Instructor Manual For

Instructor Manual For Health & Physical Assessment in Nursing, 1st Canadian Edition By Donita D'Amico Colleen Barbarito st al (All Chapters 1-27, 100% Original Verified, A+ Grade)

All Chapters Arranged Reverse:

27-1

This is The Original Instructor Manual For 1st Canadian Edition, All other Files in The Market are Fake/Old/Wrong Edition. 1 / 4

Copyright © 2012 Pearson Canada Inc. 264

CHAPTER 27

ASSESSING THE OLDER ADULT

IMAGE LIBRARY

Figure 27.1 Older adults.Figure 27.2 Adding fiber to the diet.Figure 27.3 Establishing rapport with the older adult.Figure 27.4 Geriatric depression scale.Table 27.1 Nutritional Risk Factors on Physical Assessment and Nutritional History in Older Adults

LEARNING OBJECTIVE 1

Describe several theories of aging.

CONCEPTS FOR LECTURE

• Theories of aging include those related to environmental influences as well as to cellular changes caused

by wear and tear, chemical alteration, and genetic influences. These theories include the following: wear and tear, cross-linkage, free radical, genetic, and apoptosis.

• In the wear-and-tear theory, the body is likened to a machine (Miller, 2004). Over time, cells wear out

and cannot be replaced. This eventually leads to death of the entire organism.

• In the cross-linkage theory, strands of DNA that should remain separate are linked together damaging the

DNA and leading to decreased cell function and cell death.

• In the free radical theory, highly reactive molecules that can be created by irradiation, pollutants, or

normal metabolism interact with and damage cellular components.

• The genetic theories of aging focus on chromosomal differences between persons and chromosomal

effects on cellular makeup, function, and longevity.

• The apoptosis theory seeks to explain why the process of apoptosis, or the regulation of cells through

growth restriction, appears to get out of control in aging.

• Miller (2004) concluded the following about biological aging: (a) It affects all living organisms. (b) It is

natural, inevitable, irreversible, and progressive with time. (c) The course of aging varies from individual to individual. (d) The rate of aging for different organs and tissues varies within individuals. (e) Biological aging is influenced by non-biological factors. (f) The processes are different from pathological processes.(g) Biological aging increases one’s vulnerability to disease.

POWERPOINT LECTURE SLIDES

•Theories of Aging:

•Environmental influences •Cellular changes •Theories –Wear and tear –Genetic theories –Apoptosis

•Biological Aging according to Miller (2004):

•Affects all living organisms •Natural, inevitable, irreversible & progressive with time •Course of aging varies from individual to individual •Biological Aging according to Miller (2004) 2 / 4

Copyright © 2012 Pearson Canada Inc. 265 •Rate of aging for different organs & tissues varies within individuals •Biological aging influenced by nonbiologic factors •Processes are different from pathologic processes •Increases vulnerability to disease

SUGGESTIONS FOR CLASSROOM ACTIVITIES

Ask students to compare and contrast the theories of aging.

SUGGESTIONS FOR CLINICAL ACTIVITIES

Have students assess an assign older client utilizing one of the theories.

LEARNING OBJECTIVE 2

Identify normal anatomical and physiological changes in older adults.

CONCEPTS FOR LECTURE

1.Aging has an impact on all of the organs and body systems. Specific areas of change relate to the following areas: integumentary; mouth, nose, and throat; eyes; ears; respiratory; cardiovascular; gastrointestinal; nutrition and fluid intake; genitourinary; endocrine; musculoskeletal; and neurological.

• Skin changes that occur normally with aging include lentigo senilis, or liver spots; wrinkles; baldness;

and a decrease in sweat production.

• The senses of smell and taste diminish with age because of a decrease in olfactory fibers taste buds and

saliva. Cheilitis, or angular stomatis, occurs at the mouth corners and loss of teeth occurs.

• The eyes undergo certain structural changes, and most older adults experience presbyopia, or nearsighted

vision. Xanthelasma and pingueculae are plaques and nodules occurring on or around the eyes. Cataracts may occur.

• Presbycusis, or hearing loss of high-frequency sounds, is common. Often hearing loss is simply related

to an accumulation of earwax.

• Pulmonary tissue stiffens and becomes more inelastic with age. The work of breathing becomes harder.

Environmental effects compound this, and gas exchange diminishes. The older person cannot respond as well to stress, and infection has devastating effects. Vaccination and prevention of respiratory disease is, therefore, important.

• Cardiovascular disease is a significant cause of morbidity and mortality because of the heart pumping

against a stiffening aorta, resulting in hypertension.

• The intensity of propulsion decreases in the gastrointestinal tract. This can cause feelings of premature

fullness when eating and contribute to gastritis and peptic ulcers. It can also lead to constipation, as can low-fiber and fluid intake, and over-dependence on laxative use. Continuous over-distention of the bowel and straining to pass stools may result in diverticulae, hemorrhoids, and rectal prolapse.

• Nutritional assessment should start with a calculation of body mass index (BMI). An older person with a

BMI above 28 is at significant risk for morbidity Dehydration can lead to confusion, digestion problems, constipation, and bladder infections.

• Urine is not manufactured as efficiently in older people, and glomerular filtering is decreased. This may

lead to drug toxicities and fluid loss. Urinary incontinence can be a significant problem, and sexual activities may become less frequent.

• Excess fatigue may relate to other underlying pathology, such as thyroid or other endocrine

dysfunction, rather than to sleep issues. Sleep structure changes, although total sleep time should not.

• By the age of 80, about 30 percent of muscle mass is lost. Weight bearing joints suffer from wear and

tear.

• Reaction time, learning, and short-term memory may all become slower. Yet, it is not normal to

experience actual mental confusion and significantly decreased acuity.

POWERPOINT LECTURE SLIDES

•Impact of aging on organs & body systems: 3 / 4

Copyright © 2012 Pearson Canada Inc. 266 •Integumentary •Mouth, nose, and throat •Eyes •Ears •Respiratory •Cardiovascular •Gastrointestinal –Nutrition and fluid intake

•Impact of aging on organs & body systems continued:

•Genitourinary •Endocrine –Sleep –Fatigue –Sexual function •Musculoskeletal •Neurological (Table 27.1)

INTEGUMENTARY SYSTEM

•Lentigo senilis •Wrinkles •Baldness •Decrease in sweat production

MOUTH, NOSE & THROAT•Smell & taste diminish •Cheilitis •Loss of teeth occurs EYES

•Visual alterations:

•Xanthelasma •Pingueculae •Pterygium •Arcus senilis •Cataracts •Presbyopia

EARS •Membrane more opaque •Presbycusis •Accumulation of earwax

RESPIRATORY SYSTEM

Pulmonary tissue stiffens Breathing becomes harder Gas exchange diminishes Use of more accessory muscles Capillary number decreases

CARDIOVASCULAR SYSTEM

Stiffening aorta Hypertension

GASTROINTESTINAL SYSTEM

Intensity of propulsion decreases Gastritis and peptic ulcers Constipation Dependence on laxative use

• / 4