin provides a less effective barrier to trauma due to a loss of subcutaneous tissue. o Increased risk for dehydration due to decline in lean mass & loss of body water o Decreased ability of the skin to detect and regulate temperature o Dry skin resulting from a decrease in endocrine secretion o Loss of elastin & increased vascular fragility • Keratinocytes become smaller and regeneration slows; wound healing is slower. • Hair loss occurs; women have increased facial hair • Vascular hyperplasia causes more varicosities (brown or blue discolorations) • Increased appearance of “age spots” and/or “liver spots” and raised lesions (seborrheic keratosis) • Nails becomes brittle & thick. Nursing Assessment 1. Skin dryness & tears 2. Nails for changes in shape, color, and brittleness 3. Lesions to differentiate normal from abnormal; 4. Bony prominences for signs of pressure ulcers Nursing Plans & Interventions A. Encourage the use of oils or lubricants on the skin at least twice a day. B. Discourage the use of powder, which can be drying. C. Teach to avoid overexposure to sunlight. D. Encourage balanced nutrition and increased fluid intake. E. Teach to maintain adequate humidity in the environment. F. Teach to avoid temperature extremes. G. Teach good foot care. H. Observe bony prominences for signs of pressure. I. Teach that poor peripheral circulation may slow the healing of foot and hand lesions. HINT: The Exam will test your ability to differentiate normal and pathologic causes of skin and hair conditions; for example, the differences between seborrheic keratosis and melanoma Musculoskeletal System: Age-related changes in the musculoskeletal system are gradual but have a significant impact on levels of mobility, which puts older adults at risk for falls and fractures. • The Musculoskeletal system is composed on bones, joints, tendons, ligaments, and muscles. • Age – related changes are not life threatening, but can affect function & quality of life. • Bone loss begins around age 40 and is more common in women than in men; thus; osteoporosis occurs more often in women. • Shortening of the trunk (torso) due to thinning of the vertebral disks. • Loss of bone calcium, atrophic (decrease in size) cartilage and muscle occurs. • Bone mineral density (BMD) decreases, resulting in osteopenia and osteoporosis. • Range of motion (ROM) of joint decreases. • Progressive loss of cartilage occurs, resulting in osteoarthritis. • Muscle cells are lost and not replaced. • Lean body mass decreases with increased body fat. Nursing Assessment 1. Dietary intake of calcium and vitamin D 2. Weight; underweight or overweight 3. Lifestyle habits; inappropriate nutrition, smoking, and inadequate exercise 4. History of fractures 5. ROM 6. Pain and chronic pain management strategies Nursing Plans & Interventions A. Teach that adequate calcium intake may help lessen osteoporotic changes. B. Establish muscle-strengthening program (small weights, aquatic therapy). C. Prevent accidents by ensuring a clutter-free, safe environment. D. Provide adequate lighting day and night to prevent falls. E. Teach clients not to back up but to turn around to move in the direction they wish to go. F. Teach clients to walk looking straight ahead instead of looking down at their feet to optimize balance. G. Encourage regular exercise inclusive of balance, weight-bearing, and low-resistance training. H. Teach to avoid excessive joint strain. I. Teach that medications (diuretics and sedatives) may contribute to falls. a. The following are ways to help prevent or decrease the occurrence of falls: i. Install adequate lighting. ii. Install grab bars in bathtubs. iii. Wear proper footwear that supports the foot and contributes to balance; shoes should be made of non-slippery materials. iv. Place a bell on any resident cats; cats move quickly and can get underfoot. v. Paint the edges of stairs a bright color. J. Discourage excessive alcohol intake and encourage smoking cessation. K. Encourage older people to change positions slowly to prevent orthostatic hypotension. Nursing Plans & Interventions for Osteoporosis A. Create a hazard-free environment. B. Keep bed in low position. C. Encourage client to wear shoes or nonskid slippers when out of bed. D. Encourage environmental safety. 1. Provide adequate lighting. 2. Keep floor clear. 3. Discourage use of throw rugs. 4. Clean spills promptly. 5. Keep side rails up at all times. E. Provide assistance with ambulation. 1. Client may need walker or cane. 2. Client may need standby assistance when initially getting out of bed or chair. F. Teach regular exercise program. 1. ROM exercise several times a day 2. Ambulation several times a day 3. Use of proper body mechanics 4. Regular weight-bearing exercises promote bone formation G. Provide diet that is high in protein, calcium, and vitamin D; discourage use of alcohol and caffeine. H. Encourage preventive measures for females. 1. Hormone replacement therapy (HRT) has been used as a primary prevention strategy for reducing bone loss in the postmenopausal woman. However, recent studies demonstrated that HRT may increase a woman’s risk of breast cancer, cardiovascular disease, and stroke. If using HRT, the benefits should outweigh the risks. 2. Take prescribed medications to prevent further loss of BMD. a. Bisphosphonates: inhibit osteoclast-mediated bone resorption, thereby increasing BMD. Common side effects are anorexia, weight loss, and gastritis. Instruct the client to take with full glass of water, take 30 minutes before food or other medications, and remain upright for at least 30 minutes after taking. 1. Alendronate (Fosamax) 2. Etidronate (Didronel) 3. Ibandronate (Boniva) 4. Pamidronate (Aredia) 5. Risedronate (Actonel) 6. Tiludronate (Skelid) b. Selective estrogen receptor modulator: to mimic the effect of estrogen on bone by reducing bone resorption without stimulating the tissues of the breast or uterus. The most common side effects are leg cramps and hot flashes. 1. Raloxifene (Evista) 2. Teriparatide (Forteo) 3. High calcium and vitamin D intake beginning in early adulthood 4. Calcium supplementation after menopause (Tums are an excellent source of calcium). 5. Weight-bearing exercise I. Dual-energy x-ray absorptiometry (DEXA), which measures bone density in the spine, hips, and forearm, as a 119 baseline after menopause, with frequency as recommended by health care provider J. Osteopenia is defined as bone loss that is more than normal and has a T-score less than or equal to a range of −1 to −2.5 but is not yet at the level for a diagnosis of osteoporosis. BMD is commonly reported as a “T-score,” which is the difference between the client’s BMD and the BMD of “young normal adults” of the same gender. The difference between the client’s score and the young adult norm is expressed as standard deviation below or above the average. HINT: Postmenopausal, thin, white women are at highest risk for development of osteoporosis. Encourage exercise, a diet high in calcium, and supplemental calcium. Tums are an excellent source of calcium, but they are also high in sodium, so hypertensive or edematous individuals should seek another source of supplemental calcium. The main cause of fractures in older adults, especially in women, is osteoporosis. The main fracture sites seem to be hip, vertebral bodies, and Colles fracture of the forearm. HINT: Impaired mobility, impaired skin integrity, decreased peripheral circulation, and a lack of physical activity place older adults at risk for the development of pressure ulcers. Cardiovascular System • Age – related changes in the cardiovascular system predispose the older person to the development of dysrhythmias and other cardiac problem • Cardiac Output decreases as a result of a decrease in HR and stroke volume. • Cardiac output decreases because vessels lose elasticity. The heart’s contractability decreases in response to increased demands. • Diastolic murmurs are present in more than ½ of older adults because the mitral and aortic valves become thick and rigid. • Dysrhythmias (bradycardia, tachycardia, atrial fibrillation, and heart block) become more come as one ages, in part of higher systolic blood pressure and the increased size of the atria. o Dysrhythmias in older adults are particularly serious because older people cannot tolerate decreased cardiac output, which can result in syncope, falls, and transient ischemic attacks (TIAs). The pulse may be rapid, slow, or irregular in this population. • Significant increases in systolic BP occur as a result of altered distribution of blood flow and increased peripheral resistance. • Arteriosclerosis increases with age and can cause cardiovascular problems. o Peripheral Vascular Disease o Edema o Coronary artery disease: acute coronary insufficiency, myocardial infarction, dysrhythmias, heart failure (HF) • Much heart disease is preventable. Nursing Assessment 1. BP and vital signs 2. History of dizziness or blackouts with sudden position change (orthostatic hypotension) 3. Diuresis after lying down 4. Feelings of heart palpitations