NURS 3440 Older Adult Exam I Blueprint Fall

2015
Chapter 1 8 Questions

Geriatric Research
o Dementia
o Reducing falls
o Use of restraints
o Pain Management
o Delirium
o Humane End of Life Care
Life Expectancy
Cultural Appropriate Materials
Future Geriatric Health Care Needs
The Scope of Standards of Gerontology Nursing Practices
o Function in a variety of Settings
Hospital
Home
Subacute
o Advanced Practice Gerontological Nurses
Mission
Preserve function
Enhance health
Enhance Quality of Life and Dying
Older Adult Age Groups
o Young Old- 65-74 yrs of age
o Middle Old- 74-84 yrs of age
o Old Old- greater than 85 yrs of age

Chapter 2 10 Questions

Personal Perceptions of Health and Wellness

Nursing Role
Promotion of Independence Optimal level of functioning
Wellness Based Interventions
Healthy People 2020
o Eliminate preventable disease, disability, injury, and premature
death
o Achieve health equity, eliminate disparities, and improve the
health of all groups
o Create social and physical environments that promote good
health for all
o Promote healthy development and healthy behaviors across
every stage of life
Immunization (Flu)

Preventable Risk Factors of Early Death

Chapter 3 10 Questions

Interventions that Promote Biological Theories of Aging

o Exercise on soft surfaces, use good body mechanic (Wear and Tear)
o Avoid skin dryness and joint stiffening (Cross-link)
o Avoid environmental pollutants and unnecessary radiation (Oxidative
stress)
o Monitor research related to the effects of unsaturated fats and heavy
metals on cell health (Cross-Link)
o Monitor research on use and presence of antioxidants (Oxidative stress)
o Avoid stress (Oxidative stress, Immunity)
o Minimize the potential for infection: frequent hand washing,
immunizations, avoid those who are ill (Immunity)
Theories
o Immunity
Aging is a programmed accumulation of damage and decline in the
function of the immune system immunossenescence
Damage is a result of oxidative stress
T-cells thought to be responsible for increasing age-related autoimmune disorders
o Free Radial (Oxidative)
Cellular errors are result of random damage from free radicals
Referred to as oxidative stress or oxidative damage
Mitochondrial DNA most affected by these changes
o Activity
Attempted to predict and explain how individuals adjusted to agerelated changes by looking at ones level of activity and productivity
Popular because it is consistent with Western societys emphasis
on work, wealth, and productivity
o Eriksons
Theorized predetermined order of development and specific tasks
associated with specific periods in ones life course
In older adults, there is a process of life review that brings a
coming to terms with the life that one has lives thus far (Erikson et
al, 1986, p. 70)
o Psychological
o Wear & Tear
Cellular errors a result of wearing out over time from continued
use
A progressive decline in cellular function or increased cellular death
o Continuity
Suggests that individual tends to develop and maintain consistent
pattern of behavior, substituting one role for similar one as one
matures

Personality influences role and activities we choose and level of life

satisfaction
Successful aging associated with ability to maintain and continue
previous behavior and role, or find suitable replacement

Chapter 4 29 Questions

Normal Changes of Aging

Living Environment Room Selection/Design
Head to Toe Assessments Body Systems
o Cardiovascular
Heart
Valves
o May be thicker and stiffer as result of lipid deposits,
collagen degeneration, fibrosis
Conductivity
o SA node cells decrease in number as myocardial fat,
collagen, and elastin fibers increase
o AV node and bundle of His lose conductive cells
Contractility
o Contraction prolonged most likely due to slower
release of calcium into the myoplasm during systole
Blood Vessels
o Elasticity diminished because of changes in collagen,
elastin, and possible cross-linking
o Vessel walls thicken as result of reorganization of
cellular and extracellular matrix
o Pooling of blood increases venous pressure,
diminishing effectiveness of peripheral valves
Presbycardia
o Reduced cardiac reserve evidenced by decreased
Maximum heart rate
Stroke volume
Cardiac output
Ejection fraction
Myocardial oxygen uptake
o Respiratory
Airways
Nose
o Nose elongates downward as support of upper and
lower lateral cartilage weakens
Trachea and Larynx
o Stiffening of larynx and tracheal cartilage occurs as
result of calcification
Chest Wall and Lung

Ossification or rigidity of costal cartilage and downward slant

of ribs create less compliant, more rigid rib cage, which limits
chest expansion
Oxygen Exchange
PO2 declines
Chemoreceptor function altered or blunted
o Gastrointestinal
Mouth and Teeth
Teeth eventually lose enamel and dentin, and become more
vulnerable to caries
Gums more susceptible to periodontal disease
Esophagus
Contractions increase in frequency but are more disordered
and propulsion are less effective
Stomach
Decreased gastric motility and volume and reductions in
secretion of bicarbonate and gastric mucus
Decreased production of intrinsic factor
More susceptible to peptic ulcer disease
Small Intestine
Villi become broader, shorter, and less functional
Nutrient absorption affected
Large Intestine
Peristalsis slowed
Accessory Organs
Liver and gallbladder
o Liver decreases in weight and mass
o Incidence of gallstones increases
Exocrine pancreas
Becomes more fibrotic, has increased fatty acid deposits,
atrophies slightly
o Integumentary
SKIN
Epidermis
o Keratinocytes become smaller and regeneration
slows
Dermis
o Loses about 20% of thickness with aging
Hypodermis
o Lean muscle replaced by fat; subcutaneous fat
reduced
HAIR
Becomes gray as melanin production in hair bulb decreases
Diffuse alopecia occurs in both genders with aging
NAILS
Become more brittle, flat, concave

 Cuticle becomes less thick and wide

o Musculoskeletal
Structure and Posture
Vertebral disks become thin, causing shortening of trunk
Stooped, slightly forward-bent posture common
Bones
Disequilibrium in bone maintenance develops when
resorption is more rapid than deposition of new minerals
Changes in Spine

Joints, Tendons, Ligaments

o Age-related changes in articular cartilage result from
biochemical changes
o Tendons may shorten and move from usual positions
Muscles
Muscle tissue mass decreases (atrophies) while adipose
tissue increases
o Urinary
Kidneys
Size, function of kidneys decrease
Glomerular sclerosis
Renal Vessels
Renal blood flow decreases 50% by age 80 or about 10%
per decade of adult life
Ureters, Bladder, Urethra
Some tone and elasticity lost
Capacity declines from about 500 to 600 mL of urine in
younger adult to about 250 mL in older adult
Weakened contractions during emptying can lead to postvoid residual and increased risk for urinary tract infections
Glomerular Filtration Rate
May be reduced by 50% by age 75
o Female Reproductive
Perimenopause
Menopause
o Sensory (Eyes & Ears)
Eye and vision changes
Extraocular
Ocular
Intraocular
Auditory Changes
Outer ear
Middle ear
Inner ear