what does YN stand for?
True or False
Sleep changes like sleep apnea, light sleepers and insomnia are common in the older adult
False
Insomnia is not!
sleep apnea and light sleepers are true!
- poor sleep further increases risk of falling and changes mental status
What kind of changes to smell happen in the elderly?
decrease in olfactory bulb/nasal lining
* decreases their enjoyment of foods
- affects men more
What kind of taste changes happen in the elderly?
is it faster for females or males?
decrease papillae (taste buds)
faster in females
When considering the sense of touch in the elderly, what other factor besides age should we consider?
determine if its age related or disease induced ex. neuropathy in diabetes and scleroderma
____ is the decrease in near vision in older adults?
Presbyopia!
What is entropion and what is ectropion as it refers to vision?
Entropion: eyelid turns inward
Ectropion: eyelid turns outward
Since elderly changes include sensory changes, why is it important to monitor their nutrition?
decrease smell and taste will decrease their enjoyment of food and increase crave for salt/sugary foods
So we need to make sure they are not eating excess salt/sugar and that they are still eating enough food in general
When it comes to feet ;) and the elderly, there may be inflammation and altered foot integrity, what assessments as nurses should we conduct?
assess gait, good shoes?, inspect feet, inspect circulation, sensation?
What are cataracts?
What would a glare look like?
If someone were to get corrective surgery for their cataract, why would they want to avoid bending down/heavy lifting?
Cataracts are opaque, cloudy lens
Glares look like halos
To avoid increased ocular pressure post-op! they would also want to avoid infection with dressing changes and wear an eye shield for 1 week
Galcomas have 2 types, what are they and which one is considered a medical emergency?
What elderly changes happen that leave them susceptible to glaucomas?
Primary open angle -> progressive loss of vision -> most common
Acute angle closure -> obstruction of aqueous humor by infx or trauma which increases IOP rapidly
*avoid anticholinergic eye drops
Fluid chambers in elderly shrink -> increasing their IOP, leaving them susceptible to optic damage
What would be the cues to look for that indicate vision problems in the elderly?
pain (eye), hard to see in the dark, double/blurry vision, flashes of light, headache, falls, hard to drive at night
____ is a catergory of vision impairment that affects the peripheral vision fields vs ____ is a category of vision impairment that affects central vision?
Glaucoma -> peripheral vision
ARMD (age related macular degeneration) -> central vision
What is the #1 med management for Glaucomas?
Patients 60 y/o and older should get what kind of eye exam and how often?
Beta blockers (Timolol) to decrease aqueous humor production
- cholinergics also increase the outflow of AH
Comprehensive dilated eye exam every year
Hearing decline can cause decrease self esteem, depression and safety concerns, sometimes misdiagnosing elderly people with dementia.
What is sensorineural type of hearing loss and describe it's 2 categories?
What is the appropriate tone in which to speak to an elderly person?
Sensorineural is damage to the inner ear or neural pathways
1. Presbycusis is hearing loss by old age! difficulty hearing high pitch -> speak in low tone and face to face
2. Noise induced is hearing loss by exposure to loud noise long term -> injures sensory hairs or cochlea
*other category is conductive -> cerumen, infx, fluid
What is a standard drink size?
What is the heavy drinking guideline for men and women?
standard drink: 6 oz or 14 g of pure alcohol
Men: 5 drinks/day or >15 per week
Women: 4 drinks/day or >8 per week
binging is this amount in 2 hours -> so me
For hearing loss treatment, cochlear implants directly stimulate auditory nerve, what are 2 important pieces of information a client should know about these implants?
Avoid MRI's
Implants destroy all residual hearing
- other treatments are hearing aids, service dogs, closed captions
CV changes in an older adult will decrease CO, increase PVR, and increase BP to compensate. rigid valves and turbulent blood flow will contribute to what finding in the patient?
What would be an abnormal finding in the CV of an elderly patient?
Mild systolic murmur is an expected harmless finding
Diastolic murmur is abnormal and indicated backflow/regurgitation
- for cardiac we also want to assess diet, pace activities and use meds
How would we assess for orthostatic hypotension in our elderly patient?
check BP laying down, sitting and standing , wait 1-3 min between each BP -> if it decreases by 20 or more each time, the patient has orthostatic hypotension
* can be a result of anti-hypertensive meds
Is it common for the elderly to present with fevers early when they have an infection?
most adults with an infection will NOT have a fever -> a temp of 98.6 may indicate a fever
* monitor temp and baseline because even 1 degree change can be significant
Age related macular degeneration is the #1 cause of vision loss, what are the 2 types of ARMD?
What is the screening tool for ARMD?
What is the treatment for the more rare ARMD?
Dry ARMD : breakdown layers in retina (90% of cases) can progress to wet ARMD
Wet ARMD : abnormal blood vessels that leak -> can lead to blindness in 2 years
- Amsler grid -> w/ARMD, the center will appear wavy -> educate on safety like driving
- wet ARMD treatment : anti-vascular endothelial growth factor (VEGF) drugs which blocks blood vessel growth
What is geriatric friendly alcohol screening tool?
What generation of people are more likely to increase illicit drug use (heroin, cocaine)as elderly people?
Why are elderly people often unrecognized as alcoholics? and why don't they seek help?
Short michigan alcohol screening test
Baby Boomers due to exposure in youth/culture
Due to the stigma or ageism, people believe signs of alcoholism in older adults are due to aging process and the elderly are too ashamed or embarrassed to seek help or tell others
Due to musculoskeletal changes (starting after 30) in the elderly, how would they look?
decrease in bone density increases risk of what? and is it more common in women or men?
What are interventions for musculoskeletal? What is the screening tool?
thin/shorten vertebral disk = height loss and a postural hunch aka kyphosis
risk of fractures -> 4x more common in women due to menopause
*excessive loss of bone density leads to osteoporosis
Screening -> DEXA
Intervention -> weight bearing exercise, calcium, vitamin D, fall prevention
Why would elderly patients be at risk of infection and fall risks regarding the renal urinary system?
Who is at even more increased risk of these problems specifically infection?
Interventions for these patients?
incomplete emptying of urine/retention can lead to infection and weakened muscle/capacity can lead to elderly having to get up more frequently (in middle of the night, it's dark/half asleep) or urgently causing a fall risk
- elderly also have decreased renal flow/filtration and are at risk for dehydration
Males with benign prostatic hyperplasia are more at risk because of the increase pressure leading to more retention because it's harder to urinate
prevent UTI's, hydration, *avoid caffeine late in day, female:pelvic floor exercises
What respiratory changes are in older adults. ex. deacrease gas exchange
What education/interventions for respiratory?
decrease vital capacity (lungs shrink), increase residual volume, cilia are less responsive, diminished cough reflex and lower immune response
- higher risk w/limited mobility of stroke, atelectasis
- smoking cessation, raise head of bed (aspiration precautions), increase fluids, use incentive spirometer, get flu/pneumococcal vaccine