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GERIATRIC

NURSING

Terms

geriatrics- study of old age including

physiology, pathology, dx., & treatment


of diseases of old adults
gerontology- broader, the study of the
aging process including biological,
psychological, & sociological
gerontologic or gerontic nursingspecializes in care of the elderly

Aging
normal process of time related change starting with

birth & continuing throughout life


way person ages influenced by
genetics
lifestyle
availability & quality of health care
socioeconomics
old age- final phase of life
predict by 2030- 69.4 Million (8 Mil. over 85)
23% over 65 while only 18% under 18
ageism- prejudice against distinct group define by
age boundaries

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

under the best of conditions in absence of disease


life expectancy- average number of years a person
can be expected to live
2007: 77.7 years
over 80% have @ least 1 chronic illness, 50% have 2
34 Million older- 4.4 Million (14.5%) difficulty with @
least 1 ADL (eating, bathing, dressing, transferring,
toileting)
about 1 of 8
fastest growing age group- over 75

MythsvsReality
1. families do not care for elder- 80% do take care
2. elderly- alone & deserted

67% live in family setting


66%- child within 30 minutes
62%- weekly visits
76%- talk weekly
3. sickness & aging synonymous

almost 50% rate health as good or excellent


28% 65+ assessed poor health

MythsvsReality
4. incapable of learning- although slowed due to reflexes,
capable of learning new things
5. no longer interested in sexuality/ sexual act

sexuality (lifelong need)


can provide intimacy & love without sexual

relations
6. constipation/ incontinence- expected

never normal
constipation due to inactivity or diet
incontinence- seek medical help

MythsvsReality
7. senility- expected result of age

senility (dementia found in elderly)


dementia- result of disease- not aging
8. elderly financially impoverished

median net worth- $86,300


poverty rate- 12.9%
median income- $28,983
9. spend last years in nursing home

about 5% in nursing home


% increases with age (+1%- 65-74, +4%- 75-84,

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

Normal Aging Changes


Integumentary
skin thinner
less subcutaneous tissue
wrinkles
gray hair
skin drier & more susceptible to irritation
change in pigmentation (age or liver spots)
nails- thick & brittle
less efficient cooling system
less tolerance to temperatures
Recommend
avoid sun
avoid heat
dress warmly in winter
bathe 1-2 weekly
oil or lotion prn

Normal Aging Changes


Nervous

slowed reactions
altered sleep cycle
short term memory loss
impaired senses
Recommend

at risk for accidents


assist ADL prn
watch for possibility of burns prn

Normal Aging Changes


Sensory
vision
presbyopia
reading glasses
problem with blue vs green
difficulty adjusting to dark-light changes (night blindness)
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

regular dental & oral care


small frequent meals
sit up after meals
no heavy activity after meals
antacids with supervision
limit laxatives

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

Mental Health Disorders


1. depression
a. most common affective, mood, or functional disorder
b. can be reaction to loss of independence, status or spouse
c. some medications
d. physical illness & changes
e. nursing
encourage self expression & esteem
improve appearance
provide structure & routine
assist to maintain or regain control
kind & understanding attitude
safety, security
realize potential for suicide
about 25% occur in over 65
white males over 75 highest rate

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, decline in strength, endurance, & speed)


strengths (reliability, dependability, knowledge, expertise,
experience)

Alterations in Life-style

2. retirement

mandatory age raised to 70


health problems major cause of voluntary retirement
increased leisure time
stressful when decreased ability to handle stress
tremendous anxiety
loss of daily routine & income

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

penalties of losing social security benefits if employed

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

short term concentration & retention decline


remote generally better

personality basically unchanged

Drugs & Elderly


account for 34% of Rx. & 40% of OTC
average more than 11 per year
decreased dosage due to decreased absorption,

distribution, metabolism, & excretion


Recommend

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

place with memories


should allow as long as
possible

Medicare
federal social insurance program designed to provide

health care to elderly entitled to social security benefits


part A- hospital
part B- medical

(voluntary
must pay additional fee
out-patient
office visits

not covered-nonskilled home nursing care, ongoing

nursing home care, prescriptions, glasses, dental care


deductible
only pays 45% of health care costs

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

The nurse is caring for a client with rheumatoid arthritis.


The nurse knows that the clients symptoms will be most
improvedby:
A. Takingawarmshoweruponawakening
B. Applyingicepackstojoints
C. Takingtwoaspirinbeforegoingtobed
D. Goingforanearlymorningwalk

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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