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NURSING
Terms
Aging
normal process of time related change starting with
Terms
Old Age
definition varies with frame of
reference
society indicates age 65 as
beginning of old age
young-old- 65-74
middle-old- 75-84
old-old- 85 & up
Terms
life span- maximum number of years person can live
MythsvsReality
1. families do not care for elder- 80% do take care
2. elderly- alone & deserted
MythsvsReality
4. incapable of learning- although slowed due to reflexes,
capable of learning new things
5. no longer interested in sexuality/ sexual act
relations
6. constipation/ incontinence- expected
never normal
constipation due to inactivity or diet
incontinence- seek medical help
MythsvsReality
7. senility- expected result of age
20%- 85+)
HealthPromotion&Maintenance
1. personal hygiene
bath 2-3/ week
lotion prn
shampoo 1-2/ week
keep nails short
dental supervision
try to make dressing easier (loose clothing, zippers, velcro)
2. exercise
individual planned
consider- general health, ?chronic illness, personal preference,
environment, finances
3. nutrition
balanced
decrease CHO, caffeine, fat, & Na
slowed reactions
altered sleep cycle
short term memory loss
impaired senses
Recommend
adequate lighting
avoid glare
vision aids
large print
contrasting colors
NormalAgingChanges
Sensory
hearing
presbycusis
problem with some consonants
cerumen accumulation
Recommend
low tone speaking voice
reduce background noise
face person
enunciate clearly
moderate pace
gestures prn
touch
sense of touch dulled
pain threshold higher
taste
dull salt & sweet (want more sweets)
prefer salty & highly seasoned foods
smell- diminishes
NormalAgingChanges
Respiratory
decreased gas exchange & cough efficiency
decreased activity tolerance
more vulnerable to infection
Recommend
exercise
no smoking
not in smoking areas
force fluids
flu vaccine
avoid exposure to infection
NormalAgingChanges
Reproductive
decreased hormone production
menopause in female
decreased vaginal secretions
penis & testes decrease in size
sperm production slowed
Recommend
sexual desires & activity decline but not disappear
water-soluble lubricant
sexual counselor prn
NormalAgingChanges
Musculoskeletal
osteoporosis
pathologic fractures
muscles lose strength, flexibility, & endurance
height loss
changes in posture
Recommend
high Ca, low Ph
exercise
handle gently
reduce environmental hazards
extra time to perform activities
prevent deformities
NormalAgingChanges
Cardiovascular
heart disease leading cause of death
heart valves-thicker & stiffer
arteries lose elasticity & accumulate deposits
decreased response to stress
B/P increases
cardiac output decreases
Recommend
exercise
no smoking
weight control
low fat diet
relieve stress
check B/P
NormalAgingChanges
GI
decreased motility
decreased teeth
ill fitting dentures
decreased saliva
constipation
lack of bulk
prolonged use of laxatives
ignore urge to defecate
drug side effects
emotional problems
inactivity
insufficient fluid
excess dietary fat
NormalAgingChanges
GI
Recommend
NormalAgingChanges
Urinary
decreased nephron activity
lose of muscle tone results in more frequent voiding
retention, frequency, urgency, & incontinence common
Recommend
ready access to toilet,
void regularly
pelvic floor exercises
avoid bladder irritants (caffeine, ETOH, sweeteners)
NormalAgingChanges
Endocrine
change in hormones
decreased basal metabolic rate
(BMR)
Immune
decreased function
more susceptible to infection &
disease
atypical S&S of infection
MentalHealthDisorders
2. aggressive behavior
a. abnormal anger, rage, or hostility
b. result of anxiety, stress, guilt,
insecurity, forced dependence
c. nursing
express feelings
set limits
3. other- regression, paranoid behavior
MentalHealthDisorders
4. rehabilitation for mental
problems
a. reality orientation
b. remotivation
c. reminiscence
d. cognitive training
e. relaxation therapy
Role Changes
1. crisis- sudden, not able to plan for appropriate
replacement, substitute not readily available, stress
producing
2. gradual- develop slowly & allow time for preparation
3. changes generally crisis-forced retirement, loss of
spouse, illness, friends move away or die, family
relocate or assume new roles decreasing time for
relationship
4. role losses- work (no longer bread winner), family (no
longer decision maker, loss of esteem or independence)
5. role gains- new friends, activities, or interests, purpose
& opportunity, rest & relaxation
Alterations in Life-style
1. employment
increase in number of older females working
decrease in number older males working
part-time employment more common
early retirement
involuntary limitations (health, sensory or perceptual
Alterations in Life-style
2. retirement
Alterations in Life-style
economic
fixed incomes frequently below nation's poverty levels (1 of
10)
costs increase
buying power decrease
many not receiving full benefits due to lack of knowledge or
inability to find out resources
lack of mobility
health problems
Alterations in Life-style
health
40% more than one chronic disease
increase in health care needs & costs
Alterations in Life-style
housing
prefer to remain independent
live with spouse, alone, or with family
own home
alternatives (mobile homes, retirement communities, foster
homes, life care facilities, nursing homes, homes for the
aged, convalescent homes, rest homes, house sharing,
public housing, rooming houses, hotels for single room
occupancy)
require special assistance (transportation, meals, health
hotlines, house cleaners, homemaker services, social
services, home care services)
Alterations in Life-style
recreation
more time available
problems (cost, health, decreased energy, lack of incentive,
sensory losses, lack of environmental aids, lack of conveniently
located facilities)
most depend on family
alternatives (religious, community activities, day care, senior
citizen centers, adult education, cultural events)
Intelligence
test scores decline but due to slowed responses not
actual ability
learning capacity continues
memory
education
administration times compatible with lifestyle
color coding
larger print
easily removable caps
Community
95% live in community
31% live alone
married (40% female, 74% male)
48% females widowed but only 15% males (more
remarry)
81% have living children
Elder Abuse
active or passive act or behavior that is harmful to the
elderly
physical violence (battering, sexual)
personal neglect
mental anguish (threat of institutionalization, social
isolation, sensory deprivation)
financial exploitation
violation of rights (confinement or restraint)
denial of health care
self-inflicted abuse
Safety
accidents
leading cause of death
falls most
also fires & MVA
more likely
decreased sense
increased reflex time
muscle weakness
confusion, forgetful
improper footwear
environmental hazards
drugs
Safety
prevention
short or 3/4 sleeve
no long garments
chairs with arms
no slip wax on floors, no scatter rugs or deep pile
avoid clutter
rubber tips on canes
tong reachers rather than stools or ladders
temperature controlled faucets
electric rather than gas, front controls
avoid trash accumulation
nonskid strips in tub or shower
Safety
handrails, high toilet seats, shower chairs
night light
side rails on bed prn
telephone by bed
proper lighting
stair rails, colored strips on step edges
no frayed wires
readily available emergency numbers
smoke detectors
crime prevention assessment
drug precautions
Personal Space
many are set in ways
prefer to be in familiar
Medicare
federal social insurance program designed to provide
(voluntary
must pay additional fee
out-patient
office visits
A78-year-oldclientisadmittedwithfluidvolumedeficitand
urinarytractinfection.AfterrapidIVinfusionof750mLNS,
theclientbeginstocoughandasksfortheheadofthebed
to be raised to ease breathing. Nurse Antonio assesses
jugularveindistention(JVD)andincreasedrespiratoryrate.
What should Nurse Antonio suspect is happening to this
client?
A.Fluidvolumedeficitisworsening
B.Hypervolemiaisdeveloping
C.Hypotonicwaterintoxicationisbeginning
D.Ascitesiscausingrespiratorycompromise
Thetermforhearinglossassociatedwithageis:
A. tinnitus
C.presbyopia
B. atotoxicity
D.presbycusis
Whichinstructionshouldbegiventotheclientwhoisfitted
forabehind-the-earhearingaid?
A. Removethemoldandcleaneveryweek.
B. Storethehearingaidinawarmplace.
C. Cleanthelintfromthehearingaidwithatoothpick.
D. Changethebatteriesweekly.
Whichofthefollowinginstructionsshouldbeincludedinthe
teachingfortheclientwithrheumatoidarthritis?
A. Avoidexercisebecauseitfatiguesthejoints.
B. Take prescribed anti-inflammatory medications with
meals.
C. Alternatehotandcoldpackstoaffectedjoints.
D. Avoidweight-bearingactivity.
AclienthasbeenreceivingRheumatrex(methotrexate)for
severerheumatoidarthritis.Thenurseshouldtelltheclient
toavoidtaking:
A. Aspirin
C.Omega3fishoils
B. Multivitamins
D.Acetaminophen
Thehomehealthnurseisvisitingaclientanexacerbation
ofrheumatoidarthritis.Topreventdeformitiesoftheknee
joints,thenurseshould:
A. Telltheclienttowalkwithoutbendingtheknees
B. B. Encouragemovementwithinthelimitsofpain
C. Instructtheclienttositonlyinrecliner
D. Remaininbedaslongasthejointsarepainful
AclientinanursinghomehasAlzheimersdisease.Shes
veryforgetfulandfrequentlyaskswhattimeitis.How
shouldthenurserespondthenexttimetheclientasksthe
time?
A. Asktheclientwhattimeitwasthelasttimesheasked.
B. Asktheclientwhyshecantrememberthetime.
C. Telltheclientthecorrecttime.
D. Telltheclientthisisthelasttimeshellbetold.
Whichofthefollowingdrugsisprescribefortreatmentof
Alzheimersdementia.
A.Nortriptyline(Pamelor)
B.Selegiline(Eldepry)
C.Rivastigmine(Exelon)
D.Valproicacid(Depacote)
AclientwithAlzheimersdiseaseisatagroupreality
orientationsession.Severalmembersofthegroupdiscuss
thepartytheyjustattend.Whichoutcomesuggeststhatthe
clientisbenefitingfromthissession?
A. Theclientisquitewhenotherstalkabouttheparty.
B. Theclienttellsthegroupshewasntattheparty
C. Theclientsaysshewantstohaveapartynow.
D. Theclienttalksaboutsomethingthathappenedatthe
party.
Whichofthefollowingpathophysiologicalchangesinthe
braincausesthesymptomsofAlzheimersdisease?
A.Glucoseinadequacy
B.Atrophyofthefrontallobe
C.Degenerationofthecholinergicsystem
D.Intracranialbleedinginthelimbicsystem
Whichofthefollowinginterventionswouldhelpaclient
diagnosedwithAlzheimersdiseaseperformactivitiesof
dailyliving?
A. Havetheclientperformallbasiccarewithouthelp.
B. Telltheclientmorningcaremustbedoneby9a.m.
C. Givetheclientawrittenlistofactivitieshesexpectedto
do.
D. Encouragetheclient,andgiveampletimetocomplete
basictasks
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