Older adult

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Theory lecture for first semester RN students about the special needs of older adults. We have a growing older adult population.. we need education patients and family members how to adapt to this aging changes.


<ul><li> 1. Melinda Marshall, MSN, RN Los Angeles City College Nursing 104</li></ul> <p> 2. </p> <ul><li>Potter, P. A. &amp; Perry, A. G., (2009).Fundamental of nursing(7 thed.). St Louis: Mosby-Elsevier. Chapter 14, pp. 191-214. </li></ul> <ul><li>Ochs, G. (2009) Study Guide and Skills Performance Checklist of Fundamental of Nursing (7 thed.) St. Louis: Mosby-Elseviercomplete the learning assignment for older adults. </li></ul> <ul><li>PowerPoint Slides </li></ul> <p> 3. </p> <ul><li>Students will able to: </li></ul> <ul><li>Discuss demographic trends related to older adults in the United States. </li></ul> <ul><li>Identify common myths and stereotypes about older adults. </li></ul> <ul><li>List the types of community-based and institutional health care services available to older adults. </li></ul> <ul><li>Identify selected biological and psychological theories of aging. </li></ul> <p> 4. </p> <ul><li>Discuss common development tasks of older adults. </li></ul> <ul><li>Describe common physiological changes of aging. </li></ul> <ul><li>Differentiate among delirium, dementia, and depression. </li></ul> <ul><li>Describe selected health concerns of older adults. </li></ul> <ul><li>Identify nursing interventions related to the physiological, cognitive, and psychosocial changes of aging. </li></ul> <p> 5. 6. 7. </p> <ul><li>The nurse is presenting information on nutritional guidelines at a</li></ul> <ul><li>senior community center. The nurse is going to discuss the</li></ul> <ul><li>recommendations for nutritional intake for healthy individuals during</li></ul> <ul><li>late adulthood. Which of the following foods should be eaten less? </li></ul> <ul><li>a. Fiber </li></ul> <ul><li>b. Protein </li></ul> <ul><li>c. Refined sugar </li></ul> <ul><li>d. Fruits and vegetables (vitamin A ) </li></ul> <p> 8. </p> <ul><li>Physiological </li></ul> <ul><li>Cognitive </li></ul> <ul><li>Psychosocial </li></ul> <ul><li>Levels of functional ability </li></ul> <ul><li>Dependence vs. independence </li></ul> <ul><li>Strengths and abilities</li></ul> <p> 9. A.GeriatricsThe assessment of health and functional status B.Gerontology The study of all aspects of the aging process and its consequences C.Gerontological nursing Emphasizes nurturing, caring, and comforting, more than treatment of disease D. Gerontic nursing Focuses on the diagnosis and treatment of disease 10. </p> <ul><li>Myths and Stereotypes </li></ul> <p> 11. </p> <ul><li>Is ageism discrimination? </li></ul> <ul><li>What behaviors as a student RN would you employ when caring for older adults? </li></ul> <ul><li>What are some of things that affects the attitude of nurses toward older adults? </li></ul> <ul><li>pp. 193-194 </li></ul> <p> 12. </p> <ul><li>Ill, disabled, and physically unattractive </li></ul> <ul><li><ul><li>No interest in sex or interest in sexual activities is abnormal </li></ul></li></ul> <ul><li><ul><li>Forgetful, confused, rigid, bored and unfriendly </li></ul></li></ul> <ul><li><ul><li>Unable to learn and understand new information </li></ul></li></ul> <ul><li><ul><li>Mistaken ideas about living arrangements and finances. </li></ul></li></ul> <p> 13. </p> <ul><li>Ageism is discrimination</li></ul> <ul><li><ul><li>Against people because of increasing age </li></ul></li></ul> <ul><li><ul><li>Unopposed ageism potential undermine the self-confidence of the older adult </li></ul></li></ul> <ul><li><ul><li>Limit their access to care </li></ul></li></ul> <ul><li><ul><li>Distort caregivers understanding of the uniqueness of older adults </li></ul></li></ul> <ul><li>Laws ban discrimination based on age </li></ul> <ul><li>Large proportion of older adults affects the consumer economy </li></ul> <ul><li>Older adults influence public policy </li></ul> <p> 14. </p> <ul><li>Nurses need to assess their attitudes toward older adults </li></ul> <ul><li>Nurses need to recognize and address ageism by questioning prevailing negative attitudes and stereotypes and emphasizing what really happens during the aging process. </li></ul> <p> 15. </p> <ul><li>Which of the statements made by a nurse best reflects an understanding of the negative impact of ageism regarding patient care? </li></ul> <ul><li>a. If I dont value the older patient, I will never be able to provide</li></ul> <ul><li>the care they are entitled too. </li></ul> <ul><li>b. Everyone regardless of age or position, always deserves</li></ul> <ul><li>effective, appropriate nursing care. </li></ul> <ul><li>c. As society we lose so much valuable wisdom and knowledge</li></ul> <ul><li>when we devalue our older members. </li></ul> <ul><li>d. If older patients do not feel valued, they are less likely to seek</li></ul> <ul><li>health care they need and deserve . </li></ul> <p> 16. 17. </p> <ul><li>Biological theories </li></ul> <ul><li><ul><li>Stochastic</li></ul></li></ul> <ul><li><ul><li><ul><li>Stochastic view aging as cellular damage over time </li></ul></li></ul></li></ul> <ul><li><ul><li><ul><li>Physical changes recognized as characteristics of the aging process </li></ul></li></ul></li></ul> <ul><li><ul><li>Non-stochastic </li></ul></li></ul> <ul><li><ul><li><ul><li>Genetically programmed physiological mechanisms within the body</li></ul></li></ul></li></ul> <ul><li><ul><li><ul><li>control the aging process</li></ul></li></ul></li></ul> <p> 18. </p> <ul><li>Psychological theories </li></ul> <ul><li><ul><li>Disengagement </li></ul></li></ul> <ul><li><ul><li><ul><li>Oldest psychological theory </li></ul></li></ul></li></ul> <ul><li><ul><li><ul><li>Based on withdrawal from customary roles </li></ul></li></ul></li></ul> <ul><li><ul><li><ul><li>Self-focused activities </li></ul></li></ul></li></ul> <ul><li><ul><li>Activity</li></ul></li></ul> <ul><li><ul><li><ul><li>Continuation of activities performed in middle-age</li></ul></li></ul></li></ul> <ul><li><ul><li>Continuity or development </li></ul></li></ul> <ul><li><ul><li><ul><li>Personality remains the same </li></ul></li></ul></li></ul> <ul><li><ul><li><ul><li>Behavior becomes more predictable with age </li></ul></li></ul></li></ul> <ul><li><ul><li><ul><li>Personality and behavior developed during a lifetime</li></ul></li></ul></li></ul> <p> 19. 20. </p> <ul><li>Adjusting to decreasing health and physical strength </li></ul> <ul><li>Adjusting to retirement and reduced or fixed income </li></ul> <ul><li>Adjusting to death of a spouse </li></ul> <ul><li>Accepting self as an aging person </li></ul> <ul><li>Maintaining satisfactory living arrangements </li></ul> <ul><li>Redefining relationships with adult children </li></ul> <ul><li>Finding ways to maintain quality of life </li></ul> <p> 21. </p> <ul><li>Linked to the concept of development tasks appropriate for stages in life </li></ul> <ul><li><ul><li>Health is a common loss </li></ul></li></ul> <ul><li><ul><li>Loss of significant other </li></ul></li></ul> <ul><li><ul><li>Sense of usefulness </li></ul></li></ul> <ul><li><ul><li>Socialization </li></ul></li></ul> <ul><li><ul><li>Income </li></ul></li></ul> <ul><li><ul><li>Independent living </li></ul></li></ul> <ul><li>Adjustments to changes due to aging depends on the individual </li></ul> <ul><li>Be sensitive </li></ul> <ul><li>Offer support</li></ul> <p> 22. </p> <ul><li>Normal changes without disease </li></ul> <ul><li>Body systems </li></ul> <ul><li>Age </li></ul> <ul><li>Changes in appearance </li></ul> <ul><li>Functioning</li></ul> <p> 23. </p> <ul><li>Physiological changes </li></ul> <ul><li><ul><li>Appearance</li></ul></li></ul> <ul><li><ul><li>Cosmetics </li></ul></li></ul> <ul><li><ul><li>Style of clothing </li></ul></li></ul> <ul><li>Structuralchanges </li></ul> <ul><li><ul><li>Retirement </li></ul></li></ul> <ul><li><ul><li>Continue education </li></ul></li></ul> <ul><li><ul><li>Volunteer activities </li></ul></li></ul> <ul><li><ul><li>Change in residence </li></ul></li></ul> <ul><li><ul><li>Relocation </li></ul></li></ul> <p> 24. </p> <ul><li>Functional changes </li></ul> <ul><li><ul><li>Refuse to ask for assistance with tasks </li></ul></li></ul> <ul><li><ul><li>Places older adults at a safety risk </li></ul></li></ul> <ul><li><ul><li>Some will avoid activities that are for older adults </li></ul></li></ul> <ul><li><ul><li>Require realistic review of strength and limitations </li></ul></li></ul> <p> 25. </p> <ul><li>Refining relationships </li></ul> <ul><li><ul><li>Adult Children </li></ul></li></ul> <ul><li><ul><li>Role reversal </li></ul></li></ul> <ul><li><ul><li>Control of decision making </li></ul></li></ul> <ul><li><ul><li>Dependence </li></ul></li></ul> <ul><li><ul><li><ul><li>Conflict, guilt, and loss </li></ul></li></ul></li></ul> <ul><li>Balance becomes a challenge for adult children </li></ul> <ul><li>Increase debates</li></ul> <p> 26. </p> <ul><li>Which of the following statements made by an older adult patient poses thegreatestconcern for the nurse conducting an assessment regarding the patients adjustment to the aging process? </li></ul> <ul><li>a.I use to enjoy dancing and jogging so much, but now I have</li></ul> <ul><li>arthritis in my knees so that it is hard for me to even walk. </li></ul> <ul><li>b. Ive given my grandchildren money for college so they can live a</li></ul> <ul><li>better live than I had. </li></ul> <ul><li>c. Growing old certainly presents all sorts of challenges. I wish I knew</li></ul> <ul><li>then what I know now. </li></ul> <ul><li>d. As I age Ive found it harder to do the things I loved doing but I</li></ul> <ul><li>guess it will all be over soon enough . </li></ul> <p> 27. 28. </p> <ul><li>Older adults are care for in: </li></ul> <ul><li><ul><li>Private homes </li></ul></li></ul> <ul><li><ul><li>Apartments </li></ul></li></ul> <ul><li><ul><li>Retirement communities </li></ul></li></ul> <ul><li><ul><li>Adult day care centers </li></ul></li></ul> <ul><li><ul><li>Assisted living facilities</li></ul></li></ul> <ul><li><ul><li>Nursing centers </li></ul></li></ul> <ul><li>Older adults need to help with decisions regarding which type of health care service is appropriate for them. </li></ul> <p> 29. </p> <ul><li>The interrelation between physical and psychological aspect of aging </li></ul> <ul><li>Effects of disease and disability on functional status </li></ul> <ul><li>Decreased efficiency of homeostatic mechanism </li></ul> <ul><li>Lack of standards for defining health/illness norms </li></ul> <ul><li>Altered presentation and response to specific disease </li></ul> <p> 30. 31. </p> <ul><li>Initial nurse-patient encounter </li></ul> <ul><li>Quick and care head-to-toe assessment </li></ul> <ul><li>Reveal eye contract and facial expression appropriate to situation </li></ul> <ul><li>Facial wrinkles </li></ul> <ul><li>Gray hair </li></ul> <ul><li>Lossof body mass in extremities </li></ul> <ul><li>Increase body mass in trunk area </li></ul> <p> 32. </p> <ul><li>Loss of skin elasticity </li></ul> <ul><li>Loss of moisture </li></ul> <ul><li>Epithelial layer thins</li></ul> <ul><li>Spots and lesions on skin </li></ul> <ul><li>Changes in pigmentation </li></ul> <p> 33. </p> <ul><li>Loss of subcutaneous fat </li></ul> <ul><li>Missing teeth causes face to appear asymmetrical </li></ul> <ul><li>Vocal changes causes loss of power and range </li></ul> <ul><li>Visual acuity declines due to retinal damage, reduced pupil size, and loss of lens elasticity </li></ul> <p> 34. </p> <ul><li>Prebyopiadecline ability of eyes to accommodate close detailed work </li></ul> <ul><li><ul><li>Reduced ability to see in darkness and to adapt to abrupt changes in light </li></ul></li></ul> <ul><li><ul><li>Ambient light is necessary for tasks such as reading </li></ul></li></ul> <ul><li><ul><li>Increased sensitivity to the effects of glare </li></ul></li></ul> <ul><li><ul><li>Changes in color vision </li></ul></li></ul> <ul><li><ul><li><ul><li>Difficult to distinguish between blue and green </li></ul></li></ul></li></ul> <ul><li><ul><li><ul><li>Dark color appear the same</li></ul></li></ul></li></ul> <p> 35. </p> <ul><li>Auditory changes </li></ul> <ul><li><ul><li>Ignore early signs of hearing loss </li></ul></li></ul> <ul><li><ul><li>Common auditory acuity isprebycusis </li></ul></li></ul> <ul><li><ul><li>Prebycusisaffects the ability to hear high-pitched sounds </li></ul></li></ul> <p> 36. </p> <ul><li>Reduced salivary secretion </li></ul> <ul><li><ul><li>Taste buds atrophy </li></ul></li></ul> <ul><li><ul><li>Loss sensitivity </li></ul></li></ul> <ul><li><ul><li>Lesser ability to differentiate between salty, sweet, sour, and bitter tastes </li></ul></li></ul> <ul><li><ul><li>Reduced in sense of smell </li></ul></li></ul> <p> 37. </p> <ul><li>Decrease contractile strength of the myocardium results in a decrease in cardiac output</li></ul> <ul><li>Increased with anxiety </li></ul> <ul><li>Heart rate increase during exercising to compensate for decreased cardiac output </li></ul> <ul><li>Takes heart rate longer to return baseline </li></ul> <p> 38. </p> <ul><li>Systolic and diastolic blood pressure can be abnormal </li></ul> <ul><li>Hypertension is common in the older adults </li></ul> <ul><li>Hypertensionis notnormal to the aging process </li></ul> <ul><li>Weak peripheral pulses</li></ul> <ul><li>Cooler lower extremities </li></ul> <ul><li>Changes in upper extremities pulses is less common </li></ul> <p> 39. </p> <ul><li>Increase fatty issue to trunk </li></ul> <ul><li>Decrease tone and elasticity </li></ul> <ul><li>Slower peristalsis </li></ul> <ul><li>Alternation in secretion </li></ul> <ul><li>Constipation </li></ul> <ul><li>Flatulence (gas) </li></ul> <ul><li>Diarrhea </li></ul> <p> 40. </p> <ul><li>Men </li></ul> <ul><li><ul><li>Urinary retention </li></ul></li></ul> <ul><li><ul><li>Frequency </li></ul></li></ul> <ul><li><ul><li>Incontinence </li></ul></li></ul> <ul><li><ul><li>Prostate cancer</li></ul></li></ul> <ul><li>Urinary incontinence is abnormal for men and women </li></ul> <ul><li>Women</li></ul> <ul><li><ul><li>Stress incontinence </li></ul></li></ul> <ul><li><ul><li>Related to weak perineal and bladder muscles </li></ul></li></ul> <ul><li><ul><li>Urge incontinence </li></ul></li></ul> <p> 41. </p> <ul><li>Smaller muscle fiber </li></ul> <ul><li>Decreased muscle strength</li></ul> <ul><li>Decreased bone mass</li></ul> <ul><li>Osteoporosis major health concern </li></ul> <ul><li><ul><li>Bone demineralization </li></ul></li></ul> <p> 42. </p> <ul><li>Decrease neurons </li></ul> <ul><li>Slower voluntary reflexes</li></ul> <ul><li>Less ability to respond to multiple stimuli </li></ul> <ul><li>Alternations in quality and quantity in sleep </li></ul> <p> 43. </p> <ul><li>Functional Changes </li></ul> <p> 44. </p> <ul><li>Physical, psychological, cognitive, and social domains</li></ul> <ul><li>Accepting and adjusting to changes </li></ul> <ul><li><ul><li>Denial</li></ul></li></ul> <ul><li><ul><li>Overemphasize</li></ul></li></ul> <ul><li><ul><li>Overwhelming fear </li></ul></li></ul> <ul><li>Functional status </li></ul> <ul><li><ul><li>Refers to the older adults ability to safely perform his or hers ADLs </li></ul></li></ul> <ul><li><ul><li>A sensitive indicator of health or illness </li></ul></li></ul> <ul><li>Assess for sudden changes</li></ul> <ul><li>Changes can or may be related to the onset of illness </li></ul> <p> 45. </p> <ul><li>Educate older adults to: </li></ul> <ul><li><ul><li>Promote an understanding of aging</li></ul></li></ul> <ul><li><ul><li>Effective coping in adjusting to lifestyle changes </li></ul></li></ul> <ul><li>Promote the highest-level of function in all areas: </li></ul> <ul><li><ul><li>Healthy, well-balanced diet </li></ul></li></ul> <ul><li><ul><li>Pace appropriate activities</li></ul></li></ul> <ul><li><ul><li>Regular office visits to see the doctor </li></ul></li></ul> <ul><li><ul><li>Avoid alcohol, illicit drugs, and tobacco </li></ul></li></ul> <p> 46. </p> <ul><li>Cognitive Changes </li></ul> <p> 47. </p> <ul><li>Is forgetfulness a myth? </li></ul> <ul><li>Abnormal changes with aging </li></ul> <ul><li>Symptoms of cognitive impairment included: </li></ul> <ul><li><ul><li>Disorientation </li></ul></li></ul> <ul><li><ul><li>Loss of language skills </li></ul></li></ul> <ul><li><ul><li>Loss ability to calculate </li></ul></li></ul> <ul><li><ul><li>Poor judgment </li></ul></li></ul> <p> 48. </p> <ul><li>Delirium </li></ul> <ul><li>Acute confusion r/t physiological causes: </li></ul> <ul><li><ul><li>Electrolyte imbalances </li></ul></li></ul> <ul><li><ul><li>Cerebral anoxia </li></ul></li></ul> <ul><li><ul><li>Hypoglycemia </li></ul></li></ul> <ul><li><ul><li>Cerebrovascular infection, infarction, or hemorrhage </li></ul></li></ul> <ul><li><ul><li>Systemic infection such as urinary tract infection or pneumonia </li></ul></li></ul> <ul><li>Environmental causes: </li></ul> <ul><li><ul><li>Sensory deprivation </li></ul></li></ul> <ul><li><ul><li>Unfamiliar surroundings </li></ul></li></ul> <p> 49. </p> <ul><li>Dementia </li></ul> <ul><li>Cognitive function deteriorates </li></ul> <ul><li>Generalized impairment of intellectual functioning </li></ul> <ul><li>Interferes with social and occupational functioning </li></ul> <ul><li>Ability to perform basic and instrumental activities of daily activities declines </li></ul> <ul><li>Gradual, progressive, and irreversible cerebral dysfunction</li></ul> <ul><li>Other causes include infection or trauma </li></ul> <p> 50. </p> <ul><li>Depression </li></ul> <ul><li>A mood disturbance</li></ul> <ul><li>Characterized by feelings such as sadness and despair </li></ul> <ul><li>Not a normal part of the aging process </li></ul> <ul><li>A treatable medical illness </li></ul> <ul><li>Dementia and depression increases familys distress level</li></ul> <p> 51. </p> <ul><li>Psychosocial Changes </li></ul> <p> 52. </p> <ul><li>Transitions</li></ul> <ul><li>Role change </li></ul> <ul><li>Ages 55, 65, or 75 </li></ul> <ul><li>Major turning point in life </li></ul> <ul><li>Affects individuals other people </li></ul> <ul><li>Health status influences retirement </li></ul> <p> 53. </p> <ul><li>Choice </li></ul> <ul><li>Response</li></ul> <ul><li><ul><li>Occurs after retirement </li></ul></li></ul> <ul><li>Impairments reduce social interactions</li></ul> <ul><li>Rejection associated aging with unattractiveness </li></ul> <ul><li>Homeless, confused, incontinent, or institutionalized</li></ul> <ul><li>Geographic distance</li></ul> <p> 54. </p> <ul><li>In reviewing changes in the older adult, the nurse recognizes that which of the following statements is related to cognitive </li></ul> <ul><li>functioning in the older client is true? </li></ul> <ul><li>a. Delirium is usually easily distinguished from irreversible dementia. </li></ul> <ul><li>b. Therapeutic drug intoxication is a common cause of senile</li></ul> <ul><li>dementia. </li></ul> <ul><li>c.Reversible systemic disorders are often the implicated as a cause</li></ul> <ul><li>of delirium. </li></ul> <ul><li>d. Cognitive deterioration is an inevitable outcome of the human</li></ul> <ul><li>aging process. </li></ul> <p> 55. </p> <ul><li>Sexuality involves love, warmth, sharing, and touching. </li></ul> <ul><li>Sexual activity usually decline </li></ul> <ul><li>Libido does not decrease </li></ul> <p> 56. </p> <ul><li>Touch </li></ul> <ul><li><ul><li>Sexual expression </li></ul></li></ul> <ul><li><ul><li>Part of intimacy</li></ul></li></ul> <ul><li><ul><li>Compliments traditional sexual methods </li></ul></li></ul> <ul><li><ul><li>Alternative to physical intercourse </li></ul></li></ul> <p> 57. </p> <ul><li>Need to understand physical changes in se