Gero Exam 2 Study Guide (Spring 2026)

Impaired Sensation

Condition where a person has a decreased, absent, or altered ability to receive, process

Cataracts

Common, age-related clouding of the eye's natural lens that blocks light, causing blurry vision, faded colors, and glare

Tinnitus

Perception of sound in one or both ears or in the head when no external sound is present. It's often referred to as "ringing in the ears" but can manifest as buzzing, whistling, hissing, crickets, chirping, bells, pulsating, and swishing sounds. The sounds may be constant or intermittent and are more acutely at night or in quiet surroundings.

Presbycusis

Gradual, age-related, bilateral sensorineural hearing loss affecting high-pitched sounds, impacting 1 in 3 adults aged 65-74. Caused by inner ear hair cell damage, it leads to difficulty understanding speech in noisy environments.

Impacted Cerumen

Accumulation and hardening of earwax that blocks the ear canal, causing symptoms like earaches, temporary hearing loss, tinnitus, and a feeling of fullness.

Glaucoma

increased intraocular pressure results in damage to the retina and optic nerve with loss of vision

Macular Degeneration

A progressive eye disease and leading cause of vision loss in people over 60, damaging the macula to blur central vision. It has two main forms: common "dry" (gradual breakdown) and severe "wet" (leaking blood vessels).

Presbyopia

Age-related loss of near vision due to a stiffening lens

Risk Factors (Impaired Sensation)

- Diabetes → neuropathy

- Stroke → sensory deficits

- Parkinson's disease

- Dementia (affects processing, not just sensing)

- Sedatives

- Antihypertensives

- Opioids

- Polypharmacy

- Poor lighting

- Clutter

- Lack of assistive devices

- Malnutrition (vitamin deficiencies)

- Social isolation

- Immobility

- History of falls

Recognizing Impaired Sensation

Vision:

- Squinting

- Trouble reading

- Bumping into objects

Hearing:

- Asking people to repeat

- Turning TV volume up

- Withdrawing from conversations

Touch / Neuropathy:

- Numbness/tingling

- Burns or injuries unnoticed

- Poor balance

- General behavioral signs

- Confusion

- Agitation

- Withdrawal

- Increased falls

Nursing Interventions (Impaired Sensation)

Vision Support:

- Ensure good lighting

- Remove hazards (clutter, rugs)

- Provide glasses (clean + correct prescription)

- Use large print materials

Hearing Support:

- Speak slowly and clearly

- Face the patient (lip reading helps)

- Reduce background noise

- Check hearing aids (working, batteries)

Safety:

- Fall precautions

- Bed in low position

- Non-slip footwear

- Call light within reach

Sensory stimulation:

- Encourage social interaction

- Provide clocks/calendars (orientation)

- Use touch appropriately

Nutrition:

Monitor for decreased taste/smell → poor intake

Encourage balanced diet

Collaborative Interventions (Impaired Sensation)

- Audiologist → hearing aids

-Ophthalmologist/

Optometrist → vision correction, cataracts

- Physical therapy → balance training

- Occupational therapy → adaptive devices

- Dietitian → nutrition support

- Neurology (if disease-related)

Risk factors that affect hearing and vision health in an older adults

- Aging

- Family history

- Poor nutrition (vitamin deficiencies)

- Lack of routine screenings

- Long-term exposure to loud noise

- Poor lighting

- Smoking (↑ macular degeneration risk)

- Diabetes

- Hypertension

- Stroke

- Neurological disorders

- Chronic ear infections

Nursing Interventions (Promote Hearing and Vision Wellness for Older Adults)

Communication:

- Speak slowly, clearly, and in a low tone

- Face the patient (lip reading)

- Use short, simple sentences

- Do NOT shout

Environment:

- Reduce background noise (TV, hallway noise)

- Ensure quiet setting for communication

Assistive Devices:

- Check hearing aids

Environment:

- Increase lighting (especially at night)

- Use nightlights

- Reduce glare

Safety:

- Remove clutter, loose rugs

- Mark edges of stairs

- Keep frequently used items within reach

Assistive Support:

- Encourage use of glasses

- Clean lenses regularly

- Provide large-print materials

Coping

How a person manages stress, challenges, or difficult situations

Concept of Coping

- Adaptive (effective):

problem-solving, seeking support, acceptance

- Maladaptive (ineffective): denial, withdrawal, substance use, aggression

Loss

Absence of something valued (person, function, role, independence)

- Actual (death, amputation)

- Perceived (loss of independence)

- Anticipatory (expected death)

- Situational (retirement, illness)

Grief

Emotional response to loss

Risk Factors for Altered Coping

- Multiple losses (spouse, friends, independence)

- Chronic illness

- Cognitive decline (dementia)

- Social isolation

- Fixed income/financial stress

Psychological:

- History of depression/anxiety

- Poor coping skills

- Low self-esteem

Environmental:

- Lack of support system

- Institutionalization (nursing home)

- Major life transitions

SELYE'S Stress Response Theory

Alarm, Resistance, Exhaustion

Anticipatory grief

A period of mourning when the dying person or his family is expecting the death

Acute grief

The intense physical and emotional expression of grief occurring as the awareness increases of a loss of someone or something significant

Shadow grief

Moments of intermittent sadness and may be accompanied with temporary disruption of day-to-day function (healthy, restorative)

Complicated grief

Prolonged or significantly difficult time moving forward after a loss

Disenfranchised grief

Grief following the loss that is not openly acknowledged, socially, accepted, or poor understanding of the meaning of loss.

Hospice

Treats the person holistically, not the disease/ quality of life, interdisciplinary teamwork, cost-effective treatment

- Doctors referral

- 6 months or less

Palliative Care

Similar to Hospice care; taking care of the whole person holistically with the goal of giving patients with life-threatening illnesses the best quality of life they can have through the aggressive management of symptoms

- No strict criteria like Hospice

Maladapting Coping

- Withdrawal or isolation

- Denial of reality

- Anger or irritability

- Substance use

- Noncompliance with care

- Excessive dependence

- Depression

- Anxiety

- Hopelessness

- Sleep disturbances

Nursing Interventions (Coping)

Emotional Support:

- Encourage expression of feelings

- Use therapeutic communication

- Validate emotions ("That sounds really difficult")

Promote Adaptive Coping:

- Identify past successful coping strategies

- Encourage problem-solving

- Promote independence when possible

Cognitive Support:

- Reframe negative thoughts

- Provide clear, simple information

Stress Reduction:

- Relaxation techniques

- Routine and structure

Social Support:

- Encourage family involvement

- Promote group activities

Nursing Collaboration (Coping)

- Social worker → resources/support

- Psychologist/psychiatrist → therapy/meds

- Support groups (grief counseling)

- Spiritual care (chaplain)

Stages of Grief

- Denial

- Anger

- Bargaining

- Depression

- Acceptance

Nursing Interventions (Loss and Grief)

Emotional Support:

- Encourage storytelling/memories

- Active listening (don't interrupt or rush)

Allow Time:

- Do NOT rush grieving process

- Respect cultural practices

Support Systems:

- Facilitate family presence

- Recommend support groups

Monitor Mental Health:

- Depression/suicidal thoughts

- Refer as needed

Spiritual Care:

- Offer chaplain or religious support if desired

Nursing Collaboration (Grief and Loss)

- Social worker → resources

- Therapist → grief counseling

- Physician → medications if severe depression

Grief and Loss Care Plan

- Grieving

- Complicated grieving

- Ineffective coping

- Social isolation

Goals/Outcomes:

- Patient expresses feelings openly

- Demonstrates healthy coping strategies

- Engages with support system

Shows gradual acceptance of loss

Osteoporosis

A condition in which the body's bones become weak and break easily.

- Silent disease

- Mainly in white, older, and thin females

Osteoarthritis

inflammation of the bones and joints

Morse Fall Scale

Tool used to identify risk factors for falls in hospitalized patients

- Fall history

- Gait

- Mental status

- IV therapy

Osteopenia

Abnormal reduction of bone mass

Teaching Strategies (Mobility)

Home Safety:

- Loose rugs

- Clutter

- Poor lighting

Add safety:

- Grab bars (bathroom)

- Handrails on stairs

- Non-slip mats

- Nightlights

Mobility & Footwear:

- Wear non-slip, supportive shoes

- Avoid walking in socks

- Proper use of cane/walker

Medication Teaching:

- Identify fall-risk meds:

- Sedatives

- Opioids

- Antihypertensives

Teach:

- Change positions slowly (orthostatic hypotension)

- Speak clearly and slowly

- Repeat instructions

- Use demonstration + return demo

- Include caregivers/family

Lifestyle & Prevention:

- Exercise (strength + balance)

- Hydration

- Vision/hearing exams

Factors Contributing to Falls

- Muscle weakness

- Poor balance/gait

- Vision impairment

- Cognitive impairment (confusion, dementia)

- Chronic illness (stroke, Parkinson's)

- Orthostatic hypotension

- Polypharmacy

- Sedatives

- Antidepressants

- BP medications

- Poor lighting

- Slippery floors

- Clutter

- No assistive devices

National Needs Associated with the Aging Metabolism.

- Metabolism slows down

- Muscle mass decreases

- Body needs fewer calories

- Risk of fat gain increases

(Older adults need fewer calories but MORE nutrients)

National Needs (Malnutrition)

- Malnutrition in older adults (often missed)

- Obesity + malnutrition at the same time

- Dehydration in elderly

- Vitamin deficiencies (Vitamin D, B12, iron)

- Food insecurity in older adults

Malnutrition

Lack of proper nutrition

Strategies to Meet Nutritional Needs

- Small, frequent meals

- High-protein foods (eggs, fish, chicken, beans)

- Nutrient-dense foods (more nutrition, less volume)

- Soft foods if chewing is difficult

Hydration:

- Offer fluids often

- Don't wait for thirst (older adults don't feel thirst well)

Nursing Intervention (Age Related Changes Malnutrition)

- Monitor weight regularly

- Track food intake

- Assist with meals if needed

- Check for swallowing problems

Nursing Collaboration (Age Related Changes Malnutrition)

- Dietitian → meal planning

- Speech therapy → swallowing issues

- Social worker → food access programs

Clear Liquid Diet

Transparent liquids (water, broth, pulp-free juice, plain gelatin) that are easily digested, leaving minimal residue in the digestive tract

Full Liquid Diet

Liquids and foods that turn into liquid at room temperature, including milk, strained cream soups, and smoothies

Pureed Diet

Foods have been blenderized to liquid form; consistency based on client's needs, nectar or honey thick, can be long term

Mechanical Soft Diet

Foods that are soft, moist, and easy to chew, often chopped, ground, or blended to a texture requiring minimal chewing

Diabetic Diet

Balanced intake of protein, fats, and carbohydrates of about 1,800 calories

Perfusion

The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries.

Normal Age-Related Perfusion Changes

- Reduced overall cardiac output (about 1% per year)

- Lowered blood volume due to decreased body water

- Arteries become stiffer (arteriosclerosis), causing higher systolic blood pressure, while cerebral blood flow reduces, particularly reducing regional oxygen supply to the brain

Nursing Interventions (Impaired Perfusion)

Improve Circulation:

- Encourage frequent ambulation (as tolerated)

- Change position every 2 hours if immobile

- Avoid crossing legs (reduces blood flow)

Prevent orthostatic hypotension:

- Teach patient to rise slowly

Lying → sitting → standing

- Monitor BP sitting and standing

Promote oxygen delivery:

- Position in semi-Fowler's

- Monitor SpO₂ levels

- Give oxygen if ordered

Support heart function:

- Monitor HR, BP, edema, lung sounds

- Administer cardiac meds (antihypertensives, diuretics)

- Watch for heart failure signs

Protect tissues:

Check skin often (especially feet, heels, sacrum)

Keep extremities warm

Encourage hydration (if not restricted)

Patient education:

- Stop smoking (major perfusion risk)

- Heart-healthy diet (low sodium, low fat)

Report:

- Chest pain

- SOB

- Leg pain when walking

Normal Age-Related Changes (Oxygenation)

Lung changes:

- Lungs lose elasticity → harder to expand

- Alveoli decrease in number and function → less gas exchange

- Residual volume increases (air gets trapped)

- Vital capacity decreases

Chest wall changes:

- Chest becomes stiffer

- Weaker respiratory muscle

- Less chest expansion

Airway changes:

- Increased mucus production

- Cilia function decreases → harder to clear secretions

Gas exchange changes:

- Decreased oxygen exchange → lower O₂ levels

- Increased risk of hypoxia

Control of breathing:

- Reduced sensitivity to CO₂ and O₂ levels

- Slower response to low oxygen

Nursing Interventions (Oxygenation)

Positioning:

- High-Fowler's or semi-Fowler's

- Promotes lung expansion

Promote lung expansion:

- Encourage deep breathing exercises

- Incentive spirometer

- Encourage coughing to clear secretions

Increase Mobility:

- Early ambulation

- Turn/reposition every 2 hours if immobile

Maintain airway:

- Provide suctioning if needed

- Encourage fluid intake (if not restricted) to thin mucus

Oxygen therapy:

- Monitor SpO₂

- Administer oxygen as prescribed

- Watch for signs of hypoxia:

- Confusion (early sign in elderly!)

- Restlessness

- Cyanosis (late sign)

Prevent complications:

-Oral care (reduces pneumonia risk)

Vaccinations:

- Flu

- Pneumonia

Patient education:

- Stop smoking

- Avoid respiratory irritants

Report:

- SOB

- Cough

- Fever