EXAM 2 NR 226 REVIEW OF CONCEPTS

This is a review of major concepts from weeks 3, 4, and 5. This study guide is not exclusive. Also review ppts and read assigned chapters in Perry & Potter. Review all terminology words both in ppt and book. Review all questions at the end of chapters. Review math med calc problems demonstrated in class. Review core assignments from weeks 3,4, and 5 Older adults- Chapter 14 (65 yrs old) Definition of Gerontology: study of older adults. Ageism: discrimination against people because of increasing age. How are older populations impacting healthcare in general? The growing number of elderly adults poses a risk to programs that assist the elderly (social security). Variability among older adults: The nursing care of older adults poses special challenges because of great variation in the physiological, cognitive, and psychosocial health. Most older adults can take care of themselves, however, a small number have lost the ability to do so. Myths and stereotyping: False ideas about their physical and psychosocial characteristics and lifestyles. When healthcare providers hold negative stereotypes about aging, their action often negatively affect the quality of patient care. Often stereotyped as ill, disabled, physically unattractive, forgetful, confused, rigid, bored, unfriendly, unable to learn new information, not interested in sex or sexual activities. Adult learning principles: Make sure that the patient is ready to learn before trying to teach, what for clues that indicate the patient is preoccupied or too anxious to comprehend material. Is the patient physically well enough to be taught? Is he or she in pain? Sit facing the patient so he or she is able to watch your lip movements and facial expressions, speak slowly and in a normal tone of voice, present one idea or concept at a time, emphasize concrete rather than abstract material, give patient enough time in which to respond because older adults process information slower than younger persons, keep environmental distractions to a minimum. Provide appropriate lighting and a comfortable setting, defer teaching if patient becomes distracted or tired or cannot concentrate for other reasons, invite another member of the household to join the discussion, use audio, visual, and tactile cues to enhance learning and help the patient remember information, ask for feedback to ensure that the patient understands the information, and use past experience to connect new learning to previous knowledge. Nurse attitudes: It is important for you to assess your own attitudes toward older adults. Nurses’ attitudes come from personal experiences with older adults, education, employment experiences, and attitudes of co-workers and employing institutions. Forming positive attitudes toward them and gaining EXAM 2 NR 226 REVIEW OF CONCEPTS specialized knowledge about aging and the health care needs of older adults are priorities for all nurses. It is critical to respect older adults and actively involve them in care decisions and activities. Erikson’s Developmental task for this age group and what that means: Independence vs. Dependence. Associated with varying degrees of change and loss (health, significant others, a sense of being useful, socialization, income, and independent living). Coping with retirement, residence change, and death, and changing redefining relationships with adult children. Developmental tasks for older adults: Adjusting to decreasing health and physical strength; adjusting to retirement and reduced or fixed income; adjusting to death of a spouse, children, siblings, friends; accepting self as aging person; maintaining satisfactory living arrangements; redefining relationships with adult children and siblings; finding ways to maintain quality of life. Community based vs institutional care services: Nurses encounter older-adult patients in a wide variety of community and institutional health care settings (private homes, apartments, retirement communities, adult day care centers, assisted living facilities, and nursing centers). Older adults need to help with decisions regarding which type of health care service is appropriate for them. interview techniques: Nursing assessments need to ensure an age-specific approach: 1. The interrelation between physical and psychosocial aspects of aging. 2. Effects of disease and disability on functional status. 3. Tailoring the nursing assessment to an older person. Physiological changes of an older adult that are different than younger/middle aged adults: Integumentary: loss of skin elasticity with fat loss in extremities; pigmentation changes; glandular atrophy (oil, moisture, sweat glands); thinning hair, with hair turning gray-white (facial hair: decreased in men, increased in women); slower nail growth; atrophy of epidermis arterioles. Respiratory: decreased cough reflex; decreased cilia; increased anterior-posterior chest diameter; increased chest wall rigidity; fewer alveoli, increased airway resistance; increased risk of respiratory infections. Cardiovascular: thickening of blood vessel walls, narrowing or vessel lumen, loss of vessel elasticity, lower cardiac output, decreased number of heart muscle fibers, decreased elasticity and calcification of heart valves, decreased baroreceptor sensitivity, decreased efficiency of venous valves, increased pulmonary vascular tension, increased systolic blood pressure, decreased peripheral circulation. Gastrointestinal: periodontal disease; decrease in saliva, gastric secretions, and pancreatic enzymes; smooth-muscle changes with decreased peristalsis and small intestinal motility; gastric atrophy; decreased production of intrinsic factor; increased stomach pH; loss of smooth muscle in the stomach; hemorrhoids; rectal prolapse; and impaired rectal sensation. Musculoskeletal: decreased muscle mass and strength, decalcification of bones, degenerative joint changes, dehydration of intervertebral disks, fat tissue increases. Neurological: degeneration of nerve cells, decrease in neurotransmitters, decrease in rate of conduction of impulses. Sensory: eyes (decreased accommodation to near/far vision – presbyopia, difficulty adjusting to changes from light to dark, yellowing of the lens, altered color perception, increased sensitivity to glare, smaller pupils), ears (loss of acuity for high-frequency tones – presbycusis, thickening of tympanic membrane, sclerosis of inner ear, buildup of earwax – cerumen), taste (often diminished; often fewer taste buds), smell (often diminished), touch (decreased skin receptors), proprioception (decreased awareness of body positioning in space). Genitourinary: fewer nephrons, 50% decrease in renal blood flow by age 80, decreased bladder capacity; male – enlargement of prostate, female – reduced sphincter tone. Reproductive: male – sperm count diminished, smaller testes, erections less firm and slow to develop. Female – decreased estrogen production, degeneration of ovaries, atrophy of vagina, uterus, breasts. Endocrine: general (alterations in hormone production with decreased ability to respond to stress), thyroid (diminished secretions), cortisol, glucocorticoids (increased anti-inflammatory hormone), pancreas (increased fibrosis, decreased secretion of pancreatic enzymes and hormones, decreased sensitivity to insulin). Immune system: thymus decreases in size and volume, T-cell function decreases, core temperature elevation is lowered. Functional changes: functional status in older adults includes the day-to-day ADLs involving activities within physical, psychological, cognitive, and social domains. Changes are usually linked to illness or to disease and degree of chronicity. Performance of ADLs is a sensitive indicator of health or illness. Occupational and physical therapists are your best resources for a comprehensive assessment. 3 cognitive disorders: delirium – acute confusional state, dementia – generalized impairment of intellectual functioning, depression – a mood disturbance characterized by feelings of sadness and despair. Nursing management of dementia: nursing management of older adults with any form of dementia always considers the safety and physical and psychosocial needs of the older adult and the family. These needs change as the progressive nature of dementia leads to increased cognitive deterioration. To meet the needs of the older, individualize nursing care to enhance quality of life and maximize functional performance by improving cognition, mood, and behavior. Psychosocial changes: they psychosocial changes occurring during aging involve life transitions and loss. The longer people live, the more transitions and losses they experience. Life transitions, of which loss is a major component, include retirement and the associated financial changes, changes in roles and relationships, alterations in health and functional ability, changes in one’s social network, and relocation. But the universal loss for older adults usually revolves around the loss of relationships through death. Caring for a cognitive impaired adult: provide a comprehensive assessment to differentiate between a progressive or reversible etiology; institute medical measures to correct underlying physiological alterations (e.g., infection, electrolyte imbalances, pain); maximize safe function, keep a routine, encourage activity and mobility, limit choices (e.g., clothes, what to eat), allow for rest; provide unconditional positive regard, be respectful and provide positive nonverbal communication; use behaviors to gauge activity and stimulation, watch for nonverbal signs of anxiety; teach caregivers to listen to the behaviors that show stress (e.g., verbalizations such as repetition); make sure that the environment is safe for mobility and promote way-finding with pictures or cues. Try to identify patients who wander and remove the cause (e.g., pain, thirst, unfamiliar surroundings, new noises); promote social interaction on the basis of abilities; compensate for sensory deficits (e.g., hearing aids, glasses, dentures); encourage fluid intake (make sure that fluids are accessible) and avoid long periods of giving nothing orally; be vigilant for drug reactions or interactions – consider onset of new symptoms as an