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Topics 5, 6, 7, 8, 9, 10, 11, 12, 13, 15 Chapters 11 12, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 29, 33
Promoting gastrointestinal health (p.275)
plenty of fluid intake
especially after increased fiber intake
diet rich in fruits and vegetables
regular exercise
establish a regular time for bowel elimination
useful for older adults to attempt a bowel movement after breakfast
Dysphagia (p.279)
common causes: GERD, stroke, and structural disorders
follow the recommendations of speech-language therapist
soft diet and thickening of liquids are recommended to promote ease of swallowing
eat in an upright position and remain upright for 30 minutes after
ingest small bites in an unhurried manner
have easy access to suction in the event of choking
monitor food intake and weight
Selected GI Health Conditions (p. 282)
comfort measures
pain management
promoting nutrition
good fluid intake
diet rich in fruits and vegetables
physical activity
establishment of a regular time for bowel elimination
oral hygiene
infections of the oral cavity can lead to respiratory infections
listening to patient
talking with patient!
Nutritional Needs Older Adults (p. 151)
Most Common Nutrient Deficiencies in Older Adults:
Niacin
Riboflavin
Thiamine
Vitamins B6, C, and D
Misuse Effects of Vitamin Supplements:
Excessive Vitamin D can cause calcium deposits
Excessive Vitamin K can cause bleeding and prevent blood clotting
Folic acid can mask a vitamin B12 deficiency
Excessive calcium increases the chance of kidney stones
Excessive potassium may cause arrhythmias, cardiac arrest
Kidneys and Nutritional Supplements (p. 151)
Excess calcium consumption (i.e., more than 2,000 mg/d) can lead to problems such as kidney stones and an increased risk of cancer.
If calcium supplements are used, no more than 500 mg should be taken at any one time because larger amounts are not absorbed as well.
Constipation (p. 155)
Adequate amounts of fluids, vegetables, and physical activity can improve constipation
Senna is an effective natural laxative that can be consumed in tablet or tea form
Laxatives should only be considered AFTER other measures have proved unsuccessful
Sleep Promotion (p. 167)
reduce or limit caffeine and alcohol consumption
managing pain before bedtime
regular activity during the day to promote rest and relaxation
noise control
exposure to sunlight during the day can facilitate sleep at night
a warm bath at bedtime
consuming foods high in carbs or protein snacks (e.g., warm milk)
Pathophysiology Signs / Assessment Findings (p. 168)
Measures to Manage Stress
Respond to stress in a healthy manner
good nutrition, rest, exercise, and sound health practices strengthen the body’s ability to confront stress
Manage lifestyle
Relax
Pray
unrelieved chronic stress can lead to heart disease, hypertension, cerebrovascular accident, ulcers, and other health disorders
Common Sleep Pattern (p. 162)
older adults are more likely to fall asleep earlier in the evening and awaken earlier in the morning, a behavior referred to as phase advance
sleep latency and reduction in REM sleep are prevalent
Promote Restful Sleep (p. 165 - 166)
Regular exercise, exposure to sunlight during the day, and non-caffeinated herbal teas at bedtime
Environmental noise should be controlled
A protein and carbohydrate snack at bedtime may encourage sleep
Manage stress
Valerian root or herbal tincture consumed 45 minutes before bedtime can also facilitate sleep
Reduce blue light before bed
4 Stages of Sleep (p. 163 - 164)
Reductions in non–rapid eye movement stage sleep and rapid eye movement (REM) stage sleep begin to occur after midlife.
They have a decline in the proportion of time spent in the deeper stages III and IV sleep.
Older people sleep less soundly, shift in and out of stage I sleep to a greater degree than do younger adults, and spend more time in stages I and II sleep.
Communication with Patient on Sleep Patterns Associated with Aging (p. 165)
Older adults are more likely to fall asleep earlier in the evening and awaken earlier in the morning.
The quantity of sleep does not change, but the hours in which it occurs may. This change can prove frustrating for older adults who find themselves nodding off during evening activities and wide awake in the early morning hours when everyone else is asleep.
In addition, daytime naps may be needed to compensate for reductions in nighttime sleep.
Environment to Prevent Falls (p. 190, 193)
lighting → a small light should always be on
floor surface → should be clear of any towels, hair dryers, rugs, leaks, and other items
faucets → color-code the faucet
tubs and shower stalls → should have grab bars on the wall and safety rails on the side of the tub + a shower or bath seat
toilets → should have grab bars or support frames
Environmental Risks Associated with Sensory Deficit (p. 197)
Visual Deficit Interventions
approach individuals from the front rather than from the back or side
furniture and frequently used items should be arranged in full view
Hearing Deficit Interventions
individuals should live close to someone with adequate hearing who can alert them when fire alarms or other warnings are sounded
guide dogs
during the night, place the earpieces of a stethoscope into the impaired person’s ears and speaking into the bell or diaphragm
Interventions for Other Deficits (i.e., smelling)
use gas stoves
reduced tactile sensation to pressure from shoes, dentures, or unchanged positions can lead to skin breakdown, and the inability to differentiate between temperatures can cause burns
Nursing Problem Highlights of Risk of Hip Fracture in Hospitalized Patient (p. 194)
Contributing Factors
age-related health problems, weak or immobile state, sensory deficits, improperly fitted or used mobility aids, unsafe use of medications, unsafe environment, altered mood or cognitive function
Interventions
assess risk of injury
orient to new environments
encourage patients to wear prescribed eyeglasses, hearing aids, and prosthetic devices
ensure patients use canes, walkers, and wheelchairs properly
advise patients to change positions slowly, holding on to a stable object as they do
keep floors free from litter and clutter
provide good lighting in all areas
encourage patients to use handrails and grab bars
be sure patients wear well-fitted, low-heeled shoes, and robes and pants of an appropriate length
review home environment for safety risks
Assessment for Gait Abnormality (p. 323)
ataxia: unsteady, uncoordinated, feet raised high while stepping and then dropped flat on floor
foot slapping: wide based, feet raised while stepping and then slapped down against floor, no staggering or weaving
hemiplegic: unilateral foot drop and foot dragging, leg circumducted, arm flexed and held close to side
Parkinsonian: trunk leans forward, slight flexion of hip and knees, no arm swing while stepping, short and shuffling steps, starts slowly and then increases in speed
scissors: slow, short steps, legs crossed while stepping
spastic: uncoordinated, jerking gait; legs stiff; toes drag
Low Bone Density Interventions / Osteoporosis (p. 328)
avoid heavy lifting, jumping, and other activities that could result in a fracture
persons providing care for these patients must remember to be gentle when moving, exercising, or lifting them because fractures can occur easily
compression fractures of the vertebrae are a potential complication of osteoporosis
range-of-motion exercises and ambulation are important to maintain function and prevent greater damage
increase vitamin D, vitamin C, protein, and calcium intake.
physical therapists may be able to suggest appropriate exercises to promote strength and function
Onychomycosis (p. 330)
a fungal infection of the nail or nail bed in which the toenail appears enlarged, thick, brittle, and flaky
as the fungus forms under the nail and displaces it up, the sides of the nail are pushed into the skin and cause pain
antifungal preparations assist in eliminating the infection, but these infections are challenging to treat
Rights and Safe Medication Administration (p. 211)
right patient
right documentation
right medication
right route
right dose
right frequency
right time
right education
To ensure that oral medications achieve full benefit, encourage good oral hygiene, ample fluids, and proper positioning to facilitate swallowing.
older adults are at higher risk for adverse effects
older adults are at risk for circulatory overload during intravenous drug therapy
Food and Drug Interactions: Furosemide (Table 5-2 p. 206)
furosemide increases the excretion of calcium, magnesium, potassium, sodium, and zinc
Education of Home Care Patients - Anticoagulants
aspirin can increase the effects of oral anticoagulants (increase bleeding)
monitor PT/international normalization ratio (INR)
administer anticoagulants at the same time each day to maintain a constant blood level
observe for signs of bleeding; teach patients to observe for these signs
educate patients about the need to be careful about diet
a large intake of vitamin K–rich foods (asparagus, bacon, beef liver, cabbage, fish, cauliflower, and green leafy vegetables) can reduce the effectiveness of anticoagulants
mango and papaya can increase INR
high doses of vitamin E can increase bleeding risk
advise patients to refrain from taking herbal products until they have reviewed them with their health care provider.
keep vitamin K readily available as an antidote when patients are receiving anticoagulants
Be alert to interactions:
anticoagulants can increase the effects of oral hypoglycemic agents and phenytoin and decrease the effects of cyclosporine and phenytoin
the effects of anticoagulants can be increased by acetaminophen, allopurinol, alteplase, amprenavir, androgens, aspirin and some other NSAIDs, azithromycin, bismuth subsalicylate, some calcium channel blockers, capsaicin, broad-spectrum antibiotics, chlorpromazine, colchicine, ethacrynic acid, mineral oil, phenytoin, probenecid, reserpine, thyroxine, tolbutamide, and TCAs
the effects of anticoagulants can be decreased by antacids, antithyroid agents, barbiturates, carbamazepine, chlorpromazine, cholestyramine, estrogens, rifampin, thiazide diuretics, vitamin K, ginseng, St. John’s wort, and green tea
heparin’s effects can be partially reduced by digoxin, antihistamines, nicotine, and tetracyclines
Hypertension Diet Advice (p. 267)
Dietary Approaches to Stop Hypertension (DASH) diet
rich in n fruits, vegetables, whole grains, and low-fat dairy foods
Heart-healthy diets include…
high intake of nuts, fish, as well as fiber-rich whole grains
less than 1,500 mg of sodium per day
fruits and green vegetables that are rich in essential nutrients, including antioxidants
Low-sodium diet
Diet Interventions for Poor Appetite (p. 238)
small, frequent meals
Asthma Interventions (p. 237)
instruct the patient in breathing exercises
control symptoms (e.g., pain) that could threaten effective respirations
raise the head of bed at least 30 degrees
instruct the patient to turn, cough, and deep breathe at least once every 2 hours
monitor rate, depth, and rhythm of respirations
Bed Position for Shortness of Breath (p. 237)
raise the head of the bed at least 30 degrees when the patient is laying down
Abnormal Urinalysis Findings (p. 291)
Abnormal Urine Colors
dark colors can indicate increased urine concentration
red or rust color usually is associated with the presence of blood.
yellow-brown or green-brown color can be caused by an obstructed bile duct or jaundice
orange urine results from the presence of bile or the ingestion of phenazopyridine
very dark brown urine is associated with hematuria or carcinoma.
Abnormal Urine Odor
strong odor can indicate concentrated urine associated with dehydration
ammonia-like odor can accompany infections
Reproductive System Health - Females (p. 303)
vulvitis: itchy and inflamed vulva
vaginitis
soreness
pruritus (itching)
burning
reddened vagina
foul-smelling vaginal discharge that is either clear, brown, or white
breast cancer
incidence increases with age
older women are least likely to receive mammograms and breast examinations
vaginal cancer
cervical cancer
endometrium cancer
ovarian cancer
perineal herniation
dyspareunia: pain that occurs in the genital area before, during, or after sex
Medications Producing Nocturia (p. 289)
nocturia: frequent nighttime urination
long-acting diuretics (e.g., thiazides) may cause nocturia
Promoting Independence in Patient with Neurological Condition (p. 344)
encouraging the use of assistive devices
periodic home visits by a nurse, regular contact with a family member or friend, and a daily call from a local telephone reassurance program can help the patient feel confident and protected
continuing patience, reassurance, and encouragement are essential to maximize patients’ capacities for independence
Compensation for Visual Deficits (p.353)
face the person when speaking
use several soft indirect lights instead of a single glaring one
avoid glare from windows by using sheer curtains or stained windows
use large print reading material
place frequently used items within the visual field
avoid the use of low-tone colors and attempt to use bright ones
use contrasting colors on doorways and stairs and for changes in levels
identify personal belongings and differentiate the room and wheelchair with a unique design rather than by letters or numbers
Dangers Post-Cataract Surgery (p. 353)
a secondary membrane may form, requiring an additional procedure for discission of the membrane
eye infection
loss of vitreous humor
slipping of the implant
Normal Hearing Deficits in Older Adult (p. 358)
presbycusis: age-related hearing loss
encourage audiometric examination
physical, emotional, and social health can be seriously affected
Valid Reasons for Cosmetic Surgery in Elderly (p. 385)
some older adults want to have a more youthful look
nurses should also explore patients’ reasons for seeking cosmetic surgery to ensure that it is a rational decision rather than a symptom of an underlying problem, such as depression or a neurotic disorder
counseling and therapy may be a more pressing need than surgical intervention in some circumstances
Advice for Changes in Mole (p. 384)
think “ABCD”
A - asymmetry
if one half of the mole is not like the other, it could be a sign of melanoma
B - border irregularity
borders may be uneven, ragged, notched, or blurred
C - color
a mole that has changed color over time or is varied in a shade of brown, tan, and black may be cancerous
if melanoma has progressed, the mole may become red, blue, or white
D - diameter
cancerous moles may be more than 6 mm in diameter (or ¼ inch)
NOTE: Other mole variations that may indicate melanoma include elevation in height from the skin surface both horizontally or vertically; a change in feeling, such as itchiness, tenderness, or pain; and the tendency to bleed if scratched
Changes in Handwriting for Diabetic Person (p. 367)
Duputyren’s contracture is fixed flexion of the hands due to a thickening of the fibrous tissue under the skin of the palm and fingers, a risk for persons with diabetes mellitus
Signs of Cancer (p. 400)
think “CAUTION”
Change in bowel or bladder habits
A sore throat that does not heal
Unusual bleeding or drainage
Thickening or lump in the breast or elsewhere
Indigestion or swallowing difficulty
Obvious change in a wart or mole
Nagging persistent cough or hoarseness
Goals of Palliative Care (p. 440)
Palliative care focuses on helping patients effectively live in harmony with, rather than cure, the condition.
maintain or improve self-care capacity
manage the disease effectively
boost the body’s healing abilities
prevent complications
delay deterioration and decline
achieve the highest possible quality of life
die with comfort and dignity
Decline in Immune Response (p. 396)
the increased incidence of cancer with age could result from age-related changes that reduce the ability to resist the disease or prolonged exposure to carcinogens
What is the most important action to keep hospitalized patient free of infection? (p. 497)
good hand hygiene
promoting good hydration and nutritional status
monitoring vital signs, mental status, and general health status
maintaining intact skin and mucous membrane
avoiding immobility
ensuring pneumococcal and influenza vaccines have been administered (unless contraindicated)
maintaining a clean environment
restricting contact with persons who have infections or suspected infections
storing foods properly
preventing injuries
adhering to infection control practice
Note 
Flashcard (214)