DISORDERS RELATED TO AGING

Luzviminda C. Cardino RN MAN

AGING
aging process occurs in all living things Causes physical, psychological and social changes that increase as a person gets older

THE

TH 6

DECADE

physiologic changes in the eye- night vision Ability to hear higher tone diminishesdifficulty understanding conversations Pancreas function less efficientlyhigher glucose levels Joints stiffen as cartilage deteriorates from wear and tear- pain in movement

THE

TH 7

DECADE

Blood pressure is 25% higher than that at age 20- HTN CAD- thickening of arterial walls- 50% Short term memory declines Sweat glands decrease in number- heat stroke

THE

TH 8

DECADE

risk of falls increases- hip fractures Bone mass decrease by half in many women Cognitive ability decreases and 50% over 85 years show some signs of Alzheimers disease

COMMON PHYSICAL CHANGES

Presbycusis- hearing loss Cataracts- opacity of lens Nutritional deficits- tooth loss and alterations in taste, smell and GI function Muscle strength, agility and reaction times decrease. Reflexes and vibratory sense lessen. Position sense may decline- unsteady gait and increased of falling

COMMON PHYSICAL CHANGES

Cognitive ability does not diminish greatlyshort term memory and the ability to retrieve information from long term memory decreases Personality does not change with age Sleep deprivation may occur due to decreases in stage IV sleep and total sleep time and increases in the time it takes to fall asleep Brain weight decreases by 7% and cerebral blood flow is reduced by 20%

NURSING MANAGEMENT
Assess neurologic status on a regular basis Assess the patients level of understanding and ability to communicate Ask about vision and hearing problems and refer accordingly. Provide info about glasses and hearing aids Provide assistance with ADL, body function Monitor physiologic changes, i.e. dysphagia, intolerance, etc.

NURSING MANAGEMENT
Help prevent falls in a patient with tremors or decreased motor ability by keeping the side rails up and enforcing other safety measures Reduce environmental stimuli when talking to the patient Ensure adequate sleep Orient the patient frequently to time, date and his surroundings

CARDIOVASCULAR DISORDERS
HTN and CAD are major CV diseases CV dysfunction caused by diseases rather than aging per se

NURSING MANAGEMENT
Monitor the BP and HR and check for orthostatic changes Review meds of patient. Side effects may be exacerbated in the elderly Administer meds as prescribed, ensuring that VS are within designated parameters Make sure that patients taking diuretics can get to the Bathroom easily and safely without falling

PULMONARY SYSTEM DISORDERS

Minor alterations in pulmonary functions associated with aging smoking, environmental exposures and bacterial/viral infections Skeletal changes such as kyphosis can alter pulmonary function Pneumonia and TB common among elderlyimpaired host-defense mechanisms Tachypnea and tachycardia- 1st signs of pulmonary compromise

NURSING MANAGEMENT
Obtain accurate history of previous pulmonary conditions Observe for pursed lip breathing, use of accessory muscles and tachypnea

GASTROINTESTINAL DISORDERS
Changes in GIT range from tooth loss (poor dental hygiene or lack of dental care) to malabsorption Poor nutritional intake is compounded by loss of taste buds and smell- malnutrition common Diminished peristalsis- constipation and alterations in drug absorption Constipation immobility, poor hydration

NURSING MANAGEMENT
Assess nutritional status of patient (eating habits, bowel habits) Ensure adequate hydration and fiber intake Review meds and monitor for any GI side effects

URINARY SYSTEM
Incontinence, frequent urination and prostatic hypertrophy in men Incontinence- 15-30% of elderly In hospitalized patients, urinary incontinence often occurs because the patient who need help going to the bathroom dont receive it on time Diuretics, hypnotics, alpha-adrenergic agents and anticholinergics - urinary incontinence Creatinine clearance decrease after age 40 at a rate of 1% every year- increase risk of having toxicity when taking drugs excreted by the kidneys

NURSING MANAGEMENT
Ask the patient about nocturia, urinary frequency and incontinence Make sure that the patient with nocturia has safe and easy access to the bathroom to prevent falls and secondary complications Help prevent drug toxicity by monitoring patients medications Monitor I & O and renal function as ordered Ensure privacy Tell patients limit late night fluid intake

MUSCULOSKELETAL DISORDERS
associated with changes in bone density, muscle mass and joint flexibility Falls occur in 25% of elderly patients Changes in bone occur 2ndary to demineralization Bone density declines with more rapid loss in women than in menosteoporosis, pathologic fractures

MUSCULOSKELETAL DISORDERS
Malnutrition occurs because bedridden patients have poorer nutritional intakeCHON and Vit. deficiencies, weakness and decreased muscle mass Pressure ulcers are caused solely by immobility and can be prevented 100% of the time by prompt nursing action

MUSCULOSKELETAL DISORDERS
Orthostatic hypotension may be caused or exacerbated by bedrest which slows normal postural compensatory mechanisms resulting in changes in heart rate, stroke volume and cardiac output Contractures can occur in 3-4weeks when joint ROM does not occur Falls can be caused by decreased peripheral vision, depth perception and acuity especially at night

NURSING MANAGEMENT
Recognize that pt may take longer to complete tasks due to decreased flexibility and pain from degenerative diseases Decrease the incidence of falls and fractures by removing obstacles in the patients path and improving lighting Assess and document patients functional capacity and level of mobility and offer assistive devices

NURSING MANAGEMENT
Encourage the bedridden patient to walk ASAP to prevent complications of immobility Perform daily ROM to prevent venous stasis, muscle weakening and contractures Ensure adequate nutrition, hydration and dietary fiber Evaluate patients meds to ascertain which ones might intensify fall risk or impair mobility by limiting CNS responsiveness

NURSING MANAGEMENT
Inspect the skin for breakdown and adhere to a turning schedule Monitor for orthostatic hypotension and move slowly Help the patient to go the Bathroom frequently because many patients fall when trying to get out of bed to use the BR Encourage patient to perform ADLs but provide assistance as needed

PRACTICE EXAMINATION

1. The nurse would give a phosphate, bisocodyl or enema of patients choice if he had not had a bowel movement in ______ days, per routine Hospice Orders.

2.It is important to assess for and treat underlying causes of insomnia. List 5 possible contributing factors.

3.The nurse is performing an assessment on an older adult client. Which assessment data would indicate a potential complication associated with the skin of this client?
a.Crusting b.Wrinkling c.Deepening of expression lines d.Thinning and loss of elasticity in the skin

4. The home health nurse is visiting a client for the first time. While assessing the clients medication, it is noted that there are at least 19 prescription and several over-the-counter medications that the client has been taking. Which intervention should the nurse take first?
a. Check for drug-drug interaction. b. Determine whether there are any adverse side effects. c. Determine whether there are medication duplications. d. Call the prescribing physician and report any polypharmacy.

5.The home care nurse is performing an environmental assessment in the home of an older client. Which of the following, if observed by the nurse, requires immediate attention?
a.Unsecured scatter rugs b.Clear exit passageways c.An operable smoke detector d.A prefilled medication cassette.

6. The nurse is providing medication instructions to an older client who is taking digoxin (Lanoxin) daily. The nurse notes that which age-related body changes could place the client at risk for digoxin toxicity?
a. Decreased muscle strength and loss of bone density b. Decreased cough efficiency and decreased vital capacity c. Decreased salivation and decreased gastrointerstinal motility d. Decreased lean body mass and decreased glomerular filtration rate

7.The home care nurse is visiting an older female client whose husband died 6 months ago. Which behavior by the client indicates ineffective coping?
a.Neglecting her personal grooming b.Looking at old snapshots of her family c.Participating in a senior citizens program d.Visiting her husband s grave once a month

8.The nurse is providing instructions to a nursing assistant regarding care of an older client with hearing loss. The nurse tells the assistant that client s with a hearing loss:
a.Are often distracted. b.Have middle ear changes. c.Respond to low-pitched tones. d.Develop moist cerumen production.

9.The nurse is performing an assessment on an older client who is having difficulty sleeping at night. Which statement, if made by the client, indicates that teaching about improving steep is necessary?
a.I swim three times a week. b.I have stopped smoking cigars. c.I drink hot chocolate before bedtime. d.I read for 40 minutes before bedtime.

10.The nurse develops a nursing diagnosis of selfcare deficit for an older client with dementia. Which of the following is an appropriate goal for this client?
a. The client will function at the highest level of independence possible. b. The client will complete all activities of daily living independently within a 1-hour time frame. c. The client will be admitted to a long-term care facility to have activities of daily living needs met. d. The nursing staff will attend to all the clients activities of daily living needs during the hospital stay.