care of the older adult exam 1

target demographic for herbal supplement education

• older adults 

• especially ones with chronic conditions or multipule meds

side effects of ginkgo biloba

• bleeding risk (antiplatelet effect) 

• GI upset 

• headache 

• dizziness

why ask about herbs/supplements 

to identify potential drug herb interactions and adverse affects

priority when discussing herbal supplements

• ensure safety

• assess for interactions/contraindications before use

contraindications for echinacea

• autoimmune disorders

• immunosuppresant theryapy

• allergy to ragweed family

most common visual change with aging

presbyoipa ( loss of near vision/accommodation)

true eye emergencies 

• retinal detatchment 

• acute angle closure glaucoma

• ocular truamam

• chemical burns  

most common cause of cataracts

• aging (lens protien changes);

• UV exposure

• diabetes

• steroids

most common cataract treatment

surgical removal of lns with intraocular lens impantation

best practices communicating with older adults 

• speak slowly

• clearly 

• face the person 

• minimize background noise 

• allow extra time 

most common type of hearing loss in older adults 

presbycusis (sensorineural, high frequency loss

most common malignant skin cancer

basel cell carcinoma

number one treakment of pressure ulcers

• prevention/pressure relief

• frequent reposistioning

• support surfaces

assess/manage age-related eye disease

• routine eye exams

• assess visual acuity

• fundus exams 

• provide adaptive devices and education 

risk factors for retinal detachment

• aging

• severe myopia

• truama

• previous eye surgery

• family history

findings indicating vision problems 

• squinting 

• difficulty reading 

• bumping into objects 

• halos 

• floaters 

• blurred vision 

common cause of hearing interference in older adult

impacted cerumen (earwax)

hearing aid care

• keep dry

• clean earmold with mild soap

• remove battery at night

• store safely

contributors to low hearing aid use 

• poor fit 

• background noise amplification 

• stigma 

• cost 

• lack of instruction 

assessments to do if hearing loss worsens

• audiometry

• otoscopic exam

• med review

• refferal to audiologist

causes of glaucoma

• increased intraocular pressure from impaired aqueous humor drainage

• age

• genetics

what is presbyopia

age related loss of lens elasticity causing a difficulty to focus on near objects

s/s of cataracts 

• cloudy/blurry vision 

• glare/halos

• faded colors 

• difficulty driving at night 

teaching for newly diagnosed PVD

• foot care

• no smoking

• regular walking

• manage BP/lipids

• avoid crossing legs

• inspect skin

arterial ulcers 

• small 

• deep 

• “punched out” 

• painful 

• on toes/feet 

venous ulcer

• shallow

• irregular

• less painful

• ankle/lower leg

• edema

s/s of myocardial infarction in older adult

• dyspnea

• fatiuge

• confusion

• syncope

• GI symptoms

• less chest pain

life style changes for HTN education 

• low sodium DASH diet

• weight loss 

• exercise 

• limit alcohol 

• stop smoking 

potential complications of atrial fibrillation

• stroke embolism

• heart failure

teaching plan for anticoagulation

• take as perscribes

• regular INR (warfarin)

• watch for bleeding

• consistent diet

• med aler bracelet

first diagnostic test to rule out stroke 

non-contrast CT of the head

eucational material concerning fire saftey in the home

• smoke alarms

• plan escape routs

• no space heaters near flammables

• safe cooking

priority outcome for alzheimers client support group

enhanced socialization and coping skills to reduce isolation

A 79-year-old client resides independently in the community. The visiting home health nurse finds that despite it being 90° F outside, the windows are closed and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to

age related decreased thermoregulation/perception of heat ( 75 years )

primary rational for disaster preparedness teaching

• older adults more vulnerable

• slower to evacuate

• may have sensory/cognitive limits

NORCs are

• naturally occuring retirement communites

• neighborhoods with high concentrationof older adults who age in place

burn prevention for seinors 

• lower water heater temps 

• safe cooking 

• avoid loose clothing 

• smoke alarms 

• test bath water 

fraud precautions for older adults

• do not share personal info

• verify charities

• shred sensitive papers

• beware of phone scams

• internet checks

• “irs or police are never going to call you”

benefits of telehealth

• increased access

• less travel

• more frequent monitoring

• caregiver involvement

preventing hypothermia in long term care

• maintain warm room temp

• layered clothing/blankets

• monitor temp often

driving cessation strategies 

• gradual restriciton 

• involve family 

• provide alternative transport recources 

• supportive counseling 

estimated percent of intitutionalized older adult unable to eat independently

roughluy 50%

age related GI changes

• slower motility

• reduced gastric acid

• decreased liver size

• weaker swallowing muscles

changes affecting hydration

• blunted thrist sensation

• reduced kidney concentration ability

• decreased total body water

hypothermia defined

core temp less than 95f (35c)

heat exhaustion

• mildly elevated core temp

• cool/clammy

• altered mental status

• thirst

nutritional screening tool (65<) 

mini nurtitional assessment (MNA)

primary purpose of nutritional screening

identify risks of malnutrition early to intervene

age related changes affecting nutrition

• decrease in smell/taste

• dental problems

• slower gastric emptying

• decreased appetite

age realted chagned affecting fluid intake 

• decreased thirst 

• mobility limits 

• fear of incontinence 

• impaired swallowing 

common age realted changes affecting hydration

• reduced renal concentration ability

• decreased total body water

• decreased thirst

oral care for older adults

• brush/floss if possible

• clean tounge

• moisten mouth

• regular dental check-ups

dentrue care 

• remove at night 

• clean daily with mild soap/denture cleanser 

• store in water 

• check fit 

s/s of dehydration in elderly

• confusion

• dry mucous membranes

• poor skin turgor

• tachycardia

• hypotension

• dark urine

recomended dialy water intake (healthy older adult)

about 1.5-2 L/day

elevated ESR(erythrocyte sedimentation rate) in older adult can indicate 

• inflammation

• infection 

• autoimmune disease 

• malignacy 

most common cause of confusion in older adult (labs to check)

urinary tract infection (check urinalysis and culture)