October 30, 2022

Describe and discuss the pathological conditions that might affect the sexual responses in older adults. How and why do you think Nutritional factors, psychological factors, drugs and c

Nursing

After studying Module 3: Lecture Materials & Resources, discuss the following:

Describe and discuss the pathological conditions that might affect the sexual responses in older adults.
How and why do you think Nutritional factors, psychological factors, drugs and complementary and alternative medications affect the immune system in older adults.

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Chapter 14

Infection and Inflammation

Infection is one of the 10 most common causes of death in older adults.

The presentation of infections in older adults is often masked, which can lead to delayed treatment.

The immune system enables the body to defend itself against disease-causing microorganisms and other foreign bodies.

With aging the immune system exhibits a diminished ability to provide such protection.

Introduction

For infection to occur, there must be a reservoir of an infectious disease, a portal of entry, and a susceptible host.

Source may be a person’s own microbial flora (endogenous) or something in the environment (exogenous).

Nosocomial infections: acquired in the hospital

Community acquired: acquired outside the health care facility

The Chain of Infection

Changes in both cell-mediated and antibody-mediated immune response

Atrophy of the thymus

Diminished cellular (T cell–mediated) and humoral (B-lymphocyte) immunity

Production of autoantibodies increases

Skin becomes more fragile and prone to breakdown or abrasion.

Age-Related Changes in the Immune System

Nutritional factors

Malnutrition

Iron and trace element deficiency

Psychosocial factors

Depression

Drugs

Complementary and alternative medications

Factors Affecting Immunocompetence

Every adult over the age of 65 should receive the influenza vaccination annually.

Community-acquired pneumonia is caused by multiple pathogens.

Pneumococcal vaccine is recommended for everyone over the age of 65.

Infection control measures help to reduce the risk of illness.

Many older adults present with atypical or diminished signs and symptoms.

Influenza and Pneumonia

Neoplasms occur with greater frequency in older adults.

Common types include lung cancer, breast cancer, and prostate cancer.

Presence of the cancer reveals presence of decreased immune response.

Cancer and cancer treatment can induce additional immune deficits.

Cancer

Symptoms: extreme fatigue, painful or swollen joints, unexplained fever, skin rashes, and kidney problems

Management objective is to control the severity of symptoms and prevent a flare.

Avoiding the sun, exercising, complying with drugs, limiting stress, and having regular health care visits

Systemic Lupus Erythematosus

Inflammatory polyarthritis of unknown cause

Symptoms: morning stiffness lasting for hours, tenderness, pain on motion, limited range of motion, and joint deformity in the small joints of the hands and feet

Treatment: physical therapy, first-line drugs for RA are nonsteroidal antiinflammatory drugs (NSAIDs), second-line drugs are known as disease-modifying antirheumatic drugs (DMARDs)

Rheumatoid Arthritis

Underrecognized problem among the older adult population: 31% of persons living with HIV and 17% of newly diagnosed cases are in those over the age of 50

The low clinical suspicion of HIV infection and delayed recognition of AIDS-defining infections contribute to the poor prognosis of HIV infection in older adults.

In older adults there is only a short interval from HIV infection to the development of AIDS and death.

Sex education, the use of condoms, and how and when to take an HIV test should be taught to older adults.

HIV in Older Adults

Nosocomial pathogen transmitted person to person, primarily from the hands of health care workers

Occurs when organism is present and normal flora of bowel are disturbed

The hallmark diarrhea is caused by a motility-altering factor that stimulates muscle contractions.

Consistent hand washing between contacts with patients and the use of gloves when handling body substances such as feces

Treatment: discontinue current antibiotic therapy, then treatment with oral vancomycin or fidaxomicin

Clostridium difficile

Risk factors: age more than 65 years, antimicrobial therapy, chronic renal failure, serious illness, and prolonged hospitalization

Transmitted person to person via hands of health care workers

Dedicated equipment, private rooms, and barrier precautions

Symptomatic patients should be treated with antibiotics indicated through culture and sensitivity.

Vancomycin-Resistant Enterococcus (VRE)

Transmitted patient to patient via hands of health care workers

Risk factors: insulin-dependent diabetes mellitus, chronic hemodialysis, illicit intravenous drug use, prolonged hospitalization, prolonged antibiotic therapy, stays in the intensive care unit, burn unit, or with an infected patient

Private room and barrier protection

Symptomatic patients should be treated with antibiotics indicated through culture and sensitivity.

Methicillin-Resistant Staphylococcus Aureus (MRSA)

May not exhibit classic symptoms of infection

Fever—temperature increase may be limited, or no increase may occur at all, so low-grade fever must be taken seriously.

Changes in the behavior: increased malaise or fatigue, combined with other symptoms may indicate the onset of infection.

Fever and inflammation may be reduced, whereas the white blood cell (WBC) count may still reflect an increased value.

History of infections, current disease processes, and medications especially antiinflammatory and immunosuppressant drugs

Infection Nursing Management: Assessment

The risk factors determined during the assessment indicate potential nursing diagnoses

Inadequate nutrition

Potential for infection

Need for health teaching due to knowledge deficits of immunizations, nutrition, or protection against infection from oneself or others

Reduced social interaction associated with infection and immune status

Infection Nursing Management: Diagnosis

The nurse just admitted an older adult with new onset confusion and cough. The family states that the condition came on suddenly. The nurse completes a history and physical assessment on the patient. Discuss the following assessment findings, and state whether or not they are significant and why.

1. History of RA and taking low-dose prednisone

2. White blood cell count is 8.9.

3. Lives in a senior house and dines with other residents

4. Temperature is 99.8°F.

5. Last pneumonia vaccine was 5 years ago.

Quick Quiz!

ANS:

1. History of RA and taking low-dose prednisone

Immune function is already compromised by rheumatoid arthritis and steroids.

2. White blood cell count is 8.9.

Older adults may not have elevated WBC when infection is present.

Answer to Quick Quiz (1 of 2)

3. Lives in a senior house and dines with other residents

Living in close quarters with others puts older adults at risk for infectious disease.

4. Temperature is 99.8°F.

Fever may not be present.

5. Last pneumonia vaccine was 5 years ago.

Pneumonia vaccine should be administered every 5 years in patients with chronic illness.

Answer to Quick Quiz (2 of 2)

The patient with increased risk for infection will:

Avoiding primary or secondary infection

Maintaining or improving immune status

The patient will do the following:

Increase knowledge in areas related to infection prevention, maintenance of immune status, and health practices

Consumes a well-balanced, high-caloric diet on daily basis

Performs self-care activities with minimum energy expenditure and risk of injury

Infection Nursing Management: Planning and Expected Outcomes

Prevent exposure to infections

Enhance immune system to enable patients to better resist infections

Optimum nutritional status is important.

Resolve detected deficiencies

Meals on wheels, assistance with food preparation, or ability to visit a senior center nutrition site

Nursing Interventions

Based on patients’ responses in meeting their goals and outcomes

One standard for evaluation is whether a patient contracts an infection.

Evaluation

Chapter 10

Sleep and Activity

Regulation of sleep and wakefulness occurs primarily in the hypothalamus.

Sleep is a state of consciousness characterized by the physiologic changes of reduced blood pressure, pulse rate, and respiratory rate along with a decreased response to external stimuli.

Biologic Brain Functions and Sleep

Sleep begins with the four stages of non-REM sleep, continues with a period of REM sleep, and then cycles through non-REM and REM stages of sleep for the rest of the night.

Variations in the REM and non-REM sleep stages occur with advancing age.

REM sleep is interrupted by more frequent nocturnal awakenings, and the total amount of REM sleep is reduced.

The amount of stage 1 sleep is increased, and stage 3 sleep and stage 4 sleep are less deep.

Stages of Sleep and the Older Adult

The sleep-wake cycle follows a circadian rhythm, which is roughly a 24-hour period.

The decrease in nighttime sleep and the increase in daytime napping that accompanies normal aging may result from changes in the circadian aspect of sleep regulation.

Sleep and Circadian Rhythm

Difficulty falling asleep, difficulty staying asleep, frequent nocturnal awakenings, early morning awakening, and daytime somnolence

May be transient, short term, or chronic

Affects the older adult’s quality of life with excessive daytime sleepiness, attention and memory problems, depressed mood, nighttime falls, and possible overuse of hypnotic or over-the-counter medications

Insomnia

Insomnia: the inability to sleep

Increased sleep latency, reduced sleep efficiency, nocturnal awakenings, increased early morning awakenings, and increased daytime sleepiness

Older adults awaken four or more times a night.

Daytime napping is common.

Daytime sleepiness may suggest underlying disease.

Other sleep changes are associated with chronic disease and other health problems.

Age-Related Changes in Sleep

Environment

Pain

Lifestyle

Dietary influences

Medication use and medical conditions

Depression and dementia

Factors Affecting Sleep

Schedule procedures and care activities to avoid unnecessary awakenings, modify environmental factors to promote a quiet, warm, relaxed sleep setting, and orientate older adults to the institutional setting.

Reduce noise: close doors, lower voices.

Reduce bright lighting at night.

Temperature: warmer is better than colder.

Nonpharmacologic and pharmacologic measures may be used to relieve pain.

Nursing Interventions for Sleep Environment

Loss of spouse

Retirement

Relocation

Having a roommate in long-term care facilities

Dietary influences

Depression

Dementia

Lifestyle Changes Affecting Sleep

Sleep is influenced by what we eat and drink.

Which of the following are true statements about sleep in the older adult? (Select all that apply.)

Reduced REM sleep causes irritability or anxiety the next day.

Insomnia leads to an increase in daytime falls.

Older adults commonly take naps during the day.

Cooler temperature at night is better for sleeping.

Acute or chronic pain interferes with falling asleep.

Quick Quiz!

ANS: A, C, E

Answer to Quick Quiz

Recurrent episodes of cessation of respiration

Apneic episodes may last from 10 seconds to 2 minutes and range from 10 to 100 per hour of sleep.

Three types: central sleep apnea (CSA), obstructive sleep apnea (OSA), and complex sleep apnea

OSA most common in older adults

Sleep Apnea

Due to complete or partial airway obstruction that blocks air flow increasing respiratory efforts

Risk factors: obesity, short or thick neck, jaw deformities, large tonsils, tongue or uvula, narrow airway, deviated septum, smoking, hypertension, and cardiac disease

Symptoms: daytime fatigue; waking with a headache and sore throat or dry mouth, and confusion; trouble concentrating and irritability; and sexual dysfunction

Treatment weight loss, positioning on side, CPAP, mandibular advancement devices and surgery

OSA

Repetitive kicking leg movements throughout the night

May occur every 5–90 seconds and each kick causes a brief disruption of sleep.

Report insomnia and excessive daytime sleepiness

Treatments: Drugs such as dopamine agonists and eliminate caffeine-containing products

Periodic Limb Movement in Sleep

Patient’s report of his or her sleep pattern and sleep-related problems

Determine quality and quantity of sleep.

Review the number of nocturnal awakenings and length of time awake at night.

Typical bedtime rituals or practices

Daytime sleepiness or a strong desire to nap

Assess consumption of alcohol, caffeinated beverages, sedative-hypnotics, OTC drugs, and other practices before bedtime.

Components of the Sleep History

Sleep diary

Sleep laboratory

Epworth Sleepiness Scale (ESS)

Pittsburgh Sleep Quality Index

Further Assessment of Sleep

Stable schedules and bedtime routines, a sleep-friendly environment, avoidance of any substances that would interfere with sleep, regular exercise (but not immediately before trying to sleep), and stress reduction

Nonpharmacologic interventions: relaxation therapies, stimulus control therapy, and sleep restriction therapy and cognitive behavioral therapy

Drug therapy may be necessary for a short time no more than one or two weeks.

Sleep Hygiene

Routine daily activities, diversional activities, and physical exercise

Changes occur in the activities pursued by older adults as they age or experience acute or chronic illness.

Physical exercise has health-promoting benefits for all older adults.

Activity and Older Adults

Activities that once were accomplished with ease may require modified approaches or the assistance of others.

Modification of routines and use of assistive devices help maintain independence.

Family members, friends, or paid caregivers may help with shopping and other tasks.

Dependency in basic ADLs increases the risk of relocation to a long-term care facility or to the home of a family member.

Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)

Important to maintain health, preserve the ability to perform ADLs, and improve the general quality of life

Prevents of heart disease, reduces elevated blood pressure and risk of osteoporosis, promotes appropriate weight and more restful sleep

Preserves mobility and reduces the risk of falls by promoting muscle strength and joint flexibility

Physical Exercise

Moderate-intensity aerobic exercise for 150 minutes a week

Drink water before and after exercise

Clothing should allow for easy movement and perspiration.

Athletic shoes should provide both support and protection.

Outdoor exercise should be avoided in extremely hot or extremely cold weather.

Stop exercising and seek help for chest pain or tightness, shortness of breath, dizziness or lightheadedness, or palpitations during exercise

Physical Exercise Tips

Retirement, relocation, and the loss of a spouse

Alzheimer’s disease, when it progresses, cognitive impairment increases, which adversely affects the ability to initiate and participate in routine daily activities

Older adult with advancing dementia also loses the ability to initiate diversional activities and to participate in activities that were once enjoyed.

Lifestyle Changes that Affect Activity

Activities should be meaningful, have a purpose, and foster a sense of well-being for the participants.

Physical exercise is important for general physical well-being.

Exercise may reduce agitation or wandering.

Rhythmic movement of a rocking chair may reduce agitation.

Going for a walk may redirect the impulse to wander.

Activities that tap into the older adult’s past life experiences and interests may stimulate memory.

Activity and Alzheimer’s Disease and Other Dementias

Chapter 11

Safety

The leading cause of fatal and noninjuries in older adults

Results in higher rates of morbidity and mortality among those older than 75 because of the higher incidence of frailty and a limited physiologic reserve

Leading cause of hip fractures

Education is the cornerstone of fall prevention and management.

Falls

Older individuals may not perceive a slip that results in a fall to the floor to be an actual “fall”; rather it may be termed a slip, trip, or accident, but not a fall.

Anything that causes a person to unintentionally move from one level plane to another

Definition of Falling

Is a concept that holds negative connotations because it is associated with a decline, drop, or descent to a lower level

Involves several related variables and most likely is determined according to an individual perception of how serious the fall is in terms of daily living

The health care professional may equate a fall with a decline in patient health or function or a worsening of a patient’s condition

Meaning of Falling to Older Adults

Vision—depth perception, problems with glare

Hearing—decrease in directional hearing, hearing loss

Cardiovascular—orthostatic hypotension

Musculoskeletal—osteoarthritis, muscle weakness, reduction in steppage height, which may increase risk for tripping

Neurologic—slowed reaction time

Normal Age-Related Changes That Contribute to Falling

Is not determined solely on the basis of number and kind of diseases, but on how risk factors influence areas of mobility, transferring, and negotiating within the environment

Best determined by observation of mobility

Risk categorized according to intrinsic (illness or disease-related) or extrinsic (environmental) risk

Research has shown that the individual with frailty and physical functional limitations is at greatest risk for falling.

Fall Risk

Combined effect of normal age-related changes and concurrent disease

Relates to gait, balance, stability, and cognition

Intrinsic Fall Risk

Environmental hazards, both indoors and outdoors

Steps

Floor surfaces

Edges and curbs

Lighting

Grab rails

Extrinsic Fall Risk

Hip fractures, head trauma, and internal bleeding affect a small percentage of older individuals who fall.

High mortality rate associated with hip fractures

Physical restraints can increase risk and should never be used.

Injury by attempting to remove the restraints: strangulation and asphyxiation

Elevation of both side rails can cause falls from attempts to climb over side rails.

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Describe and discuss the pathological conditions that might affect the sexual responses in older adults. How and why do you think Nutritional factors, psychological factors, drugs and c

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