Case+Study+Unit+V


 * Please have questions 1-3 answered for Wednesday, 2/10/10 and the remaining questions completed by 2/17/10. Online posts made after 2/17/10 will no be counted towards your participation for this case study.**

1. Describe the changes you would expect to find during a physical exam of the older adult patient.

Head: Balding is common as well as wrinkled skin. Graying hair Eyes: Decrease in eyesight and increased sensitivity to glare occurs Reading small print, aging eye muscles, make it harder to focus on small print. Ears: Decreased hearing occurs especially with high pitched sounds Throat and mouth: Tooth decay is common Decreased saliva, causes more mucous membrane irrations. Cardiovascular: There is a decrease in cardiac output and the aging of the cardiac muscles can cause fluid retention. A decrease in vascular elasticity occurs causing stiffened arteries.Decrease in blood flow. HTN from from decreased tissue perfusion. Respiratory: Due to aging of cardiac muscles, fluid retention in the lungs makes it difficult to breathe. Pulmonary elasticity decreases as well as cilia action which makes it more difficult to clear the lungs Decreased lung capacity due to resilence. GI: Gastric pH is less acidic because the production of HCl is reduced. The gastric emptying is also reduced because the smooth muscle tone and muscle activity is decreased. There is also less blood flow to the GI tract and the absorptive surface of the villi is worn out because of all the wear and tear. Constipation complaint due to decreased metabolism. Musculoskeletal: There is a loss of calcium in the bones which causes them to become more brittle and the joints become stiff and arthritic. Joint pain, stiffness due to decreased synovial fluid. Neurological: The CNS slows down and becomes less responsive to stimuli. The elderly pt may have trouble with coordination and pain/pressure perception becomes less efficient. Reaction respose is slower. Genitourinary: Decreased blood flow to the kidneys due to decreased cardiac output. Waste products are filtered more slowly and bladder capacity is decreased by 50% which causes frequent voiding. Complaints of polyuria, hesitation, an unable to void due to prostate enlargement with age. Psychological: The self image of the older adult changes as gradually different functions decrease and they are no longer able to do everything they used to and become more dependant on others to help them. Patient may be depressed. 2. Discuss three cognitive changes seen in a number of elderly patients. Decline of information processing Decreased space demention, i.e. perception of quanity of information that can occupy the minds attention at one time. Primary and short term memory is slowed, the recall of events and facts are slowed. 3. Identify six patient behaviors in the elderly you would associate with depression. Changes in sleep/eating patterns (insomnia/loss of appetite) Loss of interest in usual activities Excessive fatigue Loss if interest in personal care Apprehension and anxiety with no cause Low self esteem/loss of self worth Increased use of alcohol or other drugs Fixation on death/thoughts of suicide Affect display can be withdrawn or show little emotion

4. What medical conditions in the elderly could present with symptoms of depression? malnutrition, heart problems, cognitive changes. Cancer, hyper/hypothyroidism, diabeties. jr 5. What patient behaviors would you associate with delirium? The degree of delirium will fluctuate throughout the day and the person's LOC will change throughout the day. Typically the delirious person is less conscious during the evening/night hours. Some Pt behaviors associated with delirium: -Inability to orient themselves. -Decreased attention span. -Unsteady gait. -Wandering. -Pulling out IV lines and foley catheters -Falling out of bed. -Labile emotions

6. What patient behaviors would you associate with dementia? -Wanders at night. -Hears things that are not there. -Has trouble completing simple tasks. -Becomes confused and disoriented. -Threatens to harm others -Cannot control bowel/bladder function. -Is unaware of the limitations imposed by illness -Has sudden mood changes aggitation, aggression, psychosis. jr 7. What neuroanatomic changes are seen in individuals with Alzheimer’s disease? Diffuculty with complex moter task; dressing, eating, walking, unsteady gait. jr Amnesia, Aphasia, Apraxia( loss of purposeful movement), Agnosia (loss of ability to recognize obects). jr 8. Write three priority nursing interventions for the patient with delirium. -Risk for injury -Deficit fluid volume 1. Pad side rails, keep bed in low position. jr 2. Assess for correct common treatable causes, i.e. decrease of medication dosage. jr 3. Calm the patient. jr

9. Write three priority nursing interventions for the patient with dementia. -Risk for injury -Impaired verbal communication 1. Provide spouse/family with information about expected disease outcome. jr 2. Teach client/family about saftey issues. jr 3. Provide information about legal matters. jr