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NSG 326 AH IMyths & StereotypesNurses’ Attitudes Toward Older AdultsChronic IllnessSlide 5Maslow’s Hierarchy – Social Support & Older AdultPhysiologic ChangesStructure & PostureSkin, Hair & NailsLoss of ElasticityCardiovascular ChangesRespiratory ChangesKidneyEndocrine ChangesGastrointestinal ChangesNervous System ChangesSensory ChangesImmunologic ChangesNutritional NeedsSlide 20Factors Affecting Fulfillment of Nutritional NeedsProblems in NutritionEthics of NutritionNutritional AssessmentEliminationRest and SleepACTIVITYPhysical ActivityCare Alternatives for Older AdultsSlide 30Slide 31Slide 32Slide 33Slide 34Prepared by K. Ennen, PhD, RNNSG 326 AH IOlder AdultManaging Changes & NeedsMyths & StereotypesOlder adults are ---Ill, disabled, & unattractiveForgetful, confused, rigid, boring, unfriendlyUnable to learn & understand new informationNot interested in sex or sexual activitiesNurses’ 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 adultsChronic Illness4Table 5-1. Characteristics of Acute and Chronic Illness. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Chronic IllnessTrajectory of Chronic Illness 5Fig. 5-1. The Chronic Illness Trajectory is a theoretical model of chronic illness. The trajectory model of chronic illness recognizes that chronic illness will have many phases (see Table 5-3). Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Maslow’s Hierarchy – Social Support & Older AdultPhysiologic ChangesFour (4) characteristics of changes (Goldman, 1979)UniversalProgressiveDecrementalIntrinsic (Unmodifiable)Variability among older adultsStructure & PostureChange with a loss of height Vertebral thinningLoss of bone mass (Osteoporosis)Skeletal muscles atrophyLigaments, tendons, & joints become more rigidKyphosis is not uncommonSkin, Hair & NailsEpidermal cell renewal time is increasedSlow wound healingSkin changes true aging or photoagingSkin pigmentation alteredHair becomes gray with altered distribution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 functions of shock absorber for trauma and thermoregulatory maintenanceCardiovascular 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Reduced perfusion to tissues & organsRespiratory 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% to 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Serum hormone levels are reflective of secretion statusGastrointestinal ChangesDentitionDecreased peristalsis Decreased appetiteLoss of mucus 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 sensationsNervous System ChangesIntelligence & Intellectual performance constant into & beyond 8th decadeNeurons are lostBrain sizes decreases, cerebral ventricles enlargeLipofuscin and amyloidal deposits in the nerve cells & blood vesselsConduction time for peripheral nerves slowed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 risk for infectionsDecrease in T-cell function results in a decrease in immunityNutritional 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HousingProblems in NutritionHydrationAdequate fiberLactose intoleranceWeight lossVitamin & Mineral deficienciesOsteoporosisSarcopeniaMalnutritionObesityEthics of NutritionFood fadsMegavitamin therapyFeeding the impaired agedDysphagiaTube feedingIntentional starvationNutritional AssessmentInterviewPhysical examinationAnthropometric measurementsBMIBiochemical analysisEliminationBowel FunctionConstipationAssessmentInterventionLaxativesStool softenersEnemasPositionExerciseFecal ImpactionRest and SleepBiorhythm and SleepNormal sleep patternInsomniaNarcolepsySleep apneaNocturnal myoclonusRestless leg syndromeSleep disorders of dementiaSleep and drugsACTIVITYBenefitsRisks of InactivityActivity for every level of functioningAssessment HistoryPhysical exam Lab dataExercise tolerance testingSafety considerations HydrationProper footwearPhysical Activity28Fig. 5-8. Water aerobics is an example of a health promotion activity for older adults. Copyright © 2011, 2007 by


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UNCW NSG 326 - NSG 326 AH I WK #2 Older Adult

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