Safety
A nurse is assessing a 70-year-old patient who reports difficulty sleeping. Which statement by the patient indicates understanding of age-related sleep changes?
A) "I need much less sleep now than when I was younger."
B) "I should expect to wake up more often during the night."
C) "Deep sleep increases as I get older."
D) "Daytime napping means I have a sleep disorder.
What is "I should expect to wake up more often during the night."
With aging, there are fewer periods of deep sleep and frequent periods of wakefulness. Older adults spend more time in stage 1 and less time in stages 3 and 4 (NREM sleep). A common misconception is that older people need less sleep than younger people; in fact, the amount of sleep needed stays relatively constant. To compensate for nighttime awakenings, older adults often increase the number of naps taken during the day.
An older adult patient has a slower reaction time when responding to multiple stimuli. Which age-related neurological change explains this finding?
What are slowed nerve impulse transmission and decreased neurons?
Physiologically, nerve impulse transmission in the nervous system slows, resulting in a longer reaction time for older adults. Neurotransmitters change with aging as a result of the decrease in neurons. All voluntary reflexes are slower, and individuals often have less of an ability to respond to multiple stimuli. Autonomic nervous system changes include decreased efficiency in maintaining normal body temperature.
An 82-year-old patient is admitted with pneumonia. Which age-related respiratory change increases this patient's risk for respiratory infections?
A) Increased chest wall expansion
B) Decreased number and effectiveness of cilia
C) Enhanced alveolar elasticity
D) Improved cough reflex strength
What are decreased number and effectiveness of cilia?
Older adults have a decrease in the number and effectiveness of cilia in the tracheobronchial tree, which results in increased difficulty clearing secretions and increased risk of respiratory infections. Additionally, older adults have a less forceful cough and fewer functional cilia. The alveolar macrophages are also less effective at phagocytosis, and respiratory defense mechanisms are less effective due to decline in immune function.
A nurse is caring for a 78-year-old patient with a new diagnosis of hypertension. Which age-related cardiovascular change contributes to increased blood pressure in older adults?
A) Increased elasticity of blood vessels
B) Arteriosclerosis with decreased vessel elasticity
C) Increased number of pacemaker cells
D) Enhanced heart rate response to exercise
What is arteriosclerosis with decreased vessel elasticity?
Arteriosclerosis develops as the blood vessels become less elastic and are lined with deposits, resulting in increased blood pressure. With aging, cardiovascular changes involve loss of structural elasticity. The heart valves become thicker and more rigid, and there is a decrease in pacemaker cells with slowed electrical conduction. The heart loses some of its capacity to increase rate in response to exercise.
A 72-year-old postmenopausal woman is at risk for osteoporosis. Which intervention should the nurse recommend to help prevent bone demineralization?
A) Limit physical activity to prevent fractures
B) Maintain adequate calcium and vitamin D intake
C) Decrease protein consumption
D) Avoid weight-bearing exercises
What is to maintain adequate calcium and vitamin D intake?
Women who maintain calcium and vitamin D intake throughout life and into menopause have less bone demineralization than women with low calcium intake. Postmenopausal women experience a greater rate of bone demineralization and lose up to 20% or more of their bone density. Older adults who exercise regularly do not lose as much bone and muscle mass or muscle tone as those who are inactive.
What are age spots or liver spots and are most often seen on those body areas that are most exposed to sunlight.
What are senile lentigo?
An 80-year-old patient takes diphenhydramine (Benadryl PM) nightly for sleep. Which concern should the nurse address with this patient?
A) Risk for hyperactivity
B) Increased risk for falls and anticholinergic effects
C) Enhanced cognitive function
D) Improved daytime alertness
What is increased risk for falls and anticholinergic effects?
Diphenhydramine, alone or in combination with other drugs, is sedating with anticholinergic effects. Any OTC medication labeled "PM" may have diphenhydramine and should be used cautiously by older adults. Older adults' use of OTC medications or alcohol as sleep aids increases the risk for falls at night. Awakening and getting out of bed during the night (e.g., to use the bathroom) also increases fall risk.
What is a hardening or fixing of the stapes to the oval window, interferes with the transmission of sound waves to the inner ear?
What is Otosclerosis?
A nurse assesses a 75-year-old patient and notes a barrel-shaped chest and use of accessory muscles for breathing. Which age-related change explains these findings?
A) Decreased lung tissue rigidity
B) Calcification of costal cartilages
C) Increased rib mobility
D) Enhanced diaphragmatic strength
What is calcification of costal cartilages?
Calcification of the costal cartilages can interfere with chest expansion. The chest may appear barrel shaped, and the person may need to use accessory muscles to breathe. Respiratory muscle strength progressively declines after age 50, and the chest wall gradually becomes stiffer. Calcification of the cartilage leads to rigidity and stiffness of the thoracic cage.
The heart muscle decreases in size just like every other muscle leading to decreased perfusion to rest of body. Is this true? and why?
The heart does not atrophy with aging, as other muscles do. In fact, the heart muscle mass increases slightly with age, and the thickness of the left ventricular wall also increases slightly. This increase in muscle mass may occur to offset some loss of tone. The aging heart may function less effectively even when no pathologic changes are present (Table 3.4). Loss of tone typically leads to the decrease in maximal cardiac output seen in older adults. The normal conduction system, SA node, AV node, bundle of His and its branches all lose cells starting fairly early in life (in the 20s). Cardiac response to autonomic stimulation is decreased because of changes in the receptors. Older persons enhance cardiac output by increasing stroke volume, whereas younger persons increase output by increasing heart rate (cardiac output = stroke volume × heart rate).
A nurse is caring for an 80-year-old patient post-hip fracture repair. Which assessment finding requires immediate intervention?
A) External rotation and shortening of the affected leg
B) Patient reports severe pain at the fracture site
C) Signs of infection at the operative site
D) Patient using incentive spirometer every 2 hours
What are signs of infection at the operative site?
Nursing interventions after hip fracture surgery require monitoring the operative site for signs of infection and bleeding. Hip fractures are the most disabling type of fracture in older adults. When a hip fracture occurs, the affected extremity usually is rotated externally and shortened with tenderness and severe pain at the fracture site. Post-operative care includes monitoring vital signs and I&O, frequent turning, deep breathing, coughing, and incentive spirometry to prevent respiratory complications.
Decrease in function of oil and sweat glands which lead to dry skin in the elderly? What is this called?
What is xerosis?
A nurse reviews medications for an 85-year-old patient prescribed a long-acting benzodiazepine for insomnia. What is the priority nursing concern?
A) Risk for respiratory depression and falls
B) Decreased effectiveness over time
C) Improved sleep quality
D) Enhanced motor coordination
What is risk for respiratory depression and falls?
Benzodiazepines in older adults are potentially dangerous because they remain active in the body longer, causing respiratory depression, next-day sedation, amnesia, and impaired motor functioning and coordination, leading to increased fall risk. Long-acting benzodiazepines should be avoided whenever possible. Sleep medications should be started at lower doses and monitored carefully in older adults.
What is ringing in the ears? What are antibiotics and diuretics?
What is tinnitus? Which are 2 groups of medicines that can contribute to this?
An older adult reports increased shortness of breath with activities that were previously well-tolerated. Which physiological change best explains this finding?
A) Increased number of functional alveoli
B) Improved ventilation-perfusion matching
C) Decreased alveolar elasticity and fewer functional alveoli
D) Enhanced oxygen-carrying capacity
What is decreased alveolar elasticity and fewer functional alveoli?
The number of functional alveoli decreases with age, and they become less elastic. Small airways in the lung bases close earlier in expiration, so ventilation is less well matched to perfusion, lowering the PaO₂. As a result, older adults have less tolerance for exertion, and dyspnea can occur if their activity exceeds their normal exercise capacity.
What is the major risk factor to increased blood pressure and weaker pulses even in healthier older adults?
What is atherosclerosis?
What is the major bone related change related to aging? This is an important part of nutrition.
What is calcium?
Major bone-associated change related to aging is the loss of calcium (Table 3.2), which begins between ages 30 and 40. With each successive decade, the skeletal bones become thinner and relatively weaker.
This skin cancer is more deadly than other types.
What is melanoma?
A nurse is developing a fall prevention plan for a 76-year-old woman with osteoporosis. Which statement reflects the most important reason to prevent falls in this patient?
A) Falls may cause embarrassment and social isolation
B) Weakened bones may fracture before the fall occurs
C) Falls always result in hip fractures
D) Osteoporosis causes dizziness leading to falls
What are weakened bones may fracture before the fall occurs?
Commonly, weakening of the upper femur from osteoporosis causes the bone to break—and then the fall occurs. Osteoporosis results in significantly increased risk of fractures, which are possible during routine activities such as bending, lifting, coughing, and straining at stool. The characteristic low bone mass and deterioration of bone tissue make bones extremely fragile. Hip fractures are the most disabling type of fracture in older adults, and a significant percentage of patients with hip fracture die within 1 year after injury.
What are some teaching points a nurse can do to help with decreased taste and smell in the aging population?
What are good oral hygiene, better food preparation, and flavor enhancers are sometimes helpful in improving taste.
What is important to teach the elderly to help prevent getting sick? May name more than one.
What are these interventions? Teach avoidance of individuals with active infection. Teach careful handwashing and disposal of contaminated secretions. Encourage annual influenza vaccination.
What is the safest intervention as a nurse to instruct a patient to do prior to assisting them from lying in bed to walking to restroom?
What is sit on side of bed?
Hypotension is likely to occur while changing position; encourage patient to change positions slowly and to seek assistance if dizzy.
What is when the intervertebral disks shrink as the thoracic vertebrae slowly change with aging?
What is kyphosis?
The result is a condition called kyphosis, which gives the older adult a stooped or hunchback appearance, with the head dropping forward toward the chest. The combination of disk shrinkage and kyphosis results in loss of overall height. A person can lose as much as 2 inches of height by age 70. People who are concerned about their appearance find these changes disturbing because clothing no longer fits properly, and it becomes increasingly difficult to find flattering styles.
The viral infection that commonly seen in the elderly and weaken immune systems especially if not vaccinated. hint it is not influenza.
What is herpes zoster?
An 82-year-old patient demonstrates decreased muscle strength and takes smaller steps when walking. Which nursing intervention is most appropriate to reduce fall risk?
A) Encourage bed rest to prevent injury
B) Assess gait, balance, and mobility regularly
C) Restrict all physical activity
D) Provide a wheelchair for all mobility needs
What is to assess gait, balance, and mobility regularly?
Factors that increase fall risk include changes in gait, balance, and mobility; decreased muscle strength; and arthritis. Progressive loss of total bone mass results from decreased physical activity, hormonal changes, and bone resorption, resulting in weaker bones. Older adults often walk more slowly, take smaller steps, and appear less coordinated. Assessment of gait and mobility helps identify those at increased risk. Routine exercise and activity can help reduce the risk for falls. Immobilization increases physical dependence and accelerates functional losses.
What eye disorder usually starts with tunnel vision?
What is glaucoma?
What system other than respiratory contributes to decreased ability to take deep breaths or forcefully cough in the elderly?
What is the musculoskeletal system? Decreased muscle strength and endurance
What are some of the common problems related to aging? Disease processes.
What are
1. CAD
2. Valvular disease
3. Heart failure
4. Arrhythmias
Cardiomegaly
PVD
Hypertensive disease
What are some factors that lead to osteoporosis?
Female gender
• Caucasian or Asian race
• Small body frame
• Family history of osteoporosis
• Gastrointestinal disorders, such as celiac disease, inflammatory bowel disease, or weight-loss surgery
• Menopause (low estrogen levels)
• Lifestyle factors, including lack of exercise/immobility, excess alcohol consumption, cigarette smoking, deficient dietary calcium or vitamin D
• Endocrine or hormonal disorders, including diabetes, hyperthyroidism, hyperparathyroidism
• Long-term use of medications including phenytoin, heparin, aluminum-containing antacids, protein pump inhibitors, oral corticosteroids, and cancer chemotherapy drugs
All of these factors contribute to hypothermia in the aging population.
The function of sweat glands decreases; thus the amount of perspiration also decreases. This results in heat intolerance, because the body’s cooling system through evaporation is less efficient.
Decrease in subcutaneous tissue reduces the older adult’s ability to regulate body temperature. Very thin older adults lose the insulation provided by subcutaneous and adipose tissue. This loss of insulation is most likely to result in hypothermia if the person is exposed to an environment that is too cold