Geriatrics Final

How can we meet the need of hydration for our geriatric pts?

Providing fluids that the older adult enjoys to drink

What are examples of functional deficits that may contribute to weight loss and unmet nutritional needs in pts?

• Med interactions that disrupt appetite

• Severe arthritis that makes it difficult to lift pots and pans

• Mobility issues, such as difficulty ambulating, which interfere with shopping or meals

What are age related changes with nutrition?

• Decreased mobility

• Decreased saliva

• Decrease in digestive enzymes and nutrient absorption

• Decreased stomach elastacity

What can we do to help geriatric pts with eating the meals?

Provide more frequent smaller meals throughout the day for the geriatric pts

What is an age-related issue that contributes to constipation in older adults?

Reduced peristalsis, which slows down bowel movements and leads to constipation

How can we reduce constipation?

Encourage a high fiber diet and more fluids (preferably water)

What are common micro- nutrients that are lost in geriatric pts?

• Vitamin D

• Calcium

• Vitamin B12

What are warning signs of malnutrition?

• Economic hardship

• Tooth loss or mouth pain

• Reduced social contact

What are some labs that we can look at for malnutrition?

• Albumin

• Prealbumin

• Transferrin

• ***There is no single lab value that represents nutritional status

What is the difference between Cachexia and Sarcopenia?

• Cachexia → Happens at the end of life in cancer patient

• Sarcopenia → Happens with prolonged immobility

Why should you assess dysphagia in a stroke pt with aspiration pneumonia?

• Stroke can impair swallowing ability (dysphagia)

• Dysphagia increases the risk of aspiration, leading to aspiration pneumonia

What is xerostomia?

Unusual dryness of the mouth due to lack of saliva, must offer additional fluids

What key assessments are important for a pt with abdominal pain?

Onset, location, duration, intensity, quality

What are key interventions are important for a pt with abdominal pain?

• Provide comfort and pain relief

• Administer IV fluids if needed

• Use NG tube if indicated

• Monitor VS, I&O

• Watch for emesis and diarrhea

What is chronic gastritis?

Inflammation of stomach lining that may occur repeatedly or continue over period of time

What are possible causes of gastric gastritis?

Ulcers, hiatal hernias, vitamin deficiencies, chronic alcohol use, gastric mucosal atrophy, achlorhydria, and peptic ulceration

What are key management priorities for a patient with an ileus or intestinal obstruction?

• Maintain hydration

• Promote comfort

• Ensure bowel rest (NPO, possibly with NG tube)

Why is it important to assess endocrine function in geriatric pts showing changes in condition?

Endocrine disorders (like hypothyroidism) can mimic or contribute to depression in older adults

What labs would you need to assess endocrine function in geriatric pts?

• Thyroxine (T4)

• Thyroid-Stimulating Hormone (TSH)

How do hormonal changes with aging affect sexual response in older adults?

• Reduced sex hormones in both genders

• Leads to less rapid and less intense vascular responses during arousal

What factors can affect sexual function in older adults?

• Disease processes (HIV, DM, etc.)

• Surgeries affecting sexual organs

This would be a great opportunity to discuss sexuality concerns!

What are normal aging-related sexual changes that healthcare providers should recognize?

• Erectile dysfunction (ED)

• Menopause and vaginal dryness

• Absence of menstruation is normal in postmenopausal women

Why should nurses examine their personal beliefs regarding LGBT practices in older adults

• To ensure personal beliefs do not interfere with pt’s abilities to fulfill sexual needs

• Promotes respectful, nonjudgmental care for LGBT older adults

How does self-examination of bias help nurses provide better care to LGBT older adults?

• Helps nurses enter a therapeutic relationship w/o personal feeling interfering

• Encourages culturally competent and inclusive care

Why is pain a significant concern in older adults, especially those aged 85 and older?

Pain is a common experience in older adults. Adults 85+ are the fastest-growing age group in the U.S. Their pain must be recognized and addressed

What are the effects of persistent intense pain in older adults?

• Affects the mind, body, and spirit

• Impacts social interactions

• Can lead to disability and constipation.

Why is it important to manage pain in older adults proactively?

• Unmanaged pain worsens quality of life

• Leads to functional decline and complications like immobility and GI issues

Why is pain often poorly managed in patients with dementia?

Patients with dementia are often under-medicated. Their inability to verbalize pain can lead to under-assessment

What is the PAINAD scale and why is it useful?

• PAINAD stands for Pain Assessment in Advanced Dementia

• It is a valid and reliable tool developed by Warden, Hurley, and Volicer (2003)

• Helps assess pain in nonverbal patients with dementia

What factors influence pain intensity and distress in patients?

Culture, past pain experiences, individual traits, and pain threshold all play a role

What is a fracture?

A break or disruption in the continuity of the bone

How do fractures occur?

May occur due to trauma to the bone or joint. Could be as a result of pathologic processes such as osteoporosis or neoplasms that contribute to bone fragility

What are complications of hip fractures in older adults typically related to?

Immobility

How can a hip fracture be debilitating?

It puts the pt at greatest risk of functional decline

What causes gout?

Caused by excess uric acid production or decreased urinary excretion

How does gout commonly present?

Presents as sudden acute pain in one or more joints

What is the nursing goal during the acute phase of a gout attack?

Relieve pain and promote comfort

What lifestyle education should be provided to pts with gout?

• Avoid purine-rich foods (red meat, organ meats, seafood)

• Avoid alcohol

What are common foot problems in older adults?

Common problems:

• Hammertoes

• Bunions

• Corns

What are mobility goals in older adults?

Goals:

• Maintain function

• Provide education

• Manage pain

• Prevent injury

What are normal age-related changes for the heart?

• Left ventricular wall thickening

• HR decreases

• Size of left atrium decreases

• Aortic distensibility and Vascular tone decrease

What are some lifestyle changes to minimize cardiac issues in geriatric pts?

• Walking

• Cessation of smoking (5 A’s: Asking, advising, assessing, assisting, and arranging)

• Maintain healthy body weight

• Manage stress

• Reducing fat content

How do signs and symptoms of coronary artery disease (CAD) differ in the geriatric population?

• Atypical presentation due to neuropathy

• Often delayed reporting bc older adults may avoid seeking care

• Delayed care can lead to heart failure

What is the most common cause of death in the US?

Cardiovascular disease

What are non-modifiable risk factors for CAD?

Age and sex

What are modifiable risk factors for CAD?

Obesity and sedentary lifestyle

Which heart valves are most commonly affected by valvular disease?

Mitral and aortic valve

What conditions should be treated if present with valvular disease?

Heart failure and atrial fibrillation (a-fib)

Why are prophylactic antibiotics given before invasive procedures in patients with valvular disease?

To prevent infective endocarditis

What may be required if medical management of valvular disease is not sufficient?

Surgical repair or valve replacement

Why might symptoms of angina or myocardial infarction (MI) be atypical in geriatric pts?

Due to neuropathies and age-related changes in pain perception. Symptoms may be vague or non-specific

What does the acronym MONA stand for in the initial management of MI?

• Morphine

• Oxygen

• Nitroglycerin

• Aspirin

What are primary causes of hypertension?

Family, hx, age, race, diet, smoking, stress, alcohol, and drug consumption, lack of physical activity, and hormonal intake

What are secondary causes of hypertension?

Caused by underlying disease (Ex: Hyperthyroidism)

What is orthostatic hypotension a major risk for?

Syncope and falls

What is orthostatic hypotension?

Dizziness with position changes, results from decreased sensitivity of baro-preceptors

What education would a pt with orthostatic hypotension need?

Education on position changes

What types of meds are given for a-fib in geriatric pts?

Oral anticoagulants, used to reduce risk of thromboembolic events

What risk do anticoagulants bring?

Significantly increases the risk of harm (severe bleeding) in the event of a fall

What are key management goals for atrial fibrillation in the geriatric population?

• Control the underlying cause

• Slow the heart rate and/or restore normal sinus rhythm

• Prevent stroke (e.g., with anticoagulation therapy)

What are key nursing interventions for a patient experiencing syncope?

• Administer oxygen and monitor O2 saturation

• Identify underlying cause of the syncope episode

Why is it important to prevent constipation in pt with a hx of syncope?

Straining during bowel movements can trigger secondary syncope episodes

What causes symptoms in peripheral artery disease (PAD)?

Symptoms occur when arteries can't supply enough oxygenated blood to the tissues

What are common disorders associated with chronic venous insufficiency (CVI)?

• Varicose veins

• Venous ulceration

• Deep vein thrombosis (DVT)

What is a shared care priority for both PAD and CVI?

Impeccable foot care is essential to prevent complications

What is the leading cause of hospitalization in the older adult population?

Heart failure is the leading cause of hospitalization in older adults

What assessments are important in managing heart failure in geriatric patients?

• BP, apical pulse, heart rate, heart and lung sounds, and peripheral edema

• Monitor intake/output, daily weights, and electrolytes

What is the primary treatment for heart failure and what should nurses monitor?

• Diuretics are commonly used

• Monitor electrolytes, BMP (Basic Metabolic Panel), and vital signs (VS)

What nursing interventions are important for managing anemia in older adults?

• Instruct on proper diet and food selection

• Monitor for medication side effects

• Encourage balance between activity and rest

What additional assessments support anemia management in the geriatric population?

• Assess income to determine ability to buy nutritious food

• Test stool for occult blood to rule out GI bleeding

What are early signs of respiratory distress?

A change in mental status including subtle increases in forgetfulness and irritability

What are increased risk for respiratory infection?

Decreased immunoglobulin A (IgA) in nasal respiratory mucosal surface that neutralizes viruses

What is emphysema characterized by?

Progressive airflow limitation that is not fully reversible where lung tissue becomes abnormally inflamed

What are typical findings with emphysema?

Tripod position, with a barrel chest, and with retractions

What is chronic bronchitis characterized by?

Excessive mucous production with a chronic or recurrent cough on most days for a minimum of 3 months of the year for at least 2 consecutive years in a patient in whom other causes have been ruled out

What are typical findings with chronic bronchitis?

Persistent cough, dyspnea on exertion, purulent sputum, cyanosis, crackles on auscultation, tachycardia, pedal edema

What is sleep apnea?

Results in partial awakening with a startle response of snorts and gasps, which move tongue and soft palate and relieve obstruction

What affects can sleep apnea have?

Chronic affects on the cardiovascular system

What does a pt with sleep apnea require?

Nasal continuous positive airway pressure (CPAP)

What are the 7 warning signs of cancer?

• Change in bowel or bladder habits

• A sore that does not heal

• Unusual bleeding or discharge

• Thickening or lump in the breast or elsewhere

• Indigestion or difficulty swallowing

• Obvious change in a wart or mole

• Nagging cough or hoarseness

What are key nursing interventions when caring for a geriatric patient with cancer?

• Provide pain relief and emotional support

• Offer counseling and discuss treatment options

• Give factual information, education, and reassurance

How can nurses support patients and families dealing with cancer?

• Monitor vital signs (VS)

• Support decisions made by the patient and family with empathy and respect

What are key signs and behaviors that may indicate elder abuse?

• Visible signs of abuse (e.g., bruises, poor hygiene)

• Patient may appear fearful or hesitant to speak in front of a potential abuser

What is the nurse's legal responsibility if elder abuse is suspected?

Nurses are mandated reporters and must report any suspected abuse

Why are older adults more vulnerable to infections?

• Due to physiologic changes in the immune system

• Presence of underlying chronic diseases

Why is the acute care setting a high-risk environment for older adults?

It increases their risk of infection due to exposure to pathogens and weakened immune defenses

When can a facility transfer an older adult to a higher level of care?

When the facility cannot meet the resident’s medical or care needs, it has the right to transfer them elsewhere

How has COVID-19 impacted the geriatric population?

Due to immunosenescence (age-related decline in immune function), older adults are at higher risk for severe illness and complications

What is respite care?

Provides temporary relief for caregivers

Who is respite care for?

Designed for individuals who need a minimal level of assistance

What level of function do individuals in respite care typically have?

• Can perform most ADLs independently

• May need some assistance with certain tasks

What should nurses consider when caring for older adults with chronic disease during an acute episode?

• Assess the impact of the chronic condition on the current acute scenario

• Tailor interventions to address both chronic and acute needs

What are key nursing care goals for older adults with chronic diseases?

• Increase functional ability

• Prevent complications

• Promote quality of life

• Provide comfort and dignity at end of life

What is a key nursing role when managing chronic illness in older adults?

• Help patients achieve optimal physical and psycho-social health

• Ensure care goals align with the patient and family’s wishes

What is a common cause of caregiver role strain in those caring for older adults with cognitive decline?

Stress from cognitive changes in the patient, such as when the patient does not recognize family members or forgets past relationships

When an older adult’s functional status changes, what are common family roles in decision-making?

Families may help decide on living arrangements, social services, health care, and caregiving needs

What is the purpose of a general durable power of attorney in elder care?

It appoints an agent to make legal, financial, and sometimes healthcare decisions when the person can no longer do so

What legal planning question should nurses ask when assessing older adult care needs?

“Do you have an advance directive?" — to understand the patient’s healthcare wishes

What are key demographic facts about adults aged 85 and older?

• They are the fastest-growing age group in the U.S.

• Face increased risk for chronic diseases

• Often have decreased ability to perform ADLs

What financial challenges do adults aged 85+ commonly face?

• Lowest annual income among older adults

• About 10% live in poverty

• Social Security is their primary income source