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NUR 344 Exam 1 - Geriatrics

Terms in this set (65)

Ageism
the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or oneself based on age


Discrimination based on age
Roles of the gerontological nurse
-Direct-care provider
-Teacher
-Leader
-Advocate
-Evidence based clinician
Types of certifications and qualifications
Gerontology Certification
Entry Level
Practiced equivalent of 2 years full time as RN
Minimum 2000 hours of clinical practice in the specialty area of gerontological nursing within last 3 years
30 hours of continuing education in gerontological nursing within last 3 years


Advance Practice Certification
Advanced Practice Registered Nurse - APRN
Gerontological Nurse Practitioner - GNP
Clinical Nurse Specialist - CNS
Less than 1% of nurses in the U.S. hold a certification in gerontological nursing
Scope of nursing practices
1. Defined by state regulation
2. Influenced by the needs of the population being served
3. Depends on the setting in which the nurse practices
standards of nursing practices
Developed by the nursing profession

Divided into clinical care and the role of the professional nurse
Baccalaureate essentials for professional nursing practice and relationship to gerontological nursing competency
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Difference between research and evidence based practice
Research: diligent, systematic inquiry or investigation to validate and refine existing knowledge and generate new knowledge.


EBP: the conscientious use of best research evidence in combination with a clinician's expertise and pt. preferences to make decisions about the care thats provided.
Demographic trends with aging population including gender, race
Gender: Older population is predominantly female (age 65-69, there is 112 women for every 100 men, 85+ ratio is 206:100)

Race: growing aging population has significantly increased the proportion of minorities.

Global share of older people (60+) increased from 9.2% in 1990 to 11.7% in 2013 and estimated to be 22% of population by 2050
Centenarians
people who have reached the age of 100 years or older


Estimated to be over 90,000 in 2020.


population is overwhelmingly female (84%), lower educated, more impoverished, widowed, and more disabled
Health disparities
preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations

- Vaccine administration
- Colorectal cancer screening
- Coronary heart disease
- Stroke
- Preventable hospitalizations
- Hypertension
- Hypertension control
morbidity and mortality
morbidity (illness) and mortality (death)

Chronic Diseases
The incidence of chronic diseases increases with age.


Causes of Death
The leading cause of death for older adults in the United States in 2019 was diseases of the heart.
healthy aging
75% adults younger than 64 years old report having three or fewer chronic conditions
Chronic illness in the elderly
Hypertension
Arthritis
Heart Disease
Diabetes
Cancer
Three or more chronic conditions
Psychosocial theories of aging (Sociology and Psychology)
Changing roles, relationships, status, and generational cohort impact the older adult's ability to adapt.

1. Activity theory
2. Disengagement theory
3. Subculture
4. Continuity theory
5. Age stratification theory
6. Person-environment-fit theory
7. Gerotranscendence
Psychological theories of aging
Explain aging in terms of mental processes, emotions, attitudes, motivation, and personality development characterized by life stage transitions.


1. Human needs theory
2. Individualism
3. Stages of personality theory
4. Life-course/life span theory
5. Selective optimization theory
Biological theories of aging
Stochastic and non-stochastic
Stochastic
Based on random events that cause cellular damage, which accumulates as organism ages

theories:
1. Free radical theory
2. Orgel/error theory
3. Wear and tear theory
4. Connective tissue theory
Nonstochastic
Based on genetically programmed events caused by cellular damage that accelerates aging of the organism

1. Programmed theory
2. Gene/biological clock theory
3. Neuroendocrine theory
4. Immunological theory
Nursing implications for each type of theory
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functional consequences theory
environmental and biopsychosocial consequences impact functioning
Theory of Thriving
Failure to thrive results from a discord between the individual and his or her environment or relationships.
Theory of Successful Aging
successful aging means remaining physically, psychologically, socially engaged in meaningful ways that are individually defined
changes to cardiovascular structure
Ejection fraction:
- determines the efficiency of the stroke volume

stroke volume: amount of blood the heart pumps with each beat
- No age-related changes to stroke volume
Vascular changes in eldery
orthostatic hypotension
Respiratory physiological changes
Three main physiological changes:
(1) decline in chest wall ability
(2) decline in elastic recoil of the lung
(3) decline in respiratory muscle strength

incidence of Chronic respiratory diseases:

1. COPD
2. Pneumonia
Gastrointestinal system aging
longer colonic transit time
- increased risk of gallstones, constipation, fecal incontinence, infection

- GERD
Kidney and Bladder structural changes
Urination changes:
- amount of urine decreases
- increases (50-100ml) post void residual

- Renal changes affect the ability to concentrate and dilute the urine, causing electrolyte imbalance

- increased water loss

- polyuria

- nocturia
Glomerular filtration rate (eGFR)
how well kidneys filter blood

the normal eGFR number is >90 BUT eGFR declines with age, even in people without kidney disease.

declines in older individuals, but there is no resultant increase in blood creatinine concentration
Reproductive system changes
Male: Decline in testosterone
- Significant decline Andropause
- Low libido, decreased energy, strength and stamina, irritability and cognitive changes.


female (menopause)
Neurological system changes (central, peripheral, autonomic)
Brain:
-weight of brain decreases
- blood flow to brain decreases
- interference w/ thinking
- slower reaction time
- Nerve conduction speed slows down with age due to degradation of myelin sheaths that cover axons
- Change in motor speed, reaction time, and sensory abilities due to calcium modulation being compromised with age


spinal cord changes:
- Spinal cord cells decline after 60 yrs old
- Spinal cord axons decrease due to a narrowing of the spine, causing changes in sensation
Plaques and tangles and relationship to Alzheimer's disease
Neurofibrillary tangles and beta-amyloid plaques are considered hallmarks of Alzheimer's disease,
plaque
occur outside of the neuronal cell and consist of gray matter with a protein core surrounded by abnormal neurities.



Aging brain → plaques are disseminated
VS.
Alzheimer's diseased brain → plaques numerous and dense
Tangles
Occur in the neuronal cell body and consist of paired helical filaments and a few straight filaments


Aging brain → the greatest density of tangles appear in the entorhinal cortex
VS.
Alzheimer's diseased brain → plaques spread throughout the entire cortex
Peripheral Nervous system impact on nerve conduction
central:

Peripheral Nervous System → consists of sensory-somatic system and autonomic nervous system

autonomic: Body's response to changes in blood pressure changes

injury responses:
Reparative properties to a peripheral nerve injury decline with age
Changes in peripheral nervous system → lead to slower detection of stimuli
Endocrine system in aging adult
pineal gland- secretes melatonin


adrenal cortex - secretes glucocorticoids, mineralocorticoids, and sex hormones

adrenal medulla
Glucose intolerance and confounding factors
Age-related glucose intolerance include:
impaired insulin secretion
insulin resistance
alterations in glucose counter regulation


Confounding Factors of the Glucose Intolerance of Aging:
genetic predisposition
Lifestyle environmental factors
Muscular changes, bone changes in aging adult
Osteoporosis, osteoarthritis
Osteoporosis, osteoarthritis
...
Sensory system and aging
tastes/smell: The ability to touch and distinguish texture and sensation tends to decline with age due to a decrease in the number and alteration in the structural integrity of touch receptors.


hearing
vision
touch
Integumentary System: Layers of skin, intrinsic and extrinsic aging
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Immune System: types of immunity; Immunosenescence
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Hematopoietic system: anemia
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Communication basics (verbal and nonverbal)
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Internal barriers of communications
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Types of memory
short term, long term, declarative, episodic, semantic, lexical, nondeclarative, active
Presbyopia, presbycusis, tinnitus, dual sensory impairment
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Interventions used for those with cognitive and language barriers
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Strategies for communication with persons with dementia
Recognition, Negotiation, Validation, Facilitation and collaboration
Terms: Dysarthria, apraxia, aphasia, anomia
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Types of aphasia: Broca's, global, Wernicke's
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External barriers and interventions
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Language strategies for improving communication
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Communication Predicament Model of Aging
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Communication Enhancement Model
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Compensatory and restorative strategies
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Adult learning theory principles and strategies
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Types of assessments included in comprehensive assessment in older adults
Purpose of functional assessment
Disability and Ability, Levels of activities of daily living (ADLs)
Benefits to physical performance measures
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Overview of physical assessment changes with aging
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Cognitive assessment purpose
Dementia categories
Psychological assessment purpose
Quality of live and successful aging; Depression and loneliness
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Social assessment purpose
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Body mass index assessment rationale
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Principles of Comprehensive Assessment
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