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 & StereotypesOlder adults are ---Ill, disabled, & unattractiveForgetful, confused, rigid, boring, unfriendlyUnable to learn & understand new informationNot interested in sex or sexual activitiesNurses’ Attitudes Toward Older AdultsNurses 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 careSpecial Older Adult PopulationsOlder adult womenCognitively impaired older adultsRural older adultsHomeless older adultsFrail older adultsChronically ill older adultsChronic Illness4Table 5-1. Characteristics of Acute and Chronic Illness. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.Chronic IllnessTrajectory 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 ChangesFour (4) characteristics of changes (Goldman, 1979)UniversalProgressiveDecrementalIntrinsic (Unmodifiable)Variability among older adultsStructure & PostureChange with a loss of height Vertebral thinningLoss of bone mass (Osteoporosis)Skeletal muscles atrophyLigaments, tendons, & joints become more rigidKyphosis is not uncommonSkin, Hair & NailsEpidermal cell renewal time is increasedSlow wound healingSkin changes true aging or photoagingSkin pigmentation alteredHair becomes gray with altered distributionNails grow more slowly & may develop striationsLoss of ElasticityMost evident in skinAffects blood vesselsAlter blood flow to organsIncrease blood pressureLoss of water & lean body mass, increase in fat contentSubcutaneous fat decreasesAffects functions of shock absorber for trauma and thermoregulatory maintenanceCardiovascular ChangesHypertrophy & decreased coronary artery blood flowDecrease in cardiac outputValves thicken & stiffen (systolic murmurs)Pacemaker cells dramatically decrease in number (arrhythmias)Baroreceptor sensitivity declinesIncreased peripheral resistanceReduced perfusion to tissues & organsRespiratory ChangesDecreased chest wall complianceLoss of elastic recoilAlveolar enlargement, altered gas exchange, decreased cough, altered function of chemoreceptorsDeclining immune functionGreater diaphragmatic motion needed r/t restriction of the costal structures, change in muscle strength of bodyKidney20% to 30% smaller by eighth decade of life# of nephrons is diminished along with renal functionRenal blood flow significantly decreases, as does GFRRenin & aldosterone are decreasedAntidiuretic Hormone (ADH) is altered, contributing to the aging body’s risk for fluid & electrolyte imbalanceEndocrine ChangesMost glands atrophyDecreased secretory ratesSerum hormone levels are reflective of secretion statusGastrointestinal ChangesDentitionDecreased peristalsis Decreased appetiteLoss of mucus in the stomach, increased susceptibility to gastric irritationLiver atrophies, impaired protein breakdownPancreatic enzyme secretion diminishedMalabsorption of vitamins and mineralsLarge intestine – atrophy, loss of muscle tone, decreased neural sensationsNervous System ChangesIntelligence & Intellectual performance constant into & beyond 8th decadeNeurons are lostBrain sizes decreases, cerebral ventricles enlargeLipofuscin and amyloidal deposits in the nerve cells & blood vesselsConduction time for peripheral nerves slowedSpecific task completion may be slowedSensory ChangesTaste & smell diminishedPain perception altered Difficulty with balance & spatial orientation r/t changes in proprioceptionDecrease in pupil sizePeripheral vision decreasesChanges in intraocular fluid Eye lens yellowed, opaqueColor perception alteredCerumen impaction, dryer cerumen (gland atrophy)Ossicles calcifyImmunologic ChangesInvolves both cell-mediated and humoral immunity, places elders at a higher risk for infectionsDecrease in T-cell function results in a decrease in immunityNutritional NeedsFood guide pyramid & RDA FiberProtein Calcium Iron Zinc Folic AcidVitamins A, B6, C, EFactors Affecting Fulfillment of Nutritional NeedsLifelong eating habitsSocializationInformational needsIncomeTransportationHousingProblems in NutritionHydrationAdequate fiberLactose intoleranceWeight lossVitamin & Mineral deficienciesOsteoporosisSarcopeniaMalnutritionObesityEthics of NutritionFood fadsMegavitamin therapyFeeding the impaired agedDysphagiaTube feedingIntentional starvationNutritional AssessmentInterviewPhysical examinationAnthropometric measurementsBMIBiochemical analysisEliminationBowel FunctionConstipationAssessmentInterventionLaxativesStool softenersEnemasPositionExerciseFecal ImpactionRest and SleepBiorhythm and SleepNormal sleep patternInsomniaNarcolepsySleep apneaNocturnal myoclonusRestless leg syndromeSleep disorders of dementiaSleep and drugsACTIVITYBenefitsRisks of InactivityActivity for every level of functioningAssessment HistoryPhysical exam Lab dataExercise tolerance testingSafety considerations HydrationProper 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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