1
SPR 2018 GERO MIDTERM CONCEPTS TO REVIEW
● Normal physiological changes .
○ Skin changes of aging
■ Epidermis: thins, blood vessels and bruises more visible, age spots or liver spots,
and seborrheic keratoses
■ Dermis: loss of stretch, resilience, sagging
■ Hypodermis: increased sensitivity to cold, sebaceous glands atrophy ( do not
sweat as much)
○ Hair
■ Thins on the head
■ Increased hair in the ears, nose, and eyebrows
■ Women develop chin hair, and leg, axillary and pubic hair decrease
○ Nails
■ Become harder, thicker, dull and more brittle
○ Musculoskeletal changes
■ Ligaments, tendons, and joints become dry hardened and less flexible
■ Muscle mass decreases
■ Vertebral disks thin, causing a shortening of the trunk
○ Cardiovascular
■ LV wall thickens
■ Size of LA slightly increases ( increase risk for A fib)
■ Coronary blood flow, stroke volume and cardiac output decrease ( increase risk
for heart failure)
■ Heart takes longer to accelerate and then to return normal
■ Elasticity decreases and blood vessels recoil
■ Veins become stretched and the valves become less efficient
○ Respiratory
■ Tidal Volume: the normal volume of air displaced between normal inhalation
and exhalation when extra effort is not applied. In a healthy, young human adult,
tidal volume is approximately 500 mL per inspiration or 7 mL/kg of body mass.
■ IRV: max amount additional air that can be drawn into the lung after normal insp
■ Inspiratory reserve volume: the maximal amount of additional air that can be
drawn into the lungs by determined effort after normal inspiration
■ Expiratory Reserve: the additional amount of air that can be expired from the
lungs by determined effort after normal expiration.
■ Residual Volume: the volume of air still remaining in the lungs after the
expiratory reserve volume is exhaled.
■ Total Lung Capacity: all 4 of the above combined- the most air that you can
inspire into your lungs
■ Vital Capacity: IRV + TV + ERV- the greatest volume of air that can be
expelled from the lungs after taking the deepest possible breath
● Loss of recoil
● Chest wall stiffens
● Less lung capacity
● Cough is the best way to clear mucus, they struggle with this
● Gas exchange is less efficient
● Resistance to airflow increases
● Cilia are less effective
○ Renal
, 2
■ Decrease in size,
■ Decrease in nephrons/glomerulus
■ Decrease in ability to absorb sodium
■ decrease blood flow
■ Decrease overall kidney function
■ Decrease in urine creatinine clearance and GFR
■ Atherosclerosis risk
■ Increase susceptibility to fluid and electrolyte imbalances
■ Different dye and test ( iodine) is hard on the kidneys
○ Endocrine
■ Glands shrink
■ Rate of hormonal secretion can decrease
■ regulatory /feedback mechanism deteriorate a bit
■ Receptor binding affinity decreases
■ Production of sex hormones
■ Increase insulin resistance
■ Rates of type 2 diabetes and hypothyroidism are higher in older adult
■ Women: breasts are less firm, estrogen levels decrease, vaginal wall loses its
ability to lubricate, ovaries, uterus and cervix atrophy
■ Male: testes atrophy and sofen, testosterone level decreases, BPH
○ Gastrointestinal
■ Mouth: teeth lose enamel, taste buds decline in number, dry mouth
■ Stomach: GERD, decrease gastric motility and volume, decreased ability to
produce intrinsic factor- vit B12 deficiency
■ Intestines: peristalsis slows, constipation, villi the intestines are less functioning,
which affects absorption, constipation
○ Neuro changes
■ Brain size and weight decreases
■ Subtle changes in cognitive and motor functioning occur
■ Mild memory impairments and difficulties with balances may be seen
■ Decrease reaction time
○ Eyes and vision changes
■ Changes in visual acuity and accommodation
■ Near vision decrease and the lenses thicken-cataracts
■ Eyelids lose elasticity and droop
■ Color perception decrease
■ Lower eyelids turn out and dry eye syndrome
○ Ear changes
■ Ear logs sag, elongate and wrinkle
■ Ear wax is more thick and dry
■ Age- related hearing loss occurs
■ Primary lose ability to hear high-frequency sounds
○ Immune
■ Decreased cell-,mediated and humoral immune response
■ Thymus decreases
■ Oral temperature is lower
■ Decreased response to foreign antigens
■ Decreased response to foreign antigens
● Medications-issues specific to older adults
, 3
○ Absorption
■ Increased gastric pH slows down acid-dependent
■ Delayed stomach emptying diminishes the effectiveness of short-lived drug
■ Increase mobility in the small intestine diminishes drug effect because of
shortened contact time
■ Slowed intestinal motility increase the contact ime, amount absorbed and effect
○ Distribution
■ Age-related in distribution are related to changes in body composition
■ Increase body fat
■ Decrease total body water
○ Metabolism
■ Primarily occurs in the liver
■ Age-related: liver’s activity, mass, volume and blood flow are reduced
○ Excretion
■ Kidney function decreases with aging
■ Prolongs the half- life drug or the amount of time required to eliminate the drug
○ Pharmacodynamics
■ Interaction between a drug and the body
■ The older the person gets, the more likely there will be an altered or unreliable
response of the body to the drug
○ Nursing management
■ Look for discrepancies between the prescribed dosage and the actual dosage,
potential drug-drug and food-drug interactions and potential or actual adverse
drug reactions
■ BEST to see the actual medication bottle
■ Difficulties opening bottles as a result of arthritis
■ Difficulties swallowing medications
● Safety measures and fall prevention
○ Seat belts
○ Moderate alcohol: increase sensitivity and many drug interaction
○ No smoking
○ Smoke detectors
○ Avoid over the counter medications unless prescribed
○ Hazard free environment: no scatter rugs, waxed
○ Have uncluttered floor space, railings, and increase lighting are easy and practical
● Fall risk assessment
○ Fall risk assessment is an integral part of primary health care for the older person
○ Adults may be apprehensive about sharing information regarding a fall because of the
fear of losing their independence
○ Screening tools can be used to determine the risk for falling
○ Perform an initial fall assessment on admission, after any change in condition, and at
regular intervals during a stay
○ Assessment of the older adult at risk
○ Nursing assessment of the patient after a fall
○ Assessment of the environment and other situational circumstances upon admission and
during institutional stays
○ Assessment of the older adult’s knowledge of falls and their prevention
● Side rails and restraints
○ Restraints
■ Device or drug that prevents from moving freely
■ Must be prescribed by health care providers
SPR 2018 GERO MIDTERM CONCEPTS TO REVIEW
● Normal physiological changes .
○ Skin changes of aging
■ Epidermis: thins, blood vessels and bruises more visible, age spots or liver spots,
and seborrheic keratoses
■ Dermis: loss of stretch, resilience, sagging
■ Hypodermis: increased sensitivity to cold, sebaceous glands atrophy ( do not
sweat as much)
○ Hair
■ Thins on the head
■ Increased hair in the ears, nose, and eyebrows
■ Women develop chin hair, and leg, axillary and pubic hair decrease
○ Nails
■ Become harder, thicker, dull and more brittle
○ Musculoskeletal changes
■ Ligaments, tendons, and joints become dry hardened and less flexible
■ Muscle mass decreases
■ Vertebral disks thin, causing a shortening of the trunk
○ Cardiovascular
■ LV wall thickens
■ Size of LA slightly increases ( increase risk for A fib)
■ Coronary blood flow, stroke volume and cardiac output decrease ( increase risk
for heart failure)
■ Heart takes longer to accelerate and then to return normal
■ Elasticity decreases and blood vessels recoil
■ Veins become stretched and the valves become less efficient
○ Respiratory
■ Tidal Volume: the normal volume of air displaced between normal inhalation
and exhalation when extra effort is not applied. In a healthy, young human adult,
tidal volume is approximately 500 mL per inspiration or 7 mL/kg of body mass.
■ IRV: max amount additional air that can be drawn into the lung after normal insp
■ Inspiratory reserve volume: the maximal amount of additional air that can be
drawn into the lungs by determined effort after normal inspiration
■ Expiratory Reserve: the additional amount of air that can be expired from the
lungs by determined effort after normal expiration.
■ Residual Volume: the volume of air still remaining in the lungs after the
expiratory reserve volume is exhaled.
■ Total Lung Capacity: all 4 of the above combined- the most air that you can
inspire into your lungs
■ Vital Capacity: IRV + TV + ERV- the greatest volume of air that can be
expelled from the lungs after taking the deepest possible breath
● Loss of recoil
● Chest wall stiffens
● Less lung capacity
● Cough is the best way to clear mucus, they struggle with this
● Gas exchange is less efficient
● Resistance to airflow increases
● Cilia are less effective
○ Renal
, 2
■ Decrease in size,
■ Decrease in nephrons/glomerulus
■ Decrease in ability to absorb sodium
■ decrease blood flow
■ Decrease overall kidney function
■ Decrease in urine creatinine clearance and GFR
■ Atherosclerosis risk
■ Increase susceptibility to fluid and electrolyte imbalances
■ Different dye and test ( iodine) is hard on the kidneys
○ Endocrine
■ Glands shrink
■ Rate of hormonal secretion can decrease
■ regulatory /feedback mechanism deteriorate a bit
■ Receptor binding affinity decreases
■ Production of sex hormones
■ Increase insulin resistance
■ Rates of type 2 diabetes and hypothyroidism are higher in older adult
■ Women: breasts are less firm, estrogen levels decrease, vaginal wall loses its
ability to lubricate, ovaries, uterus and cervix atrophy
■ Male: testes atrophy and sofen, testosterone level decreases, BPH
○ Gastrointestinal
■ Mouth: teeth lose enamel, taste buds decline in number, dry mouth
■ Stomach: GERD, decrease gastric motility and volume, decreased ability to
produce intrinsic factor- vit B12 deficiency
■ Intestines: peristalsis slows, constipation, villi the intestines are less functioning,
which affects absorption, constipation
○ Neuro changes
■ Brain size and weight decreases
■ Subtle changes in cognitive and motor functioning occur
■ Mild memory impairments and difficulties with balances may be seen
■ Decrease reaction time
○ Eyes and vision changes
■ Changes in visual acuity and accommodation
■ Near vision decrease and the lenses thicken-cataracts
■ Eyelids lose elasticity and droop
■ Color perception decrease
■ Lower eyelids turn out and dry eye syndrome
○ Ear changes
■ Ear logs sag, elongate and wrinkle
■ Ear wax is more thick and dry
■ Age- related hearing loss occurs
■ Primary lose ability to hear high-frequency sounds
○ Immune
■ Decreased cell-,mediated and humoral immune response
■ Thymus decreases
■ Oral temperature is lower
■ Decreased response to foreign antigens
■ Decreased response to foreign antigens
● Medications-issues specific to older adults
, 3
○ Absorption
■ Increased gastric pH slows down acid-dependent
■ Delayed stomach emptying diminishes the effectiveness of short-lived drug
■ Increase mobility in the small intestine diminishes drug effect because of
shortened contact time
■ Slowed intestinal motility increase the contact ime, amount absorbed and effect
○ Distribution
■ Age-related in distribution are related to changes in body composition
■ Increase body fat
■ Decrease total body water
○ Metabolism
■ Primarily occurs in the liver
■ Age-related: liver’s activity, mass, volume and blood flow are reduced
○ Excretion
■ Kidney function decreases with aging
■ Prolongs the half- life drug or the amount of time required to eliminate the drug
○ Pharmacodynamics
■ Interaction between a drug and the body
■ The older the person gets, the more likely there will be an altered or unreliable
response of the body to the drug
○ Nursing management
■ Look for discrepancies between the prescribed dosage and the actual dosage,
potential drug-drug and food-drug interactions and potential or actual adverse
drug reactions
■ BEST to see the actual medication bottle
■ Difficulties opening bottles as a result of arthritis
■ Difficulties swallowing medications
● Safety measures and fall prevention
○ Seat belts
○ Moderate alcohol: increase sensitivity and many drug interaction
○ No smoking
○ Smoke detectors
○ Avoid over the counter medications unless prescribed
○ Hazard free environment: no scatter rugs, waxed
○ Have uncluttered floor space, railings, and increase lighting are easy and practical
● Fall risk assessment
○ Fall risk assessment is an integral part of primary health care for the older person
○ Adults may be apprehensive about sharing information regarding a fall because of the
fear of losing their independence
○ Screening tools can be used to determine the risk for falling
○ Perform an initial fall assessment on admission, after any change in condition, and at
regular intervals during a stay
○ Assessment of the older adult at risk
○ Nursing assessment of the patient after a fall
○ Assessment of the environment and other situational circumstances upon admission and
during institutional stays
○ Assessment of the older adult’s knowledge of falls and their prevention
● Side rails and restraints
○ Restraints
■ Device or drug that prevents from moving freely
■ Must be prescribed by health care providers
