Week 1 Med Surg Aging and Nursing Process

Where/with who do most older adults live?

Majority live with a spouse. Then smaller majority live alone, with other family, retirement communities, and institutional settings (assisted-living facilities and long-term care facilities)

What is aging?

• Aging is normal developmental event and refers to the process of “accuring maturity with the passage of time”

• Begins with conception, continues throughout life until death

• Aging is progressive, ubiquitous, and inevitable to all living things

What is normal aging?

• Normal deteriorative processes that all human beings will experience if they live long enough

  • Ex: decreased bone mass, presbycusis (gradual hearing loss that happens as you age), psychological gains (wisdom)

What are chronic illnesses that older adults have? Do most older adults have chronic illnesses or even multiple?

• most people over 65 yrs have at least 1 chronic illness. Some have multiple (comorbidities)

• hypertension

• stroke

• arthritis

• heart disease

• cancer

• alzheimer’s

• diabetes

• vision impairment

• hearing impairment

• osteoporosis

• Parkinson’s

• bowel-bladder problems

• Depression

What are the three theories of aging?

1. Wear-and-tear theory

2. Rate-of-living theory

3. Free radical theory

What’s the wear-and-tear theory?

Aging is inevitable as cells, tissues, and organs wear out from continued use.

What’s the rate-of-living theory?

Attributes variation in life span to varying metabolic rates per gram of metabolizing tissue across species.

Different species live longer or shorter lives because their cells “burn energy” at different speeds for each gram of tissue.

Put another way: if each gram of an animal’s body uses energy very quickly (high metabolic rate), that species tends to have a shorter lifespan; if each gram uses energy more slowly (low metabolic rate), that species tends to live longer.

Ex: bigger dogs live shorter lives. Smaller dogs live longer lives.

What’s the free radical theory?

Attributes cellular aging to free radicals.

Cardiovascular changes

• CVD: leading cause of death

• Atherosclerosis

  • Development of fatty plaques and proliferation of connective tissue in arterial walls

  • Heart ends up needing more time to do basic functions and has a harder time regulating BP

(arteriosclerosis different from atherosclerosis. Arteriosclerosis is calcification of our vessels that happens as we age. But can be sped up by smoking)

Complications of atherosclerosis

• HTN, MI, stroke, kidney disease, claudication, deep vein thrombosis, ulcerations of the skin

RF of atherosclerosis

• RF: older age, genetics, HTN, DM, high blood cholesterol level (mostly LDL hypercholesterolemia), smoking, obesity, poor physical fitness, type A personality (stress)

Respiratory changes

• Lung tissue changes as we age, and the rib cage stiffens. Chest expands less, lungs less stretchy, intercostal muscles weak

• Older adults experience SOB faster during exercise

• May lower one’s tolerance for exercise

Common respiratory health problems

• COPD (emphysema AND chronic bronchitis together)

• Pneumonia

• Lung cancer

COPD and lung cancer are PRIMARILY caused by cigarette smoking.

GI changes

• teeth become discolored and worn

• xerostomia (dry mouth)

• dysphagia (difficulty swallowing)

• Peptic ulcers and gastritis

• Gallstones, cholecystitis, pancreatitis

• Decreased ability of the liver to detoxify

Colon problems specifically

• constipation

• diverticulosis

• fecal incontinence

• atherosclerosis affecting the small and large intestines

• colorectal polyps/cancer (growths)

GU changes

• Excretion of waste

• Kidney filtration decreases. Nephrons become less efficient and fewer in number with aging

• Kidneys help eliminate meds, so drug doses for older adults are smaller than for younger adult

• Ability to regulate the concentration of bodily substances diminishes with age: older adults more susceptible to dehydration

Causes of urinary incontinence

• lowered estrogen levels in women

• multiple pregnancies

• enlarged prostate gland

• distended and weakened bladder

Contributing factors of Nocturia

• adverse effects of meds

• chronic conditions like cardiac disease, diabetes, obesity, and sleep disorder

Musculoskeletal changes

• musculoskeletal dysfunction is a major cause of disability in older adults altering mobility, fine motor control, mechanics of respiration

• decline in muscle mass

• decreased reflexes

• loss of cartilage

• thinning of vertebrae

• decreased calcium absorption (osteoporosis, especially older women because less estrogen)

• joint cartilage deterioration (osteoarthritis)

• deterioration of extrapyramidal system (in control of INvoluntary movements and balance)

• Result: increased risk for falls, fractures, and respiratory infections (can’t cough it out)

Neuro changes

• lose nerve cell mass

• some brain atrophy

• nerve cells and dendrite decline in number, slows the transformation of information and weakening reflexes

• Brain weight decreases

How does memory change?

• mild loss of memory and recall of recent events is common with age

• Long-term memory remains intact

• Early stages of dementia mimic normal memory loss of aging

How does intelligence change?

• crystallized intelligence (what you already know) can continue to increase with age

• fluid intelligence (ability to learn, assess, navigate new things) decreases with age

• overall intelligence remains stable

How does motor function change? Symptoms of impaired locomotor function?

• slowing of fine motor tasks

• diminished postural reflexes

• decreased gross motor skills

• Motor control influenced by diminished sensory input (hearing, vision)

• Older adults face greater risk of falls

• Coupled with meds (polypharmacy), fall risk INCREASES

How does sleep change?

• about half of older population reports difficulty falling or staying asleep

• sleep becomes shorter but more frequent

• Sleep disturbances

  • may be caused by insomnia, neurological conditions, breathing disorders, pain, medical diagnoses, and medications

  • tend to affect the deepest levels of sleep

Endocrine changes

• thyroid hormone production decreases

• rate of removal of thyroid hormone decreases

• Androgen and estrogen production decreases

• Aldosterone levels fall

• takes longer to reestablish normal blood cortisol levels after stressful event

• Increased risk of Type II DM

How does immune system change?

• age-related decline gives rise to:

  • infections

  • cancer

  • autoimmune disease

• importance of vaxx

Skin changes with sun exposure

Chronic overexposure associated with

• wrinkling

• coarseness

• irregular pigmentation

• development of lesions

• skin cancer

But some sun exposure necessary for vitamin D production

Hair changes

• aging associated with graying, thinning, loss of hair

• number of hair follicles decreases with age

• remaining follicles grow at slower rates and contain lower concentrations of melanin

• Reduces hair’s protective ability to screen the scalp from sunlight

Eccrine gland changes

• decreased sweat production

  • impaired thermoregulation

Sebaceous gland changes

• decreased oil production

  • Increased roughness of skin

Hearing changes

• most common condition in older adults

• Presbycusis: progressive hearing loss

• Loss of high-frequency hearing makes it difficult to hear consonants

• Changes in hearing cause cause speech to sound muffled

Taste changes

• Can be affected by: medications, increase/decrease in saliva production, oral disorders, chronic disease

• Possible decrease in taste buds with age

• Taste sensations undergo changes during the aging process

Smell changes

• Decline in numbers of mucosal sensory cells and olfactory bulb relay cells in later life—>decreased sensitivity to smell

• Hyposmia: less smell. Makes food less desirable (add more salt to compensate for taste)

• Anosmia: nos mell. Impair’s ability to detect toxic odors, spoiled food, or a fire in the home

ADL

Activities of daily living.

Bathing, dressing, toileting, transferring, continence, feeding

iADL

Instrumental activities of daily living

Using a phone, managing meds, shopping, preparing meals, house work, transportation

aADL

Advanced activities of daily living

higher-level social or role domains; leisure, recreation, entertainment

Barriers to promoting wellness

• negative attitudes

• existence of serious or pressing health concerns

• Focus on disease treatment rather than prevention or health promotion

• False attribution of symptoms of pathologic conditions

• Belief they’re incapable of learning and implementing health-promoting behaviors

What’s the ultimate goal of care?

Return the patient to the various roles they hold outside the hospital

What are steps in Maslow’s hierarchy of needs?

Physiologic needs, safety and security, belongingness and affection, esteem and self-respect, self-actualization

ADPIE

Assess pt, family, community, etc. (recognize cues)

Diagnosis can be actual problem or one pt is at risk for (analyze cues and prioritize hypothesis)

Plan care (make solutions)

Perform Interventions (take actions)

Evaluate response to interventions and outcomes

What is health?

“state of complete physical, mental, and social well-being and not merely the absence of disease” -WHO

What is wellness?

Goal of physical, psychological, and spiritual well-being in which people of any age in various stages of health are willing to “work hard”

Continuous goal we try to reach.

What’s health promotion?

Process of enabling people to increase control over their health and its determinants, thereby improving their health.

Nurses play a big role for health promotion. Every interaction with pt/consumers'/clients must be viewed as chance to promote positive health attitudes and behaviors.

What is health education?

Independent function of nursing practice and is a primary nursing responsibility.

Goal of pt and family education = improve pt outcomes.

Communication skills necessary

Q: The nurse is preparing to teach a pt about how to take his new Rx med. The nurse knows that which of the following is NOT a priority when assessing for readiness to learn?

Physical readiness, financial readiness, or emotional readiness.

A: Financial readiness

What are the 6 social determinants of health?

1. Housing, transportation, neighborhoods.

2. Racism, discrimination, violence

3. Education, job opportunities, income

4. Access to nutritious foods and physical activity

5. Polluted air and water

6. language and literacy skills.

What are some regulatory bodies of the health care system? Which one is not from the govt.?

Occupational Health and Safety Admin

Joint Commission (not from govt)

Patient Protection and affordable care act of 2010

Centers of medicare and medicaid services

Department of public health

What are QSEN competencies?

It gives standards for education RNs.

There are 6 major categories:

1. pt centered care

2. Teamwork and collaboration

3. EBP

4. Quality improvement

5. Safety

6. Informatics