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N 326 Exam #1Older Adults – Managing Changes and NeedsMyths and StereotypesOlder Adults are --- ill, disabled, and unattractive, forgetful, confused, rigid, boring, unfriendly, unable to learn & understand new information, not interested in sex or sexual activities Nurses’ Attitudes toward Older Adults- Nurses need to recognize and address ageism by questioning prevailing negative attitudes and stereotypes and emphasizing what really happens during the aging process- Ethnic older adults & culturally competent care - Special Older Adult Populations – Older adult women, Cognitively impaired older adults, Rural older adults, Homeless older adults, Frail older adults, Chronically ill older adults Chronic Illness - Acute illness – diseases that have a rapid onset and short duration, examples are colds, influenza, and acute gastroenteritis, they are usually self-limiting, respond well to treatment, complications are infrequent, after illness the person returns to previous level of functioning- Chronic Illness – diseases that are prolonged, do not resolve spontaneously, and are rarely cured completely, permanent impairments or deviations from normal, nonreversible pathologic changes, residual disability, special rehabilitation required, need for long-term medical and/or nursing management, be familiar with the trajectory of chronic illnessMaslow’s Hierarchy – Social Support & Older Adult – from bottom to top – Physiological Needs (Air, Water, Food, Shelter, Sleep, Sex), Safety and Security, Love and Belongingness, Self-Esteem, Self-Actualization (Vitality, Creativity, Self-Sufficiency, Authenticity, Playfulness, Meaningfulness) Physiologic Changes - Four (4) Characteristics of Changes (Goldman, 1979) – Universal, Progressive, Decremental, Intrinsic (Unmodifiable) - Variability among older adults Structure & Posture – Changes with a loss of height, vertebral thinning, loss of bone mass (Osteoporosis),skeletal muscles atrophy, ligaments, tendons, & joints become more rigid, and kyphosis is not uncommonSkin, Hair, & Nails – Epidermal cell renewal time is increased, slow wound healing, skin changes true aging or photo-aging, skin pigmentation altered, hair becomes gray with altered distribution, and nails grow more slowly & may develop striationsLoss of Elasticity – Most evident in skin, Affects blood vessels (alter blood flow to organs, increase blood pressure), loss of water & lean body mass, increase in fat content, Subcutaneous fat decreases (affects function of shock absorber for trauma and thermoregulatory maintenance) Cardiovascular Changes – Hypertrophy & decreased coronary artery blood flow, decrease in cardiac output, valves thicken & stiffen (systolic murmurs), Pacemaker cells dramatically decrease in number (arrhythmias), baroreceptor sensitivity declines, increased peripheral resistance, and reduced perfusion to tissues & organs Respiratory Changes – Decreased chest wall compliance, loss of elastic recoil, alveolar enlargement, altered gas exchange, decreased cough, altered function of chemoreceptors, declining immune function, greater diaphragmatic motion needed r/t restriction of the costal structures, change in muscle strength of bodyKidney – 20-30% smaller by eighth decade of life, # of nephrons is diminished along with renal function, renal blood flow significantly decreases as does GFR, Renin & aldosterone are decreased, Antidiuretic hormone (ADH) is altered, contributing to the aging body’s risk for fluid & electrolyte imbalanceEndocrine Changes – Most glands atrophy, decreased secretory rates, and serum hormone levels are reflective of secretion status Gastrointestinal Changes – Dentition, decreased peristalsis, decreased appetite, loss of mucous in the stomach, increased susceptibility to gastric irritation, liver atrophies, impaired protein breakdown, pancreatic enzyme secretion diminished, malabsorption of vitamins and minerals, Large intestine – atrophy, loss of muscle tone, decreased neural sensations Nervous System Changes – Intelligence & intellectual performance constant into & beyond 8th decade, neurons are lost, brain size decreases, cerebral ventricles enlarged, Lipofuscin and amyloidal deposits in the nerve cells & blood vessels (conduction time for peripheral nerves slowed), and specific task completion may be slowedSensory Changes – Taste & smell diminished, pain perception altered, difficulty with balance & spatial orientation r/t changes in proprioception, decrease in pupil size, peripheral vision decreases, changes in intraocular fluid, eye lens yellowed/opaque, color perception altered, cerumen impaction, dryer cerumen (gland atrophy), ossicles calcifyImmunologic Changes – involves both cell-mediated and humoral immunity, places elders at a higher riskfor infections, Decrease in T-cell function results in a decrease in immunity Nutritional Needs – Food Guide Pyramid & RDA, fiber, protein, calcium, Iron, Zinc, Folic Acid, Vitamins A, B6, C, EFactors Affecting Fulfillment of Nutritional Needs – Lifelong eating habits, Socialization, Informational needs, Income, Transportation, and HousingProblems in Nutrition – Hydration, Adequate fiber, Lactose intolerance, Weight loss, Vitamin & mineral deficiencies, Osteoporosis, Sarcopenia, Malnutrition, and Obesity Ethics of Nutrition – Food fads, Megavitamin therapy, Feeding the impaired aged (Dysphagia & Tube feeding), and Intentional StarvationNutritional Assessment – Interview, Physical Examination, Anthropometric measurements (BMI), and Biochemical analysis Elimination – Bowel function – Constipation – Assessment, Intervention (laxatives, stool softeners, enemas, position, exercise) – Fecal impaction Rest and Sleep – Biorhythm and Sleep, Normal Sleep Pattern (Insomnia, Narcolepsy, Sleep apnea, Nocturnal myoclonus, Restless leg syndrome, Sleep disorders of dementia), Sleep and drugs Activity – Benefits, Risks of Inactivity, Activity for every level of functioning, Assessment (History, PhysicalExam, Lab data, Exercise tolerance testing), Safety Considerations (Hydration, Proper footwear)ADLs (Activities of Daily Living) = BATTED (Bathing, Ambulation, Toileting, Transfers, Eating, Dressing) IADLS (Instrumental Activities of Daily Living = SCUM (Shopping, Cooking/Cleaning, Using Telephone or Transportation, Managing Money and Medications) Special Considerations for Older Adult Clients –Handle with Care – Remember:-


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UNCW NSG 326 - N 326 Test 1

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