Environment excites/stimulates the senses.

Senses pass stimuli to the cerbral cortex where recognition (perception) and interpretation (cognition) occur.

Specific regions of the cerebral cortex are responsible for detecting and processing the stimuli acquired by various senses.

Malfunction of the sensory organs or of the interpretation centers in the brain results in disturbed perception and cognition.

People with malfunction need lots of cueing in doing ADLs.

Takes place in the cerebral cortex of the brain.

Each time stimuli are introduced in the brain, they're associated (at an unconscious level) with the pool of facts, memories, and experiences that are stored there.

Once these connections are firmly established, info is said to be learned.

Once learning has taken place, info or skills can be retrieved as needed.

The ability to perform tasks or make judgments based on unfamiliar stimuli.

Sometimes referred to as the ability to "think on your feet"

They have no base of reference. Info is new.

Often called "wisdom"

They ability to perform tasks and make judgments based on the knowledge and experience acquired throughout a lifetime.

People who have alterations in cognition may be able to function for sometime due to this.

Language is the product of cognitive function.

In both spoken and written forms, language allows humans to communicate ideas and thoughts.

Sensory and cognitive problems can result in poor language development or loss of language skills.

Damage to the language centers of the brain can result in aphasia.

Visual and hearing changes, changes in taste and smell, and changes in touch and sensation all interfere with the ability to collect accurate information from the environment.

Difficulty understanding women/children (higher pitched voices; need to talk in low, monotone voice)

Trouble following a conversation if more than one person is talking.

Difficulty hearing over the phone (speak slowly)

Difficulty hearing b/c of background noise.

Complaints that other people are mumbling.

Increased volume of tv/radio. Particularly if those with normal hearing complain about the loud volume.

Straining to hear normal conversation.

Can use your stethoscope and talk into it so they can hear.

Write things down so they can read it.

Have there fire alarm have flashing lights since they can't hear it.

Does not automatically decrease with aging, nor does the ability to learn.

Some people seem less intelligent as they age because of their tendency to be slower and more cautious in their responses.

Lack of formal schooling may make older adults appear less intelligent.

Some degree of forgetfulness or memory loss is common with aging.

Many older adults begin to fear they are "losing their minds" or developing a serious problem (is this what's happening to Jo?)

Even without formal education many older persons are able to compensate for memory gaps by relying more on the large pool of experience gathered over a lifetime.

Any condition that impairs cerebral circulation and causes a disturbance in cognitive function.

Causes: trauma, dehydration, fever, meds, elevated BP, infections, hypo/hyperglycemia, hypoxia, fluid & electrolyte imbalance, med level changes.

S/SX: excessive drowsiness, disorientation, agitation, hallucinations

To identify the underlying problem and correct it! You cannot do that with dementia.

Delierium is abrupt rapid and usually post something.

Might be undiagnosed/misdiagnosed.

Altered levels of unconsciousness.

Reversible in MOST cases. 

Senile Dementia/SDAT (Senile Dementia Alzheimer's Type)

Vascular:caused by stroke/TIA, blood clots. Happens after 70 usually. People with hx of HTN, smokers, obese, or high lipids.

Lewy Body Dementia (DLB): microscopic deposits called lewy bodies on brain which cause damage to nerve cells. Signs of parkinson's and hallucinations.

Frontotemporal demntia/Pick's: After 65 usually. Degeneration to frontal & temporal lobe. Personality and behavioral issues. Cussing and hoarding sometimes seen.

Is a slow process that results in progressive loss of cognitive functioning and abstract thinking.

Usually caused by damage to the cerebral cortex.

**Permanent or progressive organic mental disorder.

Impaired memory

Decreased intellectal function

Personality changes

Confusion disorientation

Impaired control of judgment and impulses**

Most common type of dementia. 

Chronic, progressive, degenerative disease.

Brain cells and tissues are affected by:

-Atrophy (shrinking)

-Beta-amyloid plaques (not seen on MRI) Autopsy only 

-Decreased acetylcholine (brain neurotransmitter)

Other diseases can mimic alzheimer's dementia so comprehensive evaluation is essential to rule out causes before diagnosis is made.

May be genetic

May be caused by a protein called (ApoE) Apollipoprotein

Inflammation

Elevated blood sugar/levels/diabetes

Head injuries

Until 2010 only way to diagnose Alzheimer's Disease was autopsy.

Now there are some tests that can diagnose and predict this type of dementia.

Indicated by spinal fluid low in beta amyloid proteins and high in tau proteins.

The bad news is that these tests are not avaliable to the general public and are still in the research phase.

Meds (have lots of SE, diarrhea)

Meds keep them at same level or try to.

Alternative TXs: Vitamin supplements, coenzyme Q10, melatonin, Vit C and E.

Music Therapy & Horticultural therapy

OT/PT

Life review/reminiscence therapy

Wandering is common.

Better not to restrain, but to provide a safe area to pace or wander.

Safe return bracelet (thorugh Alz association)

Electronic devices used in facilities can be helpful in preventing elopment (wanderguards)

Unable to state he/she is hungry. 

Change in behavior when sun sets.

Risk Factors: unfamiliar environment, disturbed sleep patterns, use of restraints, excess sensory stimulation, sensory deprivation

****Nursing Measures: turn on lights before dark, keep some form of lighting on in room, frequently check on and orient pt, use touch when appropriate, provide afternoon acticity without overexerting pt, place familiar objects and personal possessions within view.

Many elders consume alcohol.

They are sometimes intoxicated with smaller amounts.

Recover more slowly than younger persons.

Can be manifested in diff. ways:

Drinking to calm nerves/improve mood.

Memory blackouts, gulping/rapidly drinking

Confusion & isolation

Depression

Lack of Motivation

Injuries/Falls

Insomnia, GI Distress (bleeds)

Clumsiness

Demonstrate improved ability to detect changes in the environment.

Interact appropriately with environment.

Demonstrate the ability to compensate for deficits by using prosthetic devices and althernative sense.

Ensure that all caregivers are aware of the person's sensory problems.

make appropriate sensory contact before beginning care.

Determine the best methods for communicating with older adults.

Modify the environment to reduce risks.

Verify that prostheses such as eyeglasses and hearing aides are functional.

Remain free from injury

Assist in ADLs to the highest level possible

Seek assistance when needed.

Collect date regarding behavior on admission and at regular intervals

Provide assistive sensory devices and develop a plan to deal with "acting out" behaviors.

Orient the person to person, place and time and provide any other important situational information.

Provide a structured environment that ensures safety yet enables the person to stay active as long as possible.

Provide continuity and administer psychotherapeutic meds as ordered.

Avoid use of physical & chemical restraints and have structured participation in ADLs.

Structure the environment to minimize disruption, avoid sudden changes of room or environment.

use effective communication skills and consult with family and the multidisciplinary team.

Collect data regarding the older person's communications problems and abilities.

Identify specific approaches that are effective for each person.

Document the selected techniques that facilitate communication in the care plan.

Explain effective communication techniques to family members & friends.

Teach verbally impaired older adults methods for their specific communicating needs.

Consult with speech therapist/speech pathologist to determine the most effective communication strategies.

Collect data regarding nature and severity of pain

Provide comfort measures (elevate legs, heat/ice packs)

Avoid actions that increase pain

Anticipate situations likely to cause pain

Teach nonpharmcologic approaches to pain control

Adminster meds as ordered.

**Always collect data first!!!

The study of how older adults respond to medication is a new, but growing area.

Drug testsing and establishing of therapeutic dosages does not take into account the unique characteristics of older adults.

Older adults normally have some change in body function and are more likely to suffere from at least one disease process, they are not physiologically the same as younger adults.

Pharmacokinetics

Drug absorption

Gastric acid secretion decreases as we age.

When the concentraction of acide is lower than normal, drug absorption is reduced.

Decreased acidity also affects the breakdown of capsules and tablet coatings in the stomach, resulting in a variable absorption rate depending on the way a drug is manufactured.

Pharmacokinetics

Drug distribution

Water soluble drugs tend to remain in higher concentrations in the bloodstream because there is less total body water.

Fat soluble drugs become trapped in the fatty tissue because of decreased muscle mass and increased adipose tissue.

A decrease in hemoglobin and the plasma protein albumin results in fewer avaliable sites for protein bound drugs.

Pharmacokinetics

Drug metabolism

Aging often results in decreased activity of liver cells.

Reduction in perfusion decreases the liver's effectiveness in metabolizing drugs.

When drugs are not metabolized effectively by the older adult's liver, the risk for toxicity increases.

Pharmacokinetics

Drug excretion

Aging kidneys are signigicantly less effective at removing waste products, including the byproducts of medications.

As the kidneys become less effective in the excretion of drugs, more drug remains in the circulation, leading to elevated drug levels and symptoms of drug toxicity.

Pharmacodynamics

Polypharmacy

The prescription, administration, or use of more meds than are clinically indicated is a common problem in older adults.

The more meds taken, the greater the risk for untoward reactions, drug interactions, and drug toxicities.

Lack of the literacy skills needed to read the labels and directions.

Inability to understand and comply with directions

Inability to make correct judgments about meds

May not recognize that they have to take medication.

vision changes may render an older perosn unable to read a medication label or to recognize the different shapes, sizes, or colors of the various medications.

Adequately assessing the person's ability to read labels accurately proper teaching, and using special labels or magnifying devices may help reduce the risks.

Practice is common and persists because many older adults are unaware of the dangers.

All people, particularly older adults must be aware that it is not safe to take a medication prescribed for someone else.

Many do not think OTC meds are "real" drugs because no prescription is needed to purchase them.

OTC meds are capable of potentiating or interfering with the effects of prescription meds, possibly resulting in serious harm.

Can also creat or mask symptoms of disease***

**the most commonly consumed nonprescription drug used by adults.

most older adults do not think of alcohol as a drug, os they do not think about it when taking meds.

Alcholoc beverages can cause adverse reactions when taking in conjuction with many prescription and OTC drugs

The directions provided may be very clear to a knowledgeable health care professionaly, but they are often misunderstood or misinterpreted by older adults.

Even simple misunderstandings can lead to improper self medication and result in serious consequences.

To reduce the risks, older adults often require additional instruction

Older adults living on a limited income may fail to take their meds or may make changes in the amt or frequency to conserve their supply.

Many frugal older adults save meds that were prescribed in the past, even if the drugs are no longer part of their therapy.

Often reluctant to discard costly meds, holding on to them "just in case"

Before administrating a medication, nurses should have the following info.

The therapuetic effects of the med.

The reasons this individual is recieving the med.

The normal therapeutic dosage of the med.

The normal route/routes of administration.

Any special precautions related to administration.

The common side effects/adverse effects of the medication.

Nurses must be sure to collect data regarding their older residents thoroughly before administering any meds.

After administration nurses ahouls monitor older adults continually to determine whether the med is having the desired effect.

residents should also be observed for any untowards effects or significant changes in medical condition or behavior.

Nurses should be particularly watchful for any signs or overdose or toxicity.

Coudl include the use of safety devices, call signals, behavior monitoring, or any other specific precatuion related to meds.

The care plan should inidcate when it's necessary to check vital signs, monitor lab values, or make any other special observations.

All parameters specified by the physician shhould be readily identified in the care plan.

Nursing Interventions Related to Medication Administration

Rights!

Right residents

Right medication

Right amt

Right dosage form

Right route

Right time

Right documentation

Right to know what med they're recieving and why they're recieving it.

Right to refuse to take medication.

Right to privacy during injections or any other such procedures.

use of psychotropic drugs as chemical restraints presents a risk to the rights of older adults.

Under OBRA legislation, residents of care facilities shoudl ahve the option of self medication if they are capable of doing so safely.

**A physician's order stating that self medication is permitted is usually required.

The nurse remains responsible for monitoring the residents' compliance and response to the medications.

because medications are a significant part of the medical plan of care, odler adults who live independently must learn to take them properly.

the responsibility of assessing medication taking behaviors and teaching safe self administration often falls to the home health care nurse.

Identification must be checked (following agency policies) each time a medication is administered.

Failure to do this can result in serious errors and harm to older adults.

Cognitive and sensory limitations

Special precautions and complicated time schedules

To reduce the risk for noncompliance, nurses should encourage older adults to talke to the physician and/or the pharmacist to see whether there is any safe way to reduce the number of meds or simplify the med schedule.

associating med schedules with regular daily events

Explain the importance of preparing meds in a well lit area

ensure that containers are properly labeled

apply color codes, tape strips, pictures ,or textures to containers to help older adults recognize them.

modigy containers for ease of use

establish measures to distinguish and separate similiar containers

teach older adults to store meds properly

obtain or devise a system to promote compliance

stress the importance of being alert when taking meds