Exam 3: Geriatric Care

• Slower processing

• Some difficulty recalling

• Short-term memory decline

• More time needed to learn new information

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Not expected:

• sudden confusion

• acute personality changes

• major functional decline

What are expected cognitive changes in older adults?

• ↓ cardiac output

• ↓ stroke volume

• ↑ peripheral resistance

What cardiovascular changes are expected in older adults?

• ↓ lung expansion

• ↓ elastic recoil

• ↓ cough effectiveness

What are expected respiratory changes in older adults?

• ↓ immune response

• Infection may present atypically

What are expected immune changes in older adults?

• ↓ total body water

• Increased dehydration risk

What are expected fluid changes in older adults?

• Reduced ability to regulate temperature

• Lower baseline temperature

What are expected thermoregulation changes in older adults?

Delirium:

• acute

• fluctuating

• poor attention

• reversible

• priority = find underlying cause

Dementia:

• progressive

• memory + cognitive impairment

• chronic / not reversible

• priorities = safety, functioning, support

Delirium vs Dementia

TRAP

Tremor
Rigidity
Akinesia/bradykinesia
Postural instability

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Common functional problems:

• Shuffling gait

• Falls

• Difficulty initiating movement

• Difficulty with ADLs

• Swallowing problems

What are the signs / symptoms of Parkinson’s Disease?

falls + mobility + ADLs + swallowing/nutrition

What are the nursing priorities for Parkinson’s?

Alzheimer’s Disease

(memory → judgment → ADLs → communication → dependence)

________ is a progressive neurodegenerative disease that causes memory impairment, cognitive decline, and functional decline.

• safety

• routine

• familiar environment

• simple communication

• support caregivers

• maintain independence as long / as much as possible

Nursing priorities for Alzheimer’s Disease…

• adequate fluid intake

• fiber

• physical activity

What are the nursing interventions for constipation?

• mobility

• ADLs

• Pain

• Joint function

• Independence

Arthritis may effect…

• Pain management

• Maintain mobility / function

• Promote independence

• Prevent complications from immobility

• Use assistive devices properly

Nursing goals for arthritis?

fractures

Osteoporosis increases the risk of ________.

• weight-bearing exercises

• adequate calcium and vitamin D

• fall precautions

• medication adherence when prescribed

What are some nursing interventions for osteoporosis?

Macular Degeneration

________ is characterized by the loss or distortion of central vision.

Safety + Adaptation:

• improve lighting

• reduce environmental hazards

• use prescribed visual aids

• keep frequently used items close by or in consistent locations

What are the nursing considerations for macular degeneration?

higher-pitched sounds

Age-related hearing loss is commonly characterized by difficulty hearing ________.

• Face the patient

• Speak clearly

• Use a normal/lower-pitched voice rather than shouting

• Reduce background noise

• Make sure the patient has their hearing aid if prescribed

• Confirm understanding

What are some nursing interventions for improving communication with a patient who has a hearing impairment?

• Acute confusion

• Functional decline

• Change in behavior

• Weakness

What are the s/s of a UTI in older adults?

• Hematuria

• Proteinuria

• Edema

• HTN

• Changes in urinary output

What are the S/S of glomerulonephritis?

• BP control

• Urine characteristics

• Urine output

• Edema

• Fluid status

• Renal labs

What are the nursing priorities for glomerulonephritis?

• dizziness

• weakness

• falls

• syncope

• reduced tissue perfusion

What are the s/s of hypotension?

• fall precautions

• return to safe position

• let patient sit for a moment before rising

• assess BP and orthostatic changes

• investigate contributing factors (meds, dehydration, etc)

Hypotension nursing considerations…

Orthostatic: decrease in sys BP of 20+ after rising and standing

Postprandial: decrease in sys BP of 20+ within 1 hour of eating

Orthostatic vs Postprandial Hypotension

Hyperlipidemia

________ = elevated levels of lipids in the blood, particularly cholesterol and/or triglycerides.

• Atherosclerosis

• CVD

• Stroke

Hyperlipidemia increases the risks of ________.

• heart healthy diet

• physical activity as tolerated

• weight management

• medication adherence (statins)

• lipid level monitoring

Nursing considerations for hyperlipidemia?

Asymmetry (one half does not match the other half)
Border (irregular, uneven, poorly defined)
Color (multiple or uneven colors)
Diameter (larger = more concerning; >6mm)

What is the ABCD acronym for identifying signs of malignant skin lesions?

Stage 1:

• Skin intact

• Persistent redness

• Non-blanchable

Stage 2:

• Partial thickness

• Shallow opening

• Affects top layers skin

Stage 3:

• Full thickness

• SUBQ tissue

• Deeper opening that may or may not include tunneling

Stage 4:

• Full thickness

• Muscle and bone

• Deep opening w/ necrotic tissue

• Tunneling

Unstageable:

• Full thickness

• Base covered in slough and eschar

What are the different between the stages of pressure injuries?

• Avoid age-related stereotypes

• Respect privacy

• Provide nonjudgmental care

• Assess sexual concerns when relevant

• Recognize that physical changes may affect sexual function

• Remember that sexuality is not eliminated by aging

Older adults can and do remain sexually active.

Therefore, the nurse should…

C. The patient is likely experiencing delirium and requires assessment for an underlying cause.

A hospitalized 79-year-old was alert and oriented yesterday. Today, the nurse notices that the patient is suddenly disoriented, unable to maintain attention during conversation, and alternates between agitation and lethargy. The patient's daughter says, "This isn't like my father at all."

What is the nurse's priority interpretation?

A. The patient is demonstrating normal cognitive aging.

B. The patient is most likely experiencing dementia.

C. The patient is likely experiencing delirium and requires assessment for an underlying cause.

D. The patient is experiencing normal changes associated with Alzheimer's disease.

B. The findings suggest fluid retention and possible worsening heart failure.

An 82-year-old with a history of heart failure reports that they have gained 4 lb in three days. The nurse notes bilateral lower-extremity edema and increasing shortness of breath.

What is the nurse's interpretation?

A. The weight gain is an expected consequence of normal aging.

B. The findings suggest fluid retention and possible worsening heart failure.

C. The patient is experiencing normal age-related peripheral edema.

D. The findings indicate dehydration.

B. "There are several possible causes of incontinence, so we should assess your symptoms further."

An 80-year-old tells the nurse, "I've started leaking urine, but I thought that's just something that happens when you get old."

Which response by the nurse is best?

A. "Yes, urinary incontinence is an expected part of normal aging."

B. "There are several possible causes of incontinence, so we should assess your symptoms further."

C. "You should limit your fluid intake to prevent additional leakage."

D. "You should begin wearing absorbent briefs permanently."

B. The patient is experiencing a pattern consistent with loss of central vision.

An older adult with macular degeneration tells the nurse, "I can see things around me, but I have trouble reading the words on my medication bottles and recognizing people's faces."

How should the nurse interpret this finding?

A. The patient is primarily experiencing loss of peripheral vision.

B. The patient is experiencing a pattern consistent with loss of central vision.

C. The patient is experiencing a normal age-related hearing deficit.

D. The patient is experiencing delirium.

B. Face the patient and speak clearly while reducing background noise.

The nurse is communicating with an older adult who has a hearing deficit. Which intervention is most appropriate?

A. Shout directly into the patient's ear.

B. Face the patient and speak clearly while reducing background noise.

C. Speak rapidly so the patient has less time to lose concentration.

D. Speak only to the patient's family member to ensure the information is understood.

C. The patient may have a UTI contributing to acute delirium and requires further assessment.

An 84-year-old who is normally alert and oriented suddenly becomes confused and disoriented. The patient's temperature is slightly elevated, and the nurse notes that the urine is cloudy and has a strong odor.

What should the nurse recognize?

A. The confusion is an expected age-related change.

B. The patient is definitely developing Alzheimer's disease.

C. The patient may have a UTI contributing to acute delirium and requires further assessment.

D. The patient should be placed on a cognitive stimulation program.

C. Decreased urine output

An older adult with glomerulonephritis develops dark, tea-colored urine, periorbital edema, and elevated blood pressure, and he has a urinary output of 15 mL/hr.

Which finding is most concerning as evidence of impaired renal function?

A. Tea-colored urine

B. Mild periorbital edema

C. Decreased urine output

D. The patient's report of increased thirst

B. Assist the patient to sit or lie down safely.

An older adult reports feeling lightheaded when getting out of bed. The nurse observes the patient becoming unsteady after standing.

What should the nurse do first?

A. Encourage the patient to continue walking to improve tolerance.

B. Assist the patient to sit or lie down safely.

C. Give the patient's prescribed antihypertensive medication.

D. Encourage the patient to drink coffee.

B. "High lipid levels can contribute to atherosclerosis and increase your risk for cardiovascular disease."

An older adult with hyperlipidemia asks the nurse why treatment is necessary because they "feel perfectly healthy."

Which response is best?

A. "Hyperlipidemia usually causes obvious symptoms, so you would know if it were becoming dangerous."

B. "High lipid levels can contribute to atherosclerosis and increase your risk for cardiovascular disease."

C. "High cholesterol is an expected part of normal aging."

D. "Treatment is only necessary if you develop chest pain."

B. Encourage appropriate activity while using pain-management strategies to maintain function.

An older adult with arthritis reports that joint pain has caused them to stop participating in most daily activities. Which nursing intervention is most appropriate?

A. Encourage complete bed rest until the pain resolves.

B. Encourage appropriate activity while using pain-management strategies to maintain function.

C. Tell the patient that decreased mobility is an unavoidable consequence of aging.

D. Encourage the patient to avoid using assistive devices because they promote dependence.

D. A lesion that has an irregular border, multiple colors, and asymmetry

The nurse assesses four pigmented lesions on an older adult. Which finding is most concerning for possible skin cancer?

A. A small lesion that is symmetrical with an even border and uniform color

B. A uniformly colored lesion with a smooth, regular border

C. A lesion that has remained unchanged for many years

D. A lesion that has an irregular border, multiple colors, and asymmetry

A. Stage 1 pressure injury

The nurse assesses an older adult who has been immobile in bed. The patient's sacral skin is intact but persistently red and does not blanch when pressure is applied.

How should the nurse interpret this finding?

A. Stage 1 pressure injury

B. Stage 2 pressure injury

C. Stage 3 pressure injury

D. Normal skin changes associated with aging

B. Shuffling gait

C. Mask-like facial expressions

D. Bradykinesia

Which of the following are associated with Parkinson’s disease? (SATA)

A. Hyperactive reflexes

B. Shuffling gait

C. Mask-like facial expressions

D. Bradykinesia

E. Flaccid extremities

A. New confusion

C. New incontinence

D. Nausea

E. Anorexia

An older adult with a UTI may present with which atypical findings? (SATA)\

A. New confusion

C. New incontinence

D. Nausea

E. Anorexia

A. Risk for impaired nutrition

An older adult reports eating less because their dentures are painful and they have difficulty chewing. What is the nurse's priority concern?

A. Risk for impaired nutrition

B. Normal age-related appetite changes requiring no intervention

C. Increased risk for hypertension

D. Increased resting energy expenditure

B. "Sexuality is a normal aspect of life at any age. We can discuss any concerns or health factors that may affect sexual activity."

An 76-year-old patient asks the nurse whether sexual activity is still safe at their age. Which response is best?

A. "Sexual activity is generally no longer appropriate in older adults."

B. "Sexuality is a normal aspect of life at any age. We can discuss any concerns or health factors that may affect sexual activity."

C. "You should ask your family before continuing sexual activity."

D. "Sexual activity should be avoided because aging increases the risk of complications."