Ncmb314 Lec Prelim

NCMB314 LECTURE: Exam Week
06
BSN 3RD YEAR 1ST SEMESTER PRELIM 2022
Bachelor of Science in Nursing 3YA
Professor: Caroline V. San Diego MAN, RN
Prelim Topics: changes bring to bear on job performance and related
• Concepts, Principles, History and Theories in The outcomes (e.g., work motivation)
Care of Older Adults 2) Understand age-related difference in life situations (e.g.,
• Physiologic Changes in Aging and Changes in Mind temporal shifts in work versus non-work roles and their
• Nursing care of Older Adult in wellness associated demands) and offer age-conscious policies
• Health promotion, Health maintenance and home and provisions to support the work life interface (e.g.,
health considerations Family Care, including childcare and eldercare, flexible
• Nursing Care of the Older Adult in Chronic Illness time and place policies)
3) Acknowledge temporal dynamics in individual differences
CONCEPTS, PRINCIPLES, HISTORY AND THEORIES IN THE (e.g., the age-graded re-organization of personality and
CARE OF OLDER ADULTS motives; the accrual of tacit and explicit job knowledge
Perspective of Older Adults through History and related job skills) and how these dynamics influence
• The members of the current older population in the United various work processes and outcomes.
States have offered the sacrifice, strength, and spirit that 4) Advocate for the design of work systems that optimally
made this country great. They were the proud GIs in world integrate various age-related changes, differences and
wars, the brave immigrants who ventured into a new dynamics (e.g., institute complete task job design to
country, the bold entrepreneurs who took risks that promote long term wellbeing and performance; afford
created wealth and opportunities for employment, and the workers the latitude to proactively self-manage work tasks
unselfish parents who struggle to give their children a and responsibilities via job crafting)
better life. They have earned respect, admiration, and
dignity. Today older adults are viewed with positivism Demographics of Aging
rather than prejudice, knowledge rather than myth, and - Life expectancy – the average number of years that a
concern rather than neglect. This positive view was not person can be expected to live
always the norm. - Average life expectancy - 47 years (2004)
• In the time of Confucius, there was a direct correlation • Figure had increased to 77.8 years
between a person’s age and the degree of respect to • What’s the IMPLICATION of this increasing life
which he or she was entitled. The early Egyptians dreaded expectancy?
growing old and experimented with a variety of potions - The Graying of America Percent of Total U.S.
and schemes to maintain their youth. Opinions were Population over 65 in 2030
divided among the early Greeks. Plato promoted older • In 2005, 13% of the U.S. pop. was over age 60
adults as society’s best leaders, whereas Aristotle denied - 18.3 million aged 65–74
older people any role in governmental matters. In the - 12.9 million aged 75–84
nations conquered by the Roman Empire, the sick and - 4.7% aged 85 or older
aged were customarily the first to be killed. And, woven • This number is estimated to increase:
throughout the Bible is God’s concern for the well-being of - To 20 million in 2010 (6.8% of total),
the family and desire for people to respect elders (Honor - To 33 million in 2030 (9.2%), and
your father and your mother..Exodus 20:12).Yet the honor - To almost 50 million in 2050 (11.6%)
bestowed on older adults was not sustained. • By mid-21st century, old people will outnumber young
• Medieval times gave rise to strong feelings regarding the for the first time in history
superiority of youth; these feelings were expressed in - “Age 65 and older” is widely accepted & used for reporting
uprisings of sons against fathers. Although England demographic statistics about older persons; however
developed Poor Laws in the early 17th century that turning 65 does not automatically means a person is “old”.
provided care for the destitute and enabled older persons - Persons 65 years of age and older currently represent
without family resources to have some modest safety net, about 13% of the total population.
many of the gains were lost during the Industrial - The most rapid and dramatic growth for the older adult
Revolution. No labor laws protected persons of advanced segment of the total U.S. population will occur between
age; those unable to meet the demands of industrial work the year 2010 and 2030, when “baby boom” generations
settings were placed at the mercy of their offspring of reach 65 years of age.
forced to beg on the streets for sustenance. Why They Increase?
Four ways to adopt a Lifespan Perspective on Aging at • Improved sanitation
work • Advances in medical care
1) Recognize age-related changes in abilities (e.g., physical • Implementation of preventive health services
and cognitive capacities) and the impact that such
J.A.K.E 1 of 25
CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER PRELIM 2022
• In 1900s, deaths were due to infectious diseases and • The average life expectancy of men in the United States is
acute illnesses 75.2 years
• Older population now faced with new challenge • Male exposure to risk factors may account for the
• Chronic disease differences
• Health care funding • Increases in female exposures to risk factors will reduce
• The ave. 75y/o has 3 chronic dses. & uses 5 rx meds. difference in life expectancy
• 95% of health care expenditures for older Americans are
for chronic diseases Majority of older adults enjoy good health
• Changes in fertility rates But national surveys reveal that:
• Baby boom after WWII (1946 – 1964) 3.5 children per • A 20% of adults 65y/o & above report a chronic disability.
household • Chronic disease - major cause of disability;
• Older population will explode between 2010 to 2030 when - Heart disease
baby boomers reach age 65 - Cancer,
• Based on 1997 data, 4x as many widows as widower live - Stroke
in the United States. About 5 % of persons over 65 reside - Alzheimer’s disease - 5th
in nursing facilities, but % increases dramatically with - DM - 6th
advancing age. • Majority of deaths (US) occur in people 65y/o & older
Estimates indicates that more than 80% of persons over 65 - 50% of deaths--caused by heart disease & cancer
years of age have one or more chronic health conditions. 3 - In the past 50 years --- a noted decline in overall
Leading Causes of Death for older persons, in order, heart deaths
conditions, malignant neoplasms, & CVD’s o Due to the improvements in the prevention & early
detection & treatment of diseases
Impact of the Baby Boomers o Heart disease & cancer are two top causes of
- In anticipating needs and services for future generations death, regardless of age, race, gender or ethnicity
of older adults, gerontological nurses must consider the o Positive health reports declined with advancing
realities of the baby boomers, those born between 1946 age
and 1964, which will be the next wave of senior citizens. o African American and Hispanic or Latinos - less
- Their impact on the growth of the older population is such likely to report good health than their Caucasian
that it has been referred to as a demographic tidal wave. or Asian counterparts.
- Baby boomers began entering their senior years in 2011
and will continue to do until 2030. Although they are a
highly diverse group, representing people as different as
Bill Clinton, Bill gates and Cher, they do have some clearly
defined characteristics that set them apart from other
groups:
• Most have children, but this generation’s low birth
rate means that they will have fewer biologic children
available to assist them in old age.
• They are better educated than preceding generations.
• Their household incomes tend to be higher than other
groups, partly due to two incomes (three out of four
baby boomer women are in the labor force).
• Majority of people 75y/o & over
• They favour a more casual dress code than previous - Remain functionally independent, and
generations of older adults. - The proportion of older Americans with limitations in
• They are enamored with “high-tech” products and are activities is declining (CDC, 2007a).
likely to own and use a home computer. • 70% of Physical Decline Related to Modifiable Risk
• Their leisure time is scarcer than other adults, and Factors
they are morte likely to report feeling stressed at the - Smoking
end of the day. - Poor nutrition
• As inventors of the fitness movement, they exercise - Physical inactivity
more frequently than other adults. - Failure to use preventative and screening services
Reason for the decline in limitations to activity of Older
Feminization of Later Life Adult
• Women comprise 55% of the older population • Improved nutrition,
• Women have a longer life expectancy • Decreased smoking,
• The average life expectancy of women in the United States • Increased exercise, and
is 81 years
J.A.K.E 2 of 25
• Early detection & treatment of risk factors such as First nursing journal for the care of older adults
hypertension & elevated serum cholesterol levels. published : Journal of Gerontological Nursing by
1975
Slack,Inc. First nursing conference held at the
Geriatrics International Congress of Gerontology.
- From Greek – Geras, meaning “old age,” branch of ANA Geriatric Nursing Division changes name to
medicine & deals with the diseases & problems of old age. 1976
Gerontological Nursing Division
- Gerontology – from the Greek Geron, meaning “old man,”
ANA division of Gerontological Nursing publishes
is the scientific study of the process of aging and the 1981
statement on scope of practice
problems of aged persons
Development of Robert Wood Johnson Teaching
1982
- It includes biologic , sociologic , psychologic , and Home Nursing Program
economic aspects. First university chair in gerontological nursing in the
1983
- “Gero” – old age, “Ology”- study of United States (case western reserve)
- Older Age Group: ANA revises Standards and Scope of Gerontological
• Young old – ages 65-74 1987
Nursing Practice
• Middle Old – ages 75-84 First Phd program in gerontological nursing
• Old Old – 85 and up. 1988
established
- Age Discrimination – emotional prejudice among the ANA certification established for Clinical Specialist
older adult. 1989
in Gerontological nursing
- Ageism – dislike of the aging and the older adult.
Prejudice against the old just because they are old. ANA certification available for geriatric advanced
- Senescence – Defined as a change in the behavior of an 1998 practice nurses as geriatric nurse practitioners or
organism with age, leading to a decreased power of gerontological clinical nurse specialist
survival and adjustment, occur as well.
Barbara Davis
Gerontology Nursing - She is the first nurse to speak before the American
- This specialty of nursing involves assessing the health & Geriatric Society.
functional status of older adults, planning and - First article on nursing curriculum regarding gerontologic
implementing health care & services to meet the identified nursing is published.
needs, and evaluating effectiveness of such care. Gerontologic Nurse
Landmarks in the development of gerontological The nurse must meet all of the following requirements:
nursing as a specialty - Currently hold an active registered nurse license in US or
its territories.
American Journal of Nursing (AJN) publishes first
1902 - Hold a baccalaureate or higher degree in nursing.
geriatric article by an MD - Have practiced 2000 hours within past 3 years
First geriatric nursing textbook, “Geriatric Nursing - Have had 30 contact hours Of continuing education
(Newton), published - Applicable to gerontology/ Gerontologic nursing within
1950 First master’s thesis in geriatric nursing completed the past 3 years.
by Eleanor Pingrey Gerontologic Nurse Practitioner
Geriatric becomes a specialization in nursing The nurse must meet the following requirements:
First geriatric nursing study published in Nursing - Currently hold an active RN license in the US or its
1952 territories
Research
- Hold a master’s or higher degree in nursing.
ANA recommends specialty group for geriatric
1961 - Have been prepared as a nurse practitioner in either of the
nurses
following:
ANA holds first National Nursing Meeting on
1962 • A GNP master’s degree in Program
Geriatric Nursing Practice - A formal postgraduate GNP track or program Within a
ANA forms a geriatric nursing division, First school of nursing granting graduate-level academic credit
1966 Gerontological Clinical Nurse Specialist master’s Clinical Specialist in Gerontologic Nursing
program begins at Duke University The nurse must meet all the following requirements:
First RN (Laurie Gunter) presents at the - Currently hold an active RN license in the United States or
1968
International Congress of Gerontology its territories
Development of standards for geriatric nursing - Hold a master’s or higher degree in gerontologic nursing
1969 - Hold a master’s or higher degree in nursing with a
practice
ANA creates the Standards of Practice for Geriatric specialization in gerontologic nursing.
1970 - Have practiced a minimum of 12 months after completion
Nursing
of the master’s degree
ANA offers the first generalist certification in
1973 - Meet the following requirements in current practice:
gerontological nursing
J.A.K.E 3 of 25
• If a clinical specialist must have provided a minimum Aging Well

of 800 hours (post-master’s) of direct client care or - 72% of seniors report having good to excellent health
clinical management in Gerontologic Nursing within - Numbers living in nursing homes has declined
the past 24 months - 1 out of every 5,578 people was 100 y/o or older
• If a consultant, researcher, educator, or administrator, - Older adults are active and healthy
must have provided a minimum of 400 hours - Challenge to all nurses: To promote positive lifelong
health behaviors among all populations because the
Nursing Care of Older Adults impact of unhealthy behaviors and choices = CHRONIC
- Gerontological nursing is provided in acute care, skilled DISEASE.
and assisted living, the community, & home settings. Purpose Of Nursing Theory
- Goals of care include: - Defines our practice
• Promoting & maintaining functional status, and - In gerontological nursing they must be comprehensive yet
• Helping older adults identify & use their strengths to consider individual differences
achieve optimal independence. - A good GERONTOLOGICAL THEORY:
Roles of the Gerontological Nurse • Integrates knowledge,
• Provider of care • Tells how and why phenomena are related,
- Should be educated about disease processes & • Leads to prediction, and
syndromes commonly seen in the older population • Provides process and understanding
b) • In addition, it must be holistic & take into account all
• Teacher/ Educator that impacts on a person throughout a lifetime of
- Should focus their teaching on modifiable risk factors aging
& health promotion through
• Manager Aging Theories
- They balance concerns of the patient, family, nursing - Cultural, spiritual, regional, socioeconomic, educational,
& the rest of the interdisciplinary team environmental factors, and health status impact the older
- Must be skilled in: Leadership, Time management, adults perceptions and choices about their health care
Building relationships, Communication & Managing needs
change - Limited work has been done to identify nursing-specific
- They may also supervise other nursing personnel aging theories
• Advocate - Aging is a distinct discipline that requires aging theories
- Acts on behalf of the older adults to: that have an interdisciplinary perspective
o Promote their best interests & Psychosocial Theories of Aging
o Strengthen their autonomy & decision making - Attempt to explain aging in terms of behaviour, personality
- It does not mean making decisions for older adults, and attitude change.
but empowering them to remain independent and 1) Sociological Theories – changing roles, relationship,
retain their dignity, even in difficult situations status and generational cohort impact the older adult’s
• Research Consumer ability to adapt.
- Must remain abreast of current research literature, b) Activity theory
reading & putting into practice the results of reliable & - Havighurst and Albrecht (1953)
valid studies - Remaining occupied and involved is necessary to
- The use of EVIDENCE-BASED PRACTICE RESEARCH satisfy late life.
can improve the quality of patient care in all settings: - Activity engagement and positive adaptation.
o Best method for delivery of care c) Disengagement Theory
o Based on clinical guidelines derived from - Cumming and Henry (1961)
research - Gradual withdrawal from society and
o Coding system indicates the strength of the relationships serves to maintain social
research equilibrium and promote internal reflection.
a. All nurses should: d) Subculture Theory
o Read professional journals specific to their - Rose (1965)
specialty - The elderly prefer to segregate from society in an
o Continue their education by attending seminars & aging subculture sharing loss of status and
workshops societal negativity regarding the aged.
o Participate in professional organizations e) Continuity Theory
o Pursue additional formal education or degrees - Havighurst (1960)
o Obtain certification - also known as Development Theory
- Personality influences role and life satisfaction
and remains consistent throughout life.
- 4 Personality types:
J.A.K.E 4 of 25
• Integrated - Older adults are more vulnerable to free radicals.

• Armored Defended b) Orgel/ Error Theory
• Passive Dependent - Errors in DNA and RNA synthesis occurs with
• Unintegrated aging.
f) Age Stratification Theory c) Wear and Tear Theory
- Riley (1960) - Cells wears out and cannot function with aging.
- Society is stratified by age groups that are the - Like a machine which losses function when its
basis for acquiring resources, roles, status and parts wears off.
deference from others. d) Connective Tissue Theory / Cross link theory
g) Person-Environment Fit Theory - With aging, proteins impede metabolic processes
- Lawton (1982) and cause trouble with getting nutrients to cells
- Function is affected by ego strength, mobility, and removing cellular waste products.
health, cognition, sensory perception and the
environment. 2) Non-Stochastic Theories of Aging – Based on the
2) Psychological theories – Explain aging in terms of mental genetically programmed events that cause cellular
processes, emotions, attitudes, motivation, and damage that accelerates aging of the organism.
personality development that is characterized by life stage a) Programmed Theory
transitions. - Cells divide until they are no longer able to and
a) Human needs - Maslow’s (1954) this triggers to apoptosis or cell death.
- Five basic needs motivate human behaviour in a - Shortening of the TELOMERES – the distal
lifelong process toward need fulfilment. appendages of the chromosomes arm.
- Self – Actualization - TELOMERASE – an enzyme, “cellular fountain of
b) Individualism Theory youth”
- Jung (1960) b) Gene/ Biological Clock Theory
- Personality consists of an ego and personal and - Cells have a genetically programmed aging code.
collective unconsciousness that views life from a c) Neuroendocrine theory
personal or external perspective. - Problems with the hypothalamus-pituitary-
c) Stages of Personality Development endocrine gland feedback system causes disease.
- Erikson (1963) - Increased insulin growth factor accelerates aging.
- Personality develops in eight sequential stages d) Immunologic/ Autoimmune Theory
with corresponding life tasks. The eighth phase, - Aging is due to faulty immunological function,
integrity versus despair, is characterized by which is linked to general well-being.
evaluating life accomplishments; struggles
include letting go, accepting care, detachment, PHYSIOLOGIC CHANGES IN AGING AND CHANGES IN
and physical and mental decline. MIND
d) Life-course/Lifespan Development Physiologic Changes in Aging
- Life stages are predictable and structured by 1) Integumentary Effects:
roles, relationship, values and goals. • Wrinkling
Biological Theories of Aging • Decrease of the skin’s immune responsiveness
- Explains that physiologic processes that change with • Dehydration and cracking of the skin
aging. • Decreased sweat production
1) Stochastic Theories – Based on random events that • Decreased numbers of functional melanocytes
cause cellular damage that accumulates as the organism resulting in gray hair and atypical skin pigmentation
ages. • Loss of subcutaneous fat
a) Free Radical Theory • A general decrease in skin thickness
- Membranes, Nucleic acids and proteins are • An increased susceptibility to pathological conditions
damaged by free radicals which causes cellular • Growth of hair and nails decreases; nails become
injury, brittle with age
- Exogenous Free radicals: Tobacco smoke, 2) Muskulo-skeletal
Pepticides, organic solvents, Radiation, ozone • Decreased height
and selected Medications. • Decreased ROM joints
- Health Teaching:
• Increased postural sway/ difficulty balance
• Decrease calories in order to lower weight
• Shrinking vertebral disc, slight kyposis
• Maintain a diet high in nutrients using anti-
• Loss of bone mass, bones more brittle (increased
oxidants
resorption)
• Avoid inflammation
• Muscle Atrophy/ decreased lean body mass
• Minimize accumulation of metals in the body
• Joint degeneration (Cartilage surface)
that can trigger free radicals reactions.
• Foot problems: bunions, coms, and calluses
J.A.K.E 5 of 25
3) Respiratory • Smell
• Decreased chest wall compliance - Impaired ability to identify and discriminate
• Decreased maximal breathing capacity among odors
• Decreased number of alveoli • Taste
• Decreased elasticity - High prevalence of taste impairment, although
• Decreased parenchyma most likely due to factors other than normal aging
• Impaired cough reflex because of defective • Touch
mucociliary function - Reduction in tactile sensation
• Increased vulnerability to hypoxia and emphysema 10) Endocrine
• Increased susceptibility to respiratory infections • Decrease thyroid activity
4) Cardiovascular / Hematopoietic & Lymphatic • ACTH secretion decreases
• Cardiac output decreases • Pituitary gland decreases in volume by approximately
• Aorta becomes dilated and elongated 205 in older person
• Resistance to peripheral blood flow increases by 1% • Gonadal secretion declines with age, including
per year gradual decreases in testosterone, estrogen, and
• Blood pressure increases progesterone
• Decrease cardiac output • TSH decreases
• Less elasticity of the vessel • Insufficient release of insulin by beta cells of the
• More prominent arteries in head, neck, and pancreas
extremities 11) Reproductive
• Stroke volume decreases by 1% per year • Male
5) Hematopoietic & Lymphatic - Fluid-retaining capacity of seminal vesicles
6) Gastrointestinal reduces
• Decrease esophageal motility - Possible reduction in sperm count
- Venous and arterial sclerosis of penis
• Atrophy of gastric mucosa
- Prostate enlarges in most men
• Decrease stomach motility, hunger contractions, and
emptying time • Female
- Fallopian tubes atrophy and shorten
• Less production of hydrochloric acid, lipase, and
- Ovaries become thicker and smaller
pancreatic enzymes
- Cervix becomes smaller
• Fewer cells on absorbing surface of intestine
- Drier, less elastic vaginal canal
• Slower peristalsis
- Flattening of labia
• Decreased taste sensation - Endocervical epithelium atropies
• Esophagus more dilated - Uterus becomes smaller in size
• Reduced saliva and salivary ptyalin - Endometrium atropies
7) Urinary - More alkaline vaginal environment
• Decrease in nephrons - Loss of vulvar subcutaneous fat and hair
• Between ages 20 and 90, renal blood flow decreases
53%, and glomerular filtration rate decreases 50% Changes To The Mind
• Weaker bladder muscles - Psychological changes can be influenced by general
• Decreases size renal mass health status, genetic factors, educational achievement,
• Decrease tubular function activity, and physical and social changes.
• Decrease bladder capacity - Sensory organ impairment can impede interaction with
8) Nervous the environment and other people, thus influencing
• Decrease brain weight psychological status. Feeling depressed and socially
• Reduced blood flow in brain isolated may obstruct psychological function.
• Changes in sleep pattern - Recognizing the variety of factors potentially affecting
• Decrease conduction velocity psychological status and the range of individual
• Slower response and reaction time responses to those factors, some generalizations can be
9) Special senses discussed.
• Hearing Personality
- Atrophy of hair cells of organ of corti - Drastic changes in basic personality normally do not
- Tympanic membrane sclerosis and atrophy occur as one age. The kind and gentle old person was
- Increased cerumen and concentration of keratin most likely that way when young; likewise, the
cantankerous old person probably was not mild and meek
• Sight
in earlier years.
- More opaque lens
- Decrease pupil size
- More spherical cornea
J.A.K.E 6 of 25
- Excluding pathologic processes, the personality will be creative capacities, special perceptions, and aesthetic
consistent with that of earlier years; possibly, it will be appreciation; this type of intelligence is believed to
more openly and honestly expressed. decline in later life. Some decline in intellectual function
- The alleged rigidity of older persons is more a result of occurs in the moments preceding death. High levels of
physical and mental limitations than a personality change. chronic psychological stress have been found to be
- For example, an older person’s insistence that her associated with an increased incidence of mild cognitive
furniture not be rearranged may be interpreted as rigidity, impairment.
but it may be sound safety practice for someone coping Learning
with poor memory and visual deficits. Changes in - Although learning ability is not seriously altered with age,
personality traits May occur in response to events that other factors can interfere with the older person’s ability
alter self-attitude, such as retirement, death of spouse, to learn, including motivation, attention span, delayed
loss of independence, income reduction, and disability. transmission of information to the brain, perceptual
No personality type describes all older adults. Morale, deficits, and illness.
attitude, and self-esteem tend to be stable throughout the - Older persons may display less readiness to learn and
life span. depend on previous experience for solutions to problems
Memory rather than experiment with new problem-solving
- The three type of memory are short term, lasting from 30 techniques.
seconds to 30 minutes; long term, involving that learned - Differences in the intensity and duration of the older
long ago; and sensory, which is obtained through the person’s physiologic arousal may make it more difficult to
sensory organs and lasts only a few seconds. extinguish previous responses and acquire new material.
- Retrieval of information from long-term memory can be - The early phases of the learning process tend to be more
slowed, particularly if the information in the difficult for older persons than younger individuals;
consciousness while manipulating other information- however, after a longer early phase, they are then able to
working memory function-is reduced. keep equal pace.
- Older adults can improve some age-related forgetfulness - Learning occurs best when the new information is related
by using memory aids (mnemonic devices) such as to previous learned information. Although little difference
associating a name with an image, making notes or lists, is apparent between the old and the young in verbal or
and placing objects in consistent locations. Memory abstract ability, older persons do show some difficulty
deficits can result form a variety of factors other than with perceptual motor tasks.
normal aging. - Some evidence indicates a tendency toward simply
Intelligence association rather than analysis, Because generally a
- In general, it is wise to interpret the findings related to greater problem to learn new habits when old habits exist
intelligence and the older population with much caution and must be unlearned, relearned, or modified, older
because results may be biased from the measurement persons with many years of history may have difficulty in
tool or method of evaluation used. this area.
- Early gerontological research on intelligence and aging Attention Span
was guilty of such biases. Sick old people cannot be - Older adults demonstrate a decrease in vigilance
compared with healthy persons; people with different performance (i.e. the ability to retain attention longer than
educational or cultural backgrounds cannot be compared; 45 minutes).
and one group of individuals who are skilled and capable - They are more easily distracted by irrelevant information
of taking an IQ test cannot be compared with those who and stimuli and are less to perform tasks that are
have sensory deficits and may not have ever taken this complicated or require simultaneous performance.
type of test.
- Longitudinal studies that measure changes in a specific NURSING CARE OF THE OLDER ADULT IN WELLNESS
generation as it ages and that compensate for sensory, Assessment
health, and educational deficits are relatively recent, and - Assess potential health hazard to identify risk factors for
they serve as the most accurate way of determining illness and injury
intellectual changes with age. - Risk Factors:
- Basic intelligence is maintained; one does not become • Habits
more or less intelligent with age. The ability for verbal • Lifestyle patterns
comprehension and arithmetic operations are unchanged. • Personal and family medical history
- Crystallized intelligence, which is the knowledge • Environmental conditions
accumulated over a lifetime and arises from the dominant - Comprehensive Geriatric Assessment (CGA):
hemisphere of the brain, is maintained through the adult • Physical health
years; this form of intelligence enables the individual to • Mental health
use past learning and experiences for problem solving. • Functional status
- Fluid intelligence, involving new information and
• Social functioning
emanating from the nondominant hemisphere, control
• Environment
emotions, retention of non-intellectual information,
J.A.K.E 7 of 25
MiniMetal State Examination

- Mini-Mental State Exam (MMSE) is a widely used test of
cognitive function among the elderly; it includes tests of
orientation, attention, memory, language and visual-
spatial skills.
Functional Status Assessment

- Functional status is considered a significant component
of an older adult’s quality of life. Assessing functional
status has long been viewed as an essential piece of the
overall clinical evaluation of an older person.
- Functional status assessment is a measurement of the
older adult’s ability to perform basic self-care tasks, or
ADLs, and tasks that require more complex activities for
independent living, referred to as IADLs.
- Determination of the degree of functional independence
in these areas can identify a client’s abilities and
limitations, leading to appropriate interventions.
- The client’s situation determines the location and time
when any of the scales or tools should be administered,
as well as the number of times the client may need to be
tested to enjoy to ensure accurate results.
- Many tools are available, but the nurse should use only
those which are valid, reliable, and relevant to the
practice setting.
The Katz Index
- A useful tool to describe the client’s functional level
- Katz Index of Independence in Activities of Daily Living,
commonly referred to as the Katz ADL, is the most
appropriate instrument to assess functional status as a
measurement of the client's ability to perform activities of
daily living independently.
J.A.K.E 8 of 25
PAR-Q AND YOU performance of activities of daily living (ADLs) and /or
- Physical Activity Readiness Questionnaire (PAR-Q) is a instrumental activities of daily living (IADLs).
common method of uncovering health and lifestyle issues • Objective: Observe for cues that indicate effective
prior to an exercise programmed starting. The management of deficits, including the physical
questionnaire is short and easy to administer and reveals environment in which th client resides.
any family history of illness. Nutritional / Metabolic Pattern
- This pattern encompasses evaluation of dietary and other
nutrition-related indicators.
• Subjective: Determine the older adult’s description,
patterns, and perception of food and fluid intake and
adequacy for maintaining a healthy body mass index.
• Objective: Observe general appearance and various
body system indicators of nutritional status. Note
height, weight, and fit of clothes.
Coping/ Stress-Tolerance Pattern
- This pattern encompasses the client’s reserve and
capacity to resist challenges to self-integrity, and his or
her ability to manage difficult situations.
• Subjective: Assess ways to handle big and little
problems that occur in everyday life.
• Objective: Observe for the use of coping skills and
stress-reducing techniques, and note their
effectiveness.
Cognitive/ Perceptual Pattern
Gordon’11 Basic functional Health Patterns of Older - This pattern encompasses self-management of pain,
ADULT presence of communication difficulties, and deficits in
Self-Perception/ Self-Concept Pattern sensory function.
- This pattern encompasses a sense of personal identity; • Subjective: Inquire about difficulties with sensory
body language, attitudes, and view of self in cognitive, function and communication, as well as the
physical, and affective realms; and expressions of sense assessment of any cognitive changes.
of worth and emotional state. • Objective: Assess usual patterns of communication
- Perceptions of self should be explored with direct and note the client’s ability to comprehend.
questions, asked with sensitivity. Emotional patterns can Value/ Belief Pattern
be identified during this exploration of perceptual patterns. - This pattern encompasses elements of spiritual well-
• Subjective: Determine the client’s feelings about his being that the older adult perceives as important for a
or her competencies and limitations, withdrawal from satisfactory daily living experience and the philosophic
previous activities, self destructive actions, excessive system that helps him or her function within society.
grieving, and increased dependency on others. • Subjective: Identify the older adult’s values and
• Objective: Identify verbal and nonverbal cues related beliefs about spirituality, with a special emphasis on
to the above subjective data. how this influences health promotion behaviors.
Roles/ Relationship Pattern • Objective: Determine what is important in the older
- This pattern encompasses the achievement of expected adult’s life to support coping strategies.
developmental tasks. Activity/ Exercise Pattern
- Basic needs for communication and interactions with - This pattern encompasses information related to health
other people, as well as meaningful communications and promotion that encourages the older adult to achieve the
satisfaction in relationship with others are examined. recommended 30 minutes daily of physical activity on
• Subjective: Determine family structure, history of most days of the week.
relationships, and social interactions with friends and • Subjective: Screen for safety related exercise and
acquaintances. physical activity, using screening measures such as
• Objective: Examine the family dynamics of the physical activity readiness questionnaire (PAR-Q).
interdependent, dependent, and independent • Objective: Obtain vital signs and conduct
practices among members. cardiopulmonary and musculoskeletal system
Health Perception/ Health Management Pattern assessments.
- This pattern encompasses the perceived level of health Rest and Sleep Pattern
and current management of any health problems. - This pattern encompasses the sleep and rest patterns
• Subjective: Determine the level of understanding of over a 24-hour period and their effect on function.
any treatments or therapy required for management • Subjective: Assess usual sleep patterns, including
of health deficits or activities; include assessment of bedtime and arousal time, quality of sleep, sleep
J.A.K.E 9 of 25
environment, and distribution of sleep hours within a HEALTH PROMOTION, HEALTH MAINTENANCE AND HOME
24-hour period. HEALTH CONSIDERATIONS
• Objective: Have a client keep a sleep diary that Promoting Healthy Aging
includes naps and rest periods. Healthy People Initiative
Sexuality/ Reproductive Pattern - An initiative of the US Department of Health and Human
- This pattern encompasses the older adult’s behavioral Services that set forth health care objectives designed to
expressions of sexuality. increase the quality and quantity of years of healthy life of
• Subjective: Assess client’s satisfaction or Americans and to eliminate health disparities.
dissatisfaction with current circumstances related to - FOCUS: minimize the loss of independence associated
sexual function and intimacy, including perceived with illness and functional decline.
satisfaction or dissatisfaction with sexuality or sexual
experiences. Components of Health Promotion for the Elderly
• Objective: Discuss current sexual relationship. When Exercise
none is present, elicit the meaning this has for the - Regular exercise and physical activity can improve health
client’s overall emotional and physical well-being. in a variety of ways:
Elimination Pattern • Reduction in Heart Disease, Diabetes, High Blood
- This pattern encompasses bowel and bladder excretory pressure, Colon CA, Depression, Anxiety, Excess
functions. weight, falling, bone thinning, muscle wasting and
• Subjective: Assess lifelong elimination habits and joint pain.
excretory selfcare routines. - Nursing Implication:
• Objective: Perform abdominal and rectal examination; • Motivate the elderly to have regular exercise and
external genitalia and pelvic examination may be increase their physical activity.
indicated. • Advise the elderly to have continuous exercise.
• Promote the physical activity and exercise as a habit
Planning for the elderly.
• Exploring older adults’ personal ideas and beliefs
concerning health needs
• Reading current literature regarding latest update for
specific health promotion
• Current health policy information that will safeguard client
rights
• Understanding and use of behavior change theories
Implementation
• Adopting a proactive stance toward an action plan for
health promotion of the older individual
• Activities, locations, and means of disseminating health
promotion
• Annual health promotion screening
• Program that provide vaccinations for older adult
• Screening for cancer , diabetes, and other condition
• Monthly health talks provided in senior centers
• Housing sites
• Continuing retirement communities
• Advocate and educate about health promotion
• Safe medication use
Evaluation
• Determining effectiveness of care plan
• Check established goals
• Establish appropriate and realistic revised goals and
realistic steps to achieve them
Nutrition
- Eating and drinking habits have been implicated in 6:10
leading cause of death in the elderly.
- Older adults are more prone to Obesity and Malnutrition.
J.A.K.E 10 of 25
- Nursing Implication: Proper Nutrition • Gait Disturbances

• Alcohol Consumption: Men twice a day, Women once • Decreased proprioception
a day. • visual/cognitive impairment
• Decrease Fats, Decrease Cholesterol Diet • polypharmacy
• Balance Caloric Intake • Environmental conditions: Slippery surfaces, stairs,
• Daily Calcium, Vit. B12, Vit. D, Fruits and Vegetable. irregular surfaces, poor lightning, incorrect foot ware,
Mental Health obstacles in the pathways.
- Decrease life satisfaction due to:
• Decrease Income (50%) Fall-risk Assessment: “I HATE FALLING”
• Increase emotional losses • I – nflammation of joints or joint deformity.
• Physical losses • H – ypotension (Orthostatic Blood pressure changes)
• Caregiving responsibilities. • A – uditory and Visual Impairments
- Nursing Implication: • T – remors
• Life Review – tool for preserving or enhancing the • E – quilibrium problems.
mental health of the older adults. • F – oot problems.
o Life domains • A – rrythmias, heart block, valvular disease.
o Autobiography, tape recording or videotape. • L – eg Discrepancy
• Depression • L – ack of conditioning (General Weakness)
o losses that accompanying aging such as • I – llness
widowhood, chronic medical conditions and pain , • N – utrition
and functional dependence. • G – ait disturbance
o Depression may lead to physical Decline.
o Plays a significant role in suicidal behaviors. Disease Prevention
o Undetected in the elderly. - Helps prevent functional decline.
Model Health Promotion Programs for Older Adult - Levels of Disease Prevention:
- Programs that have received federal funding and 1) Primary Prevention – designed to completely prevent a
foundation supports to evaluate their effectiveness and to disease from occurring.
encourage their replication. 2) Secondary Prevention – early detection and
- Focus: Older Adults. management of disease.
a) Health wise – provides information and prevention 3) Tertiary Prevention – manage clinical disease in order
tips on 190 common health problems. to prevent them from progressing or to avoid
b) Chronic Disease Self-Management Program complications of the disease.
- Founded by Nurse Researcher Kate Lorig.
- Chronic Diseases: Self Management Program. Quality of Life
c) Project Enhance – Enhance Fitness and Enhance - How a person rates his or her life as satisfactory or not.
Wellness. - Degree of Satisfaction and Dissatisfaction with life.
d) Ornish Program for Reversing Heart Disease - WHO (1994) An individual’s perception of his or her
- Founded by Dr. Dean Ornish position in life in the context of their culture and value
- Enhancement of Elderly Nutrition system where they live in and in relation to their goals,
e) Benson’s Mind/Body Medical Institute expectations, standards and concerns.
- Dr. Herbert Benson
- Combination of Relaxation: Nutrition, Exercise, Quality of Life Model
and Reframing from Negative thinking patterns.
• Physical Well Being – Functional Ability, Strength/Fatigue,
f) Strong for life Model – exercised program for disabled
Sleep/Rest, Nausea, Appetite and Constipation.
and nondisabled older adults.
• Psychological Well Being – Anxiety, Depression,
Re-Engagement Instead of Retirement
enjoyment, leisure, pain distress, happiness, fear,
- The likely alternative to retirement blessed with longevity,
cognition/attention.
education, health and positive attitude towards remaining
• Social Well Being – Caregiver burden, roles and
engaged.
relationship, affection/sexual function, appearance.
Green House
• Spiritual Well Being – Suffering, meaning of pain, religiosity,
- Founded by Dr. William Thomas
transcendence.
- An Innovative and home-like alternative to nursing homes.
Safety
Quality of Life Program
- Falls – leading cause of unintentional injury death in older
Active Aging
adult.
- Integrated health and quality of life program.
- Elderly are vulnerable to falls as a result of:
- Optimizing opportunities for health, participation in the
• Postural Instability
community and safe living in order to enhance quality of
• Decrease muscle Strength
life.
J.A.K.E 11 of 25
- Center of Active Aging: Provide quality of life to the elderly. Economic Determinants
- Enhance Autonomy, Independence, and Activity. Social Services Determinants
WHO’s Determinants of Health Guidelines for Primary and Secondary Health Promotion
- Affects aging and the quality of life of individuals, Activities for Older Adults
communities and nations. Health
Supportive
Behavioral Determinants Promotion Recommendation
Evidence
a) Physical Activity – contributes to muscle strength, activity
flexibility, balance, cardiovascular health and positive Based on
mood and improves cognition. Annually starting at age randomized trials;
Mammogram 40 and continue q 1 to 3 evidence for age to
b) Nutrition – powerful and modifiable lifestyle factors.
years until ages 70-85 stop screening not
- Increase in Vitamins and Minerals, increase in Vit. B6, well established
B12, D, K and folic acids, anti-oxidants Vitamins A,C, Every 1-3 years after 2-3 Based on
E, Beta-Carotene, Selenium, Calcium and Iron. Pelvic negative annual randomized trials;
c) Smoking – single most important preventable risk factors Examination/ examinations; can evidence for age
that cause Premature Death. cervical smear decrease or discontinue stop screening not
- 5 A’s : Ask, Advise, Assess, Assist and Arrange. after ages 65-70 well established
d) Alcohol Abuse and Alcoholism – Elderly have the Evidence from
increase effects of Alcohol because of pharmacologic nonrandomized or
changes associated with aging. retrospective
Fecal occult
Annually after age of 50 studies; fair
- Four Steps in Treating Alcoholism: blood test
evidence to
• Identify individuals requiring treatment support
• Determine individual’s readiness to discuss recommendation
treatment. Based on expert
• Assess individual’s requiring detoxification. Annually after age 50 if
opinions or other
• Plan for post detoxification treatment in Prostate considerations;
life expectancy is at least
coordination with other professional. examination limited evidence to
10 years
support
e) Medication Adherence
recommendation
- Non-Adherence to medication. Encourage aerobic and
- Invisible epidemic resistance exercise as
- Risk Factors: Exercise Based on
tolerated; ideally 30
randomized trials
• Polypharmacy minutes of moderate
• Physical Impairments exercise daily
• Cognitive Limitations Keep daily fat intake at
less than 35% of total
• Limited Access to or affordability of health care Low-
calories, and saturated Guidelines not
services. cholesterol
fat and trans fatty acid well established
• Low-literacy patients. diet
intake at less than 7% of
- Strategy: calories
• Promote Self-efficiency. Moderate alcohol use,
• Empower patients to become informed defined as 1 drink daily
medication consumers. that does not exceed 1.5
ounces (45ml) of liquor, 5 Guidelines/safety
• Avoid strategies that could intimidate.
Alcohol intake ounces (180 ml) of wine, not well
• Help the patient to develop a lists of short term or a standard can of beer established
goal and long term goals. (National Institute on
• Plan for regular follow-up Alcohol Abuse and
• Implement a reward system. Alcoholism,2001)
Personal Determinants
- Biological Home care and Hospice
- Genetic Impacts Home Health Care
Psychological Determinants - Consists of multiple health and social services delivered
- Intelligence to recovering, chronically ill, or disabled individuals of all
- Cognitive Capacity ages in their place of residence.
Physical Determinants - Three main categories of home care providers:
- Safe Housing 1) Home care organizations (National Association for
Social Determinants Home Care)
- Social Support 2) Medicare-certified agencies include hospice and
- Violence and Abuse freestanding
- Education and Literacy 3) Facility-based home health agencies.
J.A.K.E 12 of 25
- Benefits of HOME CARE services are individuals who: nursing assistant services, additional therapies as
1) Have a chronic medical conditions with exacerbations, needed (e.g., physical, occupational, and speech
such as congestive heart Failure, COPD, therapy), in patient related to difficulty in managing
unstable diabetes, kidney and liver disease with symptoms, medications, supplies, equipment,
subsequent transplantation, or recent strokes volunteers, respite services, continuous care in times
2) Have chronic mental illnesses, such as depression, of crisis, and bereavement services.
schizophrenia, and other Psychoses
3) Need assistance with medical regimens to prevent Community based service providers
readmission to an acute care facility - Challenged to develop affordable and appropriate
4) Need continued treatment after discharge from a programs to assist older adults to remain in the home
hospital facility (e.g. wound care, intravenous therapy). while maintaining a good quality of life.
5) Require short-term assistance at home after same- - Community-services for older adults include:
day or outpatient surgery, are terminally ill and want • Respite care – short-term relief or time off for persons
to die, or have families that want them to die with providing home care to ill, disabled, or frail older
dignity in the comfort of their homes. adults. Adult day care services are a form of respite
- Role of Home Care Agency: provided outside the home. It provided at home or in
• Referrals are called in the home care agency (agency institutional settings such as specially designated
confirms home care benefits) hospital or nursing facility.
• Schedules the admission visits • Adult day care programs – provide a variety of health
• Communicates the referral information to the nurse and social services to older adults who live alone or
who will admitting the client with their families in the community.
- Nurse’s Role: • Senior citizen centers – senior centers are community
• For initial evaluation facilities that provide a broad range of services to
o Assess physical, functional, emotional, older adults in the community. These services include
socioeconomic, and environmental well-being 1) health screening:
o Initiate plan of care 2) health promotion and wellness programs;
o Skills include: 3) social, educational, and recreational activities;
- Health and self-care teaching 4) congregate meals; and
- Coordination and case management of information and referral services for older
complex care needs individuals and their families.
- Medication administration and teaching • Homemaker programs – Homemaker services include
about all medications such things as housecleaning, laundry, food shopping,
- Wound and decubitus care meal preparation, and running errands.
- Urinary catheter care and teaching • Home– delivered meals – Nutrition services provide
- Ostomy care and teaching older adults with inexpensive, nutritious meals at
- Postsurgical care home, or in group settings.
- Care of terminally ill client • Transportation – many communities provide
- Case management transportation services for disabled older adults
- Intravenous therapy, enteral and parenteral through public or private agencies.
nutrition, and chemotherapy
- Psychiatric nursing care Factors affecting the Health Care needs of non-
Hospice institutionalized older adult
- Dying is the final phase in the trajectory of a chronic • Functional status – Term used to describe an individual’s
illness. Terminal illnesses such as cancer and acquired ability to perform the normal, expected, or required
immunodeficiency syndrome (AIDS) remain incurable. activities for self-care.
However, because of pharmacologic and technologic • Cognitive function – Assess cognitive impairment which
advances in treatments, cancer and AIDS are now affects an individual’s functional status
considered chronic illnesses.
- Many chronically ill persons choose to remain their homes Housing Options for Older Adults
during the last phase of their illness to prepare for death in Type of housing Description of housing
familiar surroundings, together with family and friends.
This is a self- contained apartment unit
- Hospice provides care and services to terminally ill within a house that allows an individual to
persons and their families that enable individuals to die in live independently without living alone. It
facilities or at home. Accessory
generates additional income for older
apartment
- Hospice Services homeowners and allows older renters to live
• Comprehensive hospice program include: Physician near relatives or friends and remain in a
services, nursing care, medical social work, familiar community.
counseling services and spiritual care, certified
J.A.K.E 13 of 25
Assisted living This is a rental housing arrangement that - 2 Categories in Community Services:
facility (also provides room, meals, utilities, and laundry 1) Formal – services that provides assessment,
called board and and housekeeping services for a group of observation, teaching, certain technical skills and
care home; residents. Such facilities offer a homelike personal care for short-period of time.
personal care atmosphere in which residents share meals
2) Informal services – include senior citizen centers,
home; or and have opportunities to interact. What
sheltered care, distinguishes these facilities from simple adult care services, nutrition services, transportation
residential care, boarding homes is that they provide services, and telephone monitoring services.
or domiciliary protective oversight and regular contact with
care facility) staff members. Assisted Living Programs
Congregate housing was authorized in 1970 - An increasingly attractive long-term care setting, placed
by the housing and Urban Development Act . between home care and the nursing facility in the
It is a group-living arrangement, usually an continuum of long-term care.
Congregate
apartment complex, that provides tenants - Regulations are minimum, so there is great diversity in the
housing
with private living units (including kitchen
types of service delivery models used, the types of
facilities), housekeeping services, and
meals served in a central dining room. services offered, and the setting within which assisted
Elder Cottage This is a small, self-contained portable unit living is provided.
Housing that can be placed in the backyard or at the - Assisted living settings are homelike and offer an array of
Opportunity side of a single-family dwelling. services, including meals, assistance with bathing and
Foster care for adults is similar in concept to dressing, social and recreational programs, personal
foster care for children. It is a social service laundry and housekeeping services, transportation, 24-
administered by the state that places an hour security, an emergency call system, health checks,
Foster home care
older person who needs some protective medication administration, and minor medical treatments.
oversight or a assistance with personal care
- Many services are purchased individually as needed by
in a family environment.
the resident.
Home sharing involves two or more
Home sharing unrelated people living together in a house
or apartment. Special Care Units
This is facility designed to support the - Since the 1980s the popularity of specialized units for
Life care or
concept of “ aging in place”. It persons with dementia has expanded.
continuing care
retirement
provides a continuum of living arrangements - Special care unit (SCU) is the designation given to
and care-from assistance with household freestanding facilities or units within nursing facilities that
community
chores to nursing facility care- all within a specialize in the care of people with Alzheimer’s disease
(CCRC)
single retirement community. and other types of dementing illnesses.
(Philippines A non-stock and non-profit organization,
- Behavioral manifestations of dementia are managed in the
settings) Kanlungan ni Maria is a home for the aged in
Kanlungan ni the Philippines serving to provide true home
environment without the use of chemical or physical
Maria Home for to all abandoned, poor, sick and homeless restraints whenever possible.
the elderly in the country.
Aged Geriatrics Units
Golden Reception a 24-hour, 7-day-a-week
and assessment/diagnostic and residential
Action Center for care facility that provides residential care
the to abandoned, neglected, unattached and
Elderly and Other homeless Filipino Senior Citizen who are 60
Special years old.
Cases
Emmaus House of Apostolate, Inc. (EHA) is
a shelter for the homeless, old and sickly
people who have been given up by their
EMMAUS house
families for a lot of reasons. One common Subacute Care
of apostolate
thing, though, they need other people to love
- Subacute care has become an increasingly popular level
and care for them. (Matt
22: 39 /1 John 3: 18)
of care. The growth of subacute care has been spurred by
the belief that up to 40 % of clients in acute medical or
Community-Based Services rehabilitation hospital units could be treated as effectively
- Assessment of functional status aids in determining the in less costly settings.
type of services an older adult needs to remain in his or - Persons in a subacute unit are stable and no longer
her home. The type of services needed, the availability of acutely ill or requiring daily physician visits. They may
the services, the cost of the services, and the require services such as rehabilitation, intravenous
requirements to qualify for the services can be determined medication therapy, parenteral nutrition, complex
by a home health agency. respiratory care, and wound management.
J.A.K.E 14 of 25
Physical Care of Older Adults (Aging skin and mucous irritation can be severe and can cause intense discomfort
Membranes) to older adults. In fact, it may be so distracting that
affected individuals cease to participate in social
activities.
- Dry, scaly skin commonly seen in older adults.
Rashes and Irritation
- Rashes and skin irritation can be caused by factors other
than dryness. Medications, communicable diseases, and
contact with chemical substances are common causes of
skin rashes and pruritus.
- Drug-induced skin reactions are seen more commonly
among older patients than in younger patients.
- Use of a potent topical corticosteroid has resulted in
severe striae.
- The atrophy was so severe that the skin tore, forming an
ulcer.
- Allergic response to medications can manifest as diffuse
rashes over the body. Whenever a rash develops soon
after administration of new medication, an allergy should
be suspected. It is appropriate to withhold that particular
medication and contact the physician to report the
symptom.
- One communicable source of skin irritation and severe
pruritus is scabies. Scabies is a superficial infection
caused by a parasitic mite (Sarcoptes scabiei var.
hominis) that burrows under the skin. Older adults,
especially individuals who suffer from chronic illness,
- Complete assessment of skin, hair, and nails is best done dementia, or a depressed immune system, are particularly
when the person is undressed so that all skin surfaces can vulnerable to scabies infections. Signs of scabies include
be inspected. Skin assessment can be performed during a intense itching and fine, dark, wavy lines at the flexor
bath, during daily personal hygiene, at bedtime, or at any surface of the wrist or elbow, the webbed area of the
other convenient time for the older person. fingers, the axilla, and the genitals. Recognition of scabies
- Independent older persons should be aware of what is may be difficult in older adults because it has an
normal for themselves, and they should bring any changes asymptomatic incubation period of 4 to 6 weeks and
to the attention of the physician. In a hospital or extended- because atypical presentations are common. When
care setting, privacy must be maintained and modesty infestation is suspected, skin scrapings should be
protected during the skin inspection. examined to determine the presence of ova or mites.
- Assessment of the skin and ancillary structures is an Pigmentation
important responsibility of nurses. - Changes in skin pigmentation are common with aging.
- Nursing assistants and attendant health care workers who Many of the changes are cosmetic and do not cause
assist with bathing or other care should be instructed to problems unless they are located on the face or arms,
report any unusual or questionable observations promptly where they may be distressing to the affected person.
to a nurse for further investigation. - Common conditions such as acne rosacea can be treated
- Inspection should follow a logical order so that no with topical medications, which help heal the skin and
pertinent observations are missed. Most nurses find that a reduce redness, whereas others can be concealed by
head-to-toe progression is the most helpful. appropriate use of cosmetics.
Dry Skin - Changes in the size or pigmentation of moles are of
- One of the most common problems of aging. Various greater significance because these changes may indicate
studies have shown that 75% to 85% of people older than the presence of a precancerous or cancerous condition
65 years of age experience some degree of problem with that needs immediate medical attention.
dry skin. Tissue Integrity
- Physiologic changes, excessive bathing, the use of harsh - Breaks in tissue integrity increase the older person’s risk
soaps, and a dry environment all contribute to problems for infection and often result in the need for costly, time-
with dry skin. consuming treatments.
- Dry skin can result in itching (pruritus), burning, and - These breaks can cause disfigurement and are frightening
cracking of the skin. Many older people develop a habit of to older adults.
scratching or picking at dry or cracked skin, increasing - Skin tears, abrasions, lacerations, and ulcers most often
their risk for further tissue damage and infection. Skin result from friction, shearing force, moisture, and
pressure.
J.A.K.E 15 of 25
- Even simple incidents such as contact with furniture, • Dysphagia – The incidence of swallowing difficulties
sliding across bed linens, a grip during a transfer, or the increases with age. Dysphagia can be oropharengeal,
removal of tape may result in significant skin trauma to characterized by difficulty transferring food bolus or liquid
the older person. from the mouth into the pharynx and esophagus and more
Pressure Ulcers common in persons with neurologic damage, or
- Pressure ulcers are a particular risk to older adults who esophageal, involving difficulty with the transfer of food
suffer from compromised circulation, restricted mobility, down the esophagus and more common in persons with
altered level of consciousness, fecal or urinary motility disorders, sphincter abnormalities, or mechanical
incontinence, or nutritional problems. obstructions caused by strictures.
- Studies estimating the occurrence of pressure ulcers vary • Fecal Impaction – Prevention of constipation aids in
widely, but one consistent point is that they occur in all avoiding fecal impaction. Observing the frequency and
settings. Although most studies show that the incidence character of bowel movements may aid in detecting the
of pressure ulcers has declined, there is still much work to development of an impaction; bowel elimination record is
be done. Pressure ulcers have negative effects on the essential for older people in a hospital or nursing home for
overall health of an elderly person. They can lead to identifying alterations in bowel elimination.
infection, pain, loss of function, and even death. • Fecal Incontinence –Involuntary defecation, fecal
- Furthermore, incidence of pressure ulcers can leave care incontinence, refers to inability to voluntary control the
facilities and nurses vulnerable to lawsuits for negligence. passage of stool. It is most often associated with fecal
- They strain the health care system with treatment costs impaction in older adults who are institutionalized or
estimated at $11 billion per year. New Medicare rules physically or cognitively impaired.
specify that a hospital will not be reimbursed for the care
of a patient who develops a pressure ulcer after being Common Problems
admitted to a hospital. This should be a great motivator for Common
Risk factors Management
hospitals to institute pressure ulcer prevention programs. problems
- Inactive lifestyle
Elimination (Bowel) - Low-fiber and low –
- Aging GI system fluid intake
• Nutrition – Good nutrition is essential to older adult - Depression
- Laxative abuse
- Age related Changes - Diet high in fiber and
- Certain medications,
• Decrease saliva production such as opiates,
fluid
• Decrease gag reflex - Regular activity
sedatives, and
- Foods ( prunes or
• Altered intestinal enzymes Chronic aluminum hydroxide
chocolate pudding)
• Abdominal wall/muscles get weaker Constipation gels
incorporated into diet
• Decrease intestinal tone - Dulled sensations
- Yogurt or applesauce
that cause the signal
• Decrease peristalsis for individual chewing
for bowel elimination
impairment
to be missed
- Failure to allow
sufficient time for
complete emptying
of the bowel
- Avoid food & meds
that Elevate HOB for
sleeping
Gerd - Medications
(Esophagus) - S MOKING
1) Antacids-
due to - LES - C AFFEINE
neutralize stomach
TONE - A LCOHOL
acid- Maalox
Selected Gastrointestinal Conditions -Heartburn- - N CREASED
2) H2 receptor
• Dry Mouth (Xerostamia) – Saliva serves several PYROSIS, INTRAGASTRIC
-substernal
blocker- gastric
important function, such as lubricating soft tissues, - PRESSURE
burning pain- acid ex.Ranitidine
- FATTY FOOD
assisting in remineralizing teeth, promoting taste Coughing (Zantac)
sensations, and helping to control bacteria and fungus in 3) Proton pump
the oral cavity. Reduced saliva, therefore, can have inhibitor(PPI)-
significant consequences. Nexium
(Esomeprazole)
• Dental Problems – Poor condition of teeth can restrict
food intake, which can cause constipation and
malnourishment, it can also detract from appearance,
which can affect socialization, and this result in a poor
appetite, which also can lead to malnourishment.
J.A.K.E 16 of 25
- Antacids- neutralize - Cigarrete smoking,

stomach acid- alcohol
GASTRITIS Maalox - Obesity, Hx of IBD
(STOMACH) - Histamine H2 - Low fiber, High fat,
Parietal cells
receptor antagonists- CHON (beef)
IF- needed for - smoking, drinking
Decreases gastric - Old (increased age)
absorption of alcohol, drinking
acid Ranitidine - Ndometrial, ovarian
Vit B12 in coffee Colorectal Ca
small (Zantac) Ca Primary tx: Surgery
intestine - Proton pump - Most common s/s:
inhibitors(PPI)- • Change in bowel
Nexium habits
(Esomeprazole) • Unexplained
- Antacids- neutralize anemia
stomach acid- • Blood in stool
Maalox • Anorexia
- Histamine H2
receptor antagonists- Activity and Exercise
Predisposing Factors:
Decreases gastric
Stress, smoking 5 Benefits of Exercise for Seniors and Aging Adults
Gastric ulcer acid ex Ranitidine
Corticosteroids, Prevent Disease
(Zantac)
Alcohol, Aspirin - Studies have shown that maintaining regular physical
- Proton pump
NSAIDS activity can help prevent many common diseases, such as
inhibitors(PPI)-
Nexium heart disease and diabetes.
(Esomeprazole) - Exercise improves overall immune function, which is
- Mucosal protectant important for seniors as their immune systems are often
Sucralfate compromised. Even light exercise, such as walking, can
LIVER
be a powerful tool for preventable disease management.
(Liver
cirrhosis) Improved Mental Health
Complicati Cause: portal HPN, - The mental health benefits of exercise are nearly endless.
ons - Exercise produces endorphins (the “feel good” hormone),
-Esophageal Associated w/ liver which act as a stress reliever and leaves you feeling happy
varices cirrhosis and satisfied.
-Dilated & - In addition, exercise has been linked to improving sleep,
tortous veins
in submucosa
which is especially important for older adults who often
of esophagus suffer from insomnia and disrupted sleep patterns.
Esophageal Decreased Risks of Falls
varices
VS ,LOC, NPO, NGT - Older adults are at a higher risk of falls, which can prove
O2, Blood Transfusion to be potentially disastrous for maintaining independence.
Esophageal - Exercise improves strength and flexibility, which also help
Vasopressin iv- lowers
tamponade /
balloon pressure Propranolol improve balance and coordination, reducing the risk of
tamponade falls.
Sengstaken- - Seniors take much longer to recover from falls, so
Blakemore or anything that helps avoid them in the first place is critical.
Minnesota Social Engagement
(Inderal)- reduces
tubes - Whether you join a walking group, go to group fitness
portal pressure
Monitor - classes or visit a gardening club, exercise can be made
respiratory into a fun social event.
distress - Maintaining strong social ties is important for aging adults
ASCITES THERAPEUTICS to feel a sense of purpose and avoid feelings of loneliness
- - Diuretics or depression. Above all, the key is to find a form of
Accumulation - Measure abdominal exercise you love, and it will never feel like a chore again.
of plasma- girth, weigh pt
rich fluid w/n Improved Cognitive Function
- Paracentesis
peritoneal - Low salt diet
- Regular physical activity and fine-tuned motor skills
cavity oncotic benefit cognitive function.
pressure - Countless studies suggest a lower risk of dementia for
-Cirrhosis – physically active individuals, regardless of when you begin
most common
cause
a routine.
J.A.K.E 17 of 25
Sleep and the Older Adults • Older women are more likely than older men to
- Sleep is a natural, periodically recurring, physiologic state - Take longer to fall asleep
of rest for the body and mind; sleep is a state of inactivity - Wake more frequently after the onset of sleep
or response that is required to remain active. - Stay awake longer during these nighttime awakenings
- Importance of Sleep • Older persons may take more daytime naps that disrupt
• Proper sleep normal sleep patterns.
• architecture and adequate Type of
Stages Selected characteristics
• total sleep time are sleep
• necessary for proper functioning.
Stage 1 Light sleep Easily awakened
- Biologic Brain Functions Responsible for Sleep
• Regulation of sleep and wakefulness occurs More relaxed then stage 1, slow
Medium
primarily in the hypothalamus, which contains both a Stage 2 eye movements, fragmentary
deep sleep
sleep center and wakefulness center. The thalamus, dreams, easily awakened
limbic system, reticular activating system is
Relaxed muscles, slowed pulse,
controlled by the hypothalamus and also influence Medium
Stage 3 decrease body temperature,
sleep and wakefulness. deep sleep
awakened with moderate stimuli
Age-Related Changes in Sleep
1) Increased Sleep Latency - a delay in the onset of sleep. Restorative sleep, body
2) Reduced Sleep efficiency is the relative percentage of Stage 4 Deep sleep movement rare, awakened
time in bed spent asleep. with vigorous stimuli
3) Increased Nocturnal Awakenings – Contribute to an Rapid eye movement, increased
overall decrease in the average number of hrs of sleep or fluctuating pulse, blood
REM Active sleep
4) Increased Daytime Sleepiness may be due to nocturnal pressure, and respirations.
awakening or other sleep disturbances. It may also due to Dreaming occurs.
medication side effects. - Wake more frequently after the onset of sleep
5) Greater difficulty falling asleep - Stay awake longer during these nighttime awakenings
6) More frequent awakenings because of reduced slow wave
sleep Common causes of insomnia and sleep problems in older
7) Decreased amounts of nighttime sleep, especially deep adults
sleep • Poor sleep habits and sleep environment. These
8) More frequent daytime napping include irregular sleep hours, consumption of alcohol
9) Increased time spent trying to sleep as sleep becomes before bedtime, and falling asleep with the TV on. Make
less efficient sure your room is comfortable, dark and quiet, and your
- Age-related changes in the nervous system can affect bedtime rituals conducive to sleep.
sleep • Pain or medical conditions. Health conditions such as a
• May be at the chemical, structural, and functional frequent need to urinate, pain, arthritis, asthma, diabetes,
levels osteoporosis, nighttime heartburn, and Alzheimer’s
• May result in a disorganization of sleep and disease can interfere with sleep. Talk to your doctor to
disruption of circadian rhythms address any medical issues.
- Declines in the cerebral metabolic rate and • Menopause and post menopause. During menopause,
cerebral blood flow many women find that hot flashes and night sweats can
- Reductions of neuronal cell counts interrupt sleep. Even post menopause, sleep problems
- Structural changes, such as neuronal can continue. Improving your daytime habits, especially
degeneration and atrophy diet and exercise, can help.
• Medications. Older adults tend to take more medications
Sleep Requirements than younger people and the combination of drugs, as
- A common myth is that you require less sleep as you age well as their side-effects, can impair sleep. Your doctor
- Most older adults require 7 to 9 hours of sleep per night may be able to make changes to your medications to
- Less than 4 hours or greater than 9 hours of sleep is improve sleep.
associated with higher mortality • Lack of exercise. If you are too sedentary, you may never
Sleep Problems in Older Persons feel sleepy or feel sleepy all the time. Regular aerobic
• Sleep problems in older persons may result from exercise during the day can promote good sleep.
- Personal characteristics • Stress. Significant life changes like retirement, the death
o Advanced age of a loved one, or moving from a family home can cause
o Female gender stress. Nothing improves your mood better than finding
o Depression someone you can talk to face-to-face.
- Environmental characteristics • Lack of social engagement. Social activities, family, and
- A combination of these factors work can keep your activity level up and prepare your body
J.A.K.E 18 of 25
for a good night’s sleep. If you’re retired, try volunteering, 5) Keep your mind sharp
joining a seniors’ group, or taking an adult education class. Sexuality and Aging
• Sleep disorders. Restless Legs Syndrome (RLS) and - An interest in sex was considered sinful and highly
sleep-disordered breathing—such as snoring and sleep improper. Although people were aware that sexual
apnea—occur more frequently in older adults. intercourse had more than a procactive function, the
• Lack of sunlight. Bright sunlight helps regulate melatonin other benefits of this activity were seldom openly shared;
and your sleep-wake cycles. Try to get at least two hours society viewed sexual expression outside of wedlock as
of sunlight a day. Keep shades open during the day or use disgraceful and indecent.
a light therapy box. - The reluctance to accept and intelligent confront human
sexuality led to the propagation of numerous myths, the
Psychosocial care of Older Adults persistence of ignorance and prejudice, and the relegation
Cognitive Function of sex to a vulgar status.
- Cognitive impairment, which often affects an individual’s - Fortunately, attitudes have changed over the years, and
functional status, is another eligibility criterion used by sexuality has come to be increasingly understood and
various community programs. appreciated. Education has helped erase the mysteries of
- Cognitive status is assessed on admission and again with sex for adults and children, and magazines, books,
every skilled nursing visit. television shows, and web sites on the topic flourish.
- Other disciplines are also responsible for reporting a - Age related changes and sexual response:
change in cognition to the nurse or case manager in home • There is a decrease in sexual responsiveness and a
health. reduction in the frequency of orgasm
- A change in cognitive status frequently signals a change in • Older men are slower to erect, mount and ejaculate
another body system. The home health nurse must • Older women may experience dyspareunia (painful
establish a baseline assessment and be alert to intercourse) as a result of less lubrication, decreased
deviations. distensibility, and thinning of the vaginal walls
- Cognitive impairments can be reversible or irreversible, • Many older women gain a new interest in sex, possibly
and home health personnel are in a key position to detect because they no longer have to fear an unwanted
any changes. Cognitive impairments are associated with pregnancy or because they have more time and
functional limitations. privacy with their children grown and gone.
- For example, individuals with deficits in memory, - Identifying barriers to sexual activity:
language, abstract thinking, and judgment have great • Unavailability of a partner
difficulty executing ADLs or IADLs (e.g. shopping, paying • Psychological Barriers
bills, preparing meals, and personal care tasks) • Medical conditions
• Self-Concept – an organized pattern of perceived • Erectile dysfunction
characteristics, along with the values attached to • Medication adverse effects
those attributes. (How a person understand himself) • Cognitive impairment
• Self-Perception – affect person’s personality (wrong - Promoting Healthy Sexual Function:
self-perception may lead to psychological problems • Basic education can help older adults and persons of
Coping and Stress all ages understand the effects of the aging process
- As we grow older, we experience an increasing number of on sexuality by providing a realistic framework for
major life changes, including career transitions and sexual functioning.
retirement, children leaving home, the loss of loved ones,
• Health assessment as part of health education cases,
physical and health challenges—and even a loss of
and during discharge planning when reviewing
independence. How we handle and grow from these
capabilities and activity restrictions.
changes is often the key to healthy aging.
• Discuss sex openly with older people demonstrate
- Coping with change is difficult at any age and it’s natural
recognition
to feel the losses you experience. However, by balancing
• Identifies physical, emotional, and social threats to
your sense of loss with positive factors, you can stay
older adults’ sexuality and intimacy and seeks
healthy and continue to reinvent yourself as you pass
solutions for problems.
through landmark ages of 60, 70, 80, and beyond.
- As well as learning to adapt to change, healthy aging also • Promote practices that can enhance sexual function,
including regular exercise, good nutrition, limited
means finding new things you enjoy, staying physically
alcohol intake, ample rest, stress management, good
and socially active, and feeling connected to your
hygiene and grooming practices, and enjoyable
community and loved ones.
foreplay.
- Tips help to maintain physical and emotional health:
1) Learn to cope with change
2) Find meaning and joy
3) Stay connected
4) Get active and boost vitality .
J.A.K.E 19 of 25
NURSING CARE OF THE OLDER ADULT IN CHRONIC • Symptoms

ILLNESS o Blurred vision
- Good sensory function is an extremely valuable asset that o Glare
is often taken for granted. For instance, people are better o Halos around objects
able to protect themselves from harm when they can see, o Double vision
hear, smell, touch, and communicate. o Lack of color contrast or faded colors
- The reduced ability to protect oneself from hazards o Poor night vision
because of sensory deficits can result in serious falls from - Surgery
unseen obstacle, missed alarms and warnings, ingestion • Phacoemulsification
of hazards because of sensory deficits can result to o “small incision cataract surgery”
serious falls from unseen obstacle, missed alarms and o small incision done outside the cornea
warnings, ingestion of hazardous substances form not o a tiny probe is inserted which emits ultrasound
recognizing bad tastes, an inability to detect the odor of waves that soften & break up the lens so that it
smoke or gas, and burns and skin breakdown because of can be removed by suction
decrease cutaneous sensation of excessive temperature • Extracapsular / Intracapsular cataract surgery
and pressure. o incision is longer on the side of cornea & removes
the cloudy core on the lens in one piece
Sensory Impairment o the rest of the lens is removed by suction
Visual Impairment - Glaucoma
- Personal cost for older person with visual impairment • Increase in intraocular pressure (IOP) → optic nerve
• Loss of independence
• Social isolation damage → vision loss
• Depression • Open angle
• Decreased quality of life o Slowed flow of aqueous humor through
- Signs of difficulty with vision trabecular meshwork → build up→ increased IOP
• Squinting or tilting head to see → damage to renal nerve fiber → loss of vision
• Changes in ability to drive, read, watch television, or
o Painless vision loss – Midperipheral visual field
write
loss
• Holding objects closer to the face
• Angle-closure
• Difficulty with color discrimination and walking up or o Angle of the iris obstructs drainage of aqueous
down stairs
humor through trabecular meshwork → increased
• Hesitation in reaching for objects
• Not being able to find something (American Society on IOP → visual changes
Aging, 2003) • Symptoms
- Cataract o Unilateral headache
• Opacity of the crystalline lens or its capsule (partial or o Visual blurring
complete) o Nausea and vomiting
• Causes o Photophobia
o injury -- traumatic • Risk Factors for Glaucoma
o exposure to heat, UV light o Increased intraocular pressure
o heredity / congenital o Older than 60 years of age
o aging (>55) – senile o Family history of glaucoma
o DM – secondary o Personal history of myopia, diabetes,
o smoking & alcoholism hypertension, or migraines
• Lens clouding → decreased light to retina → limited o African American ancestry
vision • Nursing Care
• Development is slow and painless o Explain the importance of continued use of eye
• Leading cause of blindness in the world medications as ordered to prevent further visual
loss
• > 50% of adults > 65 years have cataracts → visual
o Explain the need for continued medical
problems supervision for observation of IOP to ensure
• Risk factors: control of the disorder
o Increased age o Teach client to avoid exertion, stooping, straining
o Smoking and alcohol for a bowel movement, coughing, heavy lifting, or
o Diabetes, hyperlipidemia wearing constricting clothing, since these
o Trauma to the eye increase IOP
o Exposure to the sun and UVB rays o Instruct the client to report severe eye or brow
o Corticosteroid medications pain & nausea to the physician
J.A.K.E 20 of 25
- Eye Examination: Visual Acuity • Encompasses a variety of nursing goals and

• always start with the right eye to ensure accurate interventions communication
recording o Safety
• cover the eye not being tested with an occluder o Mobility
• 20/20 at 6 y/o o Self-care activities
• Numerator (20 ft, the distance the person stands from o Mood assessment
the chart) Hearing loss
• Denominator (distance from which the normal eye - > 30% aged 65 to 76 years
can read the chart) - 50% >75 years
• CF, HP, LP, NLP - Older men > older women
- Age-Related Macular Degeneration (ARMD) - Caucasian men and women > African American men and
• Dry (atrophic form)-involutional mac deg women
o Breakdown or thinning of macular tissue related - Temporary threshold shift (TTS)
to the aging process • Sounds < 75 dB(A) → temporary hearing loss
o Atrophy • Sounds > 85 dB(A) for 8hrs/day + many years →
o Retinal pigment degeneration
permanent loss
o Drusen accumulations
- Risk Factors
o Other symptoms
• Long-term exposure to excessive noise
o Slow progression of visual loss
• Impacted cerumen (ear wax)
• Wet (Neovascular exudates) - exudative macular
• Ototoxic medications
degeneration
o Blood or serum lead from newly formed blood • Tumors
• Diseases that affect sensorineural hearing
vessels beneath retina→ scar formation + visual
• Smoking
problems • History of middle ear infection
o Other symptoms
• Chemical exposure (e.g., long duration of exposure to
- More light required for reading
trichloroethylene)
- Blurred vision
1) Conductive Hearing Loss
- Central scotomas
- Metamorphopsia - Sound unable to be transmitted → poor reception +
• Other symptoms of Macular D amplification
o Difficulty performing tasks – close central vision – - Site of problem: External or middle ear
reading and sewing - Cause
o Decreased color vision • Otitis externa
o Dark or empty area in the center of vision • Impacted cerumen
o Straight lines appearing wavy and crooked - Most common and reversible
o Words on a page looks blurred • Otitis media
• Risk Factors for ARMD • Benign tumors
o Age (above the age of 50) • Tympanic membrane perforation
o Cigarette smoking • Foreign bodies
o Family history of ARMD • Otosclerosis
o Increased exposure to ultraviolet light - Conductive Hearing Loss
o Caucasian race and light colored eyes • Transmission hearing loss
o Hypertension or cardiovascular disease • Damage external or middle ear
o Lack of dietary intake of antioxidants and zinc • Failure of sound waves to be transmitted through
the external and/or middle ear
- Nursing Diagnoses for Vision- Impaired Older Patients - Causes
• Evaluate functional ability • Impacted earwax
o Perform activities of daily living, including the • perforated eardrum
ability to read medication labels • otosclerosis (decreased mobility of the ossicles)
o Drive or take public transportation - Treatment: hearing aids that amplify the sound, since
o Ambulate safely in familiar and strange the inner ear and organs of sound perception are not
environments damaged.
o Shop and pay for food and personal items 2) Sensorineural Hearing Loss
o Prepare food while maintaining a safe and
- Problems with cochlea + auditory nerve → sound
hygienic environment
o Engage in recreational and leisure activities distortion
- Nursing Diagnoses for Vision- Impaired Older Patients - Causes
• Sensory/perceptual alterations: visual • Presbycusis
J.A.K.E 21 of 25
• (bilateral progressive hearing loss especially at • Mood

high frequencies in elderly people) • Recreation and leisure activities
• High-frequency hearing loss from excessive noise
(industrial noise, gunfire, “rock & roll” deafness) Protocol in cerumen removal
• Impaired ability to hear high pitches • Clip and remove ear hairs
• Rare, severe hearing loss or deafness • Instill softening agent, mineral oil, carbamide peroxide or
• Damage as a result of excessive noise exposure glycerin solution
• Meniere’s disease • Irrigate the ear using bulb syringe
• Tumors • Use a solution of 3oz 3% hydrogen peroxide in 1 qt water
• Infection warmed to 98 to 100 F., or plain normal saline solution
- Perceptive / “Nerve” hearing loss • Place a towel around the client’s neck and tip head to the
- Pathologic changes in the inner ear, VIII cranial nerve, side being drained-have an emesis basin
and/or auditory centers of the brain • Tip the head to side that is being irrigated
- Causes • Place the tip of the irrigating device just inside the external
• Presbycusis (bilateral progressive hearing loss meatus –tip visible
especially at high frequencies in elderly • Straighten auditory meatus draw pinna up and down
people) • Flow of irrigating fluid should be steady, lavage continues
• High-frequency hearing loss from excessive noise until the cerumen is removed
(industrial noise, gunfire, “rock & roll” deafness) • Drain excess fluid by tilting the head toward the affected
side
Hearing Loss Assessment • Impacted cerumen must be manuallt extracted by a
- History physician or apn with an otoscope and a curette
- Physical examination
• Inspection Taste
• Examination of ear canal Contributing factors to taste alterations
• Childhood ear infections → ruptured eardrum → • Oral condition
jagged white scars on tympanic membrane in elderly ◦ • Olfactory function
Hearing Handicap Inventory for the Elderly (HHIE-S) • Medications
- Talk with family members • Diseases
Common Hearing Problems in Older Persons • Surgical interventions
• Tinnitus • Environmental exposure
- Objective — pulsatile sounds with turbulent blood • Medical conditions
flow through the ear Oral status can affect gustatory function
o Hypertension • Poor dentition → improper chewing → less flavor release
o Anemia
• Improperly fitting dentures → obstruction of palate →
o Hyperthyroidism
- Subjective — perception of sound without sound decreased taste perception
stimulus • Oral infections → release of acidic substances → altered
o Medications taste + impaired salivary stimulations → decreased ability
o Infections
o Neurological conditions for food to dissolve → diminished flavor
o Disorders related to hearing loss Focused assessment for taste disturbances
• Head and neck
Nursing Diagnoses Associated with Hearing Impairment • Mucous membranes
Assessment • Interview with focus on past dietary habits
- Ability to perform activities of daily living Education
• Communication • Implications of inability to distinguished between salt and
• Driving or taking public transportation sugar
• Safety awareness including the ability to hear alarms, • Decreased taste → lack of motivation to prepare + eat →
doorbells malnutrition
• Engaging in leisure and recreational activities
Diagnosis Xerostomia
- Sensory/perceptual alterations: hearing with a variety of - Cause
nursing goals and interventions • Systemic diseases
• Communication • Radiation
• Safety • Medications
• Self-care activities • Sjogren’s syndrome
J.A.K.E 22 of 25
- Implications Eye Examinations

• Altered taste - Healthy older adults: Complete eye examination every 1 to
• Difficulty swallowing → Risk for aspiration pneumonia 2 years
• Visual acuity
• Periodontal disease
• Retina
• Speech difficulties → embarrassment → social
• Intraocular pressure
isolation - Diabetics
• Dry lips + dry mucosa → increased infection + dental • Complete eye examination annually
caries Assessment of Vision
• Halitosis - Observe appearance
• Sleeping problems • Clothing cleanliness
• Self-care
Nursing Diagnoses Associated with Taste Impairment • Indications of bumps and bruises
- Sensory/perceptual alterations: gustatory Interview
- Intake less than necessary for caloric requirements - Adequacy of vision
Olfactory Dysfunction - Recent changes in vision
- Statistics: Males > females - Visual problems
- Causes • Red eye
• Nasal and sinus disease • Excessive tearing or discharge
• Upper respiratory infection • Headache or feeling of eyestrain when reading or
• Head trauma doing close work
• Secondary • Foreign body sensation in the eye
o Chemotherapy or other medications • New onset of double vision or rapid deterioration of
o Radiation visual acuity
o Current or past use of cocaine or tobacco • New onset of haziness, flashing lights, or moving
o Poor dentition spots
- Special concerns • Loss of central or peripheral vision
• Safety related to smoke and fire • Trauma or eye injury
• Malnourishment • Date of last exam
- Sense of smell fails to be detected because it is not • Inspection
adequately tested • Movement of eyelids
• Use three familiar smells • Abnormally colored sclera
• Repeat with both nostrils, in different orders • Abnormal or absent papillary response
- Nursing diagnoses associated with hyposmia Vision
• Sensory/perceptual alterations: olfactory • Snellen chart or reading from print
• Visual field testing
Nursing Diagnoses • Extraocular movements
- Nursing diagnosis associated with hyposmia Visual Aids
• Sensory/perceptual alterations: olfactory - Helpful aids for visually impaired
- Nursing diagnosis for changes in physical sensations • Low-vision clinics for suggestions
• Sensory/perceptual alterations: tactile • Telescopic lenses
• Books in Braille
Nursing Assessment
• Computer scanners and readers
- Assess safety and preventive measures
• Tinted glasses to reduce glare, large print books and
- Additional assessment
magazines
• Nutrition
• Seeing eye dogs
• Patient safety
• Canes
o Date and label all foods
- Often rejected because of the stigma attached
o Place natural gas detectors in the home (for gas
- Very expensive and not covered by Medicare
heat)
- Register with Commission for the Blind
o Place smoke detectors in strategic locations
• Books on tape and tape player
o Establish schedules for personal hygiene and
house cleaning • Telephones with large numbers
o Remove kitchen waste every evening • High-intensity lights
- Learning Objective: Recognize nursing interventions that Visual Difficulties May Limit Independence
can be implemented to assist the aging patient with • Interference with ability to drive
sensory changes. • Trouble reading and writing
J.A.K.E 23 of 25
Identification of Safety Problems at Home 2) Pulmonary abnormalities

• Provide adequate lighting in high-traffic areas • Inadequate gas exchange states-pulmonary disease,
• Recommend motion sensors to turn on lights when an alveolar hypoventilation
older person walks into a room • Infection-pneumonia
• Look for areas where lighting is inconsistent; use proper 3) Systemic infective processes-acute and chronic
lampshades to prevent glare • Viral
• Use contrast when painting so that walls, floors, and other • Bacterial- endocarditis, pyelonephritis, cystitis,
structural elements of the environment can be mycosis
discriminated easily 4) Metabolic disturbances
• Avoid reflective floors • Electrolytes abnormalities -hypercalcemia,
• Use “hot” colors, such as red, orange, and yellow for hyponatremia and hypernatrimia, hypokalemia and
signage hyperkalemia, hypochloremia and hyperchloremia,
• Urge the use of supplementary lamps near work and hyperphosphatemia
reading areas • Acidosis and alkalosis
• Use red colored tape or paint on the edges of stairs and in • Hypoglycemia and hyperglycemia
entryways to provide warning and signal the need to step • Acute and chronic renal failure
up or down • Volume depletion-hemorrhage, inadequate fluid
• Avoid complicated rug patterns that may overwhelm the intake, diuretics
eye and obscure steps and ledges • Hepatic failure
• Teach the importance of walking slowly when entering a • Porphyria
room 5) Drug intoxifications- therapeutic and substance abuse
• Misuse of prescribed medications
ARMD Preventive Measures • Side effects of therapeutic medications
- Nurses should encourage • Drug-drug interaction
• Wearing ultraviolet protective lenses in sun • Improper use of over-the –counter medications
• Smoking cessation • Ingestion of heavy metals and industrial poisons
• Exercising routinely 6) Endocrine disturbance
• Eating a healthy diet consisting of fruits and • Hypothyroidism and hyperthyroidism
vegetables • Diabetes mellitus
• Taking vitamins in divided doses twice a day to delay • Hypopituitarism
progression = Zinc oxide 80 mgm • Hypoparathyroidism and hyperparathyroidism
7) Nutritional deficiencies
Physiologic • B Vitamins
Primary Cerebral Disease • Vitamin C
1) Nonstructural factors
• Protein
• Vascular Insufficiency –transient ischemic attacks, 8) Physiologic stress-pain, surgery
cerebrovascular accidents, thrombosis 9) Alterations in temperature regulation-hypothermia and
• Central nervous system infection- acute and chronic hyperthermia
meningitis, neurosyphillis, brain abscess 10) Unknown physiologic abnormality-sometimes defined as
pseudodelirium
2) Structural Factors Psychologic

• Trauma-subdural hematoma, concussion, contusion, • Severe emotional stress-postoperative states, relocation,
intracranial hemorrhage hospitalization
• Tumors- primary and metastatic • Depression
• Normal pressure hydrocephalus • Anxiety
Extracranial Disease • Pain- acute and chronic
1) Cardiovascular abnormalities
• Fatigue
• Decrease cardiac output state-myocardial infarction,
• Grief
arrhythmias, congestive heart failure, cardiogenic
• Sensory/perceptual deficits-noise, alteration in function
shock
of senses
• Alterations in peripheral vascular resistance-
• Mania
increased and decrease states
• Paranoia
• Vascular occlusion-disseminated intravascular
• Situational disturbances
coagulopathy, emboli
J.A.K.E 24 of 25
Environmental How do you communicate effectively with the elderly with

• Unfamiliar environment creating a lack of meaning in the impaired verbal communication?
environment • Use proper form of address. Establish respect right away
• Sensory deprivation or environmental monotony creating by using formal language.
a lack of meaning in the Environment • Make older patients comfortable.
• Sensory overload • Take a few moments to establish rapport.
• Immobilization-therapeutic, physical, pharmacologic • Try not to rush.
• Sleep deprivation • Avoid interrupting.
• Lack of temporal spatial reference points • Use active listening skills.
• Demonstrate empathy.
Differentiating Dementia and ACS • Avoid medical jargon.
Clinical Acute confusional
Dementia
feature state
Acute/subacute; Chronic, generally
Onset depends on cause; insidious;depend on
often occurs at twilight cause
Short; diural GOOD LUCKKK WITH UR PRELIM EXAM, FUTURE NURSES!!
Long; no diural effects;
fluctuations in
symptoms progressive,
Course symptoms; worse at
yet relatively stable
night, dark, and on
over time
awakening
Hours to less than 1
Duration Months to years
month
Fluctuates, generally
Awareness Generally clear
reduced
Fluctuates-reduced or
Alertness Generally normal
increased
Impaired, often
Attention Generally normal
fluctuates
Fluctuates in severity,
Orientation May be impaired
generally impaired
Recent and immediate Recent and remote
memory impaired; memory impaired; loss
Memory unable to register new of recent memory is
information or recall first sign; some loss of
recent events common knowledge
Disorganized, distorted, Difficulty with
Thinking fragmented, slow, or abstraction and word
accelerated finding
Distorted, illusions,
Misperceptions often
Perception delusions, or
absent
hallucinations
Sleep- Disturbed, cycle
Fragmented
wake cycle reversed
Impaired verbal communication

• Language barriers (language not of dominant culture)
• Cognitive skills (developmental, physiological effects on
CNS) Short/ long term memory loss, functioning at or
below age level
• Sensory perceptual changes/ loss: hearing vision, post
CVA or neurological disease
- Receptive aphasia: Client does not have ability to
receive or interpret verbal/ non-verbal messages
- Expressive aphasia: Client does not have ability to
express verbal/ non-verbal messages
J.A.K.E 25 of 25

Ncmb314 Lec Prelim

Uploaded by

Copyright:

Available Formats

You might also like

Ncmb314 Lec Prelim

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ncmb314 Lec Prelim

Uploaded by

Copyright:

Available Formats

NCMB314 LECTURE: Exam Week

• If a clinical specialist must have provided a minimum Aging Well

• Integrated - Older adults are more vulnerable to free radicals.

MiniMetal State Examination

Functional Status Assessment

- Nursing Implication: Proper Nutrition • Gait Disturbances

- Antacids- neutralize - Cigarrete smoking,

NURSING CARE OF THE OLDER ADULT IN CHRONIC • Symptoms

- Eye Examination: Visual Acuity • Encompasses a variety of nursing goals and

• (bilateral progressive hearing loss especially at • Mood

- Implications Eye Examinations

Identification of Safety Problems at Home 2) Pulmonary abnormalities

2) Structural Factors Psychologic

Environmental How do you communicate effectively with the elderly with

Impaired verbal communication

You might also like