UNIT 3 – Basic Skills for Gerontologic Nursing Immunization

Health Promotion and Maintenance • Pneumococcal vaccine – given starting at 65 or 70

years of age, repeating the vaccination every 10 years
Recommended Health Practices for Older Adults
is recommended
Diet – older adults have different nutritional needs than other • Influenza (flu) vaccine – obtained on a yearly basis
age groups. Eating too much or too little of some nutrients • Shingles (zoster) vaccine – recommended for 60
may increase the risk of certain chronic diseases, such as heart years old and above provided they have a normal
disease and high blood pressure. immune system. Very expensive and 50% effective
• Hepatitis B immunization – based on individual
Dietary Considerations for Older Adults risk factors
1. Get More of These Nutrients – Dietary Fiber, Vitamin Factors that affect health promotion and maintenance
D, Calcium, and Potassium
2. Get less of These Nutrients: Saturated Fat, Sodium, Religious Belief – the body is a temple (stressing the
and Added Sugars importance of avoiding alcohol, tobacco, and other behaviors
that are harmful to health)
Exercise:
Cultural Beliefs and Practices – reliance on home remedies.
• Help keep joints flexible Selection of food and the methods used for food preparations
• Maintain muscle mass
• Control blood glucose levels and weight Knowledge and Motivation – health and safety teaching must
start early and be reinforced throughout life
• Promote a sense of well-being
• Walking, swimming, golfing, housekeeping, and Perception of Aging – someone who feels capable and in
active lawn work or gardening control of life is more likely to change behaviors and to work
• At least 30 minutes of continuous activity at maintaining health
Tobacco and Alcohol Impact of Cognitive and Sensory Changes – changes in
vision, smell, hearing, sensation, taste, and memory can lead
• Stop smoking to decreased awareness of normal environmental hazards
• Excessive consumption of alcohol is not
recommended Impact of Changes Related to Accessibility – access may be
• Alcoholism is a common problem in the older adults limited by decreased physical mobility, lack of transportation,
population both in men and women or limited finances
• Occasional or moderate alcohol consumption is not
Communication with Older Adults
prohibited unless some medical precludes its use
• A glass of wine or beer, as an appetite enhance, is Communication – is the process of exchanging information;
recommended sending messages back and forth between individuals or
groups of people
Physical Examinations and Preventive Overall Care
effective communication – respect the person’s right to think
• Should be examined annually and say it. This atmosphere of mutual respect and
• Physical examinations provide: understanding helps build trust and rapport
▪ An opportunity to detect problems before they
become more serious Barriers to Communication
▪ To monitor and treat chronic conditions, and
▪ Prevent some health problems Hearing Impairment – wears hearing aid; read lips

Vision Changes – should be checked yearly (monitor for Aphasia – partial or total loss of the ability to use or
glaucoma or other eye problem) understand words

Hearing examinations need to be done yearly as a basis Dementia – both cognitive and language deficits
unless a problem is suspected • Mgt. try to determine meaning of behavior, not ignore
• Audiometric testing is needed if with signs of it as meaningless
diminished hearing Cultural Differences – know what language a person speak,
Blood Cholesterol screening should be done every five years have interpreters

Uson, Paulene B
BSN – 3A
Empathy – it is the ability to put oneself in another person’s • Alcohol yields 7 calories/grams and has no
place and to understand what he or she is feeling and thinking nutritional value
in that situation
Basal Metabolic Rate
• Elderspeak – type of communication w/c is a form
of ageism • BMR – the rate at which the body uses calories
• Active listening and empathic listening (effective • The lowest recommended daily intake to adequately
communication) meet nutritional needs is 1,200 calories
o Active listening – involves interpretation • Disease that restricted mobility and physical activity
o Empathic listening - involves patience when an (arthritis, stroke) lead to decrease caloric needs
older adult needs extra time to voice a response • Other disease processes (cancer and critical illness)
or repeat the same things many times increases the caloric requirements because illness
increases metabolism
Skills and Techniques • DM patients requires special diet controls and treat
disease
• Informing
• Direct Questioning – need to be conversational and Body Mass Index
• not too aggressive
• Using open-ended Techniques • A number of calculated using a person’s weight and
• Communicating with visitors and families height that is reliable way to measure body fatness
• Confronting for most people
o Confrontation – is one of the most difficult • Determine if someone is underweight, obese, or
communication techniques to use and should be within normal parameters
used only after good rapport has been established
2. Nutrients
Nutrition
• Vital nutrients include CHO, CHON, fats, Vitamins,
When dealing with nutritional status, nurses who work with Minerals, and Fluids
older adults must consider the following; MyPlate – is a visual representation of healthy eating habits
• The basic components of a well-balanced diet for designed by US government
older adults The plate is divided into color-coded food groups, which
• How the normal physiologic changes of aging change include vegetables, fruits, grains, protein with dairy on the side
nutritional needs
• How the normal physiologic changes of aging may 3. Carbohydrates
interfere with the purchase, preparation, and
• include sugars and starches that comprise
consumption of nutrients
approximately half of the standard American diet
• How cognitive, psychosocial, and pathologic changes
• provides a ready source of energy for the body
commonly seen in aging impact one’s nutritional
• divided into 2 categories: simple & complex
status
o Simple CHO – are used more readily by the
1. Calories – are units of heat that are used to measure the body because their bonds are easily broken
available energy in consumed food o Complex CHO – must be broken into simple
sugar before they can be used by the body
Many factors influence how many calories will be used by a ▪ contain soluble fiber (bulk food aid in
person: constipation and reduce cholesterol
levels for risk in CAD)
• Activity patterns, gender, body size, age, body
▪ play an important role in the control of
temperature, emotional status, temperature of the
diabetes
climate in which the person lives, both acute and
chronic illness 4. Proteins (carbon, hydrogen, oxygen, and nitrogen)
Various Nutrients Provide Different Amounts of Calories • are composed of amino acids, which are essentials for
tissue repair and healing
• Fats (plant sources/animal sources) yield 9
• Needs remain constant or may increase slightly with
calories./gram
aging to compensate for the loss of lean body tissue
• Portein and Carbohydrates yield 4 calories/grams
• For adult women is 46g/day; for adult men, the RDA
• Vitamins, Minerals, and Water yield no calories
is 56g/day
Uson, Paulene B
BSN – 3A
 • Increasing CHON consumption has been linked with Vitamin D (bone demineralization or osteoporosis,
a lower incidence of frailty among older women depression, and immune system dysfunction)

Factors Affecting Protein Consumption Vitamin E (immune dysfunction, memory problems)

• Ability to procure and prepare foods Vitamin C (weakness, dry mouth, skin changes, delayed
• The cost of foods containing CHON tissue healing, atherosclerosis, and decreased cognitive
• The ability to chew common high-protein foods function)

Types of Proteins Vitamin B6 (neurologic and immunologic problems, elevated

homocysteine levels – risk factor for cardiovascular disease)
Complete Proteins – necessary for making and repairing
7. Minerals
tissues (ex. Red meat, poultry, fish, eggs, dairy products)
• Are inorganic chemical elements that are required in
Incomplete Proteins – w/c do not contain amino acids (ex.
many of the body functions
Plants foods such as legumes – peas and beans , nuts and
cereals such as whole grains and rice) • Make up a small portion of total body weight, yet a
slight mineral imbalance can have serious effects
Complementary Proteins – consist of two or more icomplete
proteins that together provides adequate amounts of essential 7.1. Calcium
amino acids • Most abundant miunerals in the body
High Proteins – contains large amount of fats (elevate • It is necessary for bone and tooth formation; nerve
cholesterol and triglycerides) contribute to plaque formation impulse transmission and conduction; muscle
and atherosclerosis contraction (cardiac function) and blood clotting
• Sources: milk and dairy products
5. Fats • Disease: Osteoporosis (loss of calcium)
• Recommended fats is approximately 20% to 35% of 7.2 Phosphorus
total daily caloric intake
• Fats aid in the absorption of fat-soluble vitamins and • Needed for normal bone and tooth formation;
to provide adequate amounts of essential fatty acids. activation of some B vitamins; normal neuromuscular
It adds flavor to food and provides sense of fullness functioning; metabolism of carbohydrates; regulation
with a meal of acid base balance; and other physiologic processes
• Sources: dairy products, meat, egg yolks, peas, beans,
3 Important Types of Lipoproteins nuts, and whole grains
High-density lipoprotein (HDL) – health fat, composed of 7.4. Sodium
protein that appears to protect against blood vessel disease
• One of the important elements in the body
Low-density lipoproteins (LDL) – composed of cholesterol • Involved in acid-base balance, fluid balance, nerve
and contribute to blood vessel disease impulse transmission and muscle contraction
Very-Low-density lipoproteins (VLDL) – composed of • Mostly found in extracellular fluid
triglycerides and contribute to vessel disease but to a lesser • Regulated by the kidneys, w/c retain or eliminate
extent sodium according to the body’s needs
• Interact with potassium as part of the fluid exchange
6. Vitamins through cell membrane
• Are organic compounds found naturally in foods. They 7.5 Potassium
can produced synthetically. It is needed for a variety of
metabolic and physiologic processes. • Major in intracellular ion in the body
• 2 classifications • Plays an important role in acid-base balance, fluid
✓ Fat soluble – A,D,E,K and electrolyte balance, and normal neuromuscular
✓ Water soluble – vitamin c and b – complex functioning
• Less abundant in diets of older adults than other
Vitamin Deficiencies minerals
• Deficiency (hypokalemia) is a common problem
• Vitamin A (poor wound healing, dry skin, night
• Severe muscle weakness is the most common
blindness)
observation
Uson, Paulene B
BSN – 3A
7.6 Zinc Shrunk shank means shrinking of muscles due to old age and
weakening of legs
• Trace minerals that plays a role in protein synthesis
• Insufficient zinc may lead to: delayed wound healing, • Weight loss is the most common sign of frailty
impaired immune functions, lethargy, skin changes, syndrome
diminished sense of smell and taste, decreased • Frail people usually suffer from three or more of five
appetite. symptoms that often travel together:
• Mgt. supplement
These includes the following:
Functional Food - are foods that have been found to have
overall health benefits and reduced risk factors for chronic • Unintentional weight loss (10 or more pounds within
diseases or enhance body processes that benefit health the past year)
• Muscle loss and weakness
• Soy – decreased LDL and total cholesterol, increase • A feeling of fatigue
HDL, increase bone density, stabilize blood glucose, • Slow walking speed and
and reduce breast cancer risk • low levels of physical activity
• Mushroom – enhance immunity, guard against
tumors, decrease inflammations, and improve blood Medications and Older Adults
lipid profiles
Geropharmacology – the study of how older adults respond
• Green Tea – reduce cardiovascular disease and stroke, to medication
guard against cancer and Parkinson’s stabilize blood
sugar • It is more important to consider physiologic age than
• Black Rice – rich in phenolic compound (antioxidant) chronologic age
and minerals. Reduce BMI and body fat and increase
HDL cholesterol Factors that Increase the Risk for Medication-Related
Problems
Water
• Drug–testing methodology
• Essential for life • Physiologic changes related to aging
• Necessary for the formation of many body secretions • Use of multiple medications, OTC medications, and
(tears, perspiration, and saliva) herbal supplements
• Aids in digestion and in transportation of electrolytes • Cognitive and sensory changes
and nutrients • Knowledge deficits
• Facilitates elimination of waste products • Financial concerns
• Temperature regulation
• Total amount of body fluid decrease to 8% - 10% in Pharmacokinetics – is the study of drug actions within the
older adults body, including absorption, distribution, metabolism, and
• Fluid balance – amount of fluid taken into the body excretion
should be in balance with the amount eliminated from Drug Absorption
the body
First Pass Effect – is a phase of drug absorption that is altered
Malnutrition Older Adult
in the older adult
Malnutrition – a disorder of nutrition resulting from • Oral medication takes a first pass through the liver
unbalanced, insufficient, or excessive diet or from impaired
before entering the systemic circulation, greatly
absorption, assimilation or use of food reducing drug
Frailty Syndrome • Caused: reduced liver mass and blood flow
• Decreased gastric pH, resulting in an increased
• Is a common geriatric syndrome that embodies an gastric pH and reduced drug absorption
elevated risk of catastrophic declines in health and • Decreased gastric motility and slower emptying rate
functions among older adults of the stomach
• A syndrome characterized by increased susceptibility
to stressors that can lead to negative health outcomes Polypharmacy – the prescription, administration, or use of
and functional impairment more medications than are clinically indicated; is a common
• the shrunk shank is a result of loss muscle with aging problem in older adults

Uson, Paulene B
BSN – 3A
 Herbs or Supplement Health Claim FANCAPES (acronym)
Black Cohosh Decreases hot flashes and
other menopausal symptoms • Fluid
Gingko biloba Improves memory; • Aeration
improves blood circulation • Nutrition
in the brain • Cognition, communication
St. John’s Wort Relieves depression • Activity/availabilities
Chamomile Calms upset stomach; helps
• Pain
with sleep
• Elimination
Echinacea Shortens duration of colds
and flu • Skin/socialization
Ginseng Immune system booster; Meeting the Safety Needs of Older Adults
lowers blood sugar;
improves learning Hypothermia – is defined as a core body temperature of 95’F
Green tea Prevention of CA; or lower
promotion of weight loss;
alleviates stomach disorders Hyperthermia – is a higher than normal body temperature
Soy Prevents HPN, diabetes and occurs when the body is unable to get rid of excess heat
in high cholesterol
Kava Relieves anxiety; promotes Heat exhaustion – occurs gradually and is caused by water or
sleep sodium depletion
Glucosamine sulfate Helps relieve joint pain and
arthritis Heatstroke – a condition in which the body temperature can
climb as high as 104’F, is a life threatening

CARE (acronym)

• Caution/Compliance
• Adjust
• Review regimen regularly
• Educate

Health Assessment of Older Adults

Fulmer Spices – is an acronym for 6 common “marker

conditions” in older adults that can identify potential health-
related problems

• This screening tool can be used routinely during

assessments to identify and/or prevent potential
problems and to monitor health status over time
• Identification of one or more of these problems
indicates an increased for functional decline and even
death
• Developed by Terry Fulmer

SPICES (acronym)

• Sleep disorders
• Problems with eating or feeding
• Incontinence
• Confusion
• Evidence of falls
• Skin breakdown

Uson, Paulene B
BSN – 3A