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
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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
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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
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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
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Nutritional factors
Malnutrition
Iron and trace element deficiency
Psychosocial factors
Depression
Drugs
Complementary and alternative medications
Factors Affecting Immunocompetence
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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
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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
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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
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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 Chapter 10
Sleep and Activity
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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
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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
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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
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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
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Insomnia: the inability to sleep
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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
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Environment
Pain
Lifestyle
Dietary influences
Medication use and medical conditions
Depression and dementia
Factors Affecting Sleep
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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
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Loss of sChapter 11
Safety
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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
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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
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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
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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
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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
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Combined effect of normal age-related changes and concurrent disease
Relates to gait, balance, stability, and cognition
Intrinsic Fall Risk
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Environmental hazards, both indoors and outdoors
Steps
Floor surfaces
Edges and curbs
Lighting
Grab rails
Extrinsic Fall Risk
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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.
RisChapter 12
Sexuality and Aging
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Sexuality is an important part of health, general well-being, and quality of life.
Sexuality includes various types of intimate activity, as well as the sexual knowledge, beliefs, attitudes, and values of individuals.
Nurses play a key role in the assessment of changes related to aging, disabling medical conditions and drugs, and can intervene at an early point to enhance sexuality.
Older Adults’ Sexual Needs
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“Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction … is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles, and relationships …. Sexuality is influenced by the interaction of biologic, psychological, social, economic, political, cultural, ethical, legal, historical, religious, and spiritual factors”
The World Health Organization’s
View on Sexuality
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Despite evidence supporting not only the need for, but the importance of, sexual expression in older adults, health care professionals carry out few interventions to facilitate expressions of sexuality.
Benefits of sexual expression include increased happiness, energy, and relaxation, decreased pain, improved cardiovascular health, decreased depressive symptoms, increased self-esteem, and improved satisfaction with relationships.
Sexual Expression
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Society regards sexuality in older adults as undignified.
Nurses often share society’s ageist beliefs about the asexuality of older adults, which may lead to nurses discouraging sexual activity.
Older adults may face difficulties with sexual expression.
Because of discomfort, myths, ageism, and lack of training in sexual health, problems with newly developed or chronic sexual dysfunction are ignored.
Barriers to Sexual Expression
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The orgasm response changes in both sexes.
Reduced availability of sex hormones results in less rapid and less extreme vascular responses to sexual arousal.
Erectile dysfunction
Sexual dysfunction in older women encompasses loss of sexual desire, problems with arousal, inability to achieve orgasm, and painful intercourse.
Normal Changes of the
Aging Sexual Response
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Changes in the genitourinary tract related to menopause
Genital symptoms include: dryness, burning, and irritation
Sexual symptoms include: decreased lubrication, thinning of the vaginal wall, decreased elasticity and vaginal rugae, leading to pain, and bleeding during intercourse
Urinary symptoms include: urgency, dysuria, and recurrent urinary tract infections
GeniChapter 9
Nutrition
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Food means life, comfort, and security.
Older adults living in the community may suffer from loneliness and depression, leading to weight gain or loss, and ultimately malnutrition.
Food
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Social factors include isolation, loneliness, poverty, dependency, lack of caregivers, and transportation.
Psychological factors include depression, anxiety, and dementia.
Weight loss, psychotropic drugs = anorexia, apraxia
Biological factors include hypermetabolism, anorexia, swallowing difficulty, or malabsorption.
Stroke, tremors, arthritis, infection, COPD, Parkinson’s
Nutritional Risks in Older Adults
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Several medications associated with poor appetite and weight loss
Interactions between nutrients and medicines may affect metabolism, absorption, digestion, or excretion of drugs.
Carefully assess all medications including over-the-counter drugs for drug–drug and drug–nutrient interactions.
Drug Nutrient Interactions
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Nutritional interventions that do not take into account the social, cultural, and emotional aspects of food are rarely effective because few individuals “eat to survive”; most of us “survive to eat.”
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Three main forms
Isotonic dehydration—results from the loss of sodium and water, as during a gastrointestinal illness
Hypertonic dehydration—results when water losses exceed sodium losses. Most common, from fever or limited fluid intake
Hypotonic dehydration—may occur with diuretic use when sodium loss is higher than water loss
Dehydration
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Micronutrients—vitamin D, calcium, and vitamin B12 are commonly found deficient in older adults
Vitamin D deficiency—cancer progression, osteoporosis, and fractures
Vitamin B12 deficiency—pernicious anemia, bone health, and cognitive decline
Supplementation might be necessary.
Micronutrient Deficiency
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Sarcopenia is defined as “the decline in skeletal muscle mass that can result from physical inactivity, disuse of muscles, reduced levels of growth hormone and testosterone, neuromuscular changes, insufficient dietary protein and impaired protein metabolism.”
Can occur after long hospitalization
Cachexia is characterized by a loss of fat and muscle mass accompanied with anorexia.
Terminal cancer or/and stage renal disease
Malnutrition
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Oral health is a strong predictor or measure of quality of life.
Xerostomia, or dry mouth, is one of the most common causes of poor food intake.
Drug induced can lead to dental carries.
Older adults with cognitive impairment are at increased risk for dental caries, oral infections, and periodontal disease.
Oral Health
Co
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