Geriatric Respiratory, Gastrointestinal, and Mental Health: Key Concepts and Interventions

What are the effects of aging on lung function?

Lungs lose elastic recoil, experience reduced muscle strength, and have decreased alveolar surface area, leading to less effective gas exchange.

What are SABAs and LABAs?

SABAs (Short-Acting Beta Agonists) provide quick relief of symptoms, while LABAs (Long-Acting Beta Agonists) offer longer-lasting relief for chronic conditions.

What are common signs and symptoms of pneumonia in older adults?

Signs may include slight cough, fatigue, rapid respiration, confusion, restlessness, and behavioral changes.

What is the leading cause of death in older adults related to respiratory health?

Pneumonia

What are the primary nursing interventions for promoting respiratory health?

Encouragement, promoting self-care, performing postural drainage, and promoting productive coughing.

What is the significance of bronchial secretions in respiratory health?

Effective removal of bronchial secretions is crucial for preventing infections and maintaining clear airways.

What dietary recommendations can help with respiratory issues?

Hot, spicy foods can open airways, and hard candy can help increase secretions.

What are the symptoms of fecal impaction?

Symptoms include constipation, abdominal pain, rectal discomfort, nausea, straining, and bowel incontinence.

What is the role of expectorants in respiratory care?

Expectorants help to thin mucus, making it easier to cough up and clear from the airways.

What factors increase the risk of pneumonia?

COPD, asthma, heart disease, diabetes, cancer, autoimmune disorders, smoking, secondhand smoke, alcohol consumption, surgery, and hospitalization.

What is the definition of COPD?

COPD (Chronic Obstructive Pulmonary Disease) is a group of diseases including asthma, chronic bronchitis, and emphysema, leading to respiratory disability.

What are the characteristics of chronic bronchitis?

Chronic bronchitis is defined by a daily productive cough with sputum for at least three months in two consecutive years.

What are the signs of emphysema?

Signs include reduced gas exchange surface area, increased air trapping, barrel chest, and distant quiet breath sounds.

What is the impact of aging on immune response in the respiratory system?

Aging leads to decreased cilia, reduced ability to clear mucus, and an overall decreased immune response.

What is the importance of monitoring blood gases in oxygen therapy?

Monitoring blood gases helps to prevent carbon dioxide narcosis and assess the effectiveness of oxygen therapy.

What are the risks associated with overuse of bronchodilators?

Overuse can lead to poor asthma control, increased airway hyper-responsiveness, serious side effects, and tolerance to the medication.

What is the purpose of using humidifiers in respiratory care?

Humidifiers help to moisten the air, which can ease breathing and help to clear mucus.

What are the signs of carbon dioxide narcosis?

Signs include confusion, muscle twitching, visual defects, profuse perspiration, hypotension, and progressive circulatory failure.

What is the role of complementary therapies in respiratory care?

Complementary therapies like herbs, aromatherapy, and acupuncture can support respiratory health but should be assessed for interactions with medications.

What is the significance of occult blood tests?

Occult blood tests screen for early signs of GI bleeding, particularly to detect colorectal cancer.

What lifestyle factors can contribute to constipation?

Poor nutrition, lack of fiber, inadequate fluid intake, and certain medications can lead to constipation.

What is the impact of smoking on respiratory diseases?

Cigarette smoking is a major risk factor for developing COPD and other respiratory diseases.

What are the effects of aging on airway mechanics?

Aging leads to changes in upper airway paths, reduced cough reflex, and decreased muscle strength.

What is the second leading cause of cancer death in the US?

Colon cancer

What percentage of colon cancer cases are rectal or sigmoid?

45%

What are common signs and symptoms of colon cancer?

Changes in bowel habits, sense of incomplete evacuation, abdominal pain, nausea, vomiting, weight loss, cachexia, and abdominal distention.

What diagnostic tests are used for colon cancer?

Fecal occult blood test, Cologuard, CBC, and colonoscopy.

What is a common treatment for colon cancer?

Colon resection

What impact can colostomy have on older adults?

It can significantly affect their quality of life and self-care abilities.

How can good dental hygiene affect gastrointestinal health?

It can prevent disorders that threaten nutritional intake.

What role does nutrition play in gastrointestinal health?

Proper nutrition enhances general health and minimizes the risk of indigestion and constipation.

What is the most prevalent mental health problem among older adults?

Depression

What percentage of community-based older adults experience depressive symptoms?

15%

What are common emotional symptoms of depression in older adults?

Profound self-deprecation, overwhelming guilt, pervasive apathy, feelings of hopelessness, and beliefs about being a burden.

What is pseudodementia?

A condition where cognitive deficits mimic dementia but are actually secondary to depression.

What are common behavioral changes in older adults with depression?

Significant problems with personal relationships, changes in sleep patterns, and psychomotor activity.

What are some treatment approaches for geriatric depression?

Psychotherapy, electroconvulsive therapy (ECT), herbal supplements, and complementary/alternative therapies.

What is a key assessment strategy to avoid misdiagnosis of depression in older adults?

Conduct comprehensive, unbiased assessments during routine health visits.

What are common causes of anxiety in older adults?

Adjusting to significant physical, emotional, and socioeconomic limitations.

What defines an anxiety disorder?

Unrealistic, excessive, or persistent anxiety and worry lasting 6 months or longer about two or more life circumstances.

What are common clinical manifestations of anxiety in older adults?

Multiple somatic complaints, rigidity in thinking, insomnia, hostility, and difficulty concentrating.

What is a common treatment approach for anxiety?

Identifying and addressing the underlying cause.

What is the prevalence of major depressive disorder in nursing home residents?

12-20%

What medications can cause or aggravate depression in older adults?

Antihypertensives, hormones, CNS depressants, and other medications like cimetidine and L-dopa.

What is the significance of recognizing atypical presentations of depression?

It helps in identifying depression that may present with physical complaints or self-neglect.

What is the importance of screening for depression in older adults?

Routine screening can help in early identification and treatment of depressive symptoms.

What are some common physical complaints associated with depression in older adults?

Persistent headache, chronic indigestion, and various nonspecific somatic symptoms.

What should be ensured when treating older adults with depression?

Physical needs must be met, and feelings should not be minimized.

What are some effective psychotherapy approaches for treating geriatric depression?

Cognitive-behavioral therapy (CBT), interpersonal therapy, and problem-solving therapy.

What is the role of St. John's Wort in treating depression?

It has been studied for mild to moderate depression but has significant drug interactions.

What are common clinical manifestations of anxiety?

Multiple somatic complaints, rigidity in thinking, insomnia, fatigue, hostility, restlessness, chain-smoking, pacing, fantasizing, confusion, increased dependency, elevated vital signs, increased psychomotor activity, urinary frequency, changes in appetite, intensive involvement with minor tasks, and difficulty concentrating.

What is the primary approach to treating anxiety disorders?

Treatment depends on identifying and addressing the underlying cause, including recent changes in health, living situation, or stressors.

What pharmacological intervention is commonly used for anxiety?

Anxiolytic medications prescribed at the lowest effective dose.

Name some non-pharmacological interventions for managing anxiety.

Biofeedback, guided imagery, relaxation therapy, and psychological therapy.

What environmental control measures can help manage anxiety?

Reduce environmental stimuli that trigger or worsen anxiety.

What is a common illicit substance used among older adults?

Marijuana (cannabis).

What are some other common illicit substances?

Ecstasy (MDMA), GHB, LSD, and methamphetamine.

What are anabolic-androgenic steroids often abused for?

Perceived anti-aging or muscle-building effects.

What is a significant risk of substance abuse in older adults?

It poses serious threats to physical, emotional, and social health.

What are some serious consequences of substance abuse?

Increased potential for adverse drug consequences, heightened risk for falls, decreased cognition, and vulnerability to abuse.

What are the two types of substance abusers identified?

Chronic abusers with lifelong patterns and situational abusers who start using substances in response to late-life stressors.

What common coping styles do individuals with substance use disorders employ?

Denial and rationalization.

What are some possible indications of alcohol abuse in older adults?

Drinking to calm nerves, memory issues, physical signs like malnutrition, social changes, and emotional symptoms.

What are some serious medical complications from chronic alcoholism?

Cirrhosis, hepatitis, chronic infections, pancreatitis, cardiomyopathy, and Wernicke-Korsakoff syndrome.

What screening criteria can indicate alcoholism?

Drinks a fifth of whiskey daily, experiences blackouts, blood alcohol level exceeds 150 mg/100 mL, exhibits withdrawal syndrome, and continues drinking despite medical advice.

What are some drinking patterns associated with alcohol abuse?

Episodic drinking, continuous drinking, morning drinking, increased family disruption, blackouts, hiding drinking patterns, legal problems, and withdrawal syndrome.

What is Wernicke Syndrome and its cause?

A condition occurring in chronic alcoholics due to severe thiamine deficiency, causing confusion, ataxia, and eye movement abnormalities.

What is a key barrier to treatment for substance abuse?

Denial of the problem by the patient.

What role does family involvement play in substance abuse treatment?

Providing education and support for both the patient and caregivers.

What nursing intervention can help reinforce reality for patients with substance use disorders?

Gently confront denial and present factual information about the consequences of substance abuse.

What is the long-term goal of substance abuse treatment?

Achieving sobriety, with harm reduction approaches for some patients.

What are some emotional symptoms of alcohol abuse?

Anxiety, irritability, depression, mood swings, and lack of motivation.

What are some physical signs of alcohol abuse?

Malnutrition, injuries, falls, gastrointestinal distress, and clumsiness.

What is the importance of validated screening tools in diagnosing alcoholism?

They should be used routinely to accurately identify alcohol abuse.

What should be controlled to help manage anxiety in patients?

The number and variety of persons with whom patients must interact.

What is a common nursing intervention for managing anxiety?

Allow adequate time for conversations and activities without rushing.

What demographic group has the highest suicide rate?

Males aged 75 and older.

Which demographic also shows elevated suicide rates among older adults?

Females aged 75 and older.

Name a major risk factor for suicide in older adults.

Previous suicide attempt(s).

What is a protective factor against suicide?

Effective clinical care for mental and physical health.

What should be done with all suicide threats?

Take all suicide threats (obvious and subtle) seriously.

What are subtle suicide gestures in older adults?

Indirect behaviors indicating suicidal intent, such as medication misuse or self-starvation.

What is one way to meet the needs of suicidal older adults?

Implement close observation based on assessed risk.

What behavior might indicate a decision to end life in a previously depressed patient?

Suddenly showing increased energy or happiness.

What is a foundational good health practice for preventing suicide ideation?

Proper nutrition and regular physical exercise.

Name one evidence-based psychotherapy approach for treating suicidal ideation.

Cognitive-behavioral therapy.

What type of medication is commonly used for treating depression in older adults?

Selective Serotonin Reuptake Inhibitors (SSRIs).

What is an important nursing guideline for starting antidepressants?

Start low, go slow.

What common adverse effect should healthcare providers monitor in older adults on antidepressants?

Dry mouth and sweating.

What is a potential metabolic effect of antidepressants?

Increased appetite and weight gain.

What is a common cardiovascular concern with antidepressant use?

Orthostatic hypotension.

What should be optimized regarding the timing of antidepressant administration?

Bedtime administration to minimize daytime sedation.

What is one of the barriers to accessing mental health treatment for older adults?

Social isolation and loneliness.

What should be done to ensure environmental safety for suicidal older adults?

Create a safe physical environment that minimizes opportunities for self-harm.

What is a common issue with medication adherence among suicidal older adults?

Intentional non-adherence or hoarding medications.

What is a key aspect of therapeutic listening for suicidal patients?

Demonstrate willingness to listen without judgment.

What is dementia?

Dementia is an irreversible and progressive impairment in cognitive function affecting memory, orientation, reasoning, attention, language, and problem solving, caused by damage or injury to the brain.

What is the most common form of dementia?

Alzheimer's disease

What are the stages of Alzheimer's disease?

1. Normal adult: no impairment; 2. Normal older adult: self-reported memory impairment; 3. Early AD: impairment recognized by others; 4. Mild AD: withdrawal and inability to perform complex tasks; 5. Moderate AD: disoriented and needs assistance; 6. Moderately severe AD: forgets names and has agitation; 7. Severe AD: loss of verbal skills and needs total assistance.

What interventions are available for Alzheimer's disease?

Interventions include antioxidants, anti-inflammatory agents, folic acid, vitamin B6 and B12, gene therapy, and medications like Donepezil that slow acetylcholinesterase.