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Module Four: Physiologic and Psychologic Changes Lecture Notes

Physiologic and Psychologic changes in the older adult are important t...
Course

Nursing Care of Older Adult (NUR 2214)

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Students shared 274 documents in this course
Academic year: 2022/2023
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Hailey Williams
Rasmussen University
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Module Three – Physiologic and Psychologic Changes

Integumentary  Skin is often the first sign of aging, or the most visible aspects of aging o Cherry angiomas – superficial small vascular lesions o Seborrheic keratosis – scaly tan, brown and black o Skin tags – stalk like appearance  Premalignant and malignant o Actinic keratosis – brown and scaly lesion o Basal cell carcinoma – most common skin malignancies o Squamous cell carcinoma – wart like lesion, often red and inflamed o Melanoma – irregular shape lesion, malignant skin cancer  Risk factors o Friction o Shear o Impaired sensory perception o Impaired physical mobility o Altered level of consciousness o Fecal and urinary incontinence o Malnutrition o Dehydration o Excessive body heat o Advanced age o Chronic medical conditions  Skin care o Use frequent position changes to relieve and redistribute pressure o Avoid friction and shear (life, don’t drag) o Reposition using the 30-degree titled side-lying position, or the prone position o When possible, avoid the 90-degree side-lying position or the semi recumbent position o Use pressure-relieving surfaces o Do not turn an individual onto a body surface that is already reddened from pressure o Do not use massage or rubbing for pressure ulcer prevention o Use emollients to hydrate dry skin o Protect skin from excessive moisture with barrier cream  What is the SKIN bundle? o S urface selection o K eep repositioning o I ncontinence management o N utritional support

Nurses Responsibilities  Interventions for a patient with decreased sensory perception

o Assess pressure points for signs of bed sore development o Provide pressure-redistribution surface  Interventions for a patient with incontinence o Assess need for incontinence management o Following each incontinence episode, clean area and dry thoroughly o Protect skin with moisture-barrier ointment  Interventions to avoid friction and shear o Reposition patient using draw sheet and lifting off surface o Use proper positioning technique o Avoid dragging the patient in bed o Use comfort devices appropriately  Interventions for a patient with decreased activity/mobility o Establish individualized turning schedule o Change position at least once in two hours and more frequently for the high-risk individuals  Interventions for a patient with poor nutrition o Provide adequate nutritional and fluid intake o Assist with intake as necessary o Consult dietitian for nutritional evaluation  Avoid sliding bedbound patients up without a support device or draw sheets to avoid friction and shear damaging the tissues

Vision Changes and Problems  Presbyopia – normal change of aging o Narrowing of visual field; decreased peripheral vision o Pupil less responsive to light o Potential for macular degeneration  Common eye disorders in the elderly that are NOT normal o Cataracts – a clouding of the lends of the eye, common with aging o Glaucoma – increased fluid pressure within the eye that may result in damage to the retina o Macular degeneration – loss of central vision, harder to see faces, drive, or do close-up work like cooking or fixing things around the house o Retinopathy  Blepharitis – a chronic inflammation of the eyelids, is one of the most common disorders of the eye  Diplopia, or double vision – result from disturbance of the nervous system and can cause syncope or falls  Nurses should access client’s level of vision and report immediately sudden vision loss as this could signify more serious eye problems

Hearing Changes and Problems  Hearing and balance alteration in older adult makes one prone to injury and falls  Older adults may experience hearing and balance problem due to the decreased tissue elastic and atrophy of vestibular structure, and structure in inner ear

 Hemorrhoids – inflamed veins in the rectum and anus that can cause severe pain and bleeding  The nurse should assess the client’s full health history and ask the client about normal intake and elimination patterns

Urinary Changes and Problems  Incontinence is not a normal part of aging  The kidneys play an important role in fluid and electrolyte balance, hormone and vitamin regulation and acid-base balance  Throughout the aging process the number of functioning nephrons are reduced, decreased perfusion of blood to the kidney  Benign prostatic hypertrophy (BPH) – increased size of prostate (male), occurs in about 50% of the men over the age of 65 o Prostate enlargement can lead to severe urinary retention, and many require pharmacological and surgical interventions to reduce the size of the prostate gland  Nocturnal enuresis o Incontinence that occurs during sleep o Limiting fluid intake after 6pm helps the client remain continent during the night o The total fluid intake for 24 hours should remain the same o The bladder should be emptied immediately before going to bed  Urinary incontinence – due to decreased muscle tone with aging, the urinary sphincter becomes weakened o Stress incontinence – associated with activity that causes a leakage of urine due to poor muscle tone in the urethral sphincter, and the pelvic floor muscles o Urge incontinence – strong and sudden urge to urinate because of the bladder squeezes or spasms and loses urine o Overflow incontinence – associated with a blockage such as prostate enlargement o Functional incontinence – associated with the urge to urinate however physical issues such as weakness or impaired mobility prevents the older adult from reaching the bathroom on time o Mixed incontinence – associated with both overactive and stress incontinence  The nurse should assess intake and output, daily weights, color and clarity of urine and lab work  Chronic renal failure may be a result of other chronic health conditions, such as hypertension and diabetes  With end stage renal failure, the client may require hemodialysis or peritoneal dialysis  The nurse should assess for signs of urinary tract infections  Older women are more likely to develop a UTI due to shorter urethras compared to men  Many older adults present with confusion or altered mental status with the presence of an infection, and some may present with dysuria, frequency, hesitancy, and odor in the urine  Older adults should be educated on proper hygiene, staying hydrated and emptying the bladder when one feels the urge

Musculoskeletal Changes and Problems  There are two principal effects of aging on bone tissue o Loss of bone mass

 Results from the loss of calcium from bone matrix  The loss of calcium from bones is one of the symptoms in osteoporosis o Brittleness  Results from a decreased rate of protein synthesis  Collagen fibers gives bone its tensile strength  The loss of tensile strength causes the bones to become very brittle and susceptible to fracture  Nurse’s responsibilities o Often experience musculoskeletal problems that lead to pain and mobility issues o Use assistive devices such as canes and walkers to support their ambulation o Fall prevention measures should be followed to ensure the safety of older adult client o The nurse should assess the client’s level of independence, their gait and balance, ambulation strength with physical mobility issues o Educate older clients on compliance of assistive devices and other measures to reduce falls and injuries o Often require sub-acute rehabilitation post-acute care hospitalization until they have regained their strength to return home safely if this applies o May require long-term care facility or assisted living facility due to musculoskeletal and mobility problems o Some of the common disorders that occur in older adults are osteoporosis, degenerative joint disease, osteoarthritis, rheumatoid arthritis, bursitis, and gouty arthritis o Dietary intake of calcium, phosphorus, and vitamins A, C, and D is important to keep long bones strong o Encourage physical activity to maintain bone health

Nervous System Changes and Problems  Strokes are common in the older adult client where there is impairment of blood flow to the brain tissue from a thrombus (or clot) o Transient ischemic attacks (TIAs) are brief episodes of cerebrovascular insufficiency o A cerebrovascular accident (CVA), commonly called a stroke, is a disturbance of the blood supply to the brain  Alzheimer’s disease is the most common form of dementia typically seen in individuals older than 60 years

Endocrine System Changes and Problems  Pancreas (glucose homeostasis) o Progressively deterioration in the number and function of beta cell, but no decline in insulin level o The average fasting glucose level rises 6 to 14 mg/dL for each 10 years after age 50 o Decrease glucose tolerance  Thyroid

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Module Four: Physiologic and Psychologic Changes Lecture Notes

Course: Nursing Care of Older Adult (NUR 2214)

274 Documents
Students shared 274 documents in this course

University: Rasmussen University

Was this document helpful?
Module Three – Physiologic and Psychologic Changes
Integumentary
Skin is often the first sign of aging, or the most visible aspects of aging
oCherry angiomas – superficial small vascular lesions
oSeborrheic keratosis – scaly tan, brown and black
oSkin tags – stalk like appearance
Premalignant and malignant
oActinic keratosis – brown and scaly lesion
oBasal cell carcinoma – most common skin malignancies
oSquamous cell carcinoma – wart like lesion, often red and inflamed
oMelanoma – irregular shape lesion, malignant skin cancer
Risk factors
oFriction
oShear
oImpaired sensory perception
oImpaired physical mobility
oAltered level of consciousness
oFecal and urinary incontinence
oMalnutrition
oDehydration
oExcessive body heat
oAdvanced age
oChronic medical conditions
Skin care
oUse frequent position changes to relieve and redistribute pressure
oAvoid friction and shear (life, don’t drag)
oReposition using the 30-degree titled side-lying position, or the prone position
oWhen possible, avoid the 90-degree side-lying position or the semi recumbent
position
oUse pressure-relieving surfaces
oDo not turn an individual onto a body surface that is already reddened from
pressure
oDo not use massage or rubbing for pressure ulcer prevention
oUse emollients to hydrate dry skin
oProtect skin from excessive moisture with barrier cream
What is the SKIN bundle?
oSurface selection
oKeep repositioning
oIncontinence management
oNutritional support
Nurses Responsibilities
Interventions for a patient with decreased sensory perception

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