Case+Study+Unit+V


 * ​Please have questions 1-3 answered for Wednesday, 2/10/10 and the remaining questions completed by 2/17/10. Online posts made after 2/17/10 will no be counted towards your participation for this case study.**

1. Describe the changes you would expect to find during a physical exam of the older adult patient.

Head: loss of memory, disoriented, apathy, and language disturbances. Brain receptors become more sensitive and psychoactive drugs become very potent.

Eyes:Increased rigidity of iris, dilator muscle atrophy and weakness. Lens may become more opaque and rigid. Decreased tears and dryness. Loss of orbital fat and decreased muscle tone.

Ears:Tympanic membrane can become less elastic with aging and can result in conductive hearing loss. Loss of elasticity of cartilage, increased, dry cerumen, increase in hair growth.

Throat and mouth: Retraction of gums, loss of teeth, decreased taste buds, decreased saliva, atrophy of tissues.

Cardiovascular: blood vessels become less elastic, venous return becomes less efficient. Plaque continue to deposit in the arteries. peripheral pulses are not always palpable.

Respiratory: harder to clear lungs due to decrease in ciliary action and pulmonary elasticity

GI: digestive juices diminish and nutrient absorption decreases. malnutrition and anemia become more common. decreased peristalsis may make person constipated. complaints of indigestion.

Musculoskeletal: muscle mass and strength decrease. bones become porous and brittle making fracture more common. joints stiffed and range of motion may decrease. they will lose height and posture will stoop.

Neurological: the CNS responds more slowly to multiple stimule and this maikes the cognitive and behavioral response of the older adult delayed. rate of reflex response decreases. temperature regulation, pain/pressure perception and sensation in the extremities become less efficient. there may be some difficulty with coordination and balance making them a fall risk.

Genitourinary: pt could have an uncontrollable bladder. there mucsle weakens and they are unable to hold it and they will probably need help getting to the bathroom adn not be able to make it on time so therefore they will become incontinent and need to wear depends Psychological:

2. Discuss three cognitive changes seen in a number of elderly patients. Elderly patients may experience memory loss. They may not be able to recall short term memory very well. Also they may experience a disorientation to date, time, place, year etc. Also the elderly patient may not remember how to do certain things such as bath themselves or dress or feed themselves.

3. Identify six patient behaviors in the elderly you would associate with depression.

Decreased interest in family and friends (social isolation), Decreased interest in previously enjoyed hobbies or activities, decreased appetite,insomnia,decreased participation in ADL's, suicide gestures/attempts. Feelings of hopelessness, uselessness or despair.

​ Elderly people don’t always outwardly suffer from clear cut depression; some never feel sad or withdraw from friends and activities. Instead you might expect behaviors of anxiety, irritability, drug or alcohol use, slowed movements, and even complaints of felling like a burden, not having the same energy they used to have, or even not feeling motivated.

4. What medical conditions in the elderly could present with symptoms of depression? Common medical conditions that can present as depression include dehydration, thyroid problems, vitamin B12 deficiencies, hormonal and electrolyte imbalances.

5. What patient behaviors would you associate with delirium? An individual experiencing delirium will have sudden onset of symptoms. The pt’s behavior most likely will be erratic and change suddenly from one emotional extreme to another. At pt could be euphoric one moment to irritable or even combative the next. Some will experience hallucinations, paranoia, disorientation, confusion, difficulty speaking or seem demented. 6. What patient behaviors would you associate with dementia? ​ pts will suffer from annesia and aphasia. they would also have a loss of sensory ability to recognize objects. they will use defense mechanisms such as denial, confabulation, perseveration. You will see the patient becoming disoriented and will need help doing there ADL's. They will be at high risk for injury such as falls, fires, wandering outside. they will become incontinent and have uncontrolled emotions. they may not be able to speak clearly or remember certain words. They will have decreased driving skill. they can become violent becasue they are aware of what is happening to them.

7. What neuroanatomic changes are seen in individuals with Alzheimer’s disease? These can only be seen by microscopic examination at autopsy. There is often a reduced amount of certain chemicals necessary for brain cells to communicate effectively.
 * fiber tangles within nerve cells (neurofibrillary tangles)
 * clusters of degenerating nerve endings (neuritic plaques)

8. Write three priority nursing interventions for the patient with delirium. Identify the cause.Protect patient from injury. Frequently re-orient the patient; tell them who you are, the time and where they are. Modify the environment for the needs of the client; a comfortable, safe and familiar environment including pictures of family and friends, large calenders or music that the patient enjoys.

9. Write three priority nursing interventions for the patient with dementia. 1. Use safety measures as needed as r/t pt's status. Some areas to look at when assessing for the individualized safety measures: A&O, LOC, comorbid conditions, and any deficits (cognitive, hearing, sight, language, physical) the pt may have.