Kozier Ch 23 Older Adults

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cswett
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106943
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Kozier Ch 23 Older Adults
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2011-10-16 22:58:51
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Kozier 23 Older Adults Sensory Perception
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Kozier Ch 23 Older Adults & Sensory Perception
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  1. Older Adults: Over 65 Years
    • 2010- US pop= 308,935,581
    • Approximately 40 million
    • Projected to increase to 72 M by 2030
    • 12.9% of the U.S. population in 2007
    • 19.3% of US population by 2030
    • Increasing minority pop.
    • 4.1% or 1.60 million live in nursing homes
    • States with most: CA, FL, NY, TX, PA, IL, OH, MI, NJ
  2. Attitudes toward aging
    • Different cultures view elders differently
    • Americans value youth
    • Ageism is prejudice against older Americans
    • Discrimination based solely on age
    • Exists among some professionals
    • Negative stereotypes based on myths and incorrect information
  3. Nursing and the Elderly
    • Nurses will be caring for an older population
    • Gerontology Nursing- specialized nursing practice, masters prepared RN, practice in a variety of settings
    • Geriatrics- medical care of the elderly
  4. Settings for Elders
    • Acute care facility- hospitals
    • Long-term care facility (“resident”)
    • “Nursing homes”
    • Assisted living facility (ALF)
    • -Immediate care
    • -Skilled care
    • -Alzheimer’s units
    • Hospice - end stage of life care
    • Rehabilitation
    • Community- adult day care
  5. Normal Physiological Changes of Aging
    • Skin –
    • less elastic
    • Dry
    • fragile

    • Neuromuscular-
    • Brain – atrophies
    • Reflexes – slowed while driving
    • Mass declines

    • Bones – lose minerals
    • Sensory/Perception
    • Sight
    • Hearing
    • Taste
    • Lungs- lose elasticity
    • Heart- thickens
    • Arteries- stiffen
    • Increase in BP

    • GI-
    • slow swallowing
    • Slower digestion
    • constipation

    • GU
    • Kidneys shrink
    • Bladder changes
    • Sex hormones decrease
    • Sexual difficulties

    • Immunity
    • Decreased
    • More prone to infections

    • Endocrine
    • Insulin resistance
    • Metabolism
    • Slower thyroid
    • medicines & alcohol not processed as quickly
  6. Psychosocial Aging
    • Retirement
    • Economic change
    • Grandparenting
    • Relocation
    • Home vs. ALF
    • Maintaining Independence
    • Maintaining self-esteem
    • Facing Death & Grieving
    • Women live longer
  7. Cognitive Abilities
    • Perception
    • Ability to interpret environment thro senses
    • Cognitive ability
    • Ability to think and problem solve same
    • Effected by decreased blow flow to brain or disease
    • Memory
    • Long term- slower
    • Short term- elders tend forget recent past
    • Learning- need additional time for learning
    • Motivation- need to see info as important
  8. Moral Reasoning & Spirituality
    • Moral reasoning- several theories
    • Values & beliefs due to experiences from living in a different era
    • Cultural variations
    • Spirituality
    • Spirituality does not necessarily increase with age
    • Elders today grew up when religion was important
  9. Health of the Elderly
    • Disease is not a normal outcome of aging
    • Certain problems do increase with age
    • Chronic health problems
    • Disabilities
    • Healthy People 2010 focus areas for elderly:
    • Access to care, health communication
    • Diseases: arthrititis, cancer, diabetes
    • Food safety
    • Injury & violence pevention
    • Immunizations
    • Substance abuse & tobacco use
  10. Health Problems
    • Injuries
    • Chronic Illness
    • Drug use & misuse
    • Alcoholism
    • Dementia- will discuss later
    • Elder Mistreatment (Abuse)
  11. Injuries
    • One of the Healthy People 2020 concerns
    • Falls are major cause of fractures
    • Driving injuries
    • Fire hazards
    • Hypothermia
    • Medications - Polypharmacy
  12. Frail Elderly
    • Defined as unplanned weight loss greater than 10 lbs in last year, weakness, poor endurance & energy, slowness & low activity level.
    • The old-old age 85+ are at more risk
    • Common health problems are mobility limitations, sensory impairment, cognitive decline, falls & increasing fraility
    • Greater risk for malnutrition & dehydration
  13. Chronic Disabling Illness
    • Heart disease, Cancer and Stroke leading cause of death & disability
    • Chronic lower respiratory disease, pneumonia/influenza, Alzheimer’s, Diabetes, Nephritis, Accidents, Septicemia
    • Hearing and visual diseases
    • Cognitive dysfunctions
    • Chronic diseases account for 70% of all deaths in U.S. which is 1.7 million each year
    • Chronic illness brings about many lifestyle changes for the client and family.
    • Affects client’s:
    • Ability to perform ADL’s, IADL’s (Independent)
    • Assistance with ambulation
    • Inability to pay for health care needs
  14. Drug use & alcoholism
    • Drug use & misuse
    • Polypharmacy
    • OTC
    • Alcoholism
    • The aging alcoholic
    • The new alcoholic- late-onset, widowers
  15. Elder Abuse
    • Can be physical, emotional or sexual
    • Can involve neglect or economic exploitation
    • Categories
    • Domestic, takes place at home usually by family member or SO
    • Institutional
    • Self-neglect
    • Individuals at most risk are those who are dependent because of immobility or altered mental status
    • Victims may attempt to dismiss injuries as accidental and abusers may prevent victims from receiving proper medical care to avoid discovery
  16. Sensory Reception
    Sensory Perception
    • Sensory reception
    • Process of receiving stimuli or data

    • Sensory perception
    • Conscious organization and translation of data into meaningful information
  17. Sensory Process
    • 4 aspects must be present:
    • Stimulus
    • Receptor
    • Impulse conduction
    • Perception

    To receive & interpret stimuli the person must be alert
  18. Factors Affecting Sensory Function
    • Age/stage of life- elderly lose senses
    • Culture- normal amount of stimulation varies
    • Illness- MS, diabetes
    • Medications- ASA & Lasix are ototoxic
    • Stress- sensory overload
    • Personality
    • Lifestyle
  19. Sensory Alterations
    • Sensory deprivation-
    • Sensory overload
    • Sensory deficits
    • Impaired vision
    • Impaired hearing
    • Impaired taste
    • Impaired smell
    • Impaired tactile (touch) perception
    • Impaired kinesthetic sense
  20. Nursing Process: Assessment
    • Nursing history
    • Mental status
    • Physical exam
    • Visual acuity
    • Hearing- Rinne &Weber
    • Smell
    • Taste
    • Tactile
    • Client’s environment- sensory deprevation?
    • Social support network- live alone, visitors
  21. Diagnosis
    • Disturbed Sensory Perception (specify): Visual, auditory, kinesthetic, gustatory, tactile, olfactory
    • Acute confusion
    • Chronic confusion
    • Impaired memory
    • Risk for injury
  22. Planning/ Outcomes
    • Preventing sensory overload or deprivation
    • Maintain function of senses
    • Reduce social isolation
    • Perform ADLs independently & safely
    • Preventing injury
  23. Sensory Deprivation
    • Lack of meaningful stimuli
    • Risk factors:
    • Impaired sensory reception – pts with neurological injury, dementia, depression, sleep deprivation
    • Cannot process stimuli – nerve or brain injury
    • Have restricted mobility
    • Confined to nonstimulating environment- homebound, healthcare facilities
    • Sensory deficits – vision, hearing
    • From different culture
  24. Clinical Manifestations of Sensory Deprivation
    • Excessive yawning, drowsiness, and sleeping
    • Decreased attention span, difficulty concentrating,
    • Impaired memory
    • Preoccupation with somatic complaints, such as palpitations
    • Hallucinations or delusions
    • Crying, annoyance over small matters and depression
  25. Implementation: Sensory deprivation
    • Focus is prevention
    • Support senses (e.g., glasses, hearing aids)
    • Orientation
    • •Calendar; view of environment
    • Provide stimuli
    • Regular contact; touch
    • Television/radio
    • •Pet therapy
    • •Smells
  26. Sensory Overload
    • Stimuli exceeds what the client’s sensory system can process
    • Risk factors:
    • Unfamiliar hospital environment
    • Medications that stimulate CNS (prednizone)
    • Caffeine
    • Bronchodilators
    • atropine
  27. Clinical Manifestations of Sensory Overload
    • Irritability
    • Confusion
    • Reduced attention span
    • Decreased problem-solving ability
    • Drowsiness
    • Complaints of fatigue and restlessness
  28. Sensory deficits: Vision Loss
    • Presbyopia – loss of accomodation, associated with
    • aging
    • Cataracts- clouding of lens
    • Glaucoma- increased pressure, loss of peripheral vision
    • Macular Degeneration- loss of central vision
    • Diabetic Retinopathy- hemorrhages in small vessels that supply retina
  29. Implementation: vision
    • Orient client to environment
    • Keep pathways clear
    • Organize articles for easy reach
    • Keep call bell close
    • Assist with ambulation
    • Keep glass local
    • Provide sufficient light
    • Magnifying glasses
    • Big print books & materials
    • Assess for need with help with ADLs
  30. Sensory deficit: Auditory (hearing) Loss
    • Conduction
    • – vibrations can’t be transmitted from outer to inner ear… cerumen, infections, punctured tympanic membrane, arthritis of auditory bones
    • Nerve deafness- damage to cranial nerve VII…medications, infections, loud noise

    • Central deafness- damage to auditory areas in temporal lobe…CVA (stroke), meningitis
    • Presbycusis- hearing loss of high pitched tones assoc with aging..
    • Tinnitus – ringing in ears…medications, HTN, arthritic changes of bones in ear
  31. Implementation: hearing
    • Care of a hearing aid
    • Closed-caption television
    • Regular inspection of ear canals
    • Techniques to improve communication
    • Promote safety
    • Assess for social isolation
  32. Sensory deficit: gustatory (taste)
    • Xerostomia – excessively dry mouth
    • Loss of ability to taste

    • Interventions:
    • Assess for sores or open areas in mouth
    • Encourage seasonings & spices
  33. Sensory deficit: olfactory (smell) loss
    • Anosmia – loss of sense of smell
    • Home safety issues

    • Interventions:
    • Check gas appliances
    • Check color, expiration dates on food
    • Replace batteries smoke detectors
    • Aromatherapy
  34. Sensory deficit: Tactile (touch) loss
    • Touch, pressure, heat, cold, pain
    • Hands & face have most receptors

    • Interventions :
    • Change position, proper fitting shoes & socks
    • Careful with hot & cold applications
  35. Sensory deficit: Kinesthetic sense
    • Proprioceptors detect stretch in muscles to create a picture how body is positioned
    • Problems of inner ear impair kinesthesia
    • Parkinsons, CVA, medications can impair
    • Risk for balance & coordination problems & falls

    • Interventions:
    • Tai Chi, dancing, yoga, aerobic exercise, light weights
  36. Falls
    • Account for 87% of all fractures among adults aged 65 years and older.
    • Risk factors:
    • Cognitive impairment
    • Vision impairment
    • Gait or balance impairments
    • High risk medications
    • Poor lighting
  37. The Confised Client: Delirium
    • Common syndrome in hospitalized older adults
    • Acute onset
    • Temporary, may last hours to days
    • Worsens at night
    • Attention:
    • Inattentive, easily distractible, has difficulty keeping track what is being said
    • Causes:
    • stress, sleep deprivation, polypharmacy, dehydration,
    • infections, cerebral and cardiovascular disease
  38. The Confused Client:
    Dementia (Alzheimer’s)
    • Progressive loss of cognitive function
    • Symptoms are progressive (7-15 years), slow, irreversible, poor outcome
    • No change with time of day
    • Changes in:
    • Memory, judgment, language, mathematics, reasoning, and problem solving
    • Often cared for at home, Strain on caretakers
  39. Interventions: Client with Delirium
    • Reorient frequently
    • •State your name; day, date, time
    • •Provide clocks, calendars
    • •Visual clues to time
    • •Use personal belongings

    • Maintain safe environment
    • Communicate clearly, slowly
    • •Respond to feelings
    • •Use gestures
    • Limit choices
    • Promote feelings of security
    • Use alternative therapies
  40. The Unconscious Client
    • Coma is a deep state of unconsciousness that lasts for more than 2-4 weeks
    • Be aware of sensory overload & deprivation
    • Use techniques to stimulate the unconscious client
    • Involves all 5 senses & kinesthetic
    • Never speak about them at the bedside
    • Speak to them as if they can hear you
    • Continue orientation to reality
    • Involve family members
    • Incorporate more touch in plan of care
    • May not blink- need eye care
    • Safety measures:
    • •Bed in low position
    • •Side rails up

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