Chapter 15 Nursing Care of Older Adult Patients

Answers CHAPTER 15 NURSING CARE OF OLDER ADULT PATIENTS AUDIO CASE STUDY Elise and the Older Adult 1. Nocturia; muscle tone is weaker; bladder becomes funnel shaped; the urge to void occurs later in the filling process. 2. Sleep disruption from having to get up during the night, often multiple times; incontinence increases from muscle weakness; urine presses directly on the sphincter from funnel shape; urination can’t be postponed until a convenient time due to a later urge to void. 3. Plan to do the following: • Collect data on patient’s elimination pattern. • Have toileting facilities readily available. • Use night-light for safety. • Offer toileting every 2 hours or sooner based on patient’s assessment data. • Answer call lights promptly. Avoid saying, “Will assist you soon!” Consider patient’s toileting needs a high priority for patient-centered care as well as safety. • Teach pelvic floor exercises to strengthen these muscles. • Encourage patient to void before bedtime. VOCABULARY 1. activities of daily living 2. arrhythmia 3. delirium 4. attitude 5. aspiration 6. edema 7. dementia 8. expectoration 9. constipation 10. homeostasis 11. contracture 12. pressure injury 13. nocturia 14. extrinsic factors 15. intrinsic factors 16. osteoporosis 17. sensory deprivation 18. optimal functioning 19. reality orientation 20. sensory overload AGING CHANGES 1. (1) 2. (3) 3. (5) 4. (6) 5. (2) 6. (8) 7. (4) 8. (7) 9. (11) 10. (14) 11. (13) 12. (10) 13. (9) 14. (12) 15. (16) 16. (24) 17. (18) 18. (17) 19. (20) 20. (21) 21. (19) 22. (22) 23. (25) 24. (15) 25. (23) COMMUNICATING WITH PEOPLE WHO HAVE HEARING IMPAIRMENTS 1. True 2. False. The speaker should face the patient, so the speaker’s face is visible to patient. 3. False. Speak toward patient’s best side of hearing. 4. True 5. True 6. False. High-frequency tones and consonant sounds are lost first (e.g., s, z, sh, ch, d, g). 7. True 1 2 Chapter 15 Answers MEDICATIONS Corrections are in boldface. Older patients are more susceptible to drug-induced illness and adverse medication side effects for various reasons. They take many medicines for the more than one chronic illness that they have. Different medications interact and produce side effects that can be dangerous. Over-the-counter medicines that older patients take as well as the self-prescribed extracts, elixirs, herbal teas, cultural healing substances, and other home remedies commonly used by individuals of their age cohort do influence other medications. If an older patient crushes a large enteric-coated pill so that it can be taken in food for easy swallowing , it destroys the enteric protection and can inadvertently cause damage to the stomach and intestinal system. Some patients intentionally skip prescribed doses in an effort to save money. When prescribed doses are not being taken as expected, problems do not clear up as quickly, and new problems may result. The nurse should educate the older patient and the patient’s family. Patients need to know what each prescribed pill is for, when it is prescribed to be taken, and how it should be taken. CRITICAL THINKING This is a values clarification exercise, so answers are your own individualized answers that should be based on guiding principles. 1. Your individual response. 2. Your values and beliefs (what are they?). 3. Be tactful and provide privacy during situation resolution. 4. Consider professionalism issues, patient-centered care, agency policy, and patient safety. 5. Consider professionalism and respect for others’ values. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (2) is correct. Peripheral vascular resistance increases with age, contributing to hypertension development. (1, 3, 4) decrease with aging. 2. (2) is correct. Psychological factors are the primary source of sexual dysfunction, as documented in the literature. (1, 3, 4) are not the primary source. 3. (2) is correct. Weight-bearing exercise helps fight the degeneration of bone in osteoporosis. (1) is incorrect. Calcium intake should be increased. (3, 4) do not have any influence on osteoporosis. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 4. (4) is correct. There is a decreased taste sensitivity for salt and sweet flavors. (1, 2, 3) are not aging changes. 5. (2) is correct. Circulatory status is the reason for slow, deliberate movements because gravity shifts body fluids with position change. (1, 3, 4) are incorrect. 6. (1) is correct. The older circulatory system is very sensitive to fluid-overload situations, and intravenous therapy increases the risk potential. (2, 3, 4) are incorrect. 7. (3) is correct. Whispering lowers the pitch of the sounds, making your words easier to hear for someone who has lost only high-pitched frequencies. (1, 2, 4) are incorrect for high-pitched hearing loss. 8. (1) is correct. This puts the patient’s needs ahead of the nurse’s needs. (2, 3, 4) do not show respect for the patient’s needs. 9. (2) is correct. Older adults with a disability or with no or partial high school education tend to use inappropriate medication more than those who have a college education. 10. (1, 2, 5) are correct. Gentle bathing includes the towel bath, bag bath, or glove bath. It helps protect the skin of older adults. (3,4) are incorrect. Gentle bathing methods avoid the drying effects of hot water and soap.