Oldage Care
Oldage Care
Oldage Care
J. Renal system
1. Decreased kidney size, function, and ability to
concentrate urine
2. Decreased glomerular filtration rate
3. Decreased capacity of the bladder
4. Increased residual urine and increased incidence
of infection and possibly incontinence
5. Impaired medication excretion
K. Reproductive system
1. Decreased testosterone production and
decreased size of the testes
2. Changes in the prostate gland, leading to uri-
nary problems
3. Decreased secretion of hormones with the cessa-
s FIGURE 35-1 Paper-thin, transparent skin. (From Ignatavicius, D.,
& Workman, M. [2010]. Medical-surgical nursing: Patient-centered
tion of menses
collaborative care. [6th ed., p. 465]. St. Louis: Saunders.) 4. Vaginal changes, including decreased muscle
tone and lubrication
5. Impotence or sexual dysfunction for both gen-
Height
ders; sexual function varies and depends on gen-
5'6"
eral physical condition, mental health status,
5'3" and medications
L. Special senses
5' 1. Decreased visual acuity
4'9"
2. Decreased accommodation in eyes, requiring
increased adjustment time to changes in light
4'6" 3. Decreased peripheral vision and increased sensi-
tivity to glare
4'3"
4. Presbyopia and cataract formation
5. Possible loss of hearing ability; low-pitched
tones are heard more easily
6. Inability to discern taste of food
7. Decreased sense of smell
8. Changes in touch sensation
9. Decreased pain awareness
t
Box 35-1 Mental Health Concerns t
Box 35-2 Nonspecific Symptoms That
Possibly Indicate Illness or Infection
Depression
Grief Apathy Fatigue
Isolation Anorexia Incontinence
Suicide Changes in functional status Self-neglect
Confusion Shortness of breath
Dyspnea Tachypnea
B. Grief: Client reacts to the perception of loss, including Falling Vital sign changes
physical, psychological, social, and spiritual aspects.
C. Isolation: Client is alone and desires contact with
others but is unable to make that contact.
D. Suicide: Depression can lead to thoughts of self-harm.
Crusting
s 415
Level of Cognitive Ability: Applying process. This will direct you to option 3. If you had difficulty
Client Needs: Safe and Effective Care Environment with this question review the characteristics associated with
Integrated Process: Caring elder abuse.
Content Area: Fundamental Skills—Developmental Stages Level of Cognitive Ability: Applying
Reference: Potter, P., & Perry, A. (2009). Fundamentals of Client Needs: Psychosocial Integrity
nursing (7th ed., pp. 9–10, 314, 348). St. Louis: Mosby. Integrated Process: Teaching and Learning
Content Area: Mental Health
358. 1 Reference: Ebersole, P., Hess, P., Touhy, T., Jett, K., & Luggen,
Rationale: Coping mechanisms are behaviors used to decrease A. (2008). Toward healthy aging (7th ed., p. 453). St. Louis:
stress and anxiety. In response to a death, ineffective coping is Mosby.
manifested by an extreme behavior that in some cases may be
harmful to the individual physically or psychologically. Option 361. 3
1 is indicative of a behavior that identifies an ineffective coping Rationale: Many nonpharmacological sleep aids can be used
behavior in the grieving process. to influence sleep. However, the client should avoid caffein-
Test-Taking Strategy: Note the subject, an ineffective coping ated beverages and stimulants such as tea, cola, and choco-
behavior. Eliminate options 2, 3, and 4 because they are com- late. The client should exercise regularly, because exercise
parable or alike and are positive activities in which the indi- promotes sleep by burning off tension that accumulates dur-
vidual is engaging to get on with her life. Review coping ing the day. A 20- to 30-minute walk, swim, or bicycle ride
mechanisms in response to grief and loss if you had difficulty three times a week is helpful. The client should sleep on a
with this question. bed with a firm mattress. Smoking and alcohol should be
Level of Cognitive Ability: Analyzing avoided. The client should avoid large meals; peanuts, beans,
Client Needs: Psychosocial Integrity fruit, raw vegetables, and other foods that produce gas; and
Integrated Process: Nursing Process—Assessment snacks that are high in fat because they are difficult to digest.
Content Area: Mental Health Test-Taking Strategy: Note the strategic words that teaching
References: Ebersole, P., Hess, P., Touhy, T., Jett, K., & Luggen, A. about improving sleep is necessary. These words indicate a nega-
(2008). Toward healthy aging (7th ed., p. 643). St. Louis: Mosby. tive event query and ask you to select an option that is
Touhy, T., & Jett, K. (2010). Ebersole and Hess’ gerontological an incorrect statement. Options 1, 2, and 4 are positive state-
nursing & healthy aging (3rd ed., pp. 382–383). St. Louis: Mosby. ments indicating that the client understands the methods of
improving sleep. Review the factors that can interfere with
359. 3 sleep in the older client if you had difficulty with this question.
Rationale: Presbycusis refers to the age-related irreversible Level of Cognitive Ability: Analyzing
degenerative changes of the inner ear that lead to decreased Client Needs: Physiological Integrity
hearing ability. As a result of these changes, the older Integrated Process: Teaching and Learning
client has a decreased response to high-frequency sounds. Content Area: Fundamental Skills—Developmental Stages
Low-pitched voice tones are heard more easily and can be Reference: Touhy, T., & Jett, K. (2010). Ebersole and Hess’
interpreted by the older client. Options 1, 2, and 4 are not gerontological nursing & healthy aging (3rd ed., p. 155). St. Louis:
accurate characteristics related to aging. Mosby.
Test-Taking Strategy: Think about the age-related changes
that occur in the older client. Recalling that the client with a 362. 4
hearing loss responds to low-pitched tones will direct you to Rationale: Assisting clients and families to become aware of
option 3. If you had difficulty with this question, review the available community support systems is a role and responsi-
characteristics associated with presbycusis and hearing loss. bility of the nurse. Observing that the client has begun to be
Level of Cognitive Ability: Applying confined to his room makes it necessary for the nurse to inter-
Client Needs: Physiological Integrity vene legally and ethically, so option 1 is not appropriate and
Integrated Process: Teaching and Learning is passive in terms of advocacy. Option 2 suggests committing
Content Area: Fundamental Skills—Developmental Stages the client to a nursing home and is a premature action on the
Reference: Ebersole, P., Hess, P., Touhy, T., Jett, K., & Luggen, nurse’s part. Although the data provided tell the nurse that
A. (2008). Toward healthy aging (7th ed., pp. 351–352). this client requires nursing care, the nurse does not know
St. Louis: Mosby. the extent of the nursing care required. Option 3 is incorrect
and judgmental.
360. 3 Test-Taking Strategy: Note the strategic words most important
Rationale: Elder abuse includes physical, sexual, or psycho- action. Using principles related to the ethical and legal respon-
logical abuse, misuse of property, and violation of rights. sibility of the nurse and knowledge of the nurse’s role will
The typical abuse victim is a woman of advanced age with direct you to option 4. Option 1 avoids the situation, option
few social contacts and at least one physical or mental 2 is a premature action, and option 3 is a nontherapeutic
impairment that limits her ability to perform activities of statement. Review the roles and responsibilities of the nurse
daily living. In addition, the client usually lives alone or with in caring for the older client if you had difficulty with this
the abuser and depends on the abuser for care. question.
Test-Taking Strategy: Read each option carefully and identify Level of Cognitive Ability: Applying
the client who is most defenseless as the result of the disease Client Needs: Safe and Effective Care Environment