NUR 257 Exam 2 Study Guide
This study guide covers the key concepts: age-related changes, nutrition, safe medication use,
assessment & documentation, promoting safety, hydration & oral care, and elimination.
1. Age-Related Changes
Key Physiological Changes
• Cardiovascular: ↓ Cardiac output, ↑ BP, arteriosclerosis risk.
• Respiratory: ↓ Lung elasticity, weaker cough reflex, increased risk for pneumonia.
• Musculoskeletal: ↓ Bone density (osteoporosis), muscle mass loss, joint stiffness.
• Neurological: Slower reflexes, memory changes (distinguish normal vs. dementia signs).
• GI System: ↓ Peristalsis (constipation), reduced appetite, weaker swallowing reflex.
• Renal/Urinary: ↓ Kidney filtration, increased urinary urgency, nocturia, incontinence.
• Skin: Thinner, drier skin, decreased wound healing, ↑ risk of pressure ulcers.
• Sensory: ↓ Vision (presbyopia, cataracts), ↓ Hearing (presbycusis), ↓ Taste/Smell.
Nursing Considerations
• Promote independence while considering safety (assistive devices).
• Encourage regular physical activity and proper nutrition.
• Monitor for dehydration due to diminished thirst sensation.
• Fall prevention strategies (non-slip socks, grab bars, adequate lighting).
2. Nutrition in Older Adults
Common Nutritional Concerns
• Malnutrition: Caused by poor appetite, dental problems, dysphagia, or financial limitations.
• Protein Deficiency: Leads to muscle loss, poor wound healing.
• Vitamin Deficiencies:
o Vitamin D & Calcium → Osteoporosis prevention. o Vitamin B12 → Prevents anemia
and cognitive decline.
o Iron Deficiency → Common in chronic diseases, leads to fatigue.
• Dehydration: ↓ Thirst sensation, diuretic use, mobility issues.
• Unintentional Weight Loss: May indicate malnutrition or an underlying disease.
Nursing Interventions
, • Encourage high-protein, high-calorie foods for those at risk of malnutrition.
• Ensure adequate hydration (offer fluids frequently).
• Modify food textures if dysphagia is present (pureed diet, thickened liquids).
• Monitor weight and BMI regularly.
3. Safe Medication Use in Older Adults
Common Issues
• Polypharmacy (taking multiple medications) → Increased risk of drug interactions.
• Altered Pharmacokinetics:
o Slower metabolism → Drugs stay in the system longer.
o Decreased renal function → Risk of medication accumulation/toxicity.
• Side Effects Risk: Older adults are more sensitive to sedatives, opioids, anticoagulants.
• Beers Criteria: List of potentially inappropriate medications for the elderly.
Nursing Interventions
• Medication Reconciliation: Review all medications regularly.
• Educate Patients & Caregivers: Use pill organizers, simplify regimens.
• Monitor for Adverse Effects: Watch for confusion, dizziness, GI upset.
• Encourage Non-Pharmacologic Alternatives: Pain management (heat therapy, PT), sleep hygiene
for insomnia.
4. Assessment & Documentation
Comprehensive Geriatric Assessment (CGA)
• Physical Exam: Assess vital signs, mobility, nutrition, skin integrity.
• Cognitive Function: Mini-Mental State Exam (MMSE), Confusion Assessment Method (CAM) for
delirium.
• Emotional Well-being: Geriatric Depression Scale (GDS).
• Functional Status: ADLs (bathing, dressing) vs. IADLs (shopping, cooking).
Documentation Best Practices
• Use Objective, Measurable Language: Avoid subjective terms like "appears."
• Report Changes Promptly: Even small changes (e.g., subtle confusion) can indicate a problem.
• Use Standardized Tools: Braden Scale for skin integrity, Morse Fall Scale for fall risk.
5. Promoting Safety in Older Adults
Fall Prevention Strategies
This study guide covers the key concepts: age-related changes, nutrition, safe medication use,
assessment & documentation, promoting safety, hydration & oral care, and elimination.
1. Age-Related Changes
Key Physiological Changes
• Cardiovascular: ↓ Cardiac output, ↑ BP, arteriosclerosis risk.
• Respiratory: ↓ Lung elasticity, weaker cough reflex, increased risk for pneumonia.
• Musculoskeletal: ↓ Bone density (osteoporosis), muscle mass loss, joint stiffness.
• Neurological: Slower reflexes, memory changes (distinguish normal vs. dementia signs).
• GI System: ↓ Peristalsis (constipation), reduced appetite, weaker swallowing reflex.
• Renal/Urinary: ↓ Kidney filtration, increased urinary urgency, nocturia, incontinence.
• Skin: Thinner, drier skin, decreased wound healing, ↑ risk of pressure ulcers.
• Sensory: ↓ Vision (presbyopia, cataracts), ↓ Hearing (presbycusis), ↓ Taste/Smell.
Nursing Considerations
• Promote independence while considering safety (assistive devices).
• Encourage regular physical activity and proper nutrition.
• Monitor for dehydration due to diminished thirst sensation.
• Fall prevention strategies (non-slip socks, grab bars, adequate lighting).
2. Nutrition in Older Adults
Common Nutritional Concerns
• Malnutrition: Caused by poor appetite, dental problems, dysphagia, or financial limitations.
• Protein Deficiency: Leads to muscle loss, poor wound healing.
• Vitamin Deficiencies:
o Vitamin D & Calcium → Osteoporosis prevention. o Vitamin B12 → Prevents anemia
and cognitive decline.
o Iron Deficiency → Common in chronic diseases, leads to fatigue.
• Dehydration: ↓ Thirst sensation, diuretic use, mobility issues.
• Unintentional Weight Loss: May indicate malnutrition or an underlying disease.
Nursing Interventions
, • Encourage high-protein, high-calorie foods for those at risk of malnutrition.
• Ensure adequate hydration (offer fluids frequently).
• Modify food textures if dysphagia is present (pureed diet, thickened liquids).
• Monitor weight and BMI regularly.
3. Safe Medication Use in Older Adults
Common Issues
• Polypharmacy (taking multiple medications) → Increased risk of drug interactions.
• Altered Pharmacokinetics:
o Slower metabolism → Drugs stay in the system longer.
o Decreased renal function → Risk of medication accumulation/toxicity.
• Side Effects Risk: Older adults are more sensitive to sedatives, opioids, anticoagulants.
• Beers Criteria: List of potentially inappropriate medications for the elderly.
Nursing Interventions
• Medication Reconciliation: Review all medications regularly.
• Educate Patients & Caregivers: Use pill organizers, simplify regimens.
• Monitor for Adverse Effects: Watch for confusion, dizziness, GI upset.
• Encourage Non-Pharmacologic Alternatives: Pain management (heat therapy, PT), sleep hygiene
for insomnia.
4. Assessment & Documentation
Comprehensive Geriatric Assessment (CGA)
• Physical Exam: Assess vital signs, mobility, nutrition, skin integrity.
• Cognitive Function: Mini-Mental State Exam (MMSE), Confusion Assessment Method (CAM) for
delirium.
• Emotional Well-being: Geriatric Depression Scale (GDS).
• Functional Status: ADLs (bathing, dressing) vs. IADLs (shopping, cooking).
Documentation Best Practices
• Use Objective, Measurable Language: Avoid subjective terms like "appears."
• Report Changes Promptly: Even small changes (e.g., subtle confusion) can indicate a problem.
• Use Standardized Tools: Braden Scale for skin integrity, Morse Fall Scale for fall risk.
5. Promoting Safety in Older Adults
Fall Prevention Strategies
